Promoting Effective Interdisciplinary Leadership

August 19, 2015

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TODAY’S PANEL:

MODERATOR:

• Kristine Metter, CAEVP, Member Services

America’s Essential Hospitals

SPEAKERS:

• Angelleen Peters-Lewis, RN, PhD

Senior VP Patient Care Services

Chief Nursing Officer

Women & Infants Hospital of Rhode Island

• Mark MarcantanoPresident and COO

Women & Infants Hospital of Rhode Island

• Raymond Oliver Powrie, MDChief Quality Officer

Care New England Healthcare System

Promoting Effective Interdisciplinary Leadership

Mark MarcantanoPresident and COO

Women & Infants Hospital

Angelleen Peters-Lewis RN PhDCNO and SVP Patient Care Services

Women & Infants Hospital

Raymond Powrie, MDSVP Quality

Care New England

Presentation Abstract

• The ability to form effective interdisciplinary partnerships will be the hallmark of a successful health care organization and their leaders in the new health care environment.

• Care New England Health System believes the most important partnerships are those among physicians, nurses and hospital administrators.Care New England used these partnerships in task forces to address organizational improvement challenges. The system has seen rapid change and innovation as a result, and experienced performance improvement in several areas.

• During this webinar, Care New England will review how it carried out this approach and the lessons it learned along the way. Speakers also will discuss the perspectives of physicians, nurses, and administrators, and the keys to effective problem solving.

Mark Marcantano

• NYU, Albany Law School of Union University

• Executive Dean, SVP and COO of Albany Medical College

• VP Ambulatory and Network Services, Children’s Hospital, Boston

• At Women & Infants Hospital and Care New England since 2010

Angelleen Peters-Lewis PhD RN

• Simmons College, Northeastern University and Boston College

• Nurse Director of Endoscopy at MGH, Boston

• Executive Director of Women’s and Newborn’s Services at BWH, Boston

Ray Powrie

• University of Alberta, University of Calgary and Brown University

• At Women & Infants and CNE for 23 years where he has worked as a clinician, professor and physician quality leader

Women & Infants Hospital Care New England

• Major teaching affiliate of Brown University for services unique to women and newborns– 11th largest stand alone obstetrical service with 8400

deliveries per year – 80 bed single-family room NICU– 167 adult and 140 infant beds– 12 operating rooms– 19, 369 admissions and 7413 surgeries

• 2014 Leapfrog ‘Top Hospital’• Recognized by Robert Wood Johnson Foundation

as a national leader in interdisciplinary care

Some of Our Longstanding Challenges

• Unwarranted preterm elective deliveries

• OR efficiency

• Breast feeding rates

• ER efficiency and safety

• Patient access

• Costs of obstetrical care

Progress On Longstanding Challenges

• We really had made little progress on these areas and needed a new approach

Silos• We realized nursing, physicians and non-clinical

administrators were not working in a coordinated manner…

Negotiating Silos

• ..and the failure to work as a team was making progress very difficult

TeamworkWe determined that insisting on teamwork was the only

way we were going to get things to change (and that we needed to chose an effective model for it)

Paradigm shifts: using a participatory leadership process to redesign health systemsCurr Opin Obstet Gynecol. 2014 Dec;26(6):516-22

Saleeby E, Holschneider CH, Singhal R

• “Participatory leadership is an organizational change theory that engages key stakeholders as architects in the transformation process. This review highlights the utility of this leadership strategy in designing care for women's health”

• “Physician engagement in leadership during this time of system transformation is of critical importance”

We Created Teams Led by Triads

Dyad

• Nurse

• Physician

Triad

• Nurse

• Physician

• Administrator

We Decided to FocusOur Efforts

• We knew the saying about the fox and the hedgehog from the book ‘Good to Great’ and decided to make sure we FOCUSED on doing a few key things very well.

‘Multa novit vulpes, verum echinus unum magnum.’‘A fox knows many things, but a hedgehog one important thing’-Archilochus ~650 BC

Choosing Our Focus

• We chose projects that lay in the intersection of the following three circles:– What can we be the best at?

– What drives our economic engine?

– What are we deeply passionate about?

Our Priorities and Our Passion

• Eradicating preventable preterm births

• Increasing breastfeeding

• Enhancing– OR efficiency

– ER efficiency and safety

– Patient access

• Partnering with physicians to decrease the costs of maternity care

This is When We Began to See our Silos Break Down….

..and We Began to See Progress on These Longstanding Challenges

Learning CurveIt Wasn’t All Easy So These Are The Lessons We Learned Along the way

Vision • Serving something

bigger than yourself, career or even your institution

• Being about the work

• Tapping into the desire for people to be their best selves

• We made sure we spoke and modeled and acted in a way about this work that communicated a broader vision.

Cultural characteristics of “high” and “low” performing hospitalsJournal of Health Organization and Management,

Mannion H.T.O. Davies M.N. Marshall2005;19(6):431 - 439

Apollo Zeus

Caring

‘People don’t care how much you know until they know how much you care’– Theodore Roosevelt

• All Team Leaders Needed to Consistently Know We Cared About Their Perspective and Input

Credibility TRUST

• All team members needed to know that their leadership was talking the same talk to all team members.

Professionalism: good for patients and health care organizations.Brennan MD1, Monson V2.

Mayo Clin Proc. 2014 May;89(5):644-52.

• “A recent working group of the Institute of Medicine defined the values associated with teamwork as honesty, discipline, creativity, humility, and curiosity”.

• “The values of cooperative teams are defined as self-respect, mutual respect, and equality”.

Hardwire the Triad

• It was important to make sure that every step along the way (conversations, meetings, presentations, follow up etc.) involved the entire triad

Professionalism: good for patients and health care organizations.Brennan MD, Monson V

Mayo Clin Proc. 2014 May;89(5):644-52.

• “Recategorization of ..identity from an individual to an organizational one .. provides the basis for a diverse team of professionals to work cooperatively and efficiently in placing the needs of the patients and society above self-interest.”

• “When individuals can cognitively shift from a singular identity as a surgeon, oncologist, nurse, or administrator to a more complex and overarching identity on the basis of the organization's values and purpose, greater alignment between espoused values and those in practice occurs.”

Accountability

• We created weekly, monthly, quarterly oversight and report- outs by the triads (with a broad audience) to make sure – teams had the resources they

needed – Teams were held accountable

to get the job done • Standardized format • 20% on why they were where

they where and 80% on what they were doing about it

Midpoint Summary

ACT Values

Accountability

Caring

Teamwork

• Additional Key Principles

Be strategic with resisters

Be tenacious

Be a shepherd

Tack

Be the Bigger Person

Don’t Be Waylaid by Resisting Stake Holders

• We determined to face the reality of different stakeholders and work to help them be their best selves

We Had to Be Tenacious

• Stay on message and keep pushing even when things look like they will never change

• Don’t underestimate the power of a leader’s steady, focused, resolute commitment to seeing a mission accomplished

• Remind people that their work is to determine how the thing gets done, not IF the thing gets done

Tenacity: quality of being Able to grip something firmly

persistence, determination, perseverance, doggedness, strength of purpose, tirelessness, indefatigability, resolution, resoluteness, resolve, firmness, patience, purposefulness, staunchness, steadfastness, staying power, endurance, stamina

We Came to Think of Ourselves as ‘Shepherds’ to the Projects and the Teams

• We pushed the change along in the right direction

• We became adept at using our hooks both to protect the team … and to get the wayward team members back on course

We Got Good at Tacking

We Learned to Choose Our Battles

• Make sure you and your teams are willing to be the bigger person more times that you/they might want to

Victory(and persistence)