Clint Maun, CSP
"How do you eat an elephant"? One piece at a time. This principle holds true for improving a healthcare organization in its' responsiveness to critical issues effecting day-to-day outcomes.
To achieve this, we believe in establishing the concept of "one great unit". The "one great unit" concept allows for team empowerment, group participation, continuous quality improvement and outcome based measurements.Set up a best practice pilot project in a designated section of the building, i.e., one particular operating entity. It could include one shift, on one unit, but it needs to occur within the nursing function first because this offers the greatest opportunity for success.
The team on that unit, led by the unit manager or charge nurse, should develop in association with the facility's leadership, a list of critical outcomes to be accomplished during a certain period of time. Normally, we set up a two-week period but this time frame could be expanded to include larger phases of success or shortened to accomplish one specific successful weekend in very traumatized organizations. The unit team's critical list of outcomes to be accomplished could include such things as:
- Staff attendance.
- Overtime reduction.
- Staff floating reduction.
- Agency utilization reduction.
- Staff vacancies reduction.
- Specific clinical indicator improvement (such as weight loss,
hydration, infection, in-house acquired pressure ulcers, fecal
impaction, medication errors, change of condition notification, etc.).
By designing a set of human resource connectivity and clinical outcomes, the team can set specific goals in each of these areas. Then they can develop their plan for attacking the issues of improvement as a team. The logical outcome of this program is the ability to design specific rewards/recognition that the team feels is appropriate for their success. Rewards/recognition could include:
- Food parties.
- Gifts/Gift certificates.
- Special celebrations.
- Time off.
- Other perks as appropriate.
The management team must then approve the plan for the "one great unit" and announce it throughout the organization. This published explanation would include why we're starting with one unit and how other organizational entities will be involved over time. Include an explanation as to why we started with this one unit and what we're trying to accomplish.
The management staff must also approve the plan including the rewards/recognition component. Rewards/recognition should be approved in line with a positive accomplishment theme, i.e., return on investment. If you offer cash rewards, require a reduction in critical problems that are clinical in nature, or that have cost the organization revenue i.e., overtime, agency utilization, sick pay, etc.
The concept is that the "elephant" can be broken into component parts to be successfully eaten. The team has been empowered to develop this concept on the unit and implement a positive plan for action. This includes the ability to encourage peer pressure as necessary on certain issues of team behavior.
Organizations face an overwhelming trauma when trying to improve the entire organization at once. By cutting up measurable success into component parts of the building we're able to set in motion a project that can be duplicated to the next great unit and so forth throughout the building. This positive attitude of accomplishment becomes a motivation for the entire organization.
Remember, the team on the unit needs to develop their own program. It can't be developed by management and then handed to the team. The members of the team must be involved in the program design and feel like this is truly not a gimmick but a measurable way to change the culture of the organization. The "one great unit" concept allows the facility to practice its continuous quality improvement and survey preparation efforts for annual inspection or accreditation issues. It teaches assertiveness which is often sorely lacking in some healthcare facilities.
To make the "one great unit" concept work you must realize that healthcare organizations can't be improved in a top down manner. It has to include all individuals at all levels for consistent success to occur.
For more information on the "One Great Unit" and how you can implement the concept in your facility click One Great Unit.