Are our people actually doing the right things?
The chairman of the board of a MHC institution with 2,600 employees and 500 beds questioned whether his people were doing the right things. Employees had the feeling that there was not enough time for patients, partly because of the regulations imposed from outside. Moreover, the clinic had been given instructions by the Health Care Inspectorate. The chairman came to us with his request.
We performed an organizational scan at two locations. This provided facts on how the organization was doing – practically and in the details – which we used as input for a customized approach. The facts of the matter: practitioners spent not even a quarter of their time on the direct treatment of patients, there was no goals-based treatment programme, and the treatment tasks, roles, and responsibilities were incredibly vague. People were at a loss as to what they should be doing, and there was a great deal of ‘fuss’: unstructured and pointless meetings and red tape. The management was simply unable to rise above the facts to pull things together.
We got together with people in the organization to define the aim of the improvement projects: to achieve sustained improvement so that practitioners and nurses in the units had more time again to spend on the goals-based treatment of patients.
Practitioners and nurses were struggling under the time-consuming and illogical general and technical processes. We worked with an improvement team made up of clinic employees to improve the daily work processes. For instance, the process for ordering nursing supplies has been improved so that nurses are more likely to have everything in stock. The process of ordering daily meals has been simplified as well so that it takes less time. Tasks which are not directly related to patient care have been shifted to the care assistants wherever possible.
Goals-based working: that made sense to everyone as shown by a general session with all employees. But … how is an organization to put that into practice? So we got together with a team of practitioners, nurses, and managers to design and document this process. We then spent weeks implementing the process together. And wherever the skills or expertise were lacking, we gave people the necessary training – such as on how to define clear objectives.
The new process brought clarity: employees now talk to each patient first about what they need so they can define feasible goals together. Each patient has a treatment plan to hand within a day after admission or consultation, which outlines the objectives, interventions, and evaluation schedule. Treatment interventions, reports, and treatment evaluations all have a standard place within the process – just like the roles and responsibilities. If something does not relate to the goal of the treatment, it is no longer included in the plan. This makes it clear to everyone what needs to be done, when, and by whom.
The communications structure has been reorganized to encourage people to talk less about and more with patients. In future, transfers will concentrate on changes in the treatment policy and special circumstances. Gone are the days when the entire unit would take part in a transfer; in future, the number of people involved will depend on the aim of the meeting with a view to more efficient and effective communications. The workable time saved (nearly 100 hours a week) can be used instead for the daily programme of the patients.
Hand in hand with staff and managers, we developed a system where the organization itself can work on continuous improvement. Every week, eight to ten cases are tested, focusing on twelve different areas. Any evident points for improvement are discussed and tackled. These fact-based peer group sessions ensure that changes in the behaviour of practitioners and nurses are quickly detected.
In addition, we developed a dashboard that tracks the weekly results in productivity and direct patient time – at individual and team level.
The approach has paid off. Direct customer contact has risen from 24 per cent to 62 per cent of the available time, and the higher productivity has resulted in a structural improvement of €95,000 a year. Nurses and practitioners take greater pleasure in their work because it has become more meaningful. There is also a knock-on effect: fewer complaints. And since every customer has their own up-to-date, realistic treatment plan, there are far fewer concerns about checks by insurance companies. And it shows: the Inspectorate heaped praise on the organization’s case practice.
