Embracing Team Based Improvement

1) Do you have teaming in your facility or fragmentation?

2) Teaming is where we're all involved in being successful on the problem issues of concern. Fragmentation exists when people state, "it's not my job", "I only do this much...", "I never work on that side...", "I'm only involved in these situations...", "This is my assignment list", etc. If you have fragmentation in your organization you're not going to promote an attitude toward improvement that is successful in a 1999 facility.

3) Are the teams in your organization working on real problems or are they involved in fluffy, feel-good teams. Teams today need to work on real issues that affect customer service, clinical interventions, revenue, cost, survey compliance, etc. If we're going to have successful teams, then they need to focus on pertinent assignments and be empowered to be solution oriented in their efforts. This means they have to be cross-functional in nature and be willing to drop turf territory or lines of authority at the door.

4) Begin looking for team based improvement during the meal experience. Meals occur in an institutional based health care organization three times a day, seven days a week. If you set up a dining experience for the customer where the customer comes first, then you have an opportunity to produce a major period of success.

5) The item above simply means that you either run meals that are a "dining experience" for the customer and a team based process or you end up running something similar to "three milk cow herdings per day". If you turn it into an assembly line process with fragmentation, you're never going to realize team based improvement because everything important happens around meals.

6) The statement "everything important happens around meals", implies regulatory compliance issues, reimbursement issues, perspective payment system issues and overall customer satisfaction. You can't have a milk herd philosophy if you want to be successful in putting together a major experience in a resident's life.

7) "Fair" doesn't count anymore. Involving yourself in a system that tries to set up equal or totally fair processes to ensure success won't work. Allowing people to spend all day long saying, "that's not fair", or "we're treated differently than other people", only leads to mediocrity in the organization.

8) It is important to take care of residents 24 hours a day by using a principle of prioritization and "take-offs" mentioned before. You have to make the first seven hours of the day run effectively and efficiently for success to occur. The first seven hours (6 a.m. to 1 p.m.) in a health care organization sets up the next 17.

9) If you're wearing out those first seven hours by having old systems of how you operate in-service, housekeeping, laundry, activities, maintenance, dietary, meetings, training sessions, vendor relations, corporate visitors, etc., then you're not going to have a chance to produce success with the rest of the 17 hours.

10) In addition, you will not have success in regulatory and reimbursement issues because the first seven hours definitely sets up the next 17.

11) With this in mind, you have to make a personal evaluation based upon that prioritization model of an unfair way of looking at healthcare delivery. What you need to do to make changes that will affect success in today's 1999 organization. Once you've made that decision for yourself, then it's possible to have an individual involved in a teaming process that really looks at how to change the efforts or practice patterns that affect delivery in the organization.