Surgical Improvement Project

Surgical Improvement Project

UWMC

Surgical Improvement Project

Team 4

Leadership and Culture

Minutes

June 15, 2005

Present: Matthew Agnew, Alan Artru, Peter Buckley, Dan Kaiser, Neil Kovacs, Melissa Marshburn, Kurt O’Brien, Jennifer Petritz, Cindy Ripplinger, Gail Wiener, and Doug Wood.

SIP Support: Virginia McClure

Team 4 Focus:

  • Respectful Communication
  • Taking Care of Patients
  • Incentive to do a Good Job
  • Defining Leadership
  • Teamwork

Report of Meeting:

Dr. Artru welcomed and thanked everyone for participating. Taking a few moments to review the history of the project, he noted that Julie Duncan continues to be dedicated to the role of SIP facilitation and the institutional goals of Lean thinking. He emphasized the importance of Team 4’s work— other SIP participants have stated that SIP 4 is the cornerstone to implementation of recommendations from SIP Teams 1-3 and also for long-term strategic thinking (SIP Team 5).

Explaining the agenda for the evening’s meeting, Dr. Artru reminded everyone of the meeting on Friday, June 17th—the integration and “cross-pollination” of SIP Teams—to work on the development of the SIP Vision.

In preparation for the ongoing work of the team and the all-day session, Dr. Artru asked everyone to reflect in general terms about two topics: Teamwork and Leadership. He suggested a “what would work” or “perfect world” focus be employed, in order to provide recommendations to the Surgical Improvement Project. Below are comments:

UWMC

Surgical Improvement Project

Team 4

Leadership and Culture

Minutes

June 15, 2005

Attitude:

  • Is the OR there to serve surgeons and patients or is the OR culture to service the OR?
  • If I say there’s another case, the response should be, “Let’s do it!”
  • Is the attitude, “We want patients in the operating room”?
  • A “can do” attitude is needed…that the work will get done and we’ll work together to get it done.
  • A “can-do” attitude. Everybody rallies. Somehow it expands. They take pride in it. Any patient any time of day. [A description of Harborview Medical Center in contrast to UWMC]
  • You’re all in the trenches. Hierarchy changes. Roll up your shirt-sleeves. More camaraderie. They [referring to leadership] get their shoes dirty.
  • If there’s a job to get done…Let’s get the work done together.
  • Good work attitude. Accountability. Leadership. Work ethic.

Organization:

  • The symptom is not the problem itself. The problem is the system is not working right.
  • The OR culture does not reflect a standard practice of taking care of patients.
  • The culture is institutionalized, not individualized.
  • The process of managing the machinery of the OR holds surgeons and patients at arm’s length.
  • The system favors hourly employees.
  • The OR should purposefully build excess capacity into staffing.
  • What is the leadership structure?
  • Delay, delay, delay.

Accountability:

  • “Alignment of Expectations”
  • “Circle of Trust”
  • Once the rules are understood, the mesh will happen.
  • Modeling by leadership.
  • Continuity of care. Efficiency, fluidity.
  • It is easier knowing what the expectations are.
  • It is easier when rules are known, but we need consequences for those not complying.

UWMC

Surgical Improvement Project

Team 4

Leadership and Culture

Minutes

June 15, 2005

Leadership:

  • Leadership is the great abyss. Expressing concerns to the leadership is fruitless. They don’t respond.

In the perfect world:

1. The OR is eager for work and wants to get it done as a team.

2. The staff is versatile, experienced, and cross-trained.

3. Guidelines and expectations are clearly understood by all.

4. There is alignment of expectations.

5. There are consequences for not following guidelines and meeting expectations.

6. Cases would be easily scheduled and scheduled appropriately.

7. Cases would get done on time.

8. Administrators/Leaders would be:

  • Trained
  • Visible
  • Accountable

9. Administrators/Leaders would model exceptional behavior.

10. Teams would be oriented to a surgical service and/or skill set and would stay together to get the work done (or a reasonable surrogate would replace team members who cannot stay until the conclusion of a case).

11. RN3s would be chosen by the team; not appointed by the administration.

12. Generalist practitioners would not be penalized for not choosing to work on a surgical team.

13. The Anesthesia Coordinator would be visible and easily accessible at all times.

14. There would be cooperation among units and a realization of the impact on others for not working in synchronicity.

15. Teamwork would be global (all the OR), local (each room and unit), and universally expected and rewarded.

16. An attending-to-attending retreat for surgeons and anesthesiologists would be held and the Surgical Chairs and Chiefs would have greater direct involvement in Surgical Services.

Next Meeting: The next meeting will be held next Wednesday evening, June 22nd, 5:00-7:00, in SP-2276. Dan Kaiser will be leading the group in a discussion about Respectful Communication. Goal: Specific ideas on this issue and a plan to begin implementing some or all of those ideas. Julie Ducan will provide expertise on how to plan and implement, and Michelle Anew will assist with project management of implementation.

Confidential: This document has been created as part of a Quality Improvement work product at the University of Washington Medical Center under the protection of RCW 4.24.250 &70.41.200(3).

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