Rice Memorial’s OB Stronger Thanks to TeamSTEPPS™

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Over the years, HCE has interviewed many executives, the majority of whom has found leadership and institutional success once they began adhering to a core principle: communication.

Communication is the key to a successful hospital. As obvious as this principle may seem, however, it’s possible for a hospital or healthcare organization to have good communication, but not consistent communication.

Consistency in how medical professionals communicated with each other was the primary challenge Kenneth Flowe, MD, was facing when he accepted the chief medical officer position at Rice Memorial Hospital in Willmar, Minn.

Becoming a physician leader

Prior to accepting the CMO position at Rice, Dr. Flowe had worked for 20 years as an emergency physician and had spent approximately a decade as a medical-staff leader. Early on in his career, he had resisted leadership positions, until he realized how important the decisions of the medical executive team were.

He was eventually elected a medical staff leader, and his eyes were gradually opened to the breadth of opportunity he had.

“The ability to care for one patient at a time is easy for a doctor, but the ability to care for a whole group of patients or even a county or a population is medical administration,” Dr. Flowe said. “So I found that I really enjoyed that opportunity, but I didn’t have the tool set.”

He began attending business school in order to acquire that tool set. Proving himself adept at administration, Dr. Flowe was appointed CMO of the hospital in North Carolina where he had been working, but he did not abandon practicing medicine entirely.

“I feel a physician leader or administrator loses a lot of credibility as soon as he hangs up his white coat, so to speak,” Dr. Flowe said. “I can have a conversation with the other administrators and be able to explain the reality of taking care of patients instead of just what I’ve heard. Sharing patients with others on the medical staff gives me a credibility with physicians that I would never otherwise have. It’s win-win.”

Implementing the TeamSTEPPS™ approach

Three years ago, Dr. Flowe accepted the CMO position at Rice Memorial Hospital. He immediately identified Rice’s OB department as exemplifying both the strengths and weaknesses of the hospital.

Dr. Flowe said he was impressed with the department’s innovative spirit, especially with regards to safety. The weakness was in the consistency of their intradepartmental communication.

While in North Carolina, Dr. Flowe had worked as a Master Trainer with Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS™) from the Department of Defense and the Agency for Healthcare Research & Quality (AHRQ). TeamSTEPPS™ is an evidence-based set of tools that fosters consistent communication and enhanced respect among care-team members.

Rice Memorial had experimented with the program before, but its initial experience was not great, Dr. Flowe said. The hospital knew of the program’s potential, but it was unsure about committing to the implementation of the program’s techniques.

“I was able to help encourage them to put the energy into it,” he said. “We’ve trained all the family physicians who do OB; we’ve trained all of the obstetricians; we’ve trained all of the nurses on the units; and this has had some very good effects.”

Cultivating a department of consistent communication

First, Dr. Flowe made an effort to understand the inner workings of the OB department. He realized that the OB care team was already using evidence-based strategies, and the framework was already in place and the environment was right for TeamSTEPPS™.

He then pitched strategies for implementing the program to the OB leadership, including both physicians and nurses. The response was positive, and he received conceptual buy-in.

He followed this up by enlisting two nurse leaders to collaborate with him on the program. These nurse leaders, Lori Thorson and Amanda VanderHagen, had been involved in the OB Safety Team for a long time, and Dr. Flowe said they were wonderful evangelists who prevented TeamSTEPPS™ from becoming “just another program of the year,” as many technique rollouts are considered.

This team of three turned the OB team’s conceptual buy-in of TeamSTEPPS™ into actionable buy-in. Together, they were able to determine how long they were going to spend on each aspect of the implementation strategy, including the didactic elements and simulation activities.

“The three of us were able to go to several department meetings and also several nursing meetings and playact a lot of the techniques,” he said. “There was plenty of fun and joviality, but we were always teaching the point. We were able to keep people’s interest. And the two nurses were exceptional.”

Expanding TeamSTEPPS™ to the entire hospital

The most important decision he made with TeamSTEPPS™, Dr. Flowe said, was implementing it within the right department.

“If we had wanted to start something like this in surgery, for example, it would not have gone as well because parts of the critical team weren’t ready,” he said. “Surgery is very safe, and staff and physicians have implemented some of the TeamSTEPPS™ techniques even, but they didn’t have the same innovative mindset that they did in OB. And a mindset of innovation is really key for having something like this work.“

With 800 deliveries annually, the OB was busy enough to demonstrate the success or failure of the program, and thanks to the popularity of the simulations with the entire OB team, TeamSTEPPS™ has been an overwhelming success within the OB.

Evidence for this was found on the before-and-after survey results using the AHRQ’s Hospital Survey on Patient Safety. The already-good scores showed universal intradepartmental improvement.

Thanks to that success, beginning this fall, TeamSTEPPS™ has begun expanding to other departments.

“Even people who initially didn’t want to do the simulations were able to say it was a valuable opportunity, and they were able to do things they didn’t expect to learn,” Dr. Flowe said. “There’s always skepticism towards any change, especially for professionals who pride themselves on doing a good, safe job. And in the OB case, they were doing a great job already, but they still had the innovative mindset to try something a little bit different, and it has had pretty significant results.”

-by Pete Fernbaugh

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