Report from SIP 4 (Leadership and Culture) for SIP Vision ...



Report from SIP 4 (Leadership and Culture) for SIP Vision Retreat

I. BACKGROUND

Prior to our June 15 meeting we had condensed our many focus areas into 5 categories:

Communication (respectful)

Patient care (proper environment to provide care, especially time)

Incentive (to do a good job)

Leadership (define)

Teamwork

At the June 15 meeting it was proposed that another focus area should be:

Culture (“can do” attitude, working together to “get it done”)

As our first 5 elements were being developed several months ago, we believed that those above-mentioned elements should work together to produce “our ideal workplace”.

In visits with departments and divisions since then, the most commonly stated “solution” for lack of the above-mentioned elements was “need for aligned incentive” and “teams”.

Upon reflection, neither of these two “solutions” individually or combined leads to the “our ideal workplace”.

Theoretically, our ideal workplace could be achieved in one of three ways:

Culture + Patient care

Comment: with a perfect “can do attitude” and a proper environment to take care of patients, there would be little need for leaders or incentives and respectful communication would be included in the culture.

Leadership + Patient care

Comment: with perfect leadership and a proper environment to take care of patients, there would be little need for incentives, and the leadership would define the culture and communication.

Teams + Incentives + Communication + Patient care

Comment: self-directed teams need little external leadership and define their own culture.

SIP 4 does not endorse any of the 3 above models in isolation. SIP 4 believes all the elements are needed and should work together.

II. General vision for the elements of “Leadership and Culture”

IIA. Culture

Includes the following:

The OR is eager for work and wants to get it done as a team.

There is alignment of expectations.

Cases would be easily scheduled, and scheduled appropriately.

Cases would get done on time.

“Generalist practitioners” would not be penalized for not choosing to work on a team.

How achieved:

Takes time.

Requires facilitation and project management.

Aided by leadership, teams, incentives and respectful communication, but those alone don’t suffice.

IIB. Leadership

Includes the following:

There are consequences for not following guidelines and meeting expectations.

Administrators/Leaders would be:

Trained

Visible

Accountable

Administrators/Leaders would model exceptional behavior.

RN3s would be chosen by the team; not appointed by the administration.

An attending-to-attending retreat for surgeons and anesthesiologists would be held.

Surgical Chairs and Chiefs would have greater direct involvement in Surgical Services.

How achieved:

All team members remain in OR or immediate proximity between cases. In particular, the attending surgeon (most often seen as the “team leader”) must remain as a visible and motivational representative of the team concept.

Must be supported by “next higher level” of leadership/administration.

Leadership training.

Incentives for leadership.

Leaders meet at intervals with team for dialogue; leader can be “fired” and a new leader chosen by the team.

Personal accountability for areas of responsibility rather than attempting to transfer responsibility to other team members.

IIC. Teams

Includes the following:

The staff is versatile, experienced, and cross-trained.

Guidelines and expectations are clearly understood by all.

Teams would be oriented to a surgical service and/or skill set and would stay together to get the work done (or a reasonable surrogate would replace team members who cannot stay until the conclusion of a case).

There would be cooperation among units and a realization of the impact on others for not working in synchronicity.

Teamwork would be global (all the OR), local (each room and unit), and universally expected and rewarded.

How achieved:

All team members remain in OR or immediate proximity between cases.

Incentives for productivity and efficiency.

Continued recruitment of already-employed RNs/Techs and Anesthesiologists into service lines.

Surgeons/service lines desiring teams should attempt to attract them (rather than team organization being imposed externally).

RN/Tech and Anesthesiologist participation on teams should be voluntary and not mandated.

Additional recruitment probably is needed because the current RN/Tech workforce is roughly 50% 8 hr shift, 25% 10 hr shift, and 25% 12 hr shift whereas most surgical “blocks” are 10 or 12 hr. Further, the current Anesthesiology workforce is roughly only 50% full-time, permanent faculty.

Where appropriate, consider more local control of a group of 8 or so operating rooms by RN/Tech, Anesthesiologist and Surgeon working in that cluster of rooms.

Provide incentive to stay with team until cases are done or until 1730 or 1930, at which time evening shift assumes care.

IID. Incentive

Office space, computers, other electronic services and other administrative support adjacent to OR to permit surgeons remaining near OR between cases to use that time productively.

Should provide meaningful motivation for team members to be more efficient.

When teams are efficient and get their day’s scheduled work done early, they should be able to leave without incurring any “negative incentive”.

When teams are efficient and get their day’s scheduled work done early, they should not be “rewarded” by having additional cases added to their room unless they volunteer for the additional work and receive some incentive for doing so.

Individuals volunteering to work in teams and to provide service above and beyond that currently provided should receive “incentive for performance” benefit.

Metrics should include current ones (such as on-time start for first case of the day in each room, turnover time between cases, etc) and additional ones (such as finishing all cases within block, operative time conforming to benchmarks for case type, etc).

IIE. Summary of vision

A “cultural revolution” leading to a “can do” attitude.

Leadership that is seen as “one of the workers” and is given authority to hold individuals accountable; attending surgeon becomes leader by helping plan rest of the day while in the room and remaining in OR area between cases.

Teams based on the current alignment to individual service lines or groups of service lines, evolving to alignment by individual surgeons as permitted; almost all rooms have some form of team and team incorporates operational improvements suggested by SIP teams 1-3; maximum number of operating rooms with more highly dedicated teams is probably limited to roughly 50% due to staffing limitations; requires incentives.

Incentives that reward efficiency; motivate individuals to remain with team until 1730 or 1930 whereupon the few remaining rooms would be covered by evening shift.

III. Plan

SIP 4 will meet every Wednesday (except for nights when Oversight meetings are scheduled) through August 10 with the leadership of Alan Artru and Dan Kaiser. Each of these six upcoming meetings will be dedicated to one of the six elements mentioned at the beginning of this report: communication, patient care, incentive, leadership, teamwork, and culture. The goal for each meeting will be to refine and specify ideas applicable to each element, and to plan implementation of those ideas. Facilitation by Julie Duncan and project management by Michelle Agnew will be essential for planning and implementation. Additional information from our survey and from appreciative inquiry (mentoring of AI leaders by Kurt O’Brien), and feedback from early implementation efforts will be used to further refine our plans. Guidance on incentives relating to personnel will come from Jennifer Petritz.

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