tietjen-poe-karpook-summitSAN DIEGO — While keeping up with health care’s evolving reimbursement models, technological advances and treatment philosophies requires hospital leaders to continuously look beyond their buildings’ walls, some leaders are realizing their biggest gains by subtle but steadfast cultural shifts within their own organizations.

Two hospital leaders: Terri Poe, CNO and senior associate vice president, University of Alabama Hospital, and Patricia Tietjen, vice president, medical affairs, Western Connecticut Health Network and Danbury Hospital, are prime examples. (Pictured from left to right: Tietjen, Poe and James Karpook, principal of the Chartis Group.)

In a session Monday at the Health Forum and American Hospital Association Leadership Summit in San Diego, they opened up about how they have successfully empowered their care teams to make changes and sustain improvements.

While Poe’s team has struggled to care for a large influx of patient transfers (many of whom lack insurance), Tietjen’s team was faced with patients staying overnight in the ED, “a phenomenon no one [in town] really knew existed,” Tietjen said. Foundationally, the difficulties arose from deep similarities: A lack of alignment around the care team; not prioritizing patient progression; limited opportunity and venues for collaborative problem solving; and a lack of clear responsibility and authority for decisionmaking.

With help from a Chicago-based consulting firm called The Chartis Group, the leaders were able to create a framework around seven elements of leadership that empowered their care teams and resolved their fundamental issues. They were able to get back on track by working on the following:

1. Coalescing around goals and expectations

“We had to have everybody agree that there was a problem,” Tietjen said. “Getting most senior leadership on board was very instrumental.”  With the health system president and CFO in the room, Tietjen’s team was able to begin with the important step of setting goals around getting patients “in the right place at the right time.”

Poe similarly needed the right people in the room to realize a better way to manage the hospital’s enormous influx of transfer patients: more beds wouldn’t cut it, but instead her team “had to figure out a way of doing a better job with the beds we had.”

2. Establishing a consistent team environment

“The biggest problem we had was getting the house staff to give up their biggest priority and say ‘we have to work together on this,’” said Tietjen. Once all heads were sufficiently put together, the team was able to make game-changing improvements such as geographic placement of patients that enabled instrumental multi-disciplinary rounds.  

3. Aligning accountability and authenticity

“Part of our challenge was who is going to own all this work?” Poe said. Her team added a new position, a director of throughput, and at first had the new leader work directly with an experienced nursing team. But, “when you sit a non-nurse at the table with eight nurses who have 220 years of experience, it becomes challenging when a non-nurse tries to tell them something,” Poe said. “We decided the best thing to do was make her a part of their team and [unify their goals].”

Tietjen similarly found value in establishing a transfer-handling role in which “everybody has to agree that this person has ultimate authority.”

4. Creating a culture of joint problem solving/integrating bed huddles

Poe proved that space constraints need not be an issue when it comes to collaborating around care: Every day at the University of Alabama Hospital, 80 people coalesce in a 600-square-foot room to go over the day’s issues in a 10-minute time frame. Having all concerned parties at the table, committed to efficient communication, has helped enormously in getting everyone on the same page, Poe said.

Tietjen found that her huddle “can’t just be nurses and physical therapists and a physician – it had to be the whole health care provider team” to make any real gains.

5. Hardwiring team communications

Implementing daily multidisciplinary rounds and compliance checklists has  dramatically improved communications and the culture of teamwork at both hospital systems, speakers said.

6. Gaining agreement on practice standards

Practice standards, or a set of agreements by each discipline that reflects a commitment to supporting the entire care team, can be instrumental when everyone is on the same page. “It may seem silly to tell people what their roles are, but it is important,” Tietjen said.

7. Providing feedback on performance

Utilizing executive dashboards that displayed unit-based variances helped Poe’s team realize their wins and losses and do a better job going forward, she said.

Both organizations did very well in the balance between centralizing authority but not losing the importance of throughput being everyone’s job,” said Karpook, principal at The Chartis Group. “Now, it’s really about changing things embedded in the fabric of the organization that are cultural.”