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On May 12, 2018, Piana commented on Smoothing OR flow :

Transparency should be able to state how important is to all to better distribute cases all over the week. The insitution defines OR agenda, not surgeons. YOu offer them slots they could book surgeries not the other way around. if they want to have the best time schedule they have to fit your strategy. Kind of a fidelity program. If they do what you need, they get the best times on OR schedule, but simple rules may state no days in a row, for example…

At our center we are working to provide a less stressful enviroment by:

1. Discussing stress and burnout signs and symptoms so you and your colleagues can better recongnize it when it happens.
2. Offering psycological support that people can look for outside the institution in a anonymous way.
3. Creating communities that have common hobbies –
4. Improving operational support – this is probably the most importat point. People get stressed when they cannot do all they know to patients. This can cause moral distress tha will accumulate overtime.
5. Group discussions after a death occurs to identify any staff that has a bad feeling about the care that was provided to that patient and try do elaborate on a team discussion that will try to aliviate it with a team approach.. sometimes one member of the team has some hidden information that can provide a lot of relief to the other that felt guilty.
6. Opening spaces for them to talk about difficult cases with mentors or to write about those cases. Writing aliviates a lot stressful situations. They need to talk/write.
7. Teaching communication skills can help too.

I dont believe we should teach resilience to doctors and nurses. Staff life is very difficult. They need more support and less stress in their lifes and not to learn to deal with the stress they accumulate.

On May 12, 2018, Piana commented on How can we heal the toxic culture in a medical center? :

Communicating better is the only way out. Listen to people to understand their feelings. That will let you diagnosis if hospital and staff are aligned or not in termos of identity or mission. If they are align the is about finding a road to change that is acceptable to all. Difficulties will come but if they are antecipated people will get over it. Each project should have a physician as an sponsor so they feel respected and they have some protagonism. Bring their ideas to the projects and they will also face the real challenges that administrators have when is time to change. Identify who is really connected to the institution, who is politically strong but not so aligned and listen to them. Try to find a common denominator in their speech to better plan the change. I am sure they all like the hospital and care about patients and hospital future. They want to be a protagonist of the change and not a passanger. Doctors were trained to act not to follow.

We created a multidiscipplinary “Culture Team” in our hospital to discuss every other week about the changes we are facing and how they impact the people. People from different areas, some new in the hospital, some very old bring their thoughts and we discuss a common sense that they have to speak to people working close to them. That helped a lot.

On May 12, 2018, Piana commented on Increasing Length of Stay :

I suggest you to creat a multidisciplinary team to take care of this issue. Have a white board on patients room, ask doctor to write the expected date of discharge and which criteria (no fever, end of antibiotics, etc) would be necessary in order to the discharge happen. Nurses will follow that expected date everyday, and circulating the signs or symptons that were achieved one by one. Patients will be engaged on discharge date as much the staff. Families will pay attention and plan to be there early on the day to bring the patient home. 24 hours before the expected date, the multidisciplinary team contacts the doctors and if its confirmed, social service, pharmacists, nurses, family, and start to work on discharge to guarantee that before 10 am next day the bed is free.

If you have Eletronic Medical Records you can do it eletronically. Having a TV screen at the nurse area can help follow step by step, patient by patient who is approaching the expected discharge date. If doctors alter the expected date they have to justify and restard the list of signs and symptoms list again.

Follow the doctors that can predict the lenght of stay precisely and recognize them publically.

The aim can only be achieved with all stakeholders sharing clear understanding of all challenges faced by company owners and staff. Its urgent to develop a clear diagnosis of the situation, biggest bottlenecks, make the board understand all risks involved, ask them to support you and those with energy to save the company, providing a clear message to the whole staff. The staff has to understand why tough decisions are being made. Everyone’s help is wanted and those working close to the clients know better where costs can be cut without lowering quality. You could identify Pathologists with managing skills and willing to help and ask them to lead the change around their specialties, coordenating from grossing room, slide preparation to case sign out within their specialty.
Communication of company financial and operational situation has to be very clear to all to create the sense of urgency on all employee that decide to stay and fight for the company. You have to recognize publically the challenge and give hope through a plan that guarantees quality and recognition to people. You could reward ideias that save money or time.
Needles to say that finding the new culture that will represent all merged labs has to be defined by the board and showed to the staff. Some of the the staff will prefer not to stay given the new conditions, whereas others will understand that the challenge and new culture is actually a great opportunity for those that decide to stay.

Communication, quality, recognition!