Using Participative Management to Improve Hospital Patient & Family Care
Proven Results
Caridas Consulting International helped this major teaching hospital increase patient satisfaction by 10% in less than 6 months. Nursing staff satisfaction increased by an average of 10%. Turnover dropped 36% in 3 months and has continued to improve.
The Situation & Preparation
The objective of this project was to improve patient and family care at a large healthcare teaching institution in Texas. Our client was interested in learning how to implement participative management and improve family and patient care at the same time. The Director made the comment that “many groups are talking about Participative Management but few groups know how to actually do it.” The hospital was also getting ready to be evaluated for magnet status, which requires participative management. Our method of Participative Management was of particular interest because of our track record of producing successful results. The Nursing Director wanted involvement from all areas including Patient Care Technicians. The hospital was moving away from top-down bureaucratic management towards shared governance, and this initiative was a way to introduce Participative Management to her staff.
We worked with the day and evening shift of one hospital unit. The Director wanted to improve overall performance of this unit. At first, the hospital staff was somewhat hesitant to reveal troublesome issues. The Director reassured them that the purpose of the two days was to uncover problems candidly, without blame, and design effective solutions. There would be no reprisals for revealing problems on the unit. The focus of the two-day session was to: 1) improve patient care and 2) introduce an effective method of participative management that is based on well-established research and field testing.
Assessment
We began the workshop by conducting a short assessment of the internal motivators of effective work. This gave us a baseline of where the group was is in relation to productivity issues. The assessment is called “The Six Criteria for Productive Work”. These are the internal motivators of productive work -- what gets people up in the morning to do good work. Pay is a satisfier all things being equal. The Six Criteria are as follows:
Steps:
- Control – At work people need to have the right balance of direction and freedom to make decisions about how to do their work.
- Learning – People need clear goals and feedback to correct their behavior on a timely basis.
- Variety – People need to avoid boredom, stress and fatigue by developing a comfortable rhythm in their work.
- Mutual Support and Respect – People need a supportive work environment to stay committed and engaged in their work. Respect from the people they work with is critical for self esteem and productivity.
- Meaningfulness – People need to see a clear correlation between what they do and how it impacts their organization and community.
- Desirable Future – People look for careers which offer skill development and personal growth.
If there is a problem with productivity within a work group it is usually because on of these key motivators is unsatisfied.
Getting at the Real Issues That Concern the Nursing Staff
After our quick assessment of the group, we conducted a thorough analysis of their current status and work flow. We actually mapped the work process that each shift followed everyday.
The next step was to flag problem areas and issues that needed to be addressed in order to improve patient/family care. We actually modeled the process that was necessary for participative governance. This is not easy if your management staff has traditionally told people what to do. It requires that management give their staff some leeway to make decisions regarding how the staff will do their work.
t is management’s job to tell people what is required concerning the goals of the hospital and the specific units. Managers who are excessively controlling with their staff do not garner exceptional performance from their people. People will do what is expected and no more. This type of environment does not inspire people to go the extra mile. Rather, is has the opposite effect according to social science research.
The next step was to find solutions and make recommendations to management. This would involve negotiating with management concerning what issues would be tackled and in what order. Some issues would not be addressed at all either for budgetary reasons or because it was not within Nurse Management’s responsibility. This was announced early in the workshop so people would not be disappointed if some issues were not addressed in the future.
As we worked with the two groups we noticed the energy level was increasing during the solutions phase of the workshop. There was a sense that their key concerns were being addressed and it had a very positive impact on the group.
They tackled critical issues and decided on effective ways to improve their performance. They examined areas such as Shift Change, BIC (Bed Info Center), Reporting, Pharmacy, Dietary, Supplies, Telemetry, Respiratory, Transportation, Interaction and Rounds with doctors, PCT’s, and Housekeeping. The questions they addressed concerned issues that get in the way of delivering excellent patient and family care. The groups worked on practical solutions and created action plans with metrics to measure patient satisfaction, staff satisfaction, turnover and patient rounds.
This participation is powerful because it enables the staff to see how changes impact their performance and gives them the opportunity to track their own improvements. A key aspect of this type of participative process is coordination between management and staff. In addition, control of work is placed where the work is carried out – among the staff. A group looks at its assigned responsibilities and asks what is needed in order for it to accomplish management’s goals. It is then up to the groups and individuals to meet those goals, with coaching, if necessary.
The Results
During the Participative Process Improvement workshop the staff identified about 100 situations they wanted to improve which directly related to Patient & Family Care. Management, while desiring to establish a strong Patient-Family Program, was also looking to improve Press Caney scores in Staff Turnover, Staff Satisfaction and Patient Satisfaction.
The following month, after the PII (Performance Improvement Initiative), action plans were refined by the nursing staff of Units 5 C & D based on their prioritization of the problems and solutions. Day shift primarily focused on initiating Patient/Family Rounds with multi-disciplinary teams (nursing staff, doctors, and additional hospital staff). The night shift staff, at the beginning was doubtful that improvements would occur, due to previous improvement initiatives which had suffered due to insufficient follow-through. Once they overcame understandable doubt, they concentrated on 4 challenging areas- 1) Quality Shift meetings, 2) Improved STAT response, 3) Improved PIL utilization (pharmacy coordination), and 4) Reduced Evening admissions.
Caridas Consulting International consultants worked with management and staff, encouraging commitment and continued organization and implementation of the initiative.
The first set of results shows the correlation between resolution of the problems discussed above and increases in patient satisfaction. Evidence overwhelmingly indicates that when the nursing staff’s needs were met, patient satisfaction scores increased. Patient Satisfaction increased 10% in less than six months.
In June, 2005, nurse management reported that they had resolved 65 of 98 objectives defined in the PII. Nine items were in progress of completion. Another 24 items are going to be addressed shortly regarding strategy and action planning.
The second metric reflects the impact that the Process Improvement Initiative had on Nursing Staff Satisfaction and Manager Feedback. As you can see, a survey was conducted in January, 2005 which revealed how nursing staff felt their needs were being addressed in a responsive, participatory manner. The same survey was administered again in May, 2005 where results climbed an average of 10% on all items over the four month period. The most relevant key elements were defined by nursing staff.
Turnover, which had become an emergent concern, was on the rise at 11% in 2004 over 2003 results. After the Initiative, turnover dropped 36% in the first quarter of 2005 with continued improvement reported, thereafter.
These Press Caney scores are critical indicators of the trend on these units and can be reliable lead indicators (predictors) for assessing future trends.
The team continues to measure their chief concern, Patient Family Rounds, where they involve multi-disciplinary staff, family and patient in treatment care planning. This improvement aligns all members of the patient’s treatment so problems are avoided. Before November, no patient/family rounds were conducted. December dropped with holidays and vacations, from then on, the numbers improved. The nursing teams are committed to increasing these numbers.
Summary:
The nursing team improved their performance with hard work. They were taught skills and given a model to use that actively included the team members who actually do the work. This model of participative management is based on solid research and field testing for over 45 years. Who knows best how to improve work but the very people who do that work every day? This process helps hospital management and staff achieve superior results.
CCI has enjoyed working with these teams especially due to their commitment in getting the job done and going the extra mile. When hospital staff is given the tools, you can expect great results.
Benefits of the Process:
- Proven track record of improving performance results in all types of organizations
- Based on 45 years social science research and field testing
- Faster to implement than traditional consulting methods
- More cost effective than other more expert driven methods
- Addressed the key motivators of productive work
- Gets people to take responsibility in solving their own productivity issues
- Provides a simple method for tracing key performance metrics
For further information, please contact Evangeline Caridas at 713-629-5692, Email: ecaridas@flowmanagement.net
or visit Caridas Consulting International at
http://www.flowmanagement.net