Other Articles of Interest:
Assuming Control of a Patient Care Team
Betty J. Noyes, RN, MA
reprinted from Successful Restructuring, August 1996
Patient-focused care (PFC) continues to be the best opportunity
for health care providers to take control of patient care delivery
and to embrace an interdisciplinary model for increased value
to the patient as well as the organization.
First implemented at Lakeland Regional medical Center in Florida
in 1989, patient-focused care is now being implemented by health
care organizations all over the nation. These organizations are
restructuring as "resources and personnel are organized
around patients rather than around various specialized departments"
(Scherer).
Where do you fit in? Are you being asked to lead a team to implement
PFC, or are you feeling the impact through an altered role?
Whatever the potential effects on you, there are decisions to
be made. Change can be a welcome opportunity, or leave you feeling
like a victim with no way out. Consider the following steps if
you are asked to be a leader in the process:
1. Know the true vision of our organization.
Know who drives the vision into performance practices, and if
you can and want to drive it to reality from your selected position.
Many voices in the health care arena today speak of "quality
of care," CQI, guest relations, managed care, budget cuts,
and cost containment. It would appear that we want it all: high
quality at low cost. No program can succeed without economic return.
Before you decide to join a team, you must determining what the
game is, who the coaches are, who the fans are, and what position
you are being asked to play.
Not all of us can be good at every sport or work in every organization.
The organization you were part of, and comfortable with, may be
changing in a way that no longer works for you. Seek out the planners
and the vision makers, and interview them until you have a clear
picture of the proposed new reality. Are you compatible?
2. Take charge of your own decision.
If you find, as others have, that the restructured world will
not fit your needs or values, make other plans in your career
track. Take a positive step, congratulating yourself for taking
the initiative to seek truth and reality and to take charge of
your own choices.
Choosing to stay, and to continually undermine restructuring efforts
with a negative attitude, will harm everyone, including yourself.
"Two-thirds of re-engineering efforts burn out for two
reasons -- people's reluctance to go along and management's,
especially top management's, ineptitude and fear" (Fisher).
Agree to be a supportive participant if the plan fits you; if
not, move on!
3. Understand and be able to articulate the principles
of the framework of PFC design:
- Vision of quality and service standards,
- Patient aggregation/centers of service,
- Work simplification,
- Decentralization/relocation to bring point of service to the
patient,
- Altering the skill mix to leverage professional staff,
- Cross-training care providers,
- Flatten management structure, and
- Case management.
Don't believe everybody or everything. Search for ways that you
can apply a general principle or idea to your work. Think of ways
you can pass on ideas to other members of the team. Don't close
your mind by saying, "This is all good in theory but …."
Two of the most critical principles of PFC are that of decentralization
and cross-training. Decentralization will define what is performed
by your new team on the unit. Cross training will enhance what
each team member will be doing to better maximize resources. Herein
is the opportunity for leadership and your new role in directing
a patient-focused care team.
4. Don't expect a "rose garden" and to feel totally
self-confident or secure for several months.
The hardest part of this change is letting go of the need for
immediate results. This is not a remote control process whereby
positive results are seen overnight. Be prepared for the long
haul, and a bumpy ride!
5. Develop support systems for yourself.
Change is difficult for everyone, and as a leader, your responses
ill be most visible to the team. Role model positive self-care.
Use a mentor from outside the organization as well as inside the
organization. Choose wisely. A mentor is not your best buddy,
but someone who can support and nourish your wisdom appropriately.
Do not hesitate to ask for assistance from others. You are only
part of the organization'' larger team. Teach and be taught.
6. Choose your team members carefully.
Interview your new interdisciplinary team members for behavior
attributes as well as clinical competency. Remember: clinical
skills can be taught, but attitude is hard to change. You want
individuals who are flexible and willing to take on new roles
and challenges, not ones who are looking for a comfort zone.
7. Outline your unit's service outcomes with monitors
for
evaluating success.
Your knowledge of the organizational reality will help set the
goals, but targets must also be set with employees, patients,
and physicians in mind.
Keep outcomes simple and clearly understood, based on substance,
not symbolism. Your team must buy into them and assume responsibility
for their achievement. Decide also how to celebrate your victories.
Be sure to reinforce good team behaviors of respect and mutual
appreciation. Say thank you often, and mean it!
References:
- Fisher, A. (1995) Making change stick. Fortune, 131(7),
pp. 121-129.
- Sherer, J.L. (1993) Putting patients first: Hospitals work to
define patient-centered care. Hospitals, 67(3), pp. 14-18.
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