Eight Tips for Tough Times
with Chief Nurse Executive Barbara Nelson, RN, PhD Sutter Roseville Medical Center
Sutter Roseville Medical Center, a 325 bed acute care facility and part of the Sutter Health System in Northern California, faces the same challenges as the rest of healthcare. It also operates in a union environment; must adhere to California's strict nursing ratio requirements; and cares for patients in a state with one of the lowest populations of RNs nationwide.
More recently, Sutter Roseville is working to accommodate California's new meal and break law, which mandates breaks at prescribed times. "We're seeing the application of more rigid labor laws to an environment that didn't always work that way," explains CNE Barbara Nelson. "If a meal break falls in the middle of a surgery, we need to ensure patient safety isn't compromised during hand-offs."
In spite of these challenges, Sutter Roseville has sustained patient, employee, and medical staff satisfaction in the top quartile and recently received Sutter Health's President's Award for achieving impressive results across its balanced scorecard.
Tips for Sustaining Results in Tough Times
1. We manage the medical center. The medical center and unions manage the contract. "The contract is one element of how we work with the employee—wages, hours, and working conditions—but that doesn't prescribe being nice, how we connect with patients, how we introduce ourselves or how we care for patients and each other," says Nelson. "That's doing the right thing every day."
2. Measure what you treasure. Sutter Roseville uses all kinds of measures to keep a finger on the pulse of what's most important. During rounding, leaders ask, "How many patients have you rounded on?" They distribute hot comments so everyone sees the good and the not so good of how patients perceive the care they are giving.
3. Effort is appreciated but results are what count. Patient satisfaction scores are distributed weekly and analyzed so that lower performing units can learn from higher performing units through quick interventions. Scores are kept at the forefront of daily activities.
4. Cultivate an expert team rather than a team of experts. When you have the right people on the bus, you can feel confident that someone reliable and competent will step in to help when you need it.
5. Balance your efforts. Sutter Roseville recognizes that the goal is to move results in all five Pillars—People, Service, Quality, Finance, and Growth. Sometimes that means that one initiative has to be delayed if it would impact negatively in another area that can't support it…say financials. "My colleague says it's like squeezing a water balloon," says Nelson. "Sometimes there's higher pressure in some areas but the entire unit stays intact."
6. It's not extra work. It IS the work. "When the Joint Commission comes out to talk about safety, the safety questions on the survey aren't that different from the experience of work survey or the patient satisfaction experience of our patients," says Nelson. "Let's tie it together and ask how we make people feel safer." An example: At Sutter Roseville, rounding includes safety questions rather than rounding for one thing one day and another the next.
7. Set stretch goals. Nelson sets high goals—like no pressure ulcers for patients in her building— even though she may not reach that goal. "Some years ago we believed that some patient populations were destined to get pressure ulcers in the hospital," she explains. "But then we began to take on our own myths. The only thing that changed about skin care was my mind. We have remarkably changed our outcomes by setting a vision of where people can go together towards perfect care."
8. Accountability is an agreement. "It's hard to talk about accountability and not have staff perceive it as negative," admits Nelson. "But it's really just an expectation we have for one another." Nelson, a self-professed fanatic for moving results likes to agree on a goal, set a plan, and support the plan for forward movement. "If we don't hit a goal, then we ask ourselves 'What needs to change to meet our goal?'" she adds.
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