Q I'm extremely nervous before I lead a staff meeting. Do you have any pointers?
Staff meetings can and should be a high point of your leadership practice. They're your time to connect with staff on relevant and important topics, make sense of initiatives and issues, give staff members a chance to present work they've done, brainstorm ideas, and, of course, celebrate and recognize success. Two pointers that immediately come to mind are practice and preparation.
Just like anything else, practice improves performance. The more meetings you lead, the more comfortable you'll be and the better the communication will be among your team. Schedule meetings regularly and in a routine way, for example, the first Thursday of every month for day shift and the first Wednesday for night shift. Monthly is the bare minimum and should be supplemented by daily huddles or other consistent informal communication. Work with staff on the best time for the meetings to maximize attendance, taking into consideration workflow and coverage. You may want to rotate staff and repeat the agenda twice. Keep it short—it's difficult for staff members to be away from their assignments for more than 30 to 45 minutes. You can even choose a coleader from staff members as part of their development.
Besides coordinating the schedule, you'll want to prepare your agenda. Avoid reading information; staff members can read data themselves—you should provide the interpretation and application to their work. You may want to have guests, such as representatives from the nursing quality or support departments, because not only does this take the pressure off you, it also gives face time to people who have expectations of your staff members but haven't heard their issues from the bedside. This can be eye opening on both sides. Don't set up a guest for failure with an open forum for complaints; set the stage for specific topics, discussions, and outcomes.
Your main objective is to engage and inspire your staff. Encourage back-and-forth communication. Is the unit achieving its goals? If yes, why, and if not, what can be done to improve? The tone should be warm and supportive. Provide feedback, listen, and stick to the agenda. It's very satisfying to have positive staff meetings with clear outcomes and action plans that keep everyone on the same page and actually make your job easier.
Q How do you think the development of accountable care organizations (ACOs) will affect inpatient care?
I wish I had a crystal ball. The Centers for Medicare and Medicaid Services is piloting the ACO model nationwide, with full implementation expected by 2016. Currently, 60% of the pilot ACOs are physician groups, and you want your organization to be their hospital of choice.
An ACO is incentivized very differently than our current system. Now all payments to physicians and hospitals are paid by the episode, the visit, or the admission—making payment volume-based. In the ACO world, revenue is bundled and all providers are motivated to keep patients healthy, educated, and out of the hospital. As my hospital's executive director says, “It's a game-changer.”
How will we know if we're achieving seamless, patient-centered care? The quality metrics to be evaluated will certainly affect inpatient care. Many of the metrics are familiar to us: value-based purchasing indicators (decreased readmissions and improved Hospital Consumer Assessment of Healthcare Providers and Systems scores), fewer ED visits, improved functional status, better communication to patients, and decreased length of stay. To do this, there will have to be an increased focus on relationships, the team, evidence-based protocols, disease management, analytics, informatics, data-driven decision making, and patient education and support. Any one of these alone will affect inpatient care; all together, we should anticipate a sea change in care delivery.
It will be a good time for nursing. Our role on the team is critical for direct care nurses and case managers across the continuum. Additional advanced practice nurses will most likely be needed on both the primary and the acute sides of our practice. The focus on patient-centeredness supports our nursing models. We must start thinking broader, wiser, and as a team to succeed in the new ACO world.