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 wide-spreading 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 ExcellenceTalking 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. Engage in Dialogue – Even Disagreement!2. Manage the CAVEmen/women3. Involve the Patient4. Focus on the “How,” Not Just the “What”5. Learn from Your Own Staff6. Learn from Your Own Best Performers7. Introduce the Team8. Manage UP

Excellent teamwork does 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.

ConstantlyAgainst 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 StaffAre 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.

Finance

Parking

Environmental

Transportation

FoodVolunteers

Nursing

ITData Management

Physicians

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 ResourcesPRC Resources• 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• 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 Evidence-based Relation. Literature Review. AHRQ Publication No. 05-0053, April 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/medteam/