The Multidisciplinary ED Performance Improvement Team
In previous articles we have reviewed how to recognize a broken ED, how to identify whether the "front door" or the "back door" is the bigger problem, and the ED performance scorecard. Improvement in any of these areas require not only strong administrative support and effective data collection systems, but also a team of individuals that can be tasked with objectively looking at all the data, reviewing benchmarks and goals, exploring feasible improvement solutions and developing and implementing a strong improvement plan. The focus here is to discuss the multidisciplinary team, the teamsí leader, members and support structure, and the tools and measures to guide and measure their success. Who Is The Team Leader The decision to appoint a team leader should be carefully considered during the improvement process. The performance improvement team leader sets the tone of the team, coordinates and ensures task completion, and must have the skills and leadership ability to communicate, coordinate, negotiate, delegate and appreciate the insight, perspective and competence that each of the team members bring to the table. Should the leader of this group always be the department director or the medical director? In my experience, the best leader for the team is someone with good people skills, a working knowledge of the issues, and the ability to see the big picture. The team leader should have the ability to lead the team without having a direct stake in the outcome of the improvement effort. If an improvement action fails, the failure should not affect the team leaderís ability to continue in the leadership role. The team leader must weigh successes and failures in the context of the overall objectives of the improvement initiative and continue to move the team despite success or failure. Selection of the team leader can have a significant impact on team performance. Whether it is the ED director, the performance improvement director, or an outside independent consultant, make sure that the team leader understands the importance of team leadership as well as the goals and objectives of the improvement initiative. Choosing Team Members The team should be comprised of internal ED staff and staff from ancillary departments and nursing departments that take admitted patients from the ED. This multidisciplinary approach ensures that there is a good cross section of viewpoints, integration of process analysis across departmental lines, and complete understanding of the basic causes of current process failures. The team must come together to see the ED as a facility wide problem, not just an ED problem. The following positions should be considered as members of the ED performance improvement team:
- ED Medical Director or Designee
- Administrative Advisor (DON, COO)
- ED Nursing Director
- Performance Improvement Manager/Director
- ED Nurses (two per shift )
- ED Tech (one per shift)
- Nursing Supervisor
- Admissions or Bed Control Supervisor
- Inpatient Nursing Director (Med/Surg)
- Inpatient Charge Curses (1 Med/Surg, 1 Critical Care)
- Environmental Services Shift Supervisor
- Lab and Radiology Supervisors or Lead Techs
- Every strategy implemented is called a pilot until its appropriateness is ensured.
- Set incremental, obtainable goals.
- Look for "low hanging fruit" to provide some quick wins for the team.
- Assure the team that if an improvement action doesnít work, it can always be redesigned.
- Use data to determine effectiveness, not anecdotal comments.
Brian Wilson is Vice President of the Healthcare Division of The Doug Williams Group, a Miami-based performance improvement firm that specializes in improving customer satisfaction, employee satisfaction, and profitability. Brian can be reached via email at firstname.lastname@example.org or (305) 598-9880.