What would you do if the staff engagement scores in your medical and surgical clinic dropped from the highest tier to the lowest over two years? That was the dilemma Carole McGillen faced. As the Administrative Manager at the University of Michigan (U of MI) Frankel Cardiovascular Center (CVC), she recognized team member engagement was strategically important in her large, complex cardiovascular clinic. How she and her team chose to address this challenge offers joy in work leadership lessons others may find useful.
Learn from Success
Carole had tested some hypotheses to improve communication, including implementing daily huddles and using standard work. However, these efforts did not help with engagement. Rather than continuing with actions that seemed to be more like temporary patches than system improvement, Carole requested help from a Frankel CVC colleague. Jamie Beach is Quality Data Manager for the CVC Cardiac Intensive Care Unit (CICU) leadership team. Carole had heard Jamie talk about the CICU’s participation in an IHI joy in work prototype cohort. The CICU’s work had resulted in the development of a stronger team culture and increased collaboration.
Building on what the CICU learned, Carole introduced joy in work discussions to the clinic and call center leadership team. Carole and other leaders paired with Jamie for conversations with staff for 15 minutes before and after morning huddles to ask, “What matters to you?” With one person facilitating and the other writing, they used the Conversation Guide (Appendix A in the Joy in Work white paper) to ask a series of questions. These included, “What brought you into health care?” and “What makes a good day?” They also asked, “What are the daily ‘pebbles in your shoes’ that get in the way of a good day?” Team members found they were more alike than different and that they shared a common commitment to providing the best patient care possible.
Look for Little Wins
As ideas were collected and posted on flip charts, they were visible to everyone so that even in a very large service, all had a sense of participation. After these conversations, sometimes a local leader would walk away from the huddle with one “pebble” they could address right away. Team members quickly recognized the value of the discussions because they saw fast action on an issue they could not fix on their own.
Since some of the themes were big, broad, and complex to fix, the leadership team chose to focus first on a smaller process. Their goals were to collaborate with staff on improvements and to show results quickly. One overarching theme was communication.
“Red calls” emerged as a patient safety communication problem many found frustrating. Red calls are from patients that meet the call center’s criteria for immediate action to prevent harm or avoid complications. The call center staff indicated they were not always clear about the process for responding.
When they identified red calls as a common cause for concern, staff members were willing to volunteer to help improve the system because they felt ownership of the problem. An improvement team was launched and quickly achieved substantial outcomes. These included a standard three-step escalation process for all clinic areas; call center staff who, consequently, felt more confident and clear in their actions; and clinicians who learned that call center staff needed a clearer process and not necessarily clinical assessment skills.
Identify Leaders at All Levels
Developing a well-functioning red call system helped leadership identify a range of staff members who are now actively involved in identifying what matters to them and what gets in the way of what matters. There is a growing sense of psychological safety as teams talk about their shared commitment to patients. Carole notes higher engagement in daily work as they make progress on creating more efficient processes to improve the quality of patient care.
The Frankel Center leadership team engaged all team members as valuable contributors, respected all voices, and found fast and effective solutions. They provided lessons for leaders at all levels by using a systematic approach for sustainable improvement instead of patching persistent problems and accepting workarounds. Their experience demonstrated that — when leaders focus on improving quality and producing long-term results instead of short-term wins — people pay attention and commit to finding solutions together.
No joy in work efforts are ever done, of course. Recently, progress at the Frankel Center has slowed as they deal with rapid growth, staffing changes, cost cutting, and unfilled positions. These challenges have not undermined their ongoing efforts to build joy in work, but they do serve as reminders to all leaders of the need to continuously commit to this work.
Jamie Beach is the Quality Data Manager at the University of Michigan Frankel Cardiovascular Center. Diane Lopez is the Clinical Nursing Director of the CICU and Cardiology Step-down unit at the University of Michigan Frankel Cardiovascular Center. Barbara Balik is faculty for the Institute for Healthcare Improvement.
Editor’s note: Carole and Jamie credit the full clinic leadership team with the success of this program. Team members include Medical Director P. Michael Grossman, Clinical Nursing Director Michelle Brake, Nursing Supervisor Ellice Criss, Allied Health Supervisor Lori Schultz, Clinic Lead Colleen Acuff, and Call Center Manager Keli Devries.
Barbara Balik will be a presenter for SL13: Joy in Work: Practicalities and Pitfalls at the IHI National Forum (December 9–12, 2018 in Orlando, FL, USA).