The importance of a team-based approach for performance improvement at hospitals

Regardless of the specific performance improvement task – whether it’s improving patient and staff safety or providing more efficient care – the ultimate success of a project comes down to the team.

Hospital leaders are under tremendous pressure to achieve value-based care while doing more with less.  Initiatives to support these goals and execute process changes are complex and require more than a policy shift or simple administrative change. By addressing these issues using a team-based approach, hospital leaders are more likely to achieve sustainable performance improvement.

Regardless of the specific performance improvement task – whether it’s improving patient and staff safety or providing more efficient care – the ultimate success of a project comes down to the team. More specifically, there are three essential components that team-driven performance improvement initiatives need to succeed: engagement across levels, support of leadership, and the right team.

As a certified emergency nurse and emergency department director working in the field for more than forty years, I can personally attest to the importance of a team-based approach when it comes to implementing real change in the hospital.

Engage All
Before any performance improvement (PI) initiative begins, it’s important to secure engagement across all levels. No matter if the initiative is driven by leadership or front-line staffers, you need involvement and support from everyone.  If leadership wants change “A” to happen, but the staff is really focused on change “B”, it’s important to communicate the priorities ensuring everyone understands what the group is trying to achieve in the long term.

It is incredibly difficult to affect change if the whole staff isn’t engaged.  When team members are not showing up for meetings, not delivering on assigned tasks, reluctantly participating in initiatives or just not participating at all, the apathy can be contagious resulting in a group that feels ignored and disenfranchised.

When hospital leaders are prepared to answer questions such as “why are we doing this?”, “who does this help?”, and “how will our patients benefit?” staff are able to determine how the initiative aligns within their role, their department and for their patients. If leadership can help create a strong case for why an initiative is crucial, employees are more likely to agree and support the change. Staff should also be directly involved in the process, providing valuable insights into current challenges and understanding how proposed changes will affect performance and patient care. Communication, both top-down and bottom-up, is necessary for effective change. When staff is engaged, people are far more willing to go through trial and error to get to the correct solution. Securing engagement across the board will drive consistent efforts, a critical element for the success of any project.

Support the Front Line
For the front line to feel empowered, individuals must feel they have the time and resources necessary to safely care for their patients and themselves. The role of senior leadership is to support the team from start to finish, ensuring they have the resources (data, time and autonomy) necessary to test and implement solutions.

As a new emergency department director early in my career, I wanted to implement a self-scheduling system in my ED. I suggested the idea, but the staff was not interested. Several months later some of the staff decided they wanted a self-scheduling system – we were then able to successfully make this change because of the buy-in from the people affected by the change, thus making the initiative successful. When your staff decides to address a performance or safety issue together, it’s important to support their efforts. Creating and supporting a psychologically safe environment also has a strong and positive impact on employee engagement. It is vital for staff to feel safe, both physically and mentally, while caring for patients in the ED and all departments of the hospital.

Build the Best Team
Leaders must determine what the most effective team looks like for the project at hand, as the success of any performance improvement initiative depends heavily on the people involved. Teams with an equitable representation of subject matter experts across roles (and shifts) have proven to be the most successful. Ideally, these team members should be employees (with nominal reliance on traveling nurses) to ensure team members are dedicated to the unique initiatives of their hospitals.

For instance, to reduce the number of patients leaving an Emergency Department without being seen (LWBS), an Arizona medical center created a full team of nurses from all shifts, charge nurses, representatives from ancillary services, and provider champions. After creating this team, they experienced a LWBS reduction of over 70 percent and a decrease of more than 40 percent in the time it takes a patient to be seen once they enter the hospital.

Additionally, having input from all roles and shifts may improve the design and implementation of PI projects. Because each clinician faces different challenges during their individual shift providing thorough input also ensures smoother transitions. While there are many different aspects for each PI initiative, one piece that will always be important is the team. By including focus on engagement at all levels, support and visibility of top leadership, and building an effective team, hospitals will have the foundation to carry out effective and sustainable PI initiatives.

Principles in Practice
An example of a successful team-based performance improvement initiative can be seen in the work we did at an acute care hospital in South Carolina. After hearing from the ED nurses that there was a need for novice-level nurse instruction in the emergency department, our consultants developed a comprehensive training program targeted at the specific group. The training focused on the 5-level Emergency Severity Index (ESI) triage system including inter-rater reliability and ED patient experience standards as well as the new processes and communication programs designed to support the Performance Improvement program. In this example, the entire staff was engaged to help novice-level nurses – the senior leadership supported the training, and the right people were involved in the performance improvement that led to better training for novice nurses.

I know the team-based approach to performance improvement is critical because I have worked on teams where colleagues are engaged and that much more are willing to fail, try again and learn from their mistakes resulting in stronger job performance, greater job satisfaction and a sincere commitment to the organization. Ultimately, this helps to improve not only the efficiency of care delivery and patient satisfaction, but the satisfaction of the staff as well.

Photo: manop1984, Getty Images


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