C158 Organizational leadership and Interprofessional team development
Organizational Leadership
A: Business Practices
There are many various elements to a healthcare system that can impact patient centered care including reimbursement, business practice, and regulatory requirements. Many factors guide the way care is delivered and quality is measured. Such factors are crucial in implementing quality patient-centered care within healthcare organizations.
A healthcare organization’s business practices are the backbone of the system, and not only include core values and its mission, but also policies and procedures. These specific business practices are implemented to ensure safe, quality patient-centered care by helping do things like prevent infections, and decrease adverse occurrences such as medication errors and patient falls. C158 Organizational leadership and Interprofessional team development.
Regulatory requirements ensure patient safety and establish basic standards of care. Healthcare organizations are required to comply with these to maintain licensure and certification. Federal and state agencies, such as Centers for Medicaid and Medicare Services (CMS) and New York State Department of Health (DOH) establish and monitor these rules for compliance. For outpatient dialysis facilities, there is also the End-Stage Renal Disease Network (IPRO) which works with CMS and the Department of Health and Human Services (HHS) to improve care for ESRD patients and prioritize national quality improvement goals. Failure to comply with regulatory requirements can result in penalties and loss of licenses and certifications. C158 Organizational leadership and Interprofessional team development.
In order to receive reimbursement, a healthcare facility must maintain licensure and certifications by complying with regulatory requirements. In addition, quality metrics must be met and maintained to receive full reimbursement. CMS sends dialysis patient quality surveys twice a year, called Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, to a facility’s patients to rate specific aspects of their care. In addition to meeting clinical metrics, a facility must meet goal for these patient satisfaction surveys as well in order to obtain full reimbursement. If not all goals are met, a facility will receive a penalty by having a calculated percentage of their reimbursement withheld. This data is publically reported, and also is utilized in determining star ratings for facilities. Therefore, if a dialysis center is providing optimal patient-centered care, they will have a higher star rating, either 4 or 5 stars, and will be reimbursed most, if not all by CMS. C158 Organizational leadership and Interprofessional team development.
B: Patient and Family Centered Care Tool (PFCC)
Please see separately attached document for completed PFCC Tool.
B1: Setting Description
DaVita Kidney Care is a Fortune 500 international company with over 2,900 clinics operating in 12 countries, including the United States (DaVita, Inc., 2019). Northwell Health is New York State’s largest healthcare provider and employer, with over 23 hospitals, 750 outpatient facilities, and over 69,000 employees (Northwell Health, 2019). Oyster Bay Dialysis is one of the many outpatient dialysis centers located on Long Island that is a joint venture between these two healthcare providers, with over 30 employees and 130 patients. The floor on the in-center side has 24 stations and one isolation room, and currently operates with 4 shifts on Mondays, Wednesdays, and Fridays; and 2 shifts on Tuesdays, Thursdays, and Saturdays. There is also a Home Program, which has 5 training rooms to train patients for both home hemodialysis and peritoneal dialysis. Due to its location, Oyster Bay Dialysis cares for a diverse patient population, with 57.7% Caucasian, 6.1% Black or African American, 23.1% Hispanic or Latino, and 13.1% Asian.
B2: Strengths and Weaknesses of the Organization
| Domain | Strength | Weakness |
| Leadership/Operations | Oyster Bay Dialysis has a clear statement of commitment to patient/family centered care and partnerships. Along with, explicit expectation, accountability, and measurement of patient family centered care. Leadership shows this by living through DaVita’s mission and core values. | Oyster Bay Dialysis could improve upon the inclusion of patient and family in adoption of policies and procedure, program development, Facility Health Meetings and Governing Body activities. |
| Mission, Vision, Values | Oyster Bay Dialysis does an excellent job including patient/family centered care within their Mission and Core Values; including a patient/family friendly Patient Bill of Rights and Responsibilities located in their admission packet as well as posted in the lobby. | No weakness present in this domain. C158 Organizational leadership and Interprofessional team development |
| Advisors | Oyster Bay Dialysis does have a patient advisory committee that meets with leadership quarterly
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Oyster Bay Dialysis does not have patient/family members that serve on hospital committees, or participate in quality and safety rounds. This could be improved upon greatly. |
| Quality Improvement | Patient and family members are included as part of the walk-rounds with physicians, nurses, and other Oyster Bay Dialysis staff. Patient/Family voice informs strategic, operational aims, and goals with the care team. | Patients/Family are not active participants on task forces or quality improvement teams. They are not included in IHI, NPSF, quality, safety, and risk, or other meetings held within Oyster Bay Dialysis. |
| Personnel | Oyster Bay Dialysis’ staff and physicians are prepared for and supported in patient-family-centered care practice by including them in their plans of care. Patient/family welcome new staff during their orientation by staff wearing a special PPE coat and being introduced individually by leadership. | Oyster Bay Dialysis has no expectation for collaboration with patients and families in job descriptions and Policies in Performance Appraisal Processes, nor do they participate on interview teams or search committees. |
| Environment & Design | Oyster Bay Dialysis supports patient and family presence and participation, along with, interdisciplinary collaboration. | Patients and families do not participate in clinical design projects at Oyster Bay Dialysis. |
| Information/Education | Oyster Bay Dialysis has web portals through DaVita that provide specific resources and patients and their families. The company’s website is patient/family friendly and easy to access with many resources available to all ESRD patients. Patient/family have access to/encouraged to use resource room located in the lobby.
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Patients and families do not serve as educators or faculty for clinicians and other staff members at Oyster Bay Dialysis. Clinician email access from patients and families is not encouraged. |
| Diversity & Disparities | Oyster Bay Dialysis has careful collection and measurement of race, ethnicity, and language, as well as providing navigator programs for minority and underserved patients. Our social workers are amazing with assisting the underserved, and we also have a patient fund created to help assist them. In addition, we provide patient/family timely access to interpreter services with an interpreter phone available at all times, as well as provide educational materials at appropriate literacy levels. | No weakness present in this domain. |
| Charting & Documentation | Patients and families are able to request and have full and easy access to their paper and electronic records at Oyster Bay Dialysis. | Patients and families are not able to chart at Oyster Bay Dialysis |
| Care Support | Oyster Bay Dialysis encourages family members to stay, join in rounds, and change of shift report. Patient/Family find support, disclosure, and apology with error and harm, family members are allowed to activate the rapid response system, their presence allowed/supported during a rescue event. Patients receive an updated medication history at each treatment. | At Oyster Bay Dialysis family members of the care team do not have 24/7 access. |
| Care | Oyster Bay Dialysis strives to provide the best care. Patients and families engage with clinicians within a collaborative setting. They are listened to, respected, and treated as partners in care. Oyster Bay Dialysis actively involves families in care planning and transitions, especially during plan of care meetings. Pain is always respectively managed in partnership with patients and families. | No weakness present in this domain. |
C: Area of Improvement
Oyster Bay Dialysis exhibits many strengths, but a marked need is seen in the quality improvement domain. During evaluation, the area noted to require the most improvement is the inclusion of patients and families in quality, safety, and risk meetings. By allowing patients and families to participate in the center’s monthly quality and safety committee meetings, and have the ability to provide their own ideas and perspective of things that could be improved upon, Oyster Bay Dialysis has the potential to greatly improve patient satisfaction.
C1: Improvement Strategy
To be able to effectively make an improvement, Careful planning and strategy is necessary. First, during the weekly staff meeting the team should be made aware of the impending change to improve patient-centered care. Next, letters detailing the center’s wish to have patient and family participation in the monthly meetings, as well as the meetings schedules should be provided to all patients and caregivers. C158 Organizational leadership and Interprofessional team development This will ensure that they are also all made aware of the desire to improve the center’s quality improvement practices. Ensuring that all members of the multidisciplinary are actively working to implement the change will be the only way to improve patient-centered care. The multidisciplinary team will consist of the clinical nurse manager, floor nurses, patient care technicians, clinic safety leader, social worker, and patient/family representatives from each of the center’s shifts. Inclusion of multiple departments will allow for different perspectives and ideas, and having a patient/family representative from each shift will help guarantee that all patient’s perspectives will be heard.
C1A: System or Change Theory
Lewin’s Change Theory describes behaviors as a balance between driving forces and opposing forces and incorporates a three-step process: unfreezing, moving, and refreezing (Roussel, 2016). This theory will help execute the proposed improvement plan by providing the team with the proper steps to implementing patient/family involvement in the quality and safety committee of Oyster Bay Dialysis. The first step of Lewin’s Change Theory, unfreezing, would involve the committee’s team obtaining approval from the governing body to include patients and families on the committee. Moving, the second step of Lewin’s theory, would be the team finding supportive evidence to help encourage the governing body’s approval of their proposed implementation. This evidence would include data or literature created and established by other quality and safety committees, whether from other DaVita or Northwell Health facilities, or even other committees outside of these entities. This evidence would demonstrate that the proposed implementation has been successful in the past, and could lead to improve patient-centered care at Oyster Bay Dialysis as well. Refreezing is the third and final step of Lewin’s theory. This would involve the governing body approval, as well as the change and finalization of any policies and procedures for the new implementation of patients and families on the quality and safety committee. C158 Organizational leadership and Interprofessional team development.
C2: Financial Implications
Financial implications to include patients and families on this committee would be very minimal. Since the committee has already been established previous to the proposed change, the cost of the wages of the team members and the office supplies needed for the monthly meetings would not be altered. The only additional financial implication of wages would be for the team members while initially developing the policies and procedures to implement the change, as well as recruiting patient and family volunteers C158 Organizational leadership and Interprofessional team development. The only additional money needed for office supplies would be for the initially letter of notification to the patients and family of the change to the committee, as well as distribution of any information to the additional members. Money would also be needed to provide refreshments during the meetings to patients and family members.
C3: Methods
A helpful way to evaluate the effectiveness of the change in improving patient-centered care would be to routinely provide a survey to patients and families for insight. DaVita often uses Survey Monkey, an online survey system, to acquire feedback anonymously. A survey could be created by the committee using this system, and then a link emailed to patients and families, both who participate in the committee and those who do not. The survey could be sent out quarterly to ensure for continued effectiveness and improvement in patient-centered care. A few examples of questions that could be included in the survey would be: how effective was the added involvement of patients and family to the quality and safety committee and what improvements could the committee make? Answers to these questions will help the committee determine if the involvement of patients and family members is effective in increasing patient satisfaction and patient-centered care. C158 Organizational leadership and Interprofessional team development.
D: Multidisciplinary Team
| Team Member | Role on the Team |
| Clinical Nurse Manager | As a member of the center’s governing body, the nurse manager would provide guidance for the development of policies and procedures for the involvement of patients and families in the committee, as well as oversees the committee to ensure compliance with all policies and procedures. |
| Floor Nurses | Patient and family advocate and liaison. Helps to ensure patient safety policies and procedures are followed. |
| Clinical Safety Leaders | Conducts monthly OSHA/safety audits to ensure team compliance with safety regulations, as well as advised committee of any discrepancies. Helps with promoting the inclusion of patient and family members on the safety committee. Act of committee representative during monthly Facility Health Meeting. |
| Patient Care Technicians | Will assist with the recruiting patients and family members to the committee. |
| Social Worker | Offers patient/family support, as well as can advise committee of HIPAA issues and have patients/family members complete and sign HIPAA compliance forms ensuring they understand its importance and acknowledging they will insure there will be no HIPAA violations. |
| Patient/Family Representative | Represents the patient population from their respective shifts and brings patient and family members concerns and ideas to committee. C158 Organizational leadership and Interprofessional team development |
D1: Team Diversity
New York is such a melting pot, every healthcare facility and their staff have to ensure they are providing safe, patient-centered, culturally competent care. At Oyster Bay Dialysis, with such a diverse patient population, similar diversity amongst the team is imperative to ensuring this level of care is maintained. This diversity within the team allows for different perspectives and an assortment of cultural knowledge to provide optimal patient care. Oyster Bay Dialysis has team members from a multitude of cultural backgrounds in various roles. This diversity allows for greater patient satisfaction and centered care, as the team can more easily connect and establish relationships, and therefore trust, with patients and their families. C158 Organizational leadership and Interprofessional team development.
D2: Leadership Theories
One of the most productive of the leadership theories, the transformational leadership model would be the most effective in implementing the appointment of patients and families to the quality and safety committee. Transformational leaders share their power, which motivates staff to work harder and excel, as they feel they are all part of a team, working towards the same vision. Sullivan (2017) describes it as “the goal is change in which the purpose of the leader and that of the constituent become enmeshed, creating a collective purpose”. This style cultivates relationships between all team members, as they are all working towards one main purpose, ensuring safe, quality patient-centered care. C158 Organizational leadership and Interprofessional team development Transformational leaders not only inspire others to excel, but, according to Sullivan (2017) “empowerment can result in improved patient care”.
D3: Implementation of Strategy
There can be no improvement without change. Including patients and family members as active participants in the quality and safety committee will improve patient-centered care by increasing patient satisfaction, as they will feel their voices are being heard; as well as improve patient outcomes, as it will allow for a more diverse panel of perspectives and ideas. The multidisciplinary team will work together to obtain governing body approval for the implementation; with the whole team collecting supportive evidence and data to promote the change, the nurse manager bringing the proposal to fellow members of the governing body, and then, once approved, all members help implement the change. The nurse manager will provide guidance for the development of policies and procedure, as well as provide oversight to guarantee compliance with them are maintained. The floor nurses will advocate for the patients and their families. The clinical safety leader will conduct monthly audits and advise committee of any noted areas for improvement. C158 Organizational leadership and Interprofessional team development The patient care technicians will help recruit family members and patients to the committee, as well as assist in ensuring all patient shifts are represented. The social worker will work to ensure all members understand the importance of HIPAA and provide consent forms to sign. The patient and family member representatives will provide insights from their own experiences, as well as those shared with them by their assigned patient shift census, to improve patient-centered care. After results of quarterly survey are obtained, all members of the team will review and discuss any further actions, if necessary.
D4: Communication to Organization
Monthly, during the Facility Health Meeting, in which members of DaVita as well as Northwell Health review the facility’s monthly performance, the clinical safety leader will share the committee’s findings, outcomes, and goals, as well as its proposed strategy in achieving those goals. The committee’s minutes will also be provided and reviewed on a monthly basis by the director of nursing services and facility administrator so they can provide operational oversight, address any questions or concerns, and escalate to the governing body if necessary.
D5: Tools for the Team
Today, there are a multitude of tools available to self-assess your personality. The Keirsey Temperament Sorter is utilized by many large companies for their employees to see where they are, as well as areas for opportunities in developing their relationships with other. According to Keirsey (n.d.) the tool helps “brings clarity on who you are, what you do, who you love, and what difference you make. Keirsey offers an integrated system of solutions for your most important people opportunities and challenges”. The tool will not only allow the committee to assess themselves by determining what type of personality they are, but will also lend insight into ways to improve their relationships and work with the other personality types. C158 Organizational leadership and Interprofessional team development.
According to Keirsey, there are four different temperaments: artisan, guardian, idealist, and rational. These four temperaments can further be subdivided four more times, for a total of sixteen different character types. The Keirsey temperament assessment is seventy-one questions long, and takes approximately ten minutes to complete. Once the questions are completed, the person will receive a report via email about their temperament. They can also purchase focus reports in regards to different aspects such as leadership, workplace, and career. These focus report can lend even greater insight for member of the committee in developing themselves as well as their relationships.
References
DaVita, Inc. (2019). Corporate profile. Retrieved from http://investors.davita.com/corporate-profileC158 Organizational leadership and Interprofessional team development
IPRO. (2016). Network goals. Retrieved from https://network2.esrd.ipro.org/home/about/network-goals/
Keirsey. (n.d.). Keirsey temperament assessment. Retrieved from https://www.keirsey.com/
Northwell Health. (2019). About us. Retrieved from https://jobs.northwell.edu/about_us/
Roussel, L. (2016). Management and leadership for nurse administrators (7th ed.). Burlington, MA: Jones and Bartlett Learning. ISBN: 9781284104677
Sullivan, E. (2017). Effective leadership and management in nursing (9th ed.). Upper Saddle River, New Jersey: Prentice Hall. ISBN: 9780134153209 C158 Organizational leadership and Interprofessional team development