Becker's Hospital Review

38 Executive Briefing Creating Change That Sticks: Lessons Learned From Years of Improving ORs T he fact that change has become more frequent in health- care does not mean it's easier. People are creatures of habit, and professionals in any field know it's extremely challenging to adopt and maintain new ways of working. In a field as regimented as medicine, many healthcare professionals experience discomfort when abandoning the routines, habits or points of view to which they've grown accustomed over time. Leaders are tasked to not only see their people through unease, but to ensure change is sustained in the long-term. This is not impossible. In fact, most people support change if they believe it makes a real and positive difference to patients. In the operating room, patients are exposed to several — even hundreds — of decisions, actions and relationships that can immediately help or harm them. The nontechnical skills and behaviors of a care team directly affect patient outcomes, and ORs rife with teamwork, harmonious relationships between management and staff, collegial familiarity, coordination and stress management are safer than their counterparts. These are also the ORs in which surgeons, anesthesiologists and nurses most want to work. Infusing these skills and behaviors in the OR, however, takes deliberate effort. Most hospital ORs struggle with problems related to efficiency, behaviors, cost and physician satisfaction. Over time, these problems cascade. They lead to more cancellations, low patient satisfaction, high costs, and ultimately poor financial outcomes since the operating room is one of the most ex- pensive areas in an acute care hospital. Sixty percent of the high-performing hospital's margin derives from perioperative services. Over the years, Surgical Directions has collaboratively transformed OR cultures for hundreds of clients — from rural to urban facilities, from community-based hospitals to large academic medical centers. The process takes an average of six months, and Surgical Directions is most proud of what occurs after that: Change that sticks. What does Surgical Directions do to make change stick in the OR? Tap into team cognition When working toward lasting change, leaders cannot un- derestimate the importance of interpersonal relationships and emotion. Oftentimes, change is unleashed upon employees rather than being a goal they work toward together. This puts the horse before the cart. Initiatives that focus first on people — before workflow and processes — are those that gain momen- tum and ultimately stick. Oftentimes, the glue holding 'change that sticks' is team cognition. This is a group's collective knowledge about their roles, responsibilities and capabilities. When team members understand how one role affects another, they have greater self-awareness about their own duties and more accurately anticipate their colleagues' needs. To grasp how you fit into the big picture is eye-opening. To grasp how your colleague fits into the big picture is just as important. Regardless of technical skill, a disjointed team will struggle with any attempt at cultural transformation. When surgeons, anesthesiologists, nurses and other personnel are unfamiliar with one another, their responsibilities and day to day challeng- es, it is unreasonable to assume they are capable of sustaining meaningful change that will benefit patients. "A lot of times, members of the same surgical team have different ideas about how to get through their day," says Lee Hedman, senior vice president of Surgical Directions. "It's criti- cal to align motivations and bring people onto the same page to work as a coordinated team toward the same goals." Surgical Directions addresses team cognition head-on through multidisciplinary performance improvement sessions. Individuals from other areas of the hospital meet with the OR team and participate in roundtable discussions about workflow, efficiency, morale and culture. Sometimes these sessions bring colleagues face-to-face for the very first time, even though their jobs and responsibilities have affected one another for months and years. Ms. Hedman says the strategic performance improvement sessions are remarkable for many reasons. Aside from team members finally meeting and getting to know one another, the sessions also serve as something similar to a town hall gather- ing. Each stakeholder has a chance to express his or her dissat- isfaction about OR processes or culture, and this peer-to-peer dialogue is precisely what gets things off the ground. "For many people, learning about a teammate's pain points sparks a total shift in mindset," says Ms. Hedman. "When a member of your organization tells you how your work or attitude affects them, that's a wake-up call. It sparks an internal drive for improvement, and people walk out of the session wanting to do better." Paint a vivid picture of improvement efforts While team cognition is a critical piece of the cultural im- provement process, individualization is just as key. Once team members understand one another's roles, needs and frustra- tions — as well as the greater need for cultural change — Sur- gical Directions digs into data to target improvement efforts. Surgical Directions analyzes numerous metrics and functions, including same-day cancellation rates, direct costs of supplies Sponsored by:

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