Staff Are From Saturn Physicians Are From Jupiter Administrators Are From Mars Jay Kaplan, MD, FACEP Practicing Clinician and Director, Service/Operational Excellence, CEP America Medical Director, Studer Group Member, ACEP Board of Directors Caveat #1 The Best Definition of Madness is To keep doing things the same way and expect different results... 1
Caveat #2: What Brought You to this Dance.... If the other guy s getting g better, then you d better be getting better faster than that other guy s getting better... or you re getting worse. -- Tom Peters The Circle of Innovation Caveat #3 How Most of Us Approach Change 2
Change Is Not Easy... Without challenge there is no change. If you are always in your comfort zone, you are not where you need to be. We have got to get comfortable with being uncomfortable. Just because you can ride in spin class... Our Most Difficult Task Our: Philosophy Goals Passion Commitment must be shared by everyone... 3
How We Need to Feel A Simple Fact Nurses and Staff are from Saturn Physicians are from Jupiter Health Care Administrators are from Mars 4
Saturn Jupiter 6 th planet from Sun, 2 nd largest Rings impressive in appearance, little material Interior very hot, 12,000K, radiates more energy into space than it receives from the sun Least dense of planets 5 th planet from Sun, by far largest Mass 318X Earth but core only 10-15X = Lots of gas Interior hot 20,000K Huge magnetic field, extends past orbit of Saturn Mars 4 th Planet from the Sun 7 th largest, sometimes hard to find Temperature varies widely (-270 to 80) Thin atmosphere 5
Differences & Similarities Staff Values Team Collaborate Entire patient & family Physicians Values Individual Give Orders Disease - Diagnosis Leaders Values Team Give Orders Entire Organization Work Environment (Shared) - Stressful - Unpredictable - Engenders Predictable Responses CH-46 Sea Knight 6
Comparing Ourselves to Others Helicopter Pilot Role Fly Take off Land safely Radio Communication Instrument monitoring Physician Evaluate the patient Manage the Course (inflight) Continuity of Care/Follow-up Communicating the plan of care to the team Comparing Ourselves to Others Helicopter Co-pilot Role Navigator helps to determine how they are going to get there Charts the course Backs up the pilot Communicates problems Nurses/Staff Navigates the system for the patient Assures diagnostics are completed Gives meds and assesses outcomes Backs up the physician Communicates changes in condition 7
Comparing Ourselves to Others Crew Chief Creates the environment in which safe flight can occur Assures support for the Pilot/Co-pilot Demands adherence to protocol Coordinates allocation of resources Administrative/Practice Leader Responsible for creating the safe environment Assures coordination and responsiveness of all departments Demands regulatory compliance Balances capital and personnel needs with operational realities Comparing Ourselves to Others Passengers Put their lives in the hands of those flying the aircraft Want safe and efficient flight Can be anxious about trip Need clear communication about what is happening Patients Put their lives in the hands of physicians and other health care providers Want safe and efficient care Are often anxious about what is happening to them Need clear communication 8
Effective and Safe Flight Effectiveness is enhanced by the combined experience and input from the Pilot, Co-Pilot, & Crew Chief, with the cooperation of the passengers Learning How To Communicate 9
Step #1: Communicate What? What Do You Want to Be Known For? The Role of Leader You don t need a title to be a leader... and to get where we need to go... we all need to lead... 10
What Do You Want to Be Known For? 1. I am known for (1-2 items); by next year at this time, I plan also to be known for (1 additional item): 2. We (My practice) is known for (1-2 items); by next year at this time, we plan also to be known for (1 additional item): 3. The first step I (we) need to take in order to make that happen is... 4. The single biggest obstacle we have to overcome is... Have the Conversation: What Do We Want To Be Known For? 11
Have the Conversation: What Do We Want To Be Known For? Exceptional Care, Extraordinary Service in a Safe & Efficient Environment Step #2: Colleague as Customer What can I do to help you have a great day today in working with me? 12
Step #2 Exercise Pick a person, group of people or department: If I considered d this person/group/department /d t to be one of my most important partners, I would do the following differently in order to better serve them: 1. 2. 3. If this person/group/department considered me to be one of their most p g p p important partners, I would ask them the following differently in order to better serve me: 1. 2. 3. 13
Collaborative Practice Rounding Is there anything you want to tell me about the patient? Do you have any questions about his/her illness? Would you like to round with me? Create the Team Think Football Before the game, what takes place? Do quarterbacks win games? 14
The Huddle Stand-up meeting No longer than 10 minutes Current state of the union of the unit Capacity/Staffing Focus for the day Any recent patient t saves, wins, compliments Formalize Routes of Communication Make Staff and Physician satisfaction a regular agenda item at your meetings Regular staff/physician department meetings 5 minute stand-up meetings at beginning i of shift Newsletter/Email Groups/ Social Media 15
Which Do You Get More Of? Pat on the Back Tap on the Shoulder Say Thank You More The Simplest Recognition: Saying Thank you at the end of the day (shift) 16
Step 3: Questions What do you want? Are you getting it? Do you love what you are doing? Are there things getting in the way of your loving it more? 17
ER Ownership Where s There s No Gardener, There s No Garden No one is going to create a great place for us to work or for our patients to receive care unless we participate... 18
Department Workday Assessment Work should be enjoyable. We want to make every workday satisfying and fulfilling. Please rate TODAY S workday. 1=not worth it at all 2=poor 3=fair 4=good 5=fabulous 1. Overall enjoyment of the workday 1 2 3 4 5 What got in the way or contributed to being a great workday? If not a great day, please give suggestions for preventing recurrence of the same hassle/problem. If a great day, please say why and how we can ensure you have more of the same. 2. I was treated with respect/courtesy by all members of the health care team. 1 2 3 4 5 3. Others were approachable with questions and/or suggestions. 1 2 3 4 5 4. Ease of working with other members of the department. 1 2 3 4 5 5. Communication regarding patient plan of care treatments/tests. 1 2 3 4 5 6. I felt a cooperative attitude from ancillary staff and other departments 1 2 3 4 5 7. I felt like I was a part of a team working together for everyone s benefit. 1 2 3 4 5 (our staff, patients, medical staff, etc.) 8. I felt appreciated/recognized for my efforts. 1 2 3 4 5 Date: Other comments: Department: Job title: Shift (optional): Name (optional): Help Your Hospital Help Your Practice 1. What are the 3 things which you most love about practicing medicine in this environment? 2. What are the 3 things which you most dislike about your current practice? 3. What suggestions/solutions do you have for those issues mentioned in #2? 19
Find the Issues Focus Fix Follow-up Create a Working List What is working... What is not working... Are there tools/equipment you need? Are there personnel you need? Is everyone on board? 20
Communicate What You Are Doing Stoplight Report 21
Step #4: Get Everyone On Board Once you re on the road, being on the bus becomes an active decision... Is Everyone On Board? Physicians and the Bus: Some will... Jump on Board Stand at the door Stand10 feet away Let the air out of Who takes up most of your time? the tires Who should get more assistance? 22
Are We Who We Think We Are? 5. Treats ED staff in a professional and courteous manner 6. Effectively communicates patient differential dxs/treatment plan to nurses 7. Explains the problem and treatment to patient 9. and/or Is able family to satisfactorily remain calm 8. Is easily under approachable stress and with is questions, able to problems handle and/or suggestions crises well by staff 9. Is able to remain calm under stress and is able to handle crises well 23
Defining Our Standards With each other With our patients With our medical staff With our community Defining i comes first, then accountability... Behavior Standards Commitment to Coworkers In verbal and non-verbal communication, I will treat coworkers respectfully and professionally by listening and avoiding defensiveness. I will respond promptly to any form of communication. I will report to work as scheduled. I will communicate delays as appropriate. I will offer to assist coworkers and other departments when needed. I will respectfully approach fellow employees and refrain from discipline or constructive criticism in public. I will discuss issues directly with coworkers and not go to other people unless the issue cannot be resolved. I will take responsibility for solving problems regardless of origin. I will provide coworkers with a mini report for continuity of workflow when I am planning to be out of the office. I will be mindful and respectful of others time and schedules. Meetings will start and end on time. I will be accountable when completing assignments. I will respect deadlines. 24
No Double Standards Crucial Communications May I Speak Freely? My purpose in talking with you is (a mutual goal) When you I feel... (action you are giving feedback on something they can change) I imagine that (positive intent/benefit of the doubt) And because we both want (common goal) I need (specific alternative behavior requested) Affirm him or her as a person 25
What Can We Do? Everyone has to get on board If you permit it, you promote it What you can do to not permit it 26
Summary What do we want to be known for? How can we create the team colleague as customer. What s getting in our way of having great workdays? Let s work together to make it better. Having fun happens when everyone s on board. Thank you. Jay Kaplan MD, FACEP jay@studergroup.com 27