C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development

C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development

Organizational Leadership and Interprofessional Team Development

Project in Organizational Leadership and

Interprofessional Team Development

Organizational Leadership and Interprofessional Team Development

Professional Presence

Business Practices and How They Impact Patient-Centered Care

Traditional business practices within established medical institutions vary widely from

organization to organization. Many modern facilities were born out of a desire to provide the

community with physical science-heavy, evidence based care and seem to have lost sight of the

whole person, including needs such as emotional and spiritual well-being, autonomy and

personal responsibility, finances, family and social network involvement. Typical business

practices of these organizations tend to lean toward favoring a more cerebral approach,

attempting to provide patients with correct and often very progressive procedures and

medications, but often struggling with patient comprehension and compliance. When there is a

reputation in the community for scientific advancement and top tier performance it may be even

more difficult to overhaul a culture and the old ways of thinking.

Some facilities were begun with a culture of patient centered care and successfully translate this

into new actions and policies as science and society progress. A few have managed to reinvent

themselves and have become excellent examples of patient-centered care. The culture in these

organizations from the administrative team to physicians and nursing staff to housekeepers and

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dietary workers, is one that seeks to put patient needs first. Business practices at all levels tend to

support open communication with each other and with patients and families. There are policies

and the necessary practices that not only seek to provide the best care possible, but support the

reporting of concerns and plans for evaluating and potentially taking action for continual

improvement based on needs and suggestions. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development.

There are many examples of how technology is used to keep care patent-centered. Portable

computers are used for scanning medications right at the bedside, which helps prevent errors and

keep patients informed about their medications. Smart phones are used for nurses and physicians

to communicate accurately and quickly as changes occur, improving safety and a creating a

clearer, more collaborative patient-specific care plan. There has also been a transition from

“paper charting” to electronic health records (EHRs). In 2003 only 31% of hospitals used EHRs

but by 2017, 99% of hospitals did (Landi, 2017). Pressure to implement this new, safer way of

caring for patients has improved medication and information safety, and increased the

consistency of patient education regarding their medications.

While staying at the forefront of scientific innovation is vital in today’s competitive industry, a

most important aspect of truly patient-centered care is when patients and families feel that they

are being heard. Medical institutions should create and live business practices with this actively

in mind.

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Organizational Leadership and Interprofessional Team Development

Regulatory Requirements and Reimbursement and How They Impact Patient-Centered

Care Within a Healthcare Organization

State and federal regulatory requirements and Medicare and Medicaid reimbursements have

come to have a significant impact on how a facility implements patient-centered care. “The

Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services

(CMS) initiative that rewards acute-care hospitals with incentive payments for the quality care

provided to Medicare beneficiaries (United States CMS, 2017).” These requirements for patient

care are intended to ensure that the safest, best, most evidence based care is given. These

financial incentives involve enforcement by penalties and fines, or in extreme cases by closing

down an institution. Improvement measures that are a work in progress for healthcare in general

involve more subtle but still very impactful incentives, as CMS covers care at different rates

based on how successfully the “best practice measures” are implemented. Organizations can also

earn (or loose) certifications in different areas that communicate to the community their status as

a center of excellence in the particular procedure or area of care and this is often used as a part of

a community marketing program. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development.

With the expanding healthcare cost as America ages, there is a general push for better

stewardship. For decades, voices have cried out to hold physicians and caregivers accountable to

keep patients well, rather than to just maintain them in illness. Quality improvement efforts are

being made to ensure that patients are not only cared for when acutely sick, but properly

educated to stay healthier to the best of their ability, which involves readmission rates, and to be

safe from infection or errors in the medical setting, which involves hospital infections or other

adverse events. The VBP program is intended to encourage quality improvement and is seen as

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having great potential in creating a patient-centered environment, encouraging a streamlining of

information management and consolidation of care measures.

Patient-and Family-Centered Care Organizational Self-Assessment Tool” (PFCC) Image

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Patient-and Family-Centered Care Organizational Self-Assessment Tool”

A midsize acute care hospital in the Southeastern United States was chosen for evaluation. It is a

busy hospital with 12,000 yearly admissions, 42,000 yearly emergency room visits, over 1,000

staff members, and approximately 250 physicians. It serves primarily an adult population as a

hub of care in a more generally underserved rural area.

Discussion of Strengths and Weaknesses of Each Domain of the PFCC for the Assessed

Facility (AF)

Strengths and Weaknesses in the Leadership and Operations

AF appears to be quite strong when it comes to leadership and operations issues. Statements of

the commitment to patient and family centered care and patient and family partnerships are

available online. Explicit expectation of patient-centered care is taught in periodic training

courses and is spoken in orientation and town hall meetings from administrative staff. there is

some measurements of this in patient follow-up surveys, as well as claims of accountability

structure, though there is some room for improvement as not all voices appear to be heard

equally. There appears to be a good bit of patient and family involvement in deciding on new

policies and procedures, but this, too, should be encouraged to improve. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development.

Strengths and Weaknesses in the Mission, Vision and Values

AF’s Mission and values states that it is committed to putting the patient first, but the ways in

which that might happen are poorly delineated. This could use some improvement.

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The patient bill of rights which is easily available with a quick Internet search is very strongly

patient and family friendly, very patient/family-centered. It is given to each patient on arrival.

Strengths and Weaknesses in “Advisors”

There is some report of patients and family members serving on various hospital committees,

including some advisory councils. This is not an area of particular strength with AF.

There are no patients or family members that are involved in quality or safety rounds and this

would be perceived as a real weakness.

Strengths and Weaknesses in Quality Improvement

There is patient and family presence on at least one committee that helps to evaluate AF and its

goals directions. There is discussion of strategic and operational Ames and goals in this

committee, but lack of consistent implementation is a weakness, as is little recent activity. This is

currently under review to be revamped.

Patients and family members are not active participants on task forces or quality improvement

teams at all but there is some participation in quality, safety, and risk meetings. A great strength

in the quality improvement area is that patients and family members are both interviewed during

leadership walk around quite regularly. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development

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Organizational Leadership and Interprofessional Team Development

Strengths and Weaknesses in Personnel

With as advanced as AF is in many of these areas, it is surprising that there seems to be no

collaboration at all with patients and families in staffing processes. It appears that they have no

influence with job descriptions, policies, or performance appraisals. There is no patient or family

involvement in interviewing or search committees and definitely not any welcoming committee

for new employees or orientation. This is, in general, a very weak area for AF, with the exception

of one strength: staff and physicians are prepared for and fairly well supported in patient and

family centered care practice. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development

Strengths and Weaknesses in Environment and Design

At AF there has been some involvement of patients and families and participation of clinical

design projects, and the environment improvements have supported patient and family presence

in interdisciplinary collaboration measures. This is an area that could use growth, but there has

been recent strengthening, and with several upcoming environment projects, much progress

could be made.

Strengths and Weaknesses in Information and Education

It is unknown whether clinical email access for patients and family is readily accessible, but it is

likely, because staff are occasionally shown emails and communications from patients and

families who were satisfied. There are, however, many more communications through the

Facebook page.

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One strength in this area is that AF has a web portal where clients can access their medical

information from anywhere. Awareness on the availability of this is increasing, and patients

sometimes share that they utilize this source.

There are some resource rooms available, such as a cancer resource room where people can

access wigs or bras and a chapel where people can relax and restore or spend time with a

chaplain or other staff, but in general, this is a weakness, as it could be easily capitalized upon

much more with libraries or community resource information hubs.

Strengths and Weaknesses in Diversity and Disparities

AF measures race, ethnicity, and language in the registration process and there is a push toward

timely access to interpreter services, but this is still lacking and is evaluated by many clients as a

real weakness.

Another significant weakness in this area is that there are no navigator programs for minority or

underserved patients. This said, AF is well known in the community for caring for many patients

who are unable to pay for great links of time while waiting to arrange follow-up care or help

restore patients to functionality.

There are a large number of educational materials and resources for people who are able to read

at a little level, but many of his clients are illiterate, and there is not enough audio visual

materials and other things that would be appropriate.

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Strengths and Weaknesses in Charting and Documentation

Many patients and family members are interested in having more ready access to the electronic

medical record, but this is only partly provided. AF’s policy requires completion of the chart

account (after discharge) before patient or their other health care providers access to their record.

Many patients request a more current, realtime record of their care, but information is closely

guarded due to potential liability.

The patient and family are not able to chart at all, though most rooms have communication

boards and they are encouraged to write questions on this. It would be a strength if patients could

actual enter information into the charting system, such as intake and output, percentage of meals

eaten, or even their current pain number.

Strengths and Weaknesses in Care Support

There is a wide variety of patient and family involvement in the care support aspect of AF. On

the medical surgical floors and in the emergency room, family has access to the patients 24 hours

a day, seven days a week. In the intensive care unit, there are four schedule during times of a half

hour each, with stricter or more lenient adherence based on individual situations. While this is

perceived as very helpful to the nurses, and sometimes to the well-being of the patient, it is a

cause of nearly constant frustration with family members and patients.

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And some units family members are able to stay and join in rounds and shift report but there is

still great resistance to this. Still in some units, including intensive care units, at AF, this does not

happen at all.

Patients and families are given written information about activating a rapid response system, but

this is not well understood or consistently taught.

There has been a great deal of improvement in patients receiving updated medication history

with each visit, though there is still a little way to go.

One great weakness in this area is that patients and family are only sometimes made aware of

error or harm, though if they are made aware, they are provided with reasonable support.

The lowest score in this area would probably be that family presence is usually not allowed and

definitely not encourage or supported during rescue events. It is a general part of the culture at

AF that family presence is seen as a detriment to the safety of the patient. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development.

Strengths and Weaknesses in Care

Add AF, the patient and family engagement directly with clinicians in collaborative goal setting

is limited. Positions are more directly involved with this than our nurses, but much teaching is

being done to improve this.

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Patients and family members are feeling more listened to and treated as partners as these

measures are being taken. AF is well known for being quite respectful of his patients as a part of

it long term culture. This is one of its greatest strengths.

There is not as much active involvement of families in care planning and transitions as there

should be, but case managers do work directly with many families and seeing that the best care

plan is created and that follow up is made as reasonable as possible.

There has been an improvement in management of pain in partnership with the patient and

family. There is a big push by administration to improve this even more. Pain management is

probably best drinks at AF.

Area of Improvement

One area of weakness that could use improvement at AF is that, currently, patients and family

members are not able to chart information into the electronic system. Including them in the

charting process would increase patient-centeredness in the organization by encouraging more

timely and accurate monitoring of patient information and response to treatment.

Strategy to Increase Patient-Centeredness in the Organization C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development

AF currently uses an iPhone system to keep staff members and physicians connected with the

latest patient information. One strategy for increasing patient-centeredness of the entire

organization would be to connect patients and families into this system. Each patient could be

provided with an account for accessing the bedside computers and/or an app on their own smart

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phones where they could enter information such as number and description of bowel movements,

amount of intake and output, personal care like hygiene. It could also be used for patients to text

needs directly to their nursing staff or even pictures to their physicians, or their diet preferences

for review by their nurse and then directly to the kitchen staff.

Discussion of the Application of System Theory in Addressing this Weakness

In the “system change theory,” an organization can be seen as an organism that interacts with its

environment. This method would be helpful to address the weakness of patients and families not

being able to document in the electronic system, as it encourages actively thinking about the

changes around the organization and striving to respond in ways that will maintain relevance.

Since each part of the “organism” is interconnected, any change that empowers the patient and

family will truly empower the whole system.

Medical care and patient expectations of it are changing. Patients and their families are

demanding more control in their care, and linking them into the entire communication system

would be beneficial and time saving for staff and empowering for patients and their families.

This very type of change, inviting patients and families to record their own documentation in the

system, that so directly connects clients into the process of their own care embodies system

change theory.

The system change theory could be applied to strengthen this weakness by asking for input from

various departments and patients on how exactly to implement patient and family charting. The

team would benefit from asking an applying answers to these questions: What departments and

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outside expertise might be helpful in this new direction and how? What is the ideal future picture

of communication and collaboration between patients and families and staff and what are steps to

getting there? How does this new way of charting contribute to that picture? What can patient

and families contribute to the charting system and how can they best be educated how to share

this information? How can computer systems be protected from risk of public access? How much

information should patients and families be able to access and when? How can stakeholders set

up a system that keeps them open to and pursuant of further growth?

Financial Implications of Implementation

Implementing methods for patient and family charting could be somewhat expensive initially,

including costs of programing or altering communication apps for personal devices to be able to

transmit information to the secure iPhone system and possibly extra licensing fees for patient

access to the bedside computers. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development The return on investment could be invaluable in patient

satisfaction and better rapport and trust, and, therefore, fewer lawsuits and a better relationship

with the community.

Strategy Effectiveness Evaluation

A PSDA Success of this could be measured and adjusted repeatedly at one week, one month,

three months and a year. The first method would be to initially request that all information be

documented by both patients/families and nursing staff, then the similarities and accuracy

discussed with committees that represent both groups. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development. In-house surveys can also be done with

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patients, families and staff members, evaluating satisfaction with this new practice and

adjustments can then be made with the information learned.

Another way to measure the success of this program is to monitor HCAHPS scores before and

after implementation. HCAHPS are “a survey instrument and data collection methodology for

measuring patients’ perceptions of their hospital experience…. a national standard for collecting

and publicly reporting information about patient experience. (HCAHPS 2017)” While these

scores are not as program specific as a local survey, they are consistent, scientifically based, and

already provided. Information gained from these will be beneficial. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development

A Multidisciplinary Team and Their Roles

There are a few stakeholders that will assist in key ways in implementing this strategy. Kandice

Lamar, the hospital nursing informatics director will research and manage the software and

programing portion of the project. Steven Wilson, the Chief Nursing Officer, will be “the face” to

the patient community and the staff for this project. His support will be vital as he introduces the

project to staff, physicians, patients and families for buy-in. Mandy Vasquez, the education

coordinator will work closely with Marilyn Easterman, the Assistant Chief Nursing officer to

educate both staff and patients in how best to utilize the system. Three charge nurses from

various units will also be chosen to act as liaisons and educators with both staff and patients.

Clint Minton, the Chief Financial officer, and Sarah Kim, the director of the IT department will

work to manage the financial aspect of the project and to maintain the system in working order.

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Sheila Prior, the risk management officer, will manage the legal aspect of the project and ensure

that it moves forward legally and ethically.

Cultural Diversity Within the Team

Ms. Lamar and Ms. Easterman are both Caucasian Americans in their thirties. Mr. Wilson is also

Caucasian American and is in his late sixties. Ms. Vasquez and Ms. Prior are both Latinas in

their fifties and Mr. Minton is 45 and African American. Ms. Kim, who is in her late thirties, has

an ambiguous ethnic heritage, but she is married into a first generation Korean family. The cross

section of cultures within this group should be helpful for the health of this project, as the

multiple perspectives may initiate conversation about varying patient and family needs through

this transition that might otherwise be overlooked. Cultural competency can be a major aspect of

patient centered care and the ability to better understand how needs or expression of those needs

may differ between patients and their support networks is important to creating an effective

initiative. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development.

Leadership Theories

Of the leadership theories transactional, transformational, emotional and traditional leadership,

an appropriate choice for building this team would be transformational theory.

“Transformational leaders inspire followers to achieve extraordinary outcomes and, in the

process, develop their own leadership capacity. They foster employees’ confidence to produce

creative outcomes and sustain a competitive edge in an ever-changing healthcare

environment.” (Clavelle & Prado-Inzerillo, 2018) C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development

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Unlike more traditional types of leadership, transformational leadership creates a level of buy-in

and participation that gives a project a life of it’s own so that when the current leadership moves

on, the valuable changes will remain. Transformational leadership is the one type that calls for

both leaders and followers to work as a team to create change in a logical way and to take full

ownership, allowing for evolution as better methods become available. The very DNA of this

type of team attracts like minded participants, and once mature, repels the types of leaders that

take a movement with them to the grave.

Implementation of the Strategy to Address Weakness (Fast Forward Three Months)

Kandice Lamar was able to contact the iMobile company and found out that they already have

the ability to create accounts for patients and family to log in to for adding “I’s & O’s” and a few

other pieces of information, and the ability to enter notes. They hadn’t considered the possibility

of an app that can be downloaded on patient devices, but are now researching to create an app of

this nature. Steve Wilson, Marilyn Easterman and Mandy Vasquez have already begun to discuss

the project with stakeholders and have set up a schedule for education, rollout and reassessment.

Clint Minton has run the numbers and provided a general budget and the charge nurses have

worked closely with Ms. Vasquez to develop pamphlets and posters to place in each room to

teach users. Sarah Kim has prepared her IT team to begin preparing the computers and she will

also wok closely with Ms. Vasquez to ensure that staff know what to do. Sheila Prior is on hand

for counsel as the project rolls out over the next three weeks. Very shortly the patients and

families will be able to connect directly into the electronic charting system and the excitement is

palpable. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development

Organizational Leadership and Interprofessional Team Development

Communication of Strategy and Intended Outcomes for “AF”

An email letter will be sent to each employee, including ancillary staff, a few weeks before the

go-live date, and a more detailed one will be sent to nursing staff a couple of weeks before.

During this time “Health-Stream” assignments will be assigned to staff. The CNO and ACNO

will meet together with charge nurses and heads of departments, as well as a few chosen “superusers” from nursing staff to trial the use of the system and trouble shoot before “go-live.” Ms.

Lamar from education and Mr. Wilson, the CNO, will be featured in the next two town hall

meetings to promote, explain and instruct on the new process. One of the charge nurses is quite

skilled in public presentations and her skills will be utilized as well. The day of go-live, there

will be extra nursing staff available for bedside teaching and this will continually intermittently

for a period of two weeks to ensure a smooth introduction.

A Specific Tool for Development of the Team’s Self-Assessment Skills

One specific tool that the team will use to develop self-assessment skills is the Myers Briggs

Temperament Inventory. Each of the leaders within the team will be asked to complete this test to

help them understand their own strengths and weaknesses and their own place in the team, as

well as the strengths, contributions and needs of the others (MBTI® Basics, 2018). There are

distinct differences in how people experience the world around them and this test can help team

members work together in a way that will maximize productivity.

Another specific tool that the team will use to develop self-assessment skills as a team is the

PDSA or “Plan, Do, Study, Act” cycle. “The PDSA cycle is shorthand for testing a change by

Organizational Leadership and Interprofessional Team Development

developing a plan to test the change (Plan), carrying out the test (Do), observing and learning

from the consequences (Study), and determining what modifications should be made to the test

(Act)” (Institute for Healthcare Improvement, 2018) C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development.

The “plan” stage has lasted for about two months up to this point and has involved research by

the nursing, education, IT and legal departments to find the best methods for including patients

and families in the documentation of their own information. The “do” portion is ready to begin,

as patient computer access rolls out. The “study” portion of the cycle begins shortly, too, as the

usability of the system in real-real-time and reliability of the information begin to show.

Shortcomings take the team back to the drawing board to evaluate and plan again. The “act” part

of the cycle is when this new understanding is brought back to the bedside to benefit the patients

and staff. C158 Task #1 Project in Organizational Leadership and Interprofessional Team Development