- Email: [email protected]
Lateral Service to Deliver Better Patient Care
Lateral Service to Deliver Better Patient Care Courtney Vose, RN, MBA, MSN, APRN, Kim Hitchings, RN, MSN, NEA-BC, Beth Kessler, RN, BC, Jack Dunleavy, BS, Anthony Ardire, MD, MPH, FAAP, CPE, and Andrew Barsky, CDM, CFPP
“A
s director of our level I emer-
time. As I waited outside the room, I overheard a
gency department, I was called
physician say to the patient and her family, “I’m
to a medical-surgical unit to perform service
sorry that you got stuck in that black hole of an
recovery for a newly admitted female patient who
ED.”
expressed dissatisfaction regarding her ED wait
H
ow many of us have had a colleague “manage down” or denigrate another individual or service to move away from a complaint with minimal effort? As a result, the original complaint is not addressed, patients and families are given
34
Nurse Leader
Courtney Vose, RN, MBA, MSN, APRN the impression of fragmented teamwork, and individuals and departments become silos for their own benefit and gain. At Lehigh Valley Health Network (LVHN), an academiccommunity Magnet® organization, scenarios such as the one
February 2012
above prompted us to acknowledge the opportunity for staff to treat one another with respect and demonstrate collegiality. Terming our efforts “lateral service,” we believed that “by better serving each other, we better serve our patients and families.” And so began our uncharted journey to define expectations and accountability for how we treat, not just our patients and families, but everyone with whom employees interact.
INITIAL CURRENT STATE A Patient Satisfaction Improvement Council (PSIC) has been in existence at LVHN since 2001. Composed of approximately 25 cross-functional, mid-level, and senior managers, the PSIC’s purpose is to “seek out opportunities to continually improve the patient experience process and infrastructures involved in all healthcare delivery settings at LVHN.” In the spring of 2005, using the newly released book, Hardwiring Excellence—Purpose, Worthwhile Work, Making A Difference by Quint Studer1 as a reference, PSIC members identified what they perceived as “must-do” interventions to take LVHN to the next level of service excellence. The most prominent of these interventions spoke to the need for staff accountability to effect lateral service. As a result, a lateral service work team that would report to PSIC was formed. In all honesty, for the first 6 months this new team met, little progress was made. Looking back, our perception then was that the task before us was overwhelming.We did not know where to begin. It was like a giant elephant in the room. Our charge was to address it, so we could not ignore it. As such, we had to eat it. But how do you eat an elephant? One bite at a time. Before we could take our first bite, we had to define our current state. This would, in turn, prompt a framework for action items and measures of success. In 1997, our network had adopted service standards of behavior we termed PRIDE, an acronym for the following: P—Privacy R—Respect I—Involvement D—Dignity E—Empathy Though strongly embedded within our culture, we realized the PRIDE principles explicitly emphasized patient treatment; they did not clearly make the transition to behaviors associated with interactions among patient families, coworkers, physicians, and other key customer groups. Current state metrics pointed to the need to continually address lateral service issues. For example, in early 2005, a survey was done to assess staff member opinions of a new inpatient tower. Two survey questions, in particular, pointed to opportunities for improvements in lateral service: • Communication between my department and other departments is very good. • I am highly satisfied with the level of service I receive from other departments. Data also revealed we had a low turnover rate in some disciplines, whereas turnover in others remained higher than we expected. Also, patient perception of staff teamwork was lower than we liked—a score that would play a major factor www.nurseleader.com
in us achieving our network goal to improve overall satisfaction. Finally, employee and physician satisfaction scores were not at desired levels. A positive aspect of the current state was our organization’s commitment to align and incentivize measurable goals at all levels. From the C-suite to the people performing the C-sections, every employee has annual goals focused within the LVHN’s five fundamental priorities: people, service, quality, cost, and growth. These goals are further developed to be consistent with the annual major priorities set by senior management within these five areas. The mission to address the elephant was primed; we had dissected our current state and recognized opportunities for improvement. The next step was to investigate evidence-based best practices to guide the design of structures and processes to enhance lateral accountability within our own network.
LITERATURE SEARCH AND CONCEPTUAL FRAMEWORK DRIVING THIS INITIATIVE The Lateral Service Team conducted a literature search for manuscripts that detailed organizations that had designed and implemented strategies associated with lateral service. The search phrases “lateral service” and “lateral accountability” produced little that was associated with our perception and definition of the terms. However, what we did find was literature associated with the term “bullying.” Team members thought this term could produce a perception of abuse and defensive feelings and did not want this connotation associated with what we anticipated was to become a major LVHN initiative. At this point, without a defined best practice to learn from and emulate, we turned our attention to selecting a conceptual framework to guide our efforts. We adopted the Shea Work Systems Model, which defines eight spheres of influence that drive change in individuals and their organization (Figure 1). According to Shea, at least four of the eight spheres must be addressed for change to occur, and the likelihood of success increases as more spheres are addressed. These spheres, then, became our focus for strategies to effect a culture change that embraces lateral service. In short, each sphere became a different bite of the elephant.
TARGET STATE The intent was that, once the elephant was gone, our target state of hardwiring staff accountability to effect lateral service would be achieved. We came to believe this accountability centered on a culture in which behavior matters. Evidence of this culture would include: • Demonstration of PRIDE principles within patient, family, coworker, physician, and other key LVHN customer group interactions • Aligned and incentivized LVHN goals related to lateral accountability: • Employee satisfaction scores above the national benchmark database mean score and 50th percentile • “Patient perception of staff teamwork” score in clinical areas throughout LVHN above the national benchmark database 50th percentile
Nurse Leader
35
Figure 1. Shea Work Systems Model
• Decreased turnover rates for designated disciplines; for registered nurses (RNs), the goal was turnover rate below the national benchmark database mean score.
COUNTERMEASURES Our next step was to identify potential countermeasures (solutions) to positively impact lateral service metrics. These countermeasures were designed to address five components of the Shea Work Systems Model. Tasks Within this component, we implemented two countermeasures. First, we redefined the PRIDE behaviors to include actions and responses, not just to patients, but also to patient families, coworkers, physicians, and other key LVHN customers (Figure 2). Next, we revised our annual performance appraisal. Actions and responses included within the new PRIDE behaviors, a total of nine, were added to the appraisal for all staff members and given a total weight of 40%. The two remaining sections and respective weights within the appraisal are job responsibility score (35%) and performance goals (25%). Certainly, technical competency had always been the primary expectation at LVHN; courtesy had always been assumed. Now, with the revised appraisal and subsequent weight of the PRIDE behaviors, there were no assumptions, only a clear expectation that courtesy is balanced by technical competence. Not only were the nine PRIDE behaviors added to the appraisal, each individual behavior was further defined in accordance with a Likert scale (Figure 3). A score of 3 is the “price of admission” related to behaviors at LVHN. Any single behavior scored less than 3 requires formal action planning for improvement. Measurement To address this sphere, our team added two questions to the biannual employee satisfaction survey: • There is cooperation between coworkers in my department.
36
Nurse Leader
• There is cooperation between my department and other departments I work with. The first question is customized. Although there were no national benchmarks, we recognized the value in comparing our own internal data historically.We also thought it important to capture patient perception related to lateral service.To do this, we identified the following Press Ganey patient satisfaction question as our metric: How well the team worked together to care for you. The final metrics identified within this sphere are turnover rates. Rewards As mentioned previously, our annual goals for all LVHN staff are incentivized. In addition to a monetary award associated with goal achievement, the annual performance appraisals generate an annual employee merit raise, based on the overall score. Before the revised performance appraisal, scores for PRIDE behaviors were incorporated as part of the overall score. However, they were interpreted to be related only to patient interactions, not defined in accordance with a Likert scale and weighted at 20%. As such, individuals who did not demonstrate courtesy but excelled in their technical job responsibilities often were able to attain a minimum overall score (3) that allowed them to receive the bonus tied to their incentivized goals and merit raise.The new performance appraisal—with lateral service behaviors more defined and garnering a weight of 40%—prompted increasing numbers of staff to not attain the minimum score of 3 and, thus, not be eligible for the goal incentive or merit raise. Using the concept of appreciative inquiry,2 another action of the Lateral Service Team in this sphere was distribution to all department heads of “On-the-Spot Reward and Recognition” toolkits in the form of gift bags. The intent was for the department heads to implement an immediate reward and recognition program, focusing on real-time reward and recognition of employees, physicians, and volunteers within departments and across the organization. The bags included a variety of tools, such as thank-you cards, tablets, and postcards and coupons for food and beverages. People/Skills and Information Distribution We recognized that to hold people accountable for lateral service behaviors, we needed to provide clear expectations and associated skill sets. The monthly department head meeting was used as a kick-off for communicating the definition of lateral service and the team’s vision for the same at LVHN. After each monthly 90-minute department head meeting, a 30-minute “Learning Blitz” is held on a variety of subjects. This forum was used by Lateral Service Team members to communicate and educate department managers about the new performance appraisal after it had been pilot tested in a variety of settings. The managers, in turn, were responsible for sharing the new appraisal with their staff. This occurred a year before the new appraisal was implemented, so that staff had a full year to demonstrate the revised PRIDE behaviors. Another teaching strategy to communicate the PRIDE behaviors was a mandatory electronic-learning platform educational program, available on all desktop computers and able to be accessed remotely from employee homes.
February 2012
OUTCOME MEASURES
Figure 2. PRIDE Behaviors
Metrics to evaluate success include employee satisfaction, patient perception of staff teamwork, and RN turnover rate. In addition to these quantitative outcomes, collateral gains were also made through the actions of “fire-starters.” Employee Satisfaction We have data from only one employee satisfaction survey (2009) since adding the two previously identified questions associated with lateral accountability (Figure 4). For the second question, which has a benchmark database, our raw score of 3.8 and percentile ranking of 83% achieved the goals to be above the rawscore database mean (3.6) and the 50th percentile. Patient Perception of Staff Teamwork Figure 5 demonstrates that the raw score and percentile rank progressively improved from 2004 through 2010 for the Press Ganey patient satisfaction question, “How well the team worked together to care for you.” Most recently, in 2010, the percentile ranking in the national benchmark database was 71, meeting the goal to exceed the 50th percentile.
Figure 3. LVHN Performance Appraisal Scoring Guidelines
Registered Nurse Turnover Rate The LVHN RN turnover rate has consistently declined from 2005 through 2010 (Figure 6). The 2010 RN turnover rate of 8.94% is less than the most recent American Nurses Credentialing Center Magnet Recognition Program® overall RN turnover rate (9.58%; n ⫽ 383) and the rate for Magnet hospitals with more than 701 beds (9.46%; n ⫽ 52),3 thus achieving our benchmark goal. Fire-Starters Studer speaks about fire-starters as individuals who make a difference in the lives of others.1 His original context referenced the individuals in early civilization who kept the fire going to ensure the survival of all. After the original LVHN Lateral Service efforts, multiple individuals assumed the role of fire-starter to ensure the survival and enculturation of the www.nurseleader.com
efforts. For example, a nurse administrator and her leadership team designed a 4-hour educational program, “Peers and Partners in PRIDE,” for direct care staff members. The objectives focused on skill development to promote accountability for PRIDE behaviors among peers. Other departments initiated efforts that encourage colleagues to “Take a Walk in My Shoes.” For example, staff nurses from a medical-surgical unit spent time in the patient logistics department, observing the work flow to gain a better understanding of the bed-placement process and associated challenges.The goal is to enhance relationships and communication. A final example of fire-starters is the staff who proposed creation of a quarterly “Physician Service Star.” Criteria for this award include, not only quantitative patient satisfaction scores, but qualitative feedback from bedside staff members related to the physician’s demonstration of lateral service.
Nurse Leader
37
Figure 4. Employee Satisfaction
Figure 5. Question from Patient Satisfaction Survey
Figure 6. Network RN Turnover 2005-2010
to patients may have been more dramatic. For a long time, we have recognized the value of consistency in our LVHN strategic priorities and associated actions. As such, rather than instituting a completely new initiative to address lateral service, we built upon and enhanced our long-standing service promises (PRIDE) that were readily known and carried out by our staff and recognized by our community members. We are fortunate in that we had, not only senior leadership involvement in this effort, but also active engagement. These individuals’ true passion for enhanced lateral service was evidenced in their enthusiasm, diligence, and attentiveness. Ultimately, accountability was ensured through such things as goal alignment and project and data transparency. Another lesson to share is our confidence in staff member abilities regarding lateral service and associated accountability. Our staff readily embraced the notion of “Tell me; don’t tell on me.” We believe our strong shared governance model was a foundation for this staff self-actualization. A final lesson relates back to that giant elephant in the room. Just because it seems overwhelming, and cause and effect metrics may prove difficult, do not hesitate to take that first bite. As the euphemism goes, “Culture eats strategy for lunch.” Don’t shy away from the table! NL References 1. Studer Q. Hardwiring Excellence: Purpose, Worthwhile Work, Making A Difference. Gulf Breeze, FL: Fire Starter Publishing; 2003. 2. Hammond SA. Appreciative Inquiry. 2nd ed. Plano, TX: Thin Book Publishing Co.; 1998. 3. Characteristics of Magnet organizations. American Nurses Credentialing Center Web site. http://www.nursecredentialing.org/Characteristics MagnetOrganizations.aspx. Accessed September 7, 2011.
All authors are employees at Lehigh Valley Health Network in Allentown, Pennsylvania. Courtney Vose, RN, MBA, MSN, APRN, is the administrator for patient care services. Kim Hitchings, RN, MSN, NEA-BC, is the manager of the Center for Professional Excellence; she can be reached at [email protected]. Beth Kessler, RN, BC, is director of the 6 Tower medical-surgical unit. Jack Dunleavy, BS, is an internal consultant for organizational development. Anthony Ardire, MD, MPH, FAAP, CPE, is senior vice president of quality and patient safety. Andrew Barsky, CDM, CFPP, is senior general manager food and nutrition at Sodexo in the network.
RECOMMENDATIONS AND LESSONS LEARNED The PSIC and the Lateral Service Team were composed of cross-functional, mid-level, and senior managers. In hindsight, we should have included more direct care, non-management individuals, in particular, physicians and registered nurses. These individuals represent the largest groups of caregivers; thus, engaging them in the design of actions may have propelled the spread of efforts. By this large cadre of individuals better serving each other, the subsequent service
38
Nurse Leader
1541-4612/2012/ $ See front matter Copyright 2012 by Mosby Inc. All rights reserved. doi:10.1016/j.mnl/2011.11.006
February 2012
“A
s director of our level I emer-
time. As I waited outside the room, I overheard a
gency department, I was called
physician say to the patient and her family, “I’m
to a medical-surgical unit to perform service
sorry that you got stuck in that black hole of an
recovery for a newly admitted female patient who
ED.”
expressed dissatisfaction regarding her ED wait
H
ow many of us have had a colleague “manage down” or denigrate another individual or service to move away from a complaint with minimal effort? As a result, the original complaint is not addressed, patients and families are given
34
Nurse Leader
Courtney Vose, RN, MBA, MSN, APRN the impression of fragmented teamwork, and individuals and departments become silos for their own benefit and gain. At Lehigh Valley Health Network (LVHN), an academiccommunity Magnet® organization, scenarios such as the one
February 2012
above prompted us to acknowledge the opportunity for staff to treat one another with respect and demonstrate collegiality. Terming our efforts “lateral service,” we believed that “by better serving each other, we better serve our patients and families.” And so began our uncharted journey to define expectations and accountability for how we treat, not just our patients and families, but everyone with whom employees interact.
INITIAL CURRENT STATE A Patient Satisfaction Improvement Council (PSIC) has been in existence at LVHN since 2001. Composed of approximately 25 cross-functional, mid-level, and senior managers, the PSIC’s purpose is to “seek out opportunities to continually improve the patient experience process and infrastructures involved in all healthcare delivery settings at LVHN.” In the spring of 2005, using the newly released book, Hardwiring Excellence—Purpose, Worthwhile Work, Making A Difference by Quint Studer1 as a reference, PSIC members identified what they perceived as “must-do” interventions to take LVHN to the next level of service excellence. The most prominent of these interventions spoke to the need for staff accountability to effect lateral service. As a result, a lateral service work team that would report to PSIC was formed. In all honesty, for the first 6 months this new team met, little progress was made. Looking back, our perception then was that the task before us was overwhelming.We did not know where to begin. It was like a giant elephant in the room. Our charge was to address it, so we could not ignore it. As such, we had to eat it. But how do you eat an elephant? One bite at a time. Before we could take our first bite, we had to define our current state. This would, in turn, prompt a framework for action items and measures of success. In 1997, our network had adopted service standards of behavior we termed PRIDE, an acronym for the following: P—Privacy R—Respect I—Involvement D—Dignity E—Empathy Though strongly embedded within our culture, we realized the PRIDE principles explicitly emphasized patient treatment; they did not clearly make the transition to behaviors associated with interactions among patient families, coworkers, physicians, and other key customer groups. Current state metrics pointed to the need to continually address lateral service issues. For example, in early 2005, a survey was done to assess staff member opinions of a new inpatient tower. Two survey questions, in particular, pointed to opportunities for improvements in lateral service: • Communication between my department and other departments is very good. • I am highly satisfied with the level of service I receive from other departments. Data also revealed we had a low turnover rate in some disciplines, whereas turnover in others remained higher than we expected. Also, patient perception of staff teamwork was lower than we liked—a score that would play a major factor www.nurseleader.com
in us achieving our network goal to improve overall satisfaction. Finally, employee and physician satisfaction scores were not at desired levels. A positive aspect of the current state was our organization’s commitment to align and incentivize measurable goals at all levels. From the C-suite to the people performing the C-sections, every employee has annual goals focused within the LVHN’s five fundamental priorities: people, service, quality, cost, and growth. These goals are further developed to be consistent with the annual major priorities set by senior management within these five areas. The mission to address the elephant was primed; we had dissected our current state and recognized opportunities for improvement. The next step was to investigate evidence-based best practices to guide the design of structures and processes to enhance lateral accountability within our own network.
LITERATURE SEARCH AND CONCEPTUAL FRAMEWORK DRIVING THIS INITIATIVE The Lateral Service Team conducted a literature search for manuscripts that detailed organizations that had designed and implemented strategies associated with lateral service. The search phrases “lateral service” and “lateral accountability” produced little that was associated with our perception and definition of the terms. However, what we did find was literature associated with the term “bullying.” Team members thought this term could produce a perception of abuse and defensive feelings and did not want this connotation associated with what we anticipated was to become a major LVHN initiative. At this point, without a defined best practice to learn from and emulate, we turned our attention to selecting a conceptual framework to guide our efforts. We adopted the Shea Work Systems Model, which defines eight spheres of influence that drive change in individuals and their organization (Figure 1). According to Shea, at least four of the eight spheres must be addressed for change to occur, and the likelihood of success increases as more spheres are addressed. These spheres, then, became our focus for strategies to effect a culture change that embraces lateral service. In short, each sphere became a different bite of the elephant.
TARGET STATE The intent was that, once the elephant was gone, our target state of hardwiring staff accountability to effect lateral service would be achieved. We came to believe this accountability centered on a culture in which behavior matters. Evidence of this culture would include: • Demonstration of PRIDE principles within patient, family, coworker, physician, and other key LVHN customer group interactions • Aligned and incentivized LVHN goals related to lateral accountability: • Employee satisfaction scores above the national benchmark database mean score and 50th percentile • “Patient perception of staff teamwork” score in clinical areas throughout LVHN above the national benchmark database 50th percentile
Nurse Leader
35
Figure 1. Shea Work Systems Model
• Decreased turnover rates for designated disciplines; for registered nurses (RNs), the goal was turnover rate below the national benchmark database mean score.
COUNTERMEASURES Our next step was to identify potential countermeasures (solutions) to positively impact lateral service metrics. These countermeasures were designed to address five components of the Shea Work Systems Model. Tasks Within this component, we implemented two countermeasures. First, we redefined the PRIDE behaviors to include actions and responses, not just to patients, but also to patient families, coworkers, physicians, and other key LVHN customers (Figure 2). Next, we revised our annual performance appraisal. Actions and responses included within the new PRIDE behaviors, a total of nine, were added to the appraisal for all staff members and given a total weight of 40%. The two remaining sections and respective weights within the appraisal are job responsibility score (35%) and performance goals (25%). Certainly, technical competency had always been the primary expectation at LVHN; courtesy had always been assumed. Now, with the revised appraisal and subsequent weight of the PRIDE behaviors, there were no assumptions, only a clear expectation that courtesy is balanced by technical competence. Not only were the nine PRIDE behaviors added to the appraisal, each individual behavior was further defined in accordance with a Likert scale (Figure 3). A score of 3 is the “price of admission” related to behaviors at LVHN. Any single behavior scored less than 3 requires formal action planning for improvement. Measurement To address this sphere, our team added two questions to the biannual employee satisfaction survey: • There is cooperation between coworkers in my department.
36
Nurse Leader
• There is cooperation between my department and other departments I work with. The first question is customized. Although there were no national benchmarks, we recognized the value in comparing our own internal data historically.We also thought it important to capture patient perception related to lateral service.To do this, we identified the following Press Ganey patient satisfaction question as our metric: How well the team worked together to care for you. The final metrics identified within this sphere are turnover rates. Rewards As mentioned previously, our annual goals for all LVHN staff are incentivized. In addition to a monetary award associated with goal achievement, the annual performance appraisals generate an annual employee merit raise, based on the overall score. Before the revised performance appraisal, scores for PRIDE behaviors were incorporated as part of the overall score. However, they were interpreted to be related only to patient interactions, not defined in accordance with a Likert scale and weighted at 20%. As such, individuals who did not demonstrate courtesy but excelled in their technical job responsibilities often were able to attain a minimum overall score (3) that allowed them to receive the bonus tied to their incentivized goals and merit raise.The new performance appraisal—with lateral service behaviors more defined and garnering a weight of 40%—prompted increasing numbers of staff to not attain the minimum score of 3 and, thus, not be eligible for the goal incentive or merit raise. Using the concept of appreciative inquiry,2 another action of the Lateral Service Team in this sphere was distribution to all department heads of “On-the-Spot Reward and Recognition” toolkits in the form of gift bags. The intent was for the department heads to implement an immediate reward and recognition program, focusing on real-time reward and recognition of employees, physicians, and volunteers within departments and across the organization. The bags included a variety of tools, such as thank-you cards, tablets, and postcards and coupons for food and beverages. People/Skills and Information Distribution We recognized that to hold people accountable for lateral service behaviors, we needed to provide clear expectations and associated skill sets. The monthly department head meeting was used as a kick-off for communicating the definition of lateral service and the team’s vision for the same at LVHN. After each monthly 90-minute department head meeting, a 30-minute “Learning Blitz” is held on a variety of subjects. This forum was used by Lateral Service Team members to communicate and educate department managers about the new performance appraisal after it had been pilot tested in a variety of settings. The managers, in turn, were responsible for sharing the new appraisal with their staff. This occurred a year before the new appraisal was implemented, so that staff had a full year to demonstrate the revised PRIDE behaviors. Another teaching strategy to communicate the PRIDE behaviors was a mandatory electronic-learning platform educational program, available on all desktop computers and able to be accessed remotely from employee homes.
February 2012
OUTCOME MEASURES
Figure 2. PRIDE Behaviors
Metrics to evaluate success include employee satisfaction, patient perception of staff teamwork, and RN turnover rate. In addition to these quantitative outcomes, collateral gains were also made through the actions of “fire-starters.” Employee Satisfaction We have data from only one employee satisfaction survey (2009) since adding the two previously identified questions associated with lateral accountability (Figure 4). For the second question, which has a benchmark database, our raw score of 3.8 and percentile ranking of 83% achieved the goals to be above the rawscore database mean (3.6) and the 50th percentile. Patient Perception of Staff Teamwork Figure 5 demonstrates that the raw score and percentile rank progressively improved from 2004 through 2010 for the Press Ganey patient satisfaction question, “How well the team worked together to care for you.” Most recently, in 2010, the percentile ranking in the national benchmark database was 71, meeting the goal to exceed the 50th percentile.
Figure 3. LVHN Performance Appraisal Scoring Guidelines
Registered Nurse Turnover Rate The LVHN RN turnover rate has consistently declined from 2005 through 2010 (Figure 6). The 2010 RN turnover rate of 8.94% is less than the most recent American Nurses Credentialing Center Magnet Recognition Program® overall RN turnover rate (9.58%; n ⫽ 383) and the rate for Magnet hospitals with more than 701 beds (9.46%; n ⫽ 52),3 thus achieving our benchmark goal. Fire-Starters Studer speaks about fire-starters as individuals who make a difference in the lives of others.1 His original context referenced the individuals in early civilization who kept the fire going to ensure the survival of all. After the original LVHN Lateral Service efforts, multiple individuals assumed the role of fire-starter to ensure the survival and enculturation of the www.nurseleader.com
efforts. For example, a nurse administrator and her leadership team designed a 4-hour educational program, “Peers and Partners in PRIDE,” for direct care staff members. The objectives focused on skill development to promote accountability for PRIDE behaviors among peers. Other departments initiated efforts that encourage colleagues to “Take a Walk in My Shoes.” For example, staff nurses from a medical-surgical unit spent time in the patient logistics department, observing the work flow to gain a better understanding of the bed-placement process and associated challenges.The goal is to enhance relationships and communication. A final example of fire-starters is the staff who proposed creation of a quarterly “Physician Service Star.” Criteria for this award include, not only quantitative patient satisfaction scores, but qualitative feedback from bedside staff members related to the physician’s demonstration of lateral service.
Nurse Leader
37
Figure 4. Employee Satisfaction
Figure 5. Question from Patient Satisfaction Survey
Figure 6. Network RN Turnover 2005-2010
to patients may have been more dramatic. For a long time, we have recognized the value of consistency in our LVHN strategic priorities and associated actions. As such, rather than instituting a completely new initiative to address lateral service, we built upon and enhanced our long-standing service promises (PRIDE) that were readily known and carried out by our staff and recognized by our community members. We are fortunate in that we had, not only senior leadership involvement in this effort, but also active engagement. These individuals’ true passion for enhanced lateral service was evidenced in their enthusiasm, diligence, and attentiveness. Ultimately, accountability was ensured through such things as goal alignment and project and data transparency. Another lesson to share is our confidence in staff member abilities regarding lateral service and associated accountability. Our staff readily embraced the notion of “Tell me; don’t tell on me.” We believe our strong shared governance model was a foundation for this staff self-actualization. A final lesson relates back to that giant elephant in the room. Just because it seems overwhelming, and cause and effect metrics may prove difficult, do not hesitate to take that first bite. As the euphemism goes, “Culture eats strategy for lunch.” Don’t shy away from the table! NL References 1. Studer Q. Hardwiring Excellence: Purpose, Worthwhile Work, Making A Difference. Gulf Breeze, FL: Fire Starter Publishing; 2003. 2. Hammond SA. Appreciative Inquiry. 2nd ed. Plano, TX: Thin Book Publishing Co.; 1998. 3. Characteristics of Magnet organizations. American Nurses Credentialing Center Web site. http://www.nursecredentialing.org/Characteristics MagnetOrganizations.aspx. Accessed September 7, 2011.
All authors are employees at Lehigh Valley Health Network in Allentown, Pennsylvania. Courtney Vose, RN, MBA, MSN, APRN, is the administrator for patient care services. Kim Hitchings, RN, MSN, NEA-BC, is the manager of the Center for Professional Excellence; she can be reached at [email protected]. Beth Kessler, RN, BC, is director of the 6 Tower medical-surgical unit. Jack Dunleavy, BS, is an internal consultant for organizational development. Anthony Ardire, MD, MPH, FAAP, CPE, is senior vice president of quality and patient safety. Andrew Barsky, CDM, CFPP, is senior general manager food and nutrition at Sodexo in the network.
RECOMMENDATIONS AND LESSONS LEARNED The PSIC and the Lateral Service Team were composed of cross-functional, mid-level, and senior managers. In hindsight, we should have included more direct care, non-management individuals, in particular, physicians and registered nurses. These individuals represent the largest groups of caregivers; thus, engaging them in the design of actions may have propelled the spread of efforts. By this large cadre of individuals better serving each other, the subsequent service
38
Nurse Leader
1541-4612/2012/ $ See front matter Copyright 2012 by Mosby Inc. All rights reserved. doi:10.1016/j.mnl/2011.11.006
February 2012