Dana Smetherman's Profile

In other industries, there are organized, coordinated “internal” marketing plans that specifically target a company’s own employees. Resources similar to those used to attract the attention and interest of the external, consumer market are utilized to convey messages to and win the understanding and buy-in of a company’s own employees. It might be useful for health care to look at other non-health care companies and adopt some of their strategies to communicate with physician and other employees.

I agree with several others who suggested offloading lower acuity patients to a geographically distributed network of outpatient, urgent care clinic type facilities. Last year, our health system bought a chain of established urgent care clinics in our region rather than build our own. We rebranded the urgent care clinics so it is apparent they are affiliated with our healthcare system and put our EHR in all of the sites. The urgent care volumes have exceeded everyone’s expectations but there has been some interesting side effects.

Now, the acuity of the patients in our ED’s has increased significantly. This has led to problems with our staffing model (which relied on a combination of physicians and non-physician advanced practice providers). The APP’s used to serve as our front line ED personnel but now a much higher percentage of patients who come to the ED are seriously ill and require a higher level of medical management by a physician. We are now contemplating reversing this practice by using physicians in the front line, triage function so that interventions on the sickest patients begin quickly. After initial evaluation by a physician, less acutely ill patients who come to the ED could be routed to a lower acuity, fast track service embedded within the ED where there are managed by APP’s.

Also, we are finding that the ED shifts are more stressful for all of the personnel because patient mix has shifted to a significantly higher acuity level. The ED providers are all caring for extremely ill patients with fewer low acuity patients, who used to provide something of a breather for the ED staff.

The challenges we have seen should not deter you from exploring this model, but it is probably beneficial to anticipate these difficulties so you can anticipate and plan ahead to address problems like those we have experienced if and when they arise.

This is an issue faced in many businesses as they grow beyond a small “family” of colleagues who work side by side with one another and have a common, shared experience that can be traced back to the founding of a company. There are many strategies that can be employed to maintain the culture that made you successful in the first place while recognizing that continued expansion is your new reality. Robust onboarding programs that institute your culture from the beginning are one component. Another is to develop retreats (either on site of off site) that educate both new and existing employees on the history and culture of your company as well as ensuring that everyone understands your values, mission, and strategy and how they support the work your employees do each day. Finally, some very large companies actually include a Chief Culture Officer on their administrative team. This individual is specifically tasked with supporting, overseeing, and maintaining the corporate culture.

It is very difficult to support multiple teams when the goals are not aligned or (as in this case) there are actually incentives to cannibalize resources from one group to another. Although this may be sustainable in the short term, this is, of course, not a formula for long term success. The constrained resources (support personnel in particular) seem to be disproportionately being granted to the “squeaky wheel” (Team A). Your example does not include how the various teams are compensated or if they have specific goals. One approach might be to institute some shared goals (for example, departmental RVU’s rather than individual RVU’s, departmental employee engagement, or patient satisfaction for the entire group). This could focus the individuals on the success of the whole, rather than on competing with one another to commandeer the resources.

We are experiencing a similar situation in our department where the interactions of the physician members of a particular section have become so toxic that they are starting to have a negative impact on operations. After unsuccessful attempts to remedy this situation internally, we have reached out to members of our Psychiatry Department to explore setting up some counseling sessions for the members of this department as a group. I completely agree with others who have responded that it is critical to separate personal issues from the professional behavior required to work effectively as a team. I cannot report anything about the success or failure of this new approach to dealing with severe personality conflicts as we are just initiating these efforts now, but I think there may be potential in tapping into some of the resources that are already available to us in health care, such as the counseling and therapy at which our mental health colleagues are already quite skilled.

EMDO,

This is really a problem that all hospitals seem to share, isn’t it? Last year, I gave a talk about the IOM’s Quadruple Aim with 3 other speakers I was discussing Population Health. The speaker who gave the lecture about Reducing Costs was an architect by training who now works as a Healthcare Systems Engineer and she had some great observations about patient flow in a hospital. She described a case study by Peter Viccellio that was presented at the Hospital Flow Seminar of the American College of Emergency Physicians in 2017 (Viccellio, MD, FACEP, Peter. (2017, May). Introduction to the Problem and Discussion of Full Capacity Protocol. Presentation at the Hospital Flow Seminar of ACEP, Boston, MA). One of her slides was a graph of elective vs. emergency hospital admissions by the day of the week. Emergency admissions are actually quite predictable and vary only slightly throughout the week (Saturday and Sunday are slightly lower). Elective admissions, on the other hand, vary greatly.

I would be happy to share the slides with you and wonder if they could help you make your case to hospital administration. I understand the leverage these surgeons have with their ability to move their case volume to another institution if your hospital does not cater to them. I wonder if there are other benefits hospital administration would be willing to offer that might induce at least a few of the surgeons to move their cases to a different day.

Dana