Promoting Effective Interdisciplinary Leadership August 19, 2015
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TODAY S PANEL: MODERATOR: Kristine Metter, CAE VP, Member Services America s Essential Hospitals SPEAKERS: Angelleen Peters-Lewis, RN, PhD Senior VP Patient Care Services Chief Nursing Officer Women & Infants Hospital of Rhode Island Mark Marcantano President and COO Women & Infants Hospital of Rhode Island Raymond Oliver Powrie, MD Chief Quality Officer Care New England Healthcare System
Promoting Effective Interdisciplinary Leadership Mark Marcantano President and COO Women & Infants Hospital Angelleen Peters-Lewis RN PhD CNO and SVP Patient Care Services Women & Infants Hospital Raymond Powrie, MD SVP Quality Care New England
Presentation Abstract The ability to form effective interdisciplinary partnerships will be the hallmark of a successful health care organization and their leaders in the new health care environment. Care New England Health System believes the most important partnerships are those among physicians, nurses and hospital administrators. Care New England used these partnerships in task forces to address organizational improvement challenges. The system has seen rapid change and innovation as a result, and experienced performance improvement in several areas. During this webinar, Care New England will review how it carried out this approach and the lessons it learned along the way. Speakers also will discuss the perspectives of physicians, nurses, and administrators, and the keys to effective problem solving.
Mark Marcantano NYU, Albany Law School of Union University Executive Dean, SVP and COO of Albany Medical College VP Ambulatory and Network Services, Children s Hospital, Boston At Women & Infants Hospital and Care New England since 2010
Angelleen Peters-Lewis PhD RN Simmons College, Northeastern University and Boston College Nurse Director of Endoscopy at MGH, Boston Executive Director of Women s and Newborn s Services at BWH, Boston
Ray Powrie University of Alberta, University of Calgary and Brown University At Women & Infants and CNE for 23 years where he has worked as a clinician, professor and physician quality leader
Women & Infants Hospital Care New England Major teaching affiliate of Brown University for services unique to women and newborns 11th largest stand alone obstetrical service with 8400 deliveries per year 80 bed single-family room NICU 167 adult and 140 infant beds 12 operating rooms 19, 369 admissions and 7413 surgeries 2014 Leapfrog Top Hospital Recognized by Robert Wood Johnson Foundation as a national leader in interdisciplinary care
Some of Our Longstanding Challenges Unwarranted preterm elective deliveries OR efficiency Breast feeding rates ER efficiency and safety Patient access Costs of obstetrical care
Progress On Longstanding Challenges We really had made little progress on these areas and needed a new approach
Silos We realized nursing, physicians and non-clinical administrators were not working in a coordinated manner
Negotiating Silos..and the failure to work as a team was making progress very difficult
Teamwork We determined that insisting on teamwork was the only way we were going to get things to change (and that we needed to chose an effective model for it)
Paradigm shifts: using a participatory leadership process to redesign health systems Curr Opin Obstet Gynecol. 2014 Dec;26(6):516-22 Saleeby E, Holschneider CH, Singhal R Participatory leadership is an organizational change theory that engages key stakeholders as architects in the transformation process. This review highlights the utility of this leadership strategy in designing care for women's health Physician engagement in leadership during this time of system transformation is of critical importance
We Created Teams Led by Triads Nurse Physician Dyad Triad Nurse Physician Administrator
We Decided to Focus Our Efforts Multa novit vulpes, verum echinus unum magnum. A fox knows many things, but a hedgehog one important thing -Archilochus ~650 BC We knew the saying about the fox and the hedgehog from the book Good to Great and decided to make sure we FOCUSED on doing a few key things very well.
Choosing Our Focus We chose projects that lay in the intersection of the following three circles: What can we be the best at? What drives our economic engine? What are we deeply passionate about?
Our Priorities and Our Passion Eradicating preventable preterm births Increasing breastfeeding Enhancing OR efficiency ER efficiency and safety Patient access Partnering with physicians to decrease the costs of maternity care
This is When We Began to See our Silos Break Down.
..and We Began to See Progress on These Longstanding Challenges
Learning Curve It Wasn t All Easy So These Are The Lessons We Learned Along the way
We made sure we spoke and modeled and acted in a way about this work that communicated a broader vision. Vision Serving something bigger than yourself, career or even your institution Being about the work Tapping into the desire for people to be their best selves
Cultural characteristics of high and low performing hospitals Journal of Health Organization and Management, Mannion H.T.O. Davies M.N. Marshall 2005;19(6):431-439 Apollo Zeus
Caring People don t care how much you know until they know how much you care Theodore Roosevelt All Team Leaders Needed to Consistently Know We Cared About Their Perspective and Input
Credibility TRUST All team members needed to know that their leadership was talking the same talk to all team members.
Professionalism: good for patients and health care organizations. Brennan MD 1, Monson V 2. Mayo Clin Proc. 2014 May;89(5):644-52. A recent working group of the Institute of Medicine defined the values associated with teamwork as honesty, discipline, creativity, humility, and curiosity. The values of cooperative teams are defined as self-respect, mutual respect, and equality.
Hardwire the Triad It was important to make sure that every step along the way (conversations, meetings, presentations, follow up etc.) involved the entire triad
Professionalism: good for patients and health care organizations. Brennan MD, Monson V Mayo Clin Proc. 2014 May;89(5):644-52. Recategorization of..identity from an individual to an organizational one.. provides the basis for a diverse team of professionals to work cooperatively and efficiently in placing the needs of the patients and society above self-interest. When individuals can cognitively shift from a singular identity as a surgeon, oncologist, nurse, or administrator to a more complex and overarching identity on the basis of the organization's values and purpose, greater alignment between espoused values and those in practice occurs.
Accountability We created weekly, monthly, quarterly oversight and report- outs by the triads (with a broad audience) to make sure teams had the resources they needed Teams were held accountable to get the job done Standardized format 20% on why they were where they where and 80% on what they were doing about it
Midpoint Summary ACT Values Accountability Caring Teamwork Additional Key Principles Be strategic with resisters Be tenacious Be a shepherd Tack Be the Bigger Person
Don t Be Waylaid by Resisting Stake Holders We determined to face the reality of different stakeholders and work to help them be their best selves
We Had to Be Tenacious Stay on message and keep pushing even when things look like they will never change Don t underestimate the power of a leader s steady, focused, resolute commitment to seeing a mission accomplished Remind people that their work is to determine how the thing gets done, not IF the thing gets done Tenacity: quality of being Able to grip something firmly persistence, determination, perseverance, doggedness, strength of purpose, tirelessness, indefatigability, resolution, resoluteness, resolve, firmness, patience, purposefulness, staunchness, steadfastness, staying power, endurance, stamina
We Came to Think of Ourselves as Shepherds to the Projects and the Teams We pushed the change along in the right direction We became adept at using our hooks both to protect the team and to get the wayward team members back on course
We Got Good at Tacking
We Learned to Choose Our Battles Make sure you and your teams are willing to be the bigger person more times that you/they might want to
Victory (and persistence)