Historically our department, in a large academic medical center, had relatively little physician leadership and clinical operations were controlled by non-physician administrators and managers. As new, eager physician leaders have joined our program to effect change, there is tension in clarity of roles. Would love to have input on methods to support effective, positive, nimble, collaborative
physician-administrator dyad leadership to support high quality, patient centered care. Am looking for concrete evidence-based methods that have demonstrated success at other large medical centers (beyond “encourage everyone to get along with each other” and “go on a retreat!”) What are best methods to move away from separate organizational structures where one side is administrators/managers and the other side is physicians? Our “functional” organizational structure has led to
the two groups having challenges implementing rapid change. It is not clear when there are disagreements who has the final authority to make decisions. The leadership structure and roles are not completely clear. Big decisions seem to pile up at the top and the two groups can tend to maximize their own goals rather than that of the total organization. by Tanvi Desai, MD, Vizient Accreditation AdvisorGina Holiway, MSN, MHA, RN, Vizient Accreditation AdvisorPatients rely on those taking care of them to communicate and collaborate as they manage their care to help ensure the best possible outcome and quick recovery. The best way to do that is by using a nurse-physician dyad—a leadership model incorporating the expertise of both nurses and physicians as leaders of change—which can have a positive impact on quality and safety. Improvements in quality and safety translate into improvements in regulatory compliance. Here are several areas clinical leaders should examine to ensure that their nurse-physician dyad can achieve maximum impact. The impact on quality Health care organizations pride themselves on delivering high-quality care to the patients they serve. One of the ways to make sure this care is high quality is having the physician and nurse work collaboratively to discuss the plan of care and any barriers that may impact it. In the inpatient setting, this should include the current day’s plan of care as well as for the duration of the patient’s stay. Rounding by the nurse-physician dyad as well as other interdisciplinary team members allows for the opportunity to discuss the care plan, helping to reduce possible miscommunication or errors that could affect patient quality. If errors or potential errors (near misses) are identified, they should be reported to the leaders in quality. Leaders in quality should include nurses, physicians, executives and even members of the governing body. The process of reporting the errors not only addresses the errors and potential errors for future patients, it fosters a culture of quality and safety for the entire team. In addition, when the leaders in quality are continuously evaluating for quality concerns and implementing changes when necessary, it complies with Joint Commission standards. The impact on safety Maintaining a culture of safety is necessary for the nurse-physician dyad to function at its best. There needs to be an environment in which nurses can speak up about safety questions without fear of being wrong or receiving negative feedback. Hesitancy to speak up can lead to errors and other mistakes that can affect patient outcomes. For example, if a patient has a change in their mental status, then the nurse should be able to call the physician and provide this information without worrying if they are bothering the physician. A nurse working the night shift recognizes that calling a physician in the middle of the night is difficult, especially if that physician is a covering physician who may not be as familiar with the patient. If vital information is not relayed in a timely manner, patient safety can be compromised. Organizations should work to understand the barriers that can prevent effective communication and the ability to speak up so that training programs can be used to target those barriers. The SBAR Tool (Situation, Background, Assessment, Recommendation) is one tool that many organizations use to assist the nurse to communicate the issue clearly and effectively whether verbally or written. The SBAR tool has been endorsed as a standardized communication method by The Joint Commission. Care can be delivered seamlessly when members of the team can bring up concerns without fear of ridicule or retribution. The impact on communication Communication is vital when caring for patients. A recent study found that failure in communication between nurses and physicians was associated with higher medical errors and poor patient safety outcomes. It also found that implementation of dyad rounding improved provider satisfaction with communication and had the potential to identify near-miss situations. Handoff communication plays an important role in the care a patient receives for both nurses and physicians. Effective handoffs can reduce, if not eliminate, near-misses or errors. Evaluating the effectiveness of communication is also a regulatory requirement. If your organization is accredited by The Joint Commission, the standards require hospitals to have a process for hand-off communication. The process should provide for the opportunity for discussion between the giver and receiver of patient information. In fact, the Joint Commission had identified the need for effective communication in 2006. The result was the development of the National Patient Safety Goal that required organizations to establish a process for hand-off communication. Although the requirement was moved to the Provision of Care standards; hospitals are still required to evaluate the effectiveness of communication. There are a variety of studies and tools that have been developed to evaluate nurse-physician communications. Surveys are one way to get baseline information to help understand nurse and physician attitudes about communication. These experiences tend to lead to a positive or negative perception of communication between nurses and physicians. Another study found that nurses from the unit which reported the weakest safety culture also were the least satisfied in their communication with physicians. Qualitative analysis corroborated quantitative findings and demonstrated the importance of contextual influences on nurse/physician communication. The nurse-physician dyad is essential in providing patient-centered care and delivering high quality care to all patients. This dyad allows for patient, caregiver, and provider satisfaction, as well as overall process efficiency in caring for patients and care transitions. The nurse-physician partnership enhances the ambulatory and hospital patient care. While the work the individuals do is different, they both have the same goal which is taking care of the patient. The coordinated effort between nurses and physicians assures the patients that their concerns will be listened to and addressed and allows the patients to focus on healing knowing that their doctors and nurses are working together to help them get better. About the authorsIn her role as accreditation advisor, Dr. Tanvi Desai is responsible for delivering accreditation and regulatory services to Vizient members encompassing hospital, ambulatory and critical access organizations through onsite assessments and various education programs and blogs. Prior to joining Vizient, Dr. Desai was a TJC surveyor of the Comprehensive Accreditation Manual for Hospitals conducting triennial surveys, extension surveys and Medicare deficiency surveys. Dr. Desai is certified by the American Board of Pediatrics and is licensed to practice medicine in North Carolina.  |
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