Transcript Document 7175799

Building Service Excellence
through Teamwork
From the presentation given by Joe
Snipp, PRC Consultant on 10/26/2011
"The sum total of medical knowledge is now so great and widespreading that it would be futile for one man to attempt to
acquire...a good working knowledge of any large part of the
whole. The very necessities of the case are driving
practitioners into cooperation. The best interest of the
patient is the only interest to be considered, and in order that
the sick may have the benefit of advancing knowledge,
union of forces is necessary.“
~William James May, MD, June 15, 1910
Why improve TEAMWORK?
• According to the Institute for Healthcare
Improvement, there is an average of 24 handoffs per
inpatient admission.
• 70% of sentinel events are caused by poor
communication or miscommunication.
 Joint Commission
Why improve TEAMWORK? (continued)
• Teamwork results in better patient care and
outcomes.
 Horak, B.J. et al. (2004) Journal of Healthcare Quality, 26(2), 6-13.
 Gitell, J.H., et al (2000) Medical Care, 38(8), 807-819.
• It’s important to our patients!
Teamwork as a Key Driver at Vanderbilt
(continued)
– Of the 603 measured areas in over ten studies:
 56.6% have Teamwork as any key driver
 23.5% have Teamwork as their #1 key driver
– Only one study does not have a Teamwork key
driver
 Pediatric ED
– But, for Pediatric ED, it was #1 THREE years in a
row and on the list for the past five years
What does Teamwork Mean?
Teamwork Activity:
• Step 1: Discussion with staff – How would we
rate our teamwork?
• Step 2: Discussion with staff – What does
teamwork mean to us?
• Step 3: Discussion with staff – What does
teamwork mean to our patients?
What does excellent “teamwork” sound like
among staff?
•
•
•
•
“The hospitalist told me what he told the patient.”
“Lab calls when they fall behind.”
“The doctor lets us know when he is rounding.”
“The night shift gives us more detailed reporting on
patients.”
• “Radiology communicates to the outpatient side when
they get slammed with an urgent ED case.”
• “The ED doctor tells me if the patient is waiting for a note
or a script.”
Classification: Process, Attributes
What does excellent “teamwork” sound like
among patients?
• “My nurse knew what the doctor told me.”
• “My doctor knew what the nurse told me.”
• “Everyone gave me the same instructions [for care at
home].”
• “They all spoke so highly of one another. It’s like they
were friends.”
• “They said I was in great hands.”
• “When I arrived for surgery, they told me about the
team of people I would have taking care of me.”
Classification: Outcomes, Benefits
Two Approaches to Customer Service
• Service Recovery
–
–
–
–
Focuses on fixing problems
Targets a relatively small patient population
“Fair/Poor” responses
An individual skill, not a service strategy
• Service Excellence
– Focuses on excellent customer service
– Targets a broad patient population
– “Good/Very Good”  “Excellent” responses
– Greater impact on overall patient perceptions and
compliance
Talking About Service Excellence
Why Won’t They Just Tell Me What They Want?
• It is difficult to articulate what “excellence” looks like
• Tend to identify small things and not big concepts
• The “exceeding expectations” paradox
How to Improve Teamwork:
Eight Strategies
1.
2.
3.
4.
5.
6.
7.
8.
Engage in Dialogue – Even Disagreement!
Manage the CAVEmen/women
Involve the Patient
Focus on the “How,” Not Just the “What”
Learn from Your Own Staff
Learn from Your Own Best Performers
Introduce the Team
Excellent teamwork does
Manage UP
not happen by accident. It
happens by design.
1. Engage in Dialogue – Even
Disagreement!
Dysfunction: Fear of Conflict
“When team members do not openly debate
and disagree about important ideas, they
often turn to back-channel personal
attacks, which are far nastier and more
harmful than any heated argument over
issues.” (pg 203)
• Avoidance is not on the Journey to
Excellence
2. Manage the CAVEmen/women
•
Opposing a view is different
than being a consistent
obstacle to progress.
• A “body” is not necessarily
better than “nobody.”
• CAUTION: Do NOT let this
consume all your time.
• Peer interviews and hiring for
team competencies can help
prevent problems with
CAVEmen.
Constantly
Against
Virtually
Everything
3. Involve the Patient
• What is the degree of participation that the patient
prefers?
• What is the family’s role on the care team?
“Care that is truly patient-centered considers patients’ cultural
traditions, their personal preferences and values, their family
situations and their lifestyles. It makes the patient and their loved
ones an integral part of the care team who collaborate with health
care professionals in making clinical decisions” ~IHI
4. Focus on the “How,” Not Just the
“What”
The “What”: Many Valuable Strategies
• Managing Up
• Post-Discharge Phone Calls
• Nurse hourly rounding with patient
• Leader rounding with patient
• Leader rounding with staff
• Bedside Reporting/Bedside Shift Change
• Etc.
4. Focus on the “How,” Not Just the
“What”
The “How”
Are we doing it 100% of the time?
• Do we keep accurate and up-to-date rounding logs?
• What percentage of patients receive post-discharge calls?
How well are we doing it?
• Are we truly connecting with the patient? Where are our
feet facing?
• Do we collect examples of managing up to share?
• Do we hold staff accountable if we fall short?
• Do our staff, our physicians, our support services know
what our action plan is and how we are doing on it?
5. Learn from Our Own Staff
Are we “Excellent” at Teamwork?
• Teamwork Activity:
• Step 1:
Start staff meetings with question: “What great
examples of teamwork can we share from (yesterday,
last week, last month)?”
• Step 2:
Be prepared for less than enthusiastic
responses at first
• Step 3:
Repeat at subsequent meetings until the
stories start to flow
• Step 4: Continue
6. Learn From Our Own Best Performers
• Remember everyone is a caregiver
• Patient cannot parse out their experience like we’d like.
• Everyone that wears a badge is responsible for patients’
experiences.
Parking
Physicians
Nursing
Environmental
Volunteers
Food
Finance
IT
Transportation
Data Management
Would you rate the overall teamwork between the doctors, nurses, and staff as:
Rankings for All Service Lines by Unit in Jan-Mar 12*
7. Introduce the Team
…to each other
• Ideas:
• Invite physicians, ancillary staff, etc. to staff meetings
• Preference Cards: add fun, personal information,
create for all staff, ancillary staff, physicians
• Celebrate team achievements with the WHOLE team
7. Introduce the Team
…to patients
Ideas:
• A.I.D.E.T.
• Department Brochures: “Welcome to
____ Hospital’s Surgical Services”
• Department Poster(s): “Here is our team,
here is what we do”
•As Process:
“Passport to Care”
“Creating a safe patient environment can be accomplished only
when everyone involved with treating the patient knows that
he or she is an integral part of a well-functioning team of
experts who have a common goal – creating satisfied patients.
When an organization of medical professionals has
developed a high level of teamwork, which requires trust in
each other, it will experience greater staff fulfillment, lower
levels of staff turnover and most likely a standardized level
of care that all team members respect.”
– Betsi Gore, Director of Clinical Services, Nueterra Healthcare. Establishing an
Organizational Culture Centered on Patient Safety. PHA Pulse, Fall 2010
8. Manage UP
• The First Impression Most Patients Have About
the Quality of Care at Your Hospital Comes
From…You
• Not Managing Down Does Not Equal Managing
Up (but it’s a start)
“What does Managing Up do for patients? I believe it makes them
feel better about their care, demonstrates our commitment to their
safety, increases their comfort with their surroundings, and makes
them feel more relaxed by lowering blood pressure, heart rate, and
anxiety.” Hardwiring Excellence” by Quint Studer
“
8. Manage Up
• Teamwork Activity:
• Think of employees that you can “manage up” to
patients.
• Think of a phrase you could use that would help relax
the patient and manage up the care they will receive.
• Share
Additional Resources
PRC Resources
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Corporate Website: www.PRConline.com
Best Practices on www.PRCEasyView.com
Client Connection Forum: http://forum.prconline.com/
PRC’s Resource Archive: http://archive.prconline.com/
Other Resources
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Essentials for Great Patient Experiences by Wendy Leebov
Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference by Quint Studer
The Five Dysfunctions of a Team by Patrick Lencioni
Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of
Inpatient Hospital Care. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for
Healthcare Improvement; 2011. (Available on www.IHI.org)
Baker DP, Gustafson S, Beaubien J, Salas E, Barach P. Medical Teamwork and Patient Safety: The Evidencebased Relation. Literature Review. AHRQ Publication No. 05-0053, April 2005. Agency for Healthcare
Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/medteam/