This informative session was geared towards team-building enthusiasts as well as those just starting to develop hospital-based teams. The speakers introduced the meeting with a case study on Amazing Medical Center, a 400-bed metropolitan hospital with five medical-surgical units. This center had no formal interdisciplinary teams (IDTs) and the unit members were devoid of clear rounding roles and responsibilities, standardized timing, structure, and objectives. As a result, lengths of stay, readmission rates, patient experience metrics, and overall physician wellness were all negatively impacted. The audience was polled several times and the vast majority agreed IDTs comprised of physicians, advanced practice practitioners, nurses, physical and occupational therapists, and discharge planners (case managers or social workers) are the foundation of any highly reliable organization (HRO).
The speakers aptly identified five main principles behind every HRO: effective communication, improvement models, continuous learning, accountability, and transparency.
Effective communication is often achieved with the use of a rounding script, clear identification of the rounding leader (usually a nurse manager or case manager), and the expectation of every member of the team to voice their expertise in the patient’s care plan. The presenters stressed using improvement models for process simplification for patient throughput; for example, narrowing discussions to discharge sensitive barriers and minimizing consult utilization that can otherwise be deferred to the outpatient setting. Continuous learning requires a safe psychological environment where members can discuss quality or safety issues without punitive repercussions. Safety huddles, debriefs, or anonymous online platforms are examples of event reporting venues. Accountability is essential to sustain positive outcomes achieved with IDTs. The audience agreed accountability and sustainment are the most challenging to achieve because of the need for persistent auditing to ensure minimal deviation from standard practice. Lastly, transparency in data and constant examination of data are imperative for successful HROs. For example, instead of complacently accepting successes as pure chance, always examine why your triumphs happened, i.e., why were our catheter-associated urinary tract infection rates at an all-time low last month? What did we do to have such a successful month, and how can we continue this trend?
The session concluded with a discussion of various process measures to track the standardization of IDT rounding practices. With experience, we all come to recognize that outcomes are impossible without a solid framework of process measures. Amazing Medical Center established a set of IDT best practices and closely tracked the following processes: team participation (who on the IDT team was in daily attendance?), use of workstations (does the team regularly use a workstation to place real-time orders?), catheter use assessments (is there a catheter de-escalation protocol in place?), estimated date of discharge (do all patients have this date documented?), and IDT scripting adherence. This didactic provided a comprehensive and easily digestible overview of what it takes to be a high-functioning organization, no matter how big or small your institution is.
Dr. Kang is an assistant professor and academic hospitalist at Northwell Health–Long Island Jewish Medical Center in New York. She currently serves as the site director for the division of hospital medicine at LIJMC.