Building Strong Healthcare Teams

By Megan M. Krischke, contributor

September 14, 2011 - How well do your clinicians work together? If their communication and performance could use some improvement, there are some initiatives that can make a difference. In fact, the efforts that go into building patient care teams that function at their best can reap substantial benefits for everyone in the organization—including clinicians, patients and the leadership team.

All for one, and one for all

“Teamwork is one of the most important elements in creating the context for safe patient care,” noted Sharon Pappas, RN, Ph.D., NEA-BC, CNO of Porter Adventist Hospital in Denver and CNE of Centura Health. “We can’t over-resource or over-recognize the importance of having positive relationships among those who work together to care for patients.”

Pappas outlines three building blocks for strong teams:

1. Hire leaders who are good at developing teams
“Nurse managers who are capable leaders not only lead well but will also hire people who are good team members. In order to find these types of leaders we use behavioral-based interviewing; so we ask candidates questions such as, ‘Give me an example of when you were part of a team that worked to improve patient safety,’” she said.

2. Create regular opportunities to practice teamwork
One of the key environments where nurses at Porter are able to put their teamwork skills into practice is in nursing practice councils. These councils are made up of nurses who work in direct patient care and they come together to improve practices related to nurse sensitive outcomes—those patient outcomes that depend directly on nursing care. These councils elect their own peer leaders, revise policies and make recommendations for education or changes in how care is delivered.

3. Recognize where effective teamwork is happening
“For instance, on our patient units we track the number of patient fall-free days. When a unit reaches three months without a patient falling the team is recognized, and again at six months. We also provided breakfast, lunch and dinner to our ICU, including all members of the team, when they achieved one year with no patients acquiring ventilator associated pneumonia,” Pappas added.

Transparency, consistency, accountability

Transparency, consistency, and accountability are the foundations for creating a positive work environment according to Polly King, RN, BSN, MSNc, patient care manager of the mother/baby unit at Scripps Memorial Hospital La Jolla in San Diego, Calif.

King, who co-manages the unit with Lisa Ruff, RN, BSN, MSNc, said establishing trust was key when they took over leadership of the unit in 2007.

“Lisa and I came out saying that what you can expect from us is that we are 100 percent committed to patients—to their quality of care and to their satisfaction. We also were very transparent, not only about what our employees could expect from us, but about what we expected from them and what they could expect from each other,” King explained. “It is difficult to have a strong team if some people feel like others are getting away with things they shouldn’t—like coming into work 10 minutes late.”

When King and Ruff came into leadership they were committed to holding their employees accountable for their actions in a timely manner and found that over time employees either made changes to meet expectations or weeded themselves out.

The pair also have an open door policy, strive to respond to employee calls and e-mails immediately, show appreciation for feedback they receive from their staff, recognize employee accomplishments, and work to create an environment that allows people to learn from mistakes.

“What we are doing here isn’t new; it is what you read about in any leadership book. Perhaps what sets us apart is that we are consistent about what we are doing,” remarked King.

King says accountability from her superiors, between Ruff and herself and from the employees is the key to remaining consistent.

All of the Scripps facilities participate in an annual “Great Place to Work” survey which looks at five crucial elements of a positive work environment: credibility, respect, fairness, pride, and camaraderie. When Ruff and King took leadership of the unit, it was scoring in the upper 70 percentiles; the unit now consistently scores in the 90s.

For the strongest foundation, start at the top

The results of the Great Place to Work survey caught the attention of Michele Borkowski, RN, BSN, supervisor of patient care areas for Scripps Coastal Medical Center in Vista, Calif., when one of the clinics she manages received a 69 percent.

Borkowski knew that there was tension on this team, which had recently experienced a significant amount of change, but found that her efforts to help weren’t working. So she turned to the employee assistance program (EAP) for help.

“I wanted to focus on myself and improving my leadership, not on what the team was or wasn’t doing,” commented Borkowski.

A psychologist from the EAP met first with Borkowski and human resources and then met with each of the employees and physicians working at the clinic. The psychologist helped to identify what was important to the team and helped Borkowski develop a chronological plan for addressing its needs.

“I felt confident knowing I was doing what the team really needed. It was significant for me to learn more about myself, the kind of person I am and how my team perceives me,” she reflected. “Attending a leadership class about addressing generation gaps also helped me to better understand the ways my employees, who are mostly younger than I, think.”

Team members also attended a crucial conversations class to improve their communication skills.

After just one year, this team’s results on the Great Place to Work survey jumped 19 percentage points to 88 percent.

Look through your patients’ eyes

When Cardon Children’s Medical Center in Mesa, Ariz., was preparing to move from its “hospital within a hospital” location into its brand new child-centered facility in 2009, CEO Rhonda Anderson, RN, DNSc, FAAN, FACHE, led the hospital’s 1,000 employees through a defining transition process.

The hospital’s staff members, from housekeeping and security to physicians and nurses, were put into groups in which each employment area was represented to go through this transition experience.

“The covenant we created for our new hospital is entitled, ‘Through the Eyes of a Child,’ so we wanted to help all our staff to begin thinking about how to see the world as a child sees it. So when they entered the orientation, they entered through a child-sized door and were asked to reflect on what the world looks like from that vantage point,” Anderson explained. “We had people write about their experience and how striving to see the world through the eyes of a child would affect their work—it was moving to read what people wrote.”

“For the nurses, the orientation was powerful because they had a chance to share patient stories and talk about what they experience when caring for children and their families. They were also able to hear that other team members, such as speech and respiratory therapists, don’t always feel heard by the nurses and that their stories of what a patient experienced in therapy don’t affect the child’s care plan the way the would like it to,” she added.

One of the values clinicians took from this experience, and also Cardon’s covenant which says, “Let’s build a place where kid’s orders are just as important as doctor’s orders,” is that “The whiteboard is for everyone.” A whiteboard in each patient’s room lists goals for that day, goals for the stay, and other information that is important for caregivers who enter the room. All information is readily available to everyone, and all clinicians, parents and the child are encouraged to write on the board.

“We have had absolutely nothing but soaring patient satisfaction scores since we opened in the new facility. They were strong before that, but having many staff work to create this orientation and then taking the entire staff team through it, took our scores to a new level,” Anderson concluded. “We were in the 80s before and now are in the 90s on a consistent basis.”