Engaging Physicians as Partners & Team Collaboration Angela Hawkins, BSN, RN, CCRN, CNRN, SCRN System Stroke Program Manager Saint Luke’s Hospital of Kansas City Saint Luke’s Marion Bloch Neuroscience Institute Saint Luke’s Health System Presented: April 23, 2015

Disclosure Information Angela M. Hawkins, BSN, RN, CCRN, CNRN, SCRN Saint Luke’s Hospital-Kansas City, MO FINANCIAL DISCLOSURE: No relevant financial relationship exists

Saint Luke’s Hospital-Plaza Campus 11 hospital locally owned not-for-profit Health System Licensed 602 bed tertiary/quaternary care teaching hospital Level 1 Stroke Center Designation Level 1 Trauma Center Designation Advanced Comprehensive Stroke Center Received 3rd Magnet Nursing designation in spring 2014 All in one 8 story tower neuroscience facility specifically designed to integrate care and provide a continuum of services for improved neuroscience outcomes

Objective Discuss strategies for engaging and maintaining a dynamic partnership with physicians within the institution and beyond. Goal To promote standards of conduct, build relationships, nurture clinical collaboration, minimize conflict over practice decisions, improve communication and elevate care quality

Definition of Physician Engagement Physician engagement is an intentional and deliberate process to bring physicians and other stakeholders together to address problems and continuously improve care and the patient experience.

Value of Physician Engagement • Decreased physician turnover • Improved physician – staff relationships • Decreased disruptive physician behavior • Increased goal achievement • Improved patient experience • Decreased preventable readmissions • Increased standards compliance

Which Physicians do I engage? Minimum: Physicians that need stroke hours as designated by regulatory Stroke Medical Director Neurologists Ed Physicians Others Defined as “stroke team” Also: Physiatrist, Hospitalists, Radiologists

Stroke Medical Director Responsibilities • Leadership and management of daily operational issues that involve medical staff and patient care & collaboration with program coordinator • Translation of program objectives, plans, policies and procedures, guidelines, protocols • Active participation in monitoring and evaluating the quality of care • Peer review of stroke care (e.g. inter-professional M & M meetings) • Achievement of positive patient outcomes • Management of medical staff performance related issues • Professional development • Participates in stroke research and publication projects • Support and Participate in all Joint Commission survey preparation initiatives

Size & Constitution of the Team OR Have you ever asked yourself….. “ How many disciplines does my stroke patient interact with throughout their care?”

Stroke Team Responsibilities Responsible for Care Initiation and Delivery: Core Measures Data Quality Best Practices Research Transition of Care Follow-ups (Phone Calls, Clinic Visits)

Identify Invisible Individuals: Then Empower Them! Often many more people make the stroke team work and effect the outcome of the patient and they stay behind the scenes. Examples include: Transfer Team EMS Rehab/Social Work Insurance Companies VRC/Nighthawk/Radiology

The Stroke Coordinator should Coordinate Set clear expectations of the team Make the goals for the team measureable Clear role allocation of each team member (This allows for ownership and pride in the role) When there is confusion or conflict in the process, seek first to understand, then be understood

Engagement & Alignment: The Critical Difference in Success Engagement - measures the teams appraisal of their work environment, emotional experiences, and attachment to workplace. A highly engaged team may be content with day-to-day, patient-facing activities, but resisting organizational change and prevents the department from attaining key goals. Alignment - measures the extent to which a physician feels a strong partnership or connection with the organization's leadership.

Communication: You can never over communicate Consider communication preferences Establish a Standard that you will communicate to the team and then follow through as scheduled: Meetings Bulletin Boards Emails

Trust: The Circular Concept Trust in the leadership team precedes and any collaboration, participation, and alignment Vital element to the team engagement process Trust begets more trust If you Promise, then Deliver Follow-up communications Demonstrate responsiveness Ensure all complaints receive a response (heard, investigated, and properly addressed) **Good processes include: Peer review, M & M, Loop Closure meetings, etc.

Data speaks Volumes Absolutely essential : Credible data Identifies areas that need improvement and systematically assess progress Uses external, risk-adjusted data to improve data credibility Appeal to the competitive nature of physicians and the team through individual-level data or distribute aggregated quality scorecards Include benchmarked data for comparison **Best way to effect change is Data: It convicts you & challenges you!

Regulatory Compliance is your Friend Agencies like The Joint Commission, CMS, etc exist to hold standards of quality very high Utilize these regulatory standards to drive your care Best Practices can be applied to simplify processes Ensures standardization of care and that policies and procedures are Evidence Based.

Practicing in Partnership The most fundamental intervention for improving nurse-physician communication is fostering an organizational culture that is patient- centric, safety-focused, and supportive of open communication and teamwork.

Steps to True & Effective Practice Change Review and finalize guidelines at Stroke Committee level (and reflect in meeting minutes) Review & revise relevant hospital policy (e.g. Stroke Team Activations) and/or order sets, as applicable Imbed practice change by integrating into: Resource guide and pocket guides Documentation: ensure EMR includes key factors to enable team to document Develop communication plan Develop education plan Set an implementation date Monitor for compliance and measure outcome metrics and report through Stroke Committee (loop closure)

Global Tips for Successful Team Engagement Be Visible Round with the team/service; attend Grand Rounds presentations, departmental meetings Schedule regular meetings with your Medical Director & Stroke Team Become resource savvy -identify key physicians and departmental leaders for each area Seek first to understand before forming an opinion – don’t be afraid to say ‘Let me do some homework on this issue and get back to you’ Develop a global organizational perspective – volunteer for organizational committees e.g. Ethics, PNT Committee Provide frequent, small f/u communications on issues or requests **Above all Praise the Team for what they do well!

Successful Team Engagement The Team: Comes to you to address issues Looks to you for your input Open to your suggestions for improvement Additionally: You know who to go to and how to get things done within your organization Quality metrics meet/exceed or show steady improvement

Thank You!! Angela Hawkins, BSN, RN, CCRN, CNRN, SCRN System Stroke Program Manager Saint Luke’s Hospital of Kansas City Saint Luke’s Marion Bloch Neuroscience Institute Saint Luke’s Health System Office: (816) 932-2261 ahawkins@saint-lukes.org