Organizational Leadership and Interprofessional Team Development

Introduction

Healthcare reforms in recent years have focused on quality improvement (QI) and patient-family-centered care (PFCC) delivery in a bid to cut down costs and enhance efficiency. Developing essential skills in organizational leaders and interprofessional teams is critical to building a patient-centric culture to support these goals. In particular, competencies in care coordination across clinical settings are vital to achieving optimal outcomes. This paper examines the unique leadership and team development dynamics in healthcare to develop a strategy for improving PFCC in the context of the business practices and regulatory requirements impacting it.

Business Practices

Organizational policies and procedures are unique to each healthcare setting. Business models dictate the business practices of a hospital. Adopting PFCC is critical to achieving improvements in quality, financial performance, CAHPS scores, staff satisfaction, and patient outcomes (Agency for Healthcare Research and Quality, 2017). Organizations often maintain a lean workforce as a cost-cutting strategy. However, this business strategy may not work in a PFCC environment, which requires adequate clinicians to serve patients. Staff shortage and overworking are significant barriers to PFCC practice (Hsu et al., 2019).

These variables impact the quality of nursing care, safety, and patient care outcomes. Some facilities have adopted innovations for payment and information exchange, such as electronic health records, to support PFCC. Others use consumer feedback, patients/families as advisors, nurse bedside shift reporting, and discharge planning to deliver PFCC (Agency for Healthcare Research and Quality, 2017). These strategies are designed to promote stronger engagement in order to provide patient-family-centered care.

On regulations, healthcare standards, and guidelines impact organizations. Stringent policies affect hospitals’ policies to meet the required targets or operational goals. Patient-centeredness is evident in meaningful use rules, where physicians and facilities utilizing health IT receive financial incentives (Tzelepis, Sanson-Fisher, Zucca, & Fradgley, 2015). Stringent accreditation requirements also influence hospitals to deliver patient-centered care.

Additionally, the Institute of Medicine-endorsed patient-centric quality measures, such as patient values and communication, has led to the development of PFCC models and patient-reported measures by hospitals (Hsu et al., 2019). The regulatory environment has also led to a greater focus on patient experience and involvement in clinical decisions.

Hospitals must be run as a business to succeed. In particular, they must use one or more financing models – private or public – to support operations. Eligibility for federal reimbursement entails superior quality care. Reported indicators, including readmission rates, hospital-acquired infections, and patient experience, determine the amount of compensation a facility receives (Hsu et al., 2019). Thus, to increase federal reimbursement, PFCC must be prioritized. High hospital rating for quality measures leads to more private donations to promote quality and patient-centered care.

Patient and Family-Centered Care Tool (PFCC)

Please see the separately attached document for the completed PFCC Tool.

Setting Description

The healthcare setting selected for this assessment is the Community Behavioral Health Hospital (CBHH) in Rochester, Minnesota. The network is one of the seven 16-bed small hospitals in the state providing acute short-term mental healthcare services to patients in the community modeled on patient-centered treatment. The small-size facilities were established after a large psychiatric hospital was closed in the late 1990s.

CBHH provides intensive, multidisciplinary services that include psychosocial and physical assessments, individual plan development, integrated mental health management, diagnosis for substance use disorders, individualized discharge planning, and coordinated outpatient support. All these programs are designed following the PFCC approach. Its 35 rained clinicians, including nurse specialists, psychiatrists, and social workers, provide acute in-patient care.

CBHH serves diverse ethnic groups. Patients with mental conditions such as schizophrenia, obsessive-compulsive disorder, and posttraumatic stress disorder from different ethnicities are treated here. The facility admitted about 1,500 people, 45% of them being female. This population comprised 85% Caucasian, 7% Native Americans, 3.5% African American, 2.5% Latino/Hispanic, and 1% Asian. It serves over 120,000 people primarily from Olmsted County and the surrounding areas because the CBHH is located in this region.

Strengths and Weaknesses of the Organization

Domain Strength Weakness
Leadership/Operations
  • A clear statement of PFCC commitment – describes its Illness Management and Recovery model as being patient-centered
  • Patients, family, and case manager involvement in treatment planning and transitional care
  • Accountability in PFCC due to individualized plans
The measurement of PFCC is not evident
Mission, Vision, Values
  • The mission, vision, and values focus on the patient
  • Patient/family responsibilities in PFCC are clearly defined
The employees are not captured in the statement, potentially affecting staff morale.
Advisors
  • Community members are members of the American Indian Adult State Advisory Council on Mental Health
  • Family/patients are included in hospital committees on safety
  • Patient/family participation in safety/quality rounds is limited
  • No clear guideline on consultations and advisory
Quality Improvement Utilizes evidence-based practices in mental health practice – patient/family voice in operational goals and participation in meetings No clear quality improvement procedure or strategy
Personnel
  • Includes patient/family experience of care in performance appraisals
  • Strong employee orientation program (family/patient meeting new staff) and care support through PFCC training
Patient/family involvement in staff recruitment is lacking
Environment & Design The therapeutic environment does not favor isolation or use of restraints but supports safety, family participation, and optimal interprofessional performance Patient/family engagement in all clinical design projects is limited
Information/Education
  • CBHH promotes data security and privacy during creation, storage, and exchange through EHRs
  • Resource rooms are provided to in-patients
Patient/family does not serve as educators for clinicians/staff
Diversity & Disparities
  • A detailed assessment is done, capturing patient race and language
  • Navigator programs and differentiated educational materials are available to patient/family
Interpreter services may be inadequate for immigrants
Charting & Documentation EHRs allow easy and secure patient/family access to individual medical records Patient/family involvement in charting is limited due to a lack of training
Care Support
  • Patient/family involved in individualized care plans along with clinicians
  • Patient/family receive adequate support, can initiate rapid response actions, and receive regular updates on patient condition
Family/patient does not participate in rounds or shift handovers

Area of Improvement

The main weaknesses identified above include limited family/patient participation in quality/safety rounds, advisory councils, charting, and bedside handoffs. Involvement of patients or their families in staff recruitment and educating clinicians is also lacking. One area of improvement for addressing these bottlenecks is family/patient empowerment. Building this population’s capacity and providing support on clinical issues will ensure their involvement in quality/safety rounds and strengthen their advisory role.

Improvement Strategy

CBHH should advance the health literacy of patients and families to encourage their engagement in PFCC. An appropriate improvement strategy is sharing medical information with patients and families to enable them to play a more significant role in CBHH’s patient-centered care initiatives. A multidisciplinary team comprising of psychiatrists, nursing staff, psychologists, physicians, social workers, patients, and families will be involved in care co-design. Sharing the outcomes of clinical tests at the bedside with the patient and family will help decide the optimal course of treatment jointly (Marcus, 2014).

Progress notes that allow clients to input their comments will also foster this collaboration. Thus, empowerment can be achieved through informational strategies – personalized information packets designed for specific family/patient needs.

System or Change Theory

Lewin’s change theory will guide the design, implementation, and evaluation of the proposed improvement strategy. The goal is to build a personalized, dialogue-based culture of patient empowerment at the facility. The theory involves three phases: unfreezing, changing, and refreezing (Batras, Duff, & Smith, 2016). The first stage entails disrupting existing behavior patterns. Statistics on length of stay, readmissions, and their effect on hospital ranking will be used to overcome resistance and create the impetus for change. The changing step will entail developing a routine approach for patient/family empowerment for self-care in clinical and non-clinical settings.

Leveraging health IT, community self-referrals, and online peer support programs will help implement the recommended change. In the refreezing stage, the focus is on making the new strategy more permanent. Involvement of patients/families in advisory councils and appointing champions from this group will strengthen the foundation for PFCC anchored on empowerment. Patient/family participation rates will help assess the impact of the strategy on patient-centered care outcomes.

Financial Implications

A cost-benefit analysis reveals that creating the conditions for PFCC through patient empowerment has definite financial benefits. PFCC can increase patient satisfaction that is a core indicator of healthcare quality for federal reimbursements under the Affordable Care Act (Bowling, Newman, White, Wood, & Coustasse, 2018). A satisfied consumer base will expand the market share of CBHH. The facility’s expenditure will also decrease due to lower readmission rates and length of hospital stay. The proposed change will reduce spending on malpractice lawsuits since it promotes communication and staff responsiveness. In implementing a patient empowerment program, some costs must be considered. They include salary for the multidisciplinary team and investment in health IT infrastructure and personalized informational resources.

Methods

Implementation effectiveness is a crucial indicator of the feasibility of a healthcare intervention. The success of the proposed strategy will be measured using the pre-/post-test method. Baseline data on patient participation in quality/safety rounds, advisory councils, charting, and bedside handoffs will be compared with post-implementation scores to evaluate the innovation. Another method will involve evaluating real-time interactions between clinicians and patients (Daaleman, Shea, Halladay, & Reed, 2014). Self-administered patient experience surveys will also be useful in measuring the effectiveness of the PFCC innovation.

Multidisciplinary Team

Team Member Role on the Team
Patient/family Provide consumer perspective and input in treatment and discharge planning consistent with PFCC principles
Psychiatrist Develop patient/family empowerment and informational resources on mental health
Clinical nurse specialist Conduct patient/family education to improve clinical knowledge and engagement
Psychologist Provide psychosocial counseling to family/patients
Social worker Deliver post-discharge personalized informational packages to patients at their homes and establish transitional care linkages
Board representative Articulate the management’s position on the change and allocate financial resources to the initiative.

Team Diversity

Cultural diversity in the multidisciplinary team will broaden individual perspectives and the ability to empathize and connect with the patient and family. It will also help address language and cultural barriers that prevent minority groups from receiving patient-centered, culturally appropriate care for their illnesses (Cuevas, O’Brien, & Saha, 2017). A diverse healthcare workforce will be sensitive to the medical, linguistic, and personal needs of the patient and family during empowerment programs, as they understand their values and beliefs. Therefore, active participation from all parties to realize the outcomes of the initiative will be enhanced with team diversity.

Leadership Theories

Effective management of the healthcare workforce fosters quality and patient-centered care. The transformational leadership style, which entails relationship-building and employee motivation, will be used to develop the team to support patient/family empowerment. According to Sfantou et al. (2017), a transformational leader in clinical contests inspires self-confidence, trust, and respect and articulates a shared vision to his/her followers. He or she uses feedback from all parties to support the change. Associated quality outcomes include productivity gains, motivated staff, and job satisfaction.

Implementation of Strategy

A strong partnership and dedication from all members will be required to implement the strategy. Based on Lewin’s unfreezing step, the team will strategize how to execute the change – patient empowerment – and develop goals. The team leader will then communicate to the administration the weakness identified from the PFCC tool and the recommended improvement to obtain buy-in and support. The multidisciplinary team will collaborate to develop personalized informational resources and disseminate the material at the bedside or through informal meetings consistent with the changing step of the model.

Implementing working with patients/families will involve three steps. First, a staff liaison to engage the management on the infrastructure required for PFCC will be formed. Additionally, this working group shall prepare staff to collaborate with patients/families on quality and safety grounds at the facility. Second, opportunities for patient/family involvement. This group will be invited for a walkabout inpatient room and admission area to identify how the facility can receive and support patients and families. The third step is coordinating collaborative rounding activities for better outcomes.

This component will entail coaching and mentoring participants, as well as monitoring achievements. The team members will include a unit manager and clinicians drawn from quality/safety committees as well as patient/family members. The responsibilities of the administrator will include working with the hospital leadership to promote commitment to the strategy and communicating quality and safety walk-round activities and achievements to the senior management. He/she will also obtain the necessary resources for the project. The clinicians shall educate patients/families on how to detect and prevent adverse events during rounding.

Patients and families will give feedback and work with the clinical staff to develop and implement quality projects. They can communicate what went well, potential risks, or ideas for improvement after a quality/safety round. The sustainability of the change will be achieved through hospital policies.

Communication to Organization

The identified strategy and intended outcomes will be conveyed to the hospital during biweekly management meetings. Presentations by the team leader will explain the formation of the team, the development of empowerment tools and resources, and anticipated outcomes. Unit managers will help disseminate this information to other employees through newsletters and emails.

Tools for the Team

Self-assessment helps an individual know one’s personality traits and professional alignment. The Keirsey Temperament Sorter is an important tool that will be used to evaluate and develop the team’s preferences and personalities to achieve success (Harris & McKay, 2018). Each member will understand his/her personality trait and those he/she is likely to work with to accomplish team goals. The leader will use self-assessment results to assign roles based on individual strengths and group compatibility.

References

Agency for Healthcare Research and Quality. (2017). Guide to patient and family engagement in hospital quality and safety. Rockville, MD: AHRQ.

Batras, D., Duff, C., & Smith, B. J. (2016). Organizational change theory: Implications for health promotion practice. Health Promotion International, 31(1), 231–241. Web.

Bowling, B., Newman, White, C., Wood, A., & Coustasse, A. (2018). Provider reimbursement following the affordable care act. The Health Care Manager, 37(2), 129-135. Web.

Cuevas, A. G., O’Brien, K., & Saha, S. (2017). What is the key to culturally competent care: Reducing bias or cultural tailoring? Psychology & Health, 32(4), 493-507. Web.

Daaleman, T. P., Shea, C. M., Halladay, J., & Reed, D. (2014). A method to determine the impact of patient-centered care interventions in primary care. Patient Education and Counseling, 97(3), 327-331. Web.

Harris, J., & McKay, D. (2018). Personality distribution of Canadian medical students: A first look. Canadian Medical Education Journal, 9(2), 11-19. Web.

Hsu, C., Gray, M. F., Murray, L., Abraham, M., Nickel, W., Sweeney, J. M., … Reid, R. (2019). Actions and processes that patients, family members, and physicians associate with patient- and family-centered care. BMC Family Practice, 201(35), 1-14. Web.

Marcus, C. (2014). Strategies for improving the quality of verbal patient and family education: A review of the model. Health Psychology and Behavioral Medicine, 2(1), 482-495. Web.

Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in health settings: A systematic review. Healthcare, 5(4), 73-79. Web.

Tzelepis, F., Sanson-Fisher, R. W., Zucca, A. C., & Fradgley, E. A. (2015). Measuring the quality of patient-centered care: Why patient-reported measures are critical to reliable assessment. Patient Preference and Adherence, 9, 831-835. Web.