Guest Author Donald “Tex” Bryant: Good Communications Equals Good Outcomes

According to Charles Duhigg in his newly released book, The Power of Habit, Rhode Island Hospital was one of the nation’s leading medical institutions. It was the teaching hospital for Brown University and the only Level I trauma center in southeastern New England. Rhode Island Hospital also had a reputation as “a place riven by internal tensions”. In one surgery for instance, a neurosurgeon was preparing an emergency surgery for an elderly gentleman with a critical subdural hematoma. Just before the surgery a surgical nurse noticed that the medical chart and other paper work did not indicate the location of the hematoma. The nurse cautioned that the surgeon should wait until the needed paper work was seen. The surgeon yelled at her that he had seen the cranial scan and said he knew where to operate. He didn’t. He opened the skull on the wrong side. Although he corrected his mistake quickly, the patient died soon thereafter. Such errors are not foreign to most hospitals but the number of errors at this hospital due to poor communication, especially between nurses and physicians who overpowered them with their authority, eventually created a culture of high tension and anxiety.

Poor outcomes for patients and doctors are found in many other medical settings besides surgeries, although these seem to get the most attention in the press. Consider the following scenario, for instance. A family physician during a well baby visit was looking for a pediatric stethoscope. It was not in her office. She excused herself from the exam room and went searching for it in the office. It took her 5 minutes to find it. The incident was very annoying to her and the mother of the child. She had to hurry through the exam and did not have as much time as she needed to talk to the mother. There were no serious consequences from this visit but the outcomes were not optimal either. The mother lost a bit of trust in the doctor that day.

Besides the failure to communicate adequately with the mother, the misplaced stethoscope is also a failure to communicate with staff. With good communication habits at the ambulatory site there likely be good organization too: a place for everything and everything in its place. Good routines and habits would emerge and time spent with patients would improve. Outcomes would improve. Doctors and staff would be more satisfied with their work.

What, then, are some characteristics of good communication? One is that each staff member has the opportunity in the right setting to express his or her opinion about how a particular process could be improved or how patient safety could be improved. Being able to express oneself is not enough, though. Leadership must make sure that good ideas for improvement and safety are implemented in a timely manner. The person who made the suggestion should be recognized.

Another characteristic of quality communication is that time is set aside for staff meetings to address suggestions brought to the attention of leaders at the site. For instance, in the ambulatory setting described above, the physician can suggest to the office staff director that something should be done about making sure that physicians need not leave their office during a patient encounter to look for missing supplies or the physician as leader in the office can call the meeting. Meetings such as these should be scheduled regularly; other issues other than processes and safety can be addressed. For instance, meetings can be used for training, such as for EMR implementation.

Team meetings are a good place for problem solving using effective communication. To be effective they must be well organized and run. Based upon my experience in working with a variety of teams in a variety of settings and based upon discussions with colleagues along with research, I believe that there are several elements that are necessary for effective team meetings. These are:

  • Strong leadership
  • Preparation
  • An agenda
  • Staying focused
  • Participation by all members
  • Decision rules
  • A time limit

Keeping focused is not always easy. There can be staff members who distract or disturb the meeting. Team leaders should be alert for distractors and quickly refocus the group. The Wall Street Journal listed a few of the types of distractors recently in an article titled “Meet the Meeting Slayers”. One is the “know-it-all”. This person keeps promoting his own ideas and will not consider the ideas of others. There is also the “naysayer”; this person tends to shoot down most ideas. Another is team member who tends to drift off to other topics, such as the birth of a child or grandchild.

As you can see there are many skills required of a team leader. Besides controlling disruptions, he must also encourage all to participate. Someone who may be timid to speak should be encouraged; his or her idea may be one of the most innovative and important. When I am leading a meeting before I close discussion of a topic I make sure that I personally address any who have been quiet and ask if they have any comments. If not, I may ask them to summarize the previous discussion so that they will be involved.

As you can tell, communication is very important at medical sites. There are many benefits to effective and ongoing communication—optimal outcomes for patients, satisfaction among staff that they are delivering quality care in a culture that supports them and improved income. While I believe that most recognize that effective communication is necessary for these outcomes, achieving it takes a lot of effort.

On another note, I suggest that you read Power of Habit. It has many good ideas that you can apply to your patient encounters. The second section of the book also describes in detail ways to become an effective organization.

Headshot of Guest Author Donald "Tex" Bryant

Bryant’s Healthcare Solutions offers training and advice for helping you achieve optimal patient or client outcomes while improving the bottom line.
(www.bryantsstatisticalconsulting.com). If you want to discuss more about good communication contact Bryant’s Healthcare Solutions. Mr. Bryant is certified by the University of Michigan as a Lean Healthcare facilitator.

Contact Mr. Bryant at t.Bryant@alumni.utexas.net or call 616-826-1699 if you need more information. With my help, I promise that we can meet your needs. Would love to chat over a cup of coffee or over the phone. Looking forward to hearing from you. If you need a speaker to present at a meeting or conference, please contact me and I will consider doing so.




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My Take on “10 Ways to Keep Employees Happy” in Medical Practices

© Linqong | Dreamstime.comI don’t often find articles that reflect my own views as closely as the article “10 Ways to Keep Employees Happy” from HowStuffWorks by Cristen Conger does.  Not only does Ms. Conger hit the list with 10 strong concepts, but she also gives great sources to back up her points.  Here are her 10 points – click each one to go to the page for more information.

10. Offer Flexible Work Options Some jobs in medical practices are ideal for flexible work options, but most are not. Any position that requires face-time with the patient will likely need to adhere to appointment hours.  My question: is it “fair” to allow some positions to have flex-time and others not?  If you have a group of people all doing the same general job, letting some people have flex-time and others not may lead to a mutiny.  Consider carefully the precedent you are setting when allowing flex-time, and make sure employees understand that as the needs of the organization change, work arrangements may need to change.

9. Practice Open Communication I couldn’t agree with this one more.  Communicate, communicate, communicate.  One-on-one, in departments, in all-staff meetings, in all-organization meetings.  I typically send out an electronic newsletter every Friday (an idea from my mentor, Tom Girton) that announces/reminds people of events, clarifies policies and acknowledges achievements.  Oh, and don’t forget to make sure that people are understanding what you’re trying to communicate.  Touch base every once in awhile to make sure the message you’re sending is the one they’re receiving.

8. Pencil In Face Time When beginning a new job I often meet with every employee who reports to me (and sometimes meet with everyone in the organization in a smaller practice) for at least an hour to learn a bit about them and hear what they think the practice is doing well, and what the practice could be doing better.  Yes, it takes a lot of time, but it starts to form a bond with individuals and it gives me more information that anything else I could do to start to learn about my new group.  People are fascinating and I really enjoy an uninterrupted hour with someone – it’s almost a luxury in this day and age.  Once you’ve established that bond, make sure to nourish it by connecting with individuals on a regular basis.  Letting people know you truly care about them as individuals is how dynamite teams are created.  And the karma ain’t bad either.

7. Recognize Success and don’t save it all up!  Recognizing efforts, going the extra mile, dealing with a difficult patient, all deserve a pat on the back in front of other employees.  Remember to always praise in public and counsel in private.  Share the joy of something well done, and let the employee have the privacy of a critique.

6. Set Goals I like to establish individual goals every six months during the annual performance review and six months later during a less-formal touch base.  12 months is a long time to keep a goal in mind, so I prefer to deal with 6-month goals.  Performance evaluations should not be a rehash of what was done right and wrong over the year, but rather should be a time to review the goals from the last six months and see what wasn’t accomplished and why, as well as celebrating the goals that were accomplished. See my simple evaluation for more information.

5. Explain the Big Picture I’m often surprised how many medical practice employees don’t understand how their job (especially done well) contributes to the big picture.  Check-in staff might not understand how their job impacts billing.  Scheduling might not understand how their job impacts the nurses.  Nurses might not understand how their job impacts the check-out.  No one may understand what their efforts mean to the financial viability of the practice.  If all the staff know that they haven’t had raises for two years yet new medical equipment is being purchased for a new service line, they need to have some insight into why a decision was made and what potential it may have for keeping the practice viable.

4. Provide Career Growth Opportunities This fits in well with the 6-month performance evaluation when you set goals with your employees.  Goals may include projects, new skills, improved skills, shadowing other jobs, cross-training on other jobs, conferences and workshops, and online or classroom training.  Never think that someone can’t do something as predicting success is one of the hardest things in the world.  Encourage everyone!

3. Give Employees Respect Give everyone respect.  Know that every single person is much deeper than you will ever know and more fragile that you would ever expect.  Never forget that you can make someone’s day and break someone’s day.  Being a manager is making a choice to care for and respect the people who have chosen to work with you.  In many ways, management is the most powerless job (next to parenting) there is.

2. Provide Consistent Feedback For you to effectively provide feedback, positive or negative, the employee must have been trained, must have resources to help them do their job and must understand the expectations of the job.  Do not take for granted that your front desk person knows instinctively that your expectation is to have the day’s charges posted and reconciled before the end of the day.  Have written performance expectations for each person, then explore the reasons why those expectations are not being met (communication, misunderstanding, workload, etc.)

1. Build Trust I’m so glad Ms. Conger put this as #1 -I agree!  Here’s how I build trust: Keep confidences.  Follow the same rules I set for the staff (if they can’t eat at their desks, neither can I.)  Make promises sparingly and fulfill all promises.  Don’t mess up peoples’ payroll or their time off.  Understand the details of their job.  Don’t allow the doctors or the patients to abuse them.

What’s not on this list that you would add?




Online Surveys Help You Find Out What Everyone is Thinking

I am about to use SurveyMonkey again.  The first time I used SurveyMonkey was to ask the staff questions about benefits.  I knew that we were facing some big health insurance premium increases and I wanted to know what employees’ priorities were.  SurveyMonkey walked me through the process of designing a simple survey (10 questions) and compiled the results for me.

I presented the results of the survey at my first quarterly staff meeting and discussed what my challenges were in trying to meet the needs of the employees and the needs of the organization in choosing a health plan.  The use of the survey tool and my discussion of the results let the staff know that their feedback counts.

Now, we’re designing a new office and I am soliciting information (not anonymous this time) about what people value in a workspace and what their needs are for technology and comfort.  Feedback from the staff is that they like being asked what they think and enjoy the surveys.  Feedback from me is that SurveyMonkey is easy to use and at $20.00 per month for unlimited surveys, it’s a tool that delivers the value.

Here are some other ways you might use surveys:

  • Put a survey on your practice website.
  • Put a survey on a computer monitor or tablet in your reception area.
  • Send a survey to patients via email.
  • Ask the staff or docs at referring physician practices to complete a quick survey about the service you provide to their patients.
  • If you’ve sent patients for tests, therapy or surgery, have them complete a survey about their experiences.
  • Have a computer for surveys at health fairs asking visitors to participate for a chance to win a prize.
  • Add a link on all marketing materials to a community survey.

What are your survey ideas?

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