How to Create an Award Winning Team

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How to Create an Award Winning Team
Cape Canaveral Hospital
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Challenges

• Increased patient volume
• Significant overcrowding
• Patient satisfaction at the 12th percentile
• Lack of teamwork and low morale

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Goals

• Decrease ED wait times
• Improve patient satisfaction
• Improve the quality of patient care
• Increase staff productivity
• Improve staff and physician satisfaction

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Barriers to Efficiency

• Lengthy and inconsistent triage process
• Fluctuations in patient volume
• Inflexible staffing mechanisms to compensate for
  volume increases
• Delay in discharge of ED patients
• Delay in admission of ED patients
• Lack of space

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Space Issues
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Increased Volume
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Snowflakes are one of natures most fragile
things, but just look at what they can do when
they stick together
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Strategies Implemented

• Established flexible staffing patterns
• Simplified triage process
• Initiated bedside registration
• Created ED Case Manager position
• Purchased and implemented ED Information System
• Opened Express Care Area
• Established Nursing Process Council

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Nursing Process Council

• Membership includes
• Nursing
• Radiology
• Respiratory Therapy
• Registration
• Environmental Services
• Other departments on an ad-hoc basis.

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Key Initiatives

• Establish collaborative methods to identify
  and resolve issues related to patient flow within
  the acute care setting

• Eliminate barriers
• Dissolve territories
• Focus on overall patient care

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Key Initiatives (cont.)

• Empower staff to make decisions regarding work
  setting issues that impact patient care

• Identify issues that negatively impact patient
  care
• Provide the opportunity for staff to create
  change
• Redesign work setting processes

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Issues/Problems Identified

• Multiple points of entry for the potential
  inpatient
• Increased wait time for direct admissions
• Increased patient holding in outpatient areas
  waiting for beds

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Issues/Problems Identified (cont.)

• Interdepartmental issues related to bed
  availability and staffing
• Lack of communication from physician offices
• Discharge delays related to orders,
  transportation and testing impacting bed
  availability and patient care

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Prioritizing the Issues

• The Admission, Discharge, Transfer(ADT) process
  was selected as the project with the highest
  priority because it had the greatest impact on
  the delivery of quality, timely and safe patient
  care .
• The goal was to streamline the admission process
  to improve productivity, efficiency and
  patient/staff satisfaction.

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Previous Direct Admit Process
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Streamlined Direct Admit Process
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NPC Accomplishments

• Eliminated multiple points of entry for patients
  requiring direct admission
• Decreased ER holding hours
• Increased bed availability due to
• Streamlined patient placement
• Appropriate resource allocation in all areas that
  impact patient care for weekends and holidays
• Improved housekeeping process facilitating bed
  turnover

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NPC Accomplishments (cont.)

• Improved communication and cooperation between
  departments
• Hired Admission Nurse to facilitate appropriate
  patient placement and timely acquisition of
  orders
• Created a culture that supports staff empowerment
  and enhances collaboration between departments

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Emergency DepartmentPatient Holding Hours2002
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Improved Patient Flow
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Lengths of Stay
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Patient Satisfaction
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Outcomes

• 85 decrease in average triage to bed time
• 87 decrease in ED holding hours
• 23.8 increase in ED volume
• 90th percentile ED patient satisfaction
• 97th percentile ED staff satisfaction
• 0 RN vacancy rate

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Practical Tips

• Expect the unexpected
• Anticipate resistance
• Remain positive
• Listen to the users
• Accept differences will exist among departments

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Lessons Learned

• Establish an environment of trust
• Create a common vision
• Encourage participation in problem-solving and
  decision making
• Solicit feedback
• Provide opportunities for growth based on
  individual staff members personal goals

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2003 Modern Healthcare Sodexho Award