1. 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

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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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

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

10. 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)

11. 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

12. 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

13. 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.

14. 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 s

15. 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.

16. 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!

17. 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.

18. 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.

19. 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)

20. 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!

21. 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

22. 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)