The Coach Leader highlights regular front-line coaching conversations to provide you with new insights and perspective on how to improve care coordination and lead your organization to a more Patient-Accountable Culture.
Wednesday, December 18, 2013
Tip 25: Upgraded to Team-Based Care
Q: A nursing executive from the audience shares…”our team is doing so many things these days to transition to value based care, improve quality and the patient experience. But, the simple errors keep on coming, the hand-offs are questionable at best and we’re getting slower than expected improvements. Please tell me that it’s not just our team?”
A: Overwhelmed… Inefficient and Fragmented are the three words that might best summarize how we often feel as a leadership team as we take on initiative after initiative. One benefit to traveling (besides the free hybrid upgrade) the country from system to system is observing the shared experiences and patterns. I assured her that she is not alone…we’re all fighting the same fight, and while some organizations are making real strides in error reduction, improving hand-offs, etc.; as an industry the numbers aren’t budging much and change is not coming quick enough.
To move metrics in patient safety, experience, and quality, and gain efficiencies required in this reform era, we must become effective at delivering coordinated team based care.
The hot topic of conversation at the opening keynote session of U.S. News & World Report's Hospital of Tomorrow conference mirrors what’s not only on my mind, but on the minds of more and more leaders as we warm-up to realizing the root cause of the problem…
Donna Shalala, Ph.D., president of University of Miami and former U.S. Secretary of Health and Human Services said, “ [We need] physician assistants and nurses and pharmacists and other care providers working as a team… we’ve got to get over the hierarchy, we have to take on the scope-of-practice rules, state by state if necessary, because that's what restrains us from creating these teams.” Adding to the mix, former Senate Majority Leader Bill Frist shared, “Our professional ethics is not to be team-based. We like to say that it is… but that's not the way doctors are trained.” Which led to the closing speaker Gregory Sorensen, M.D., CEO of Siemens Healthcare North America. He spoke of the importance of moving toward a coordinated, team-based healthcare model, and its inherent challenges, saying, "It will be a mindset change. There's a definite hierarchy, and those hierarchies get in the way… and people have learned that you can build a system that delivers consistent high quality if you can build teams."
Consensus builds…but what’s the solution? How to migrate from a system that can best be described as uncoordinated (i.e. poor hand-offs, suboptimal staff interaction, medical hierarchies, etc.) to one that delivers consistent coordination of team based care?
I’ll assume we all agree that healthcare is the “ultimate” team sport. But, what are we doing to make it so?
Let me ask this question: “What’s your role? (Not your job. Your role.) This simple question and the responses we get can teach us a lot about why we struggle to deliver team-based care and how to create it.
The coming New Year is a great time for leaders to set a new context for yourself and for your team. Feel free to reach out if you’d like to hear how other executives and physician leaders I’m working with are leveraging this question to build more Patient-Accountable Cultures.
See you in the New Year.
In The News...
A Patient Dies. A Hospital Heals
By Bill Santamour
H&HN Managing Editor
A fictional account of a tragedy and how a hospital changes for the better.
A patient dies after surgery despite the fact that checklists and other cutting-edge policies are in place to prevent such a tragedy. The clinical staff become defensive. Physicians close ranks to deflect blame. Nurses know that if somebody has to take the fall, it will, no doubt, be one of them. The hospital CEO understands that the fault lies not with individuals or policies, but with a staff too focused on their own task-filled workdays to see the bigger picture and too cynical to believe that things can ever fundamentally change. And the CEO herself is so overwhelmed by putting out everyday fires that she has no time to think about long-term solutions.
That’s the set-up of Heroes Need Not Apply, Brian D. Wong’s fictional account of Angels Hospital and the aftermath of a patient’s death, a death that could and should have been prevented. Wong, an M.D. and founder of The Bedside Trust, paints a familiar picture of today’s hospital staff, in which the sincere goal of putting the patient at the center of everything they do can get lost in the crush of workloads, silos, egos, long-standing hierarchies, skepticism and plain fear. His vivid cast of characters includes a brilliant but intransigent surgeon, a young doctor with conflicting loyalties, an outspoken nurse, a new CEO and the person she brings in to help change the culture.
OK, I can see you rolling your eyes at the term “change the culture.” But by getting inside each individual’s mind and allowing us to listen in on their thoughts and conversations, Wong avoids consultant jargon and preachiness. He presents a true-to-life scenario of personality conflicts common to all hospital staff and the endemic skepticism that often straitjackets any leader’s efforts to foster meaningful change. And he shows how a hospital CEO can overcome those obstacles to, as the book’s subtitle puts it, “build a patient-accountable culture without putting more on your plate.”
The crux of that culture change is eliminating the chain-of-command structure and moving to one in which listening and respect across job titles and individuals can lead to true team care. As someone at Angels Hospital says, “No one person, no matter how smart, was nearly as smart as a roomful of people.”
In his introduction, AHA President and CEO Rich Umbdenstock writes that Wong’s story “brings a human element to the equation and underscores the importance of making patients and their families full partners in the care process."
Heroes Need Not Apply is an excellent resource for you and your physicians, nurses, C-suite and board members. Might even make a good stocking stuffer. For more information, click here.
The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.
Improved care coordination is essential to gaining the efficiencies required in this healthcare reform era. To move metrics in patient safety, experience, and quality, we must become effective at delivering coordinated team based care.
In his new book, Heroes Need Not Apply, Brian Wong MD, uncovers the reasons why many of us experience spotty improvements in patient safety, episodic service excellence, and insufficient engagement and accountability. To make sustainable improvements, we need to know how to migrate from a system that can best be described as uncoordinated (i.e. poor hand-offs, suboptimal staff interaction, medical hierarchies, etc.) to one that delivers consistent coordination of team based care.
The purpose of Heroes Need Not Apply is to give healthcare organizations a template for creating a strong foundation for effective coordinated care. This “how-to” book gives every executive, physician, nurse, and clinical team member the tools to make specific changes at the local level, and uses relatable characters to showcase effective patient-centered skills to improve efficiency, decrease costs, and improve the patient experience. If your hospital is looking to accelerate improvements in care coordination and improve team care,Heroes Need Not Apply is a timely resource designed to equip your organization with the practical skills required for improved care coordination.
The book has already caught the attention of many top physicians, nurses, and executives as an innovative resource to lead our industry into a new era of value based healthcare that is both cost effective and accountable to patients.
Dr. Wong's Heroes Need Not Apply is receiving praise by noted physician leaders and industry experts throughout the country...
“Heroes Need Not Apply examines the root causes of healthcare’s most pressing safety and quality challenges. It offers practical strategies to improve communication among staff, dismantle silos, and build high-performing teams.” — Richard J. Umbdenstock, President and CEO of the American Hospital Association
“I believe this book will help save lives, improve quality, and recommit healthcare providers and patients to new levels of trust.” — Sue Collier, MSN, RN, FABC - Performance Improvement Specialist, Patient-Family Engagement, NC Quality Center/NC Hospital Association
“Dr. Wong’s book “Heroes Need Not Apply” breaks new ground as a field manual for what WE can all do on the front lines to be leaders as opposed to “reactors’ of healthcare transformation.” — Stephen K. Klasko, M.D., M.B.A., President and CEO, Thomas Jefferson University Hospitals
"...[Dr. Wong] speaks the truth of what we must become as leaders in health care."
— Jeff Selberg, EVP and Chief Operating Officer, Institute for Healthcare Improvement.
“Amazing! Timely, accurate, stunning, motivating, frightening. More than reading, I consumed the book. What a wonderful story of cold truth.”
— Jack Cochran, MD, Executive Director, The Permanente Federation, LLC
“On the journey to team-based and patient-centric care the evolving healthcare system is indeed a place to which Heroes Need Not Apply."
—Joseph S. Bujak, MD, FACP
“Dr. Wong draws the reader into the world of the hospital and an understanding of the cultural barriers that contribute so much to preventable medical error.”
— Gordon R. Clark, President and CEO of iProtean