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How do you get from 'here' to 'there'?
No doubt quality managers are eager to sign on to many of the goals outlined in The Joint Commission's white paper, "Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future," but in a number of cases, getting from "here" to "there" will require some detailed and well-thought-out strategies. Members of the roundtable who put the report together have some valuable insights to share in this regard.
For example, notes Herbert Pardes, MD, president and CEO, New York Presbyterian Hospital and New York Presbyterian Healthcare System and the roundtable chair, if you want to see improvements in your hospital's design, "there are people whose expertise is the architectural design of hospitals; bring them in, do a review, ask what you can do to make your facility more patient friendly," he suggests.
For example, he notes, when his system built a new children's hospital "we designed it to include pictures of things kids like — such as kids playing or nature scenes. We had a play room and a central area for entertainment to be beamed to the rooms. When we first opened, a six-year-old patient who had been in our other hospital said, 'I guess this one's for kids.'"
What's the best way to approach administration or the board to convince them of the necessity of making such changes — be it redesign or expansion? "I would bring the administration whatever information is out there about hospitals doing this, and the results and impact the changes had," Pardes recommends. "Tell the CEO it will be valuable to have 'X' person come in and make a presentation, which can include pictures of other facilities."
The implementation of the teamwork concept is another change recommended in the white paper. "The quality manager could begin by engaging in a review of the literature on the teamwork concept so he or she becomes much more aware of benefits," suggests Rita Munley Gallagher, PhD, RN, senior policy fellow, department of nursing practice and policy for the American Nurses Association and a member of the roundtable. "For some quality managers, much of that search might focus on the reduction of complications through the implementation of teamwork. He or she would see the bottom line dollars and sense a real benefit."
Once the quality manager feels he or she is able to provide a sufficient level of evidence, Gallagher continues, "there needs to be a movement toward inservice education to the existing staff, because there are specific competencies required for people to really engage in teamwork."
Another strategy recently implemented at New York Presbyterian, says Pardes, is "Patient Safety Fridays." About 1,000 employees get together every Friday, suspend their other activities, and identify areas of patient safety and go around the hospital to see how people are doing in these areas. "When you get hundreds of people together, they get excited about seeing how they can do better," says Pardes.