In 2008, avoidable medical injuries cost the US economy approximately $80 billion. The complexity of patient care demands effective communication and collaboration between team members to minimize error and maximize quality and safety. The potential for error remains high until people are clear about the tasks they must complete and the way they should be performed.
Disputes between two cardiothroacic (CT) surgeons were threatening a hospital’s reputation. Referring cardiologists had grown dissatisfied with the lack of communication and collaboration between the two CT surgeons, particularly in the postoperative care of their patients. Referrals began to decline.
The CT team, OR, and ICU staff split into camps based on the surgeon they preferred. Team members avoided Dr. Smith, calling him “Dr. A-hole” behind his back. As a birthday gift, team members were given the day off from working with Dr. Smith. Dr. Jones chose to ignore Dr. Smith’s behavior and work independently, which led to disjointed, confusing work orders for the staff, a lack of collaboration among team members, and low morale.
Dr. Smith refused to participate in discussions about team complaints. He told the hospital CEO and chief of staff that he was not the sole problem and highlighted other team issues. Six nurses and OR technologists quit, and more were threatening to leave.
The CEO and the chief of staff felt that firing Dr. Smith was not an option because clinical outcomes did not warrant revoking his hospital privileges and reporting him to the state medical board. Instead, they decided to invest in developing Dr. Smith’s capabilities as a CT team leader.
A consulting team, comprised of a physician, an executive coach, a psychologist, and a group facilitator, were brought in to coach the CT team to improved performance. Dr. Smith agreed to participate in the intervention because he believed that his perception of the team’s issues would be validated. The goal of the intervention was to deal with chronic difficulties in the group, restore the reputation of the heart program, and build the CT group into a high-functioning team.
As one of the interventions, the CT team developed a social contract, summarized their agreement in writing, signed it, and posted the guidelines in common staff areas:
- Express appreciation for each other to foster a positive work climate
- No gossiping
- Communicate respectfully (defined as using a moderate tone of voice, no yelling, no name-calling, no sarcasm, and no demeaning comments)
- No matter what your position or role on the team, you have a right to confront anyone with whom you have an issue
- If you have an issue with someone, address that person directly without running to someone else or to that person’s supervisor
- If the issue is not dealt with respectfully or if reasonable attempts to resolve the issue are unsuccessful, you may involve your supervisor
- Conflict resolution must occur away from patients and families
Some of the actions the CT team took to sustain momentum included:
- Take personal responsibility
- Maintain open communication and follow established guidelines
- Orient new CT team members to CT expectations and culture
- Standardize protocols through teaching and orientation
- Remain open to one other’s views
For two years, staff recruitment and retention improved, from 19 percent staff turnover and zero hires in the two years pre-intervention to 0 percent turnover and 12 hires in the three years post-intervention. While patient acuity remained unchanged, the team’s observed mortality (operative) dropped from 3.6 percent pre-intervention to 1.9 percent post-intervention and remained at 1.5 percent and 1.4 percent for the next two years, respectively. Given the number of operations performed by the CT team over this time (an average of 187 per year), an estimated 12 lives were saved as a result of coaching a team to improved performance.
This post represents a very brief summary of a complex intervention. I encourage you to read the chapter to grasp the full meaning of some of the lessons learned in coaching a team to improved performance:
- Quality of care is rooted in the competency of healthcare providers, their relationships with one another, and optimal team performance
- High team performance coupled with effective operating systems creates outstanding clinical outcomes
- To optimize teamwork, leaders must address underlying organizational cultural issues and develop improvement strategies, so that team members focus on common goals
- In the long run, the effectiveness of work done by outside consultants depends on the extent to which internal leaders take ownership of, champion, and engage team members in the effort
As always, I welcome your input to improve healthcare collaboration and get it done.
Kenneth H. Cohn
© 2011, all rights reserved
Disclosure: I have not received any compensation for writing this content.