This is part of an ongoing series of audio profiles of front-line improvers.
Vice President of Patient Care Services
My name is Tami Merryman and I’m the Vice President of Patient Care Services at UPMC Shadyside in Pittsburgh, Pennsylvania. My journey began, actually, eight years ago, when I was first promoted to be the Vice President. And myself and one of my colleagues were sitting one spring day, thinking about all the troubles and woes that were facing us at the time, relative to some of the patient outcomes we were seeing, relative to the financial issues we were seeing, and we kept saying, “There has to be a better way. It can’t be about working smarter, working harder, try more, give more; there has to be a new way.”
When we looked across the country about what was happening with clinical practice at the bedside, and particularly in a medical surgical unit, we couldn’t find a lot of work. So we felt we were really forging a new path of saying, “How are we going to make nurses’ lives better? How are we going to provide them more time with patients?” Because we know more time that a nurse has with a patient results in better care. So we started one year, one summer, and from that first summer of having 15 improvements, and giving back $670,000 to the organization in time, we’ve just kept it going.
There’s not a health care professional who doesn’t start their day and say, “I want to do the best I can for my patients.” When my nurses start their day, they’re provided various technological devices to be able to make their world a better place. Particularly non-cellular phones. Up until that point in time, nurses’ only communication devices were their feet. They’d run up and down the hall like crazy people trying to get answers for patients. They now have a non-cellular phone. Save them on average of 30 minutes a day of running to a phone.
I think nurses bring to bear the fact that they worked in all those broken systems usually at some point and time in their career. A physician’s experience of a broken system is very different than a nurse, or a pharmacist, or a dietician. So I do think we do naturally kind of understand patient flow. But I also think though that many nurses have not had the strongest financial training in understanding how that process change can lead you to better operational and financial efficiencies within your organization. So I think we come at it naturally clinically prepared, but we need good partnerships for the data management and the data financial management to go along with it to make the business case in the boardroom that this is the right thing to do.
“Who is my nurse?” “How do I find him or her?” Putting names in rooms, numbers in rooms. Providing them a guide to care, questions they should ask. Providing them safety tips, things that matter a lot about their safety in the hospital. We have patient gowns now that say on their pocket, “Please remember to wash your hands.” So that literally if I go to touch you, and I haven’t done it, I’m going to think twice before I touch you. Because we’ve recognized hand washing is an interdisciplinary issue that health care is woefully inadequate at. It took some getting used to definitely; the physicians thought we were a little crazy. And it was amazing; I think that’s again where leadership pulls into this. My CEO thought it was the best idea she had ever heard in her life. And so when we brought the gowns out and took them to Med Exec and we talked about all the things we could impact, over all the snickers, when there’s a CEO saying, “Wait a minute, ladies and gentlemen. Only 70 percent of you by direct observation are washing your hands today. Tell me that this isn’t a good thing to do.” Then all of a sudden the snickers get a more quiet.
I think you have to have a lot of energy because it’s hard work. It’s hard because many executives underestimate the amount of detail that they need to be involved in to be successful. There comes a point in a career path development where as you grow and you have — for example, I have a span of control of 1,300 people — that you think, “Oh, that should be someone else doing that.” Because you think about the structure and how you can be pulled up into your organization. So you have to be an individual that works very hard to pull yourself down into your organization. And be in the sandbox with the rest of the team building castles. And so I think that does require a sense of needing to recognize that’s where the value is. There’s value in the boardroom, no doubt, in being able to present your image there, but there’s equal value with your employees, and your patients, and spending the same kind of effort and energy in working with them that you do in putting a presentation together for your board. That’s a lesson that people do need to learn. I think it is learnable and teachable, because once you do it, the joy is really there.
When I was a nurse, I always knew that I could take good care of the people that were assigned to me. I decided to become a chief nurse executive because I wanted to make it a better place for a lot of nurses and a lot of patients. And so while I always had that vision, it wasn’t until I was able to learn and grow, to know that this was the way I would do it. I have 20 years to work, and I feel like I have work to last me for all of that and more. And I hope building the hospital of the future, really where the right patient gets the right care at the right time every time, is my legacy and is the contribution I make to health care. Because there’s not a day that goes by that I don’t find a chance to make something better. And it’s that changing, even if it’s sometimes just telling someone to stop doing something that they’ve done because they thought they had to, just invigorates the heck out of me.