The Secret of Outstanding Clinical Team Performance

How do teams recover when they’re down?

They can’t call in new players.

They can’t increase the number of players on the field.

They can’t quit and go home.

How do they make the best of a losing situation?

Leadership + ‘Coaching with Teeth’

When losers say, “We’ll never win!” Leaders respond with, “We can do this! We’ve beat this team before!”

Leaders speak up. They control the tone on the field.

But what if players drown out positive messages by screaming, “We’ll lose!”

Coaching with Teeth

At some point, a coach owns the outcome. If leadership on the side-lines allows the wrong team on the field, we hold them responsible for the outcome.

Library shelves sag with books on how to inspire teams to peak performance; how to recruit the best in everyone.

Sports teams know the answer:

Wrong attitude? No playing time.

How do you handle this at work?

Who decides which team is on the field in hospitals?

Who decides who gets to play?

Is it even possible to keep certain players off the field?

How do we promote the best?

How do we keep our best players in the game?

Performance Management

We hire staff based on clinical competence, and we manage it on our teams.

We hire staff based on their attitude, but do we manage attitude?

If you steal medications, you get fired. If you bully, you get fired. But, no one gets fired for a bad attitude. You will never lose your job for saying, “We’re going to lose!”

Clinical competence is necessary, but NOT sufficient for outstanding performance. Without a great attitude, your clinical team will never shine.

Attitude must be a key measure in performance management.

What do you think? Click Leave a Reply or # Replies to comment.

See How Patient Flow Improved: Mini-Trial of RN-MD Triage

Early Success!

We tried a nurse-physician team with 3 stretchers in our old (empty) waiting room. We did not change our old process; just added a parallel process out front.

An RN met all ambulatory arrivals at the front door for a quick look as before (pre-triage). Ambulance patients came in through a separate process. We ran the parallel RN-MD trial from 10:00 – 13:00.

Process

Patient arrives to see an RN screener/sorter/pre-triage.

Patient directed to an RN-MD team with 3 beds in the waiting room.

Patient sent to registration.

Patient sent home or to appropriate clinical area.

If RN-MD process overwhelmed, patient sent to traditional triage.

At any point, patient sent to acute room as indicated.

Results for 3 hour trial:

30 ambulatory patients seen (less than average volumes?)

Time to see MD = 0 minutes for 27 patients (< 3 minutes from RN screener).

3 patients direct to acute room by RN screener.

5 patients (17%) seen and discharged home by the MD-RN team

3 exam spots added (6% additional capacity) at ZERO cost.

0 left without being seen

0 patients required traditional triage

Reflection

We identified a number of things to improve for our relaunch next week.

Staff who had strongly opposed the trial turned optimistic.

As a team, we had become overly anxious to try new things after a major change ‘failed’ in 2012 (we tried something for 2 1/2 days that didn’t work as hoped). We got a boost today.

We’ll share process detail and performance data as we gain more experience.

Have you tried something like this? Share your thoughts by clicking on Leave a Reply or # replies below.

See What We’re Trying Next to Improve ED Patient Satisfaction, Quality and Flow

So far, we’ve posted what works. In two days, we will try something that (almost) never works.

Does repeated failure mean something is impossible?

Hundreds of teams of really smart people have failed to improve outcomes and efficiency by putting physicians at triage. In some cases, flow did not change. In others, costs were too high. We want to try it anyways.

Why would we bother?

Pros

It’s what we want for our families.

When nurses and physicians need a medical opinion, they go straight to the nearest MD they trust. Direct access. All the non-value added steps removed.

Time equals quality in emergency medicine.

The sooner we diagnose and treat patients, the higher quality of care we can guarantee.

Irresistible.

The chance to radically improve flow and efficiency is just too attractive to ignore. Imagine being able to see and treat even 10% of your patients out front – a chunk of patients would never enter the ED. 30 fewer patients and family members packed into the bowels of the ED seems reason enough to try it.

Fewer steps = lower cost.

If we could exam and begin treatment without a lengthy pre-screen, triage and registration process, we would decrease the number of providers involved and decrease patient length of stay. Staffing costs and length of stay directly impact efficiency.

Parallel processing beats sequential processing.

Modern ED Triage is sequential. It’s guaranteed to become a bottleneck unless an oversupply of staff continually support it. A parallel RN-MD clinical stream right at the front door seems destined to succeed.

Cons

“If it ain’t broke…”

We’ve ranked with the top 3 EDs in Ontario for time to physician initial assessment (PIA) for 18 months. Our average PIA hovers just under 1 hour. However, Voltaire said, “The good is enemy of the best” (approximately). Unless we continually improve, we will slip back.

Everyone failed – why won’t you?

Failed attempts don’t mean something is impossible. As Thomas Edison said, “I have not failed. I’ve just found 10,000 ways that won’t work.” If a concept seems logical and irresistible, it’s worth trying again. Also, St. Joe’s Hamilton seems to enjoy early success with their recent attempt at putting a physician at triage which inspires us to try it for ourselves.

We’ll let you know how it turns out when we try it in 48 hrs. Please share your thoughts below – tell us what we need to know. There’s still time to change what we’re about to attempt!