A concerted plan to foster teamwork and empower staff can maximize a long-term care facility’s success, from care delivery to return on investment.

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ever before has today’s healthcare organization seen such a need to address team involvement. Indeed, teams are absolutely essential to process daily work, solve problems, and empower the overall organization. Moreover, there is no longer time or money to operate under the old parent-child model of healthcare delivery. This ineffective model consists of high-level board members and progresses down through the administrative and management chain to supervisors, coordinators, team leaders, staff, and lastly to customers. Simply put, employees are not interested in being managed in this top-down style. And no customer wants to be at the bottom of the food chain—waiting for care, treatment, and involvement in a pyramid-type operation.
       To be effective, your healthcare organization must become involved in “real-time teaming” solutions and opportunities.

Time to Get Real

       Real-time teaming is when employees act as a team to make changes on a daily basis. With real-time teaming, issues and/or opportunities are not taken off site to a room with a number of private meetings. Rather, a policy of “BSCTP”— Best Solutions Closest to Problem—is implemented. When organizations implement real-time teaming, change occurs at the level where the most pressing issues, concerns, or pain is currently being felt.
       For example, if the housekeeping department is using too many supplies, the department itself should be involved to correct the situation. In many healthcare settings, however, the “solution” would be achieved differently. The problem would first be pushed to the housekeeping supervisor, who would probably develop a checklist to be posted on the housekeeping supply door. If that did not fix the issue, it would go to the management team, which would then write a new policy on supply usage. If not fixed there, it would then go to the board or home office, where a manual would be written, a consultant hired, or a performance improvement group formed to solve the problem. I think we all recognize that this is crazy. The housekeepers are the ones who need to be mobilized to figure out the best solution(s).
       Of course, I am not trying to say that senior management and administration should be left out of real-time teaming. To be sure, they are a critical piece of the puzzle. Take customer problems and complaints, for example. When a customer issue arises, it should be taken to the administrator and/or management team. And when the problem is presented to managers, they have the perfect opportunity to involve themselves as well as staff in real-time teaming. For example, management can use the “come with me” approach as a process to set up real-time teaming. The situation should play out as follows. Management should go to the department or area that is affected by the customer concern. The customer or family member should also be brought to that area; from there, management can say something as simple as, “Hey, Mary, how do we go about fixing these kinds of situations with the customer? We have a problem here we need to resolve.”
       This involves the employee immediately, allows for an immediate solution, and creates trust and respect among the customer. This approach can be used in many other areas on a daily basis, particularly by individuals in isolated situations like home care. These individuals must be able to make immediate decisions that would fix the situation at hand.

Make it Happen

       We can no longer allow for long-term processes and approaches to solve problems that need an immediate attention. Now, long-term teams are certainly necessary when there are major systemic issues. What I am talking about here, however, is the opportunity to make immediate, effective decisions during the real day, with real teams, at the real time of the real situation.
So, how do you make this happen? To follow are 7 strategies you can implement at your organization. You will find that implementing even just one of these strategies will create an atmosphere of real-time teaming. In our consulting work, we have found that healthcare organizations that implement these strategies reap very beneficial outcomes.
       1. Initiate interview involvement. It is critical to involve staff when interviewing new hires. When staff is involved in the interview process, management gains great insight as to whom their employees think they should and should not hire. When given the chance to be involved, employees also have an immediate positive attitude toward the new hire. They are more likely to make sure his or her orientation schedule and initial workload go smoothly and successfully. On the contrary, when management is the only unit involved in interviewing and hiring, staff is often left saying things like, “Look who she’s hired now.”
       2. Tackle destructive employee behavior together. Destructive behavior and internal conflict should be dealt with by teams. In most instances, when an individual has a problem with another coworker he or she will “snitch” on that coworker to his/her manager—who must then have a private consoling session. In our experience, however, we found immediate results when teams are involved in handling employee conflict. A system in which management as well as staff confront the individual in an intervention format is an effective approach. Together, the team indicates the problem and what needs to be done to resolve it. This type of approach also allows for accountability; the problem is less likely to slip through the cracks when an entire team is aware of it.
       3. Huddle up. Brief “stand-ups” or “huddles” are extremely effective in engaging teams. Daily team-based huddles are particularly helpful in direct care units. For example, nursing staff can meet with the charge nurse at predetermined times to get a quick update on what is going on in the unit—who needs assistance, who is ahead, who is behind, etc. These team-based huddles also allow staff to self-report. This is a very important component; good employees love to report that they are right on track. Additionally, individuals who are never on task or on time will be forced to report their status. This will either cause them to get the job done (in fear of being embarrassed in front of the group) or allow the rest of the team to identify the problem and solve it before the shift ends. This is critical, as I am sure you are well aware of situations where problems from one shift are passed on to the next shift. In fact, we even have a name for it: continuative care.
       4. Implement team-based admission assessments. Team-based admission assessments are particularly important on Medicare units where customers are constantly coming in and out. In these situations, employees are usually running around like chickens with their heads cut off, trying to corner the customer and family members to get the assessment done. This madness and mayhem can be placated by a simple, brief group meeting. In this meeting, allow for a 35-minute team-based admission assessment process. This not only improves customer service (by not bothering the customer) but also tells the customer that you know what you are doing.
       Start with an honest evaluation of the length of stay needed for safe transition. If the team goes on record to the customer with that number and then posts it on a calendar, it is more likely to case-manage that person toward a successful outcome. Further, this approach gives teams the opportunity to master the calendar and discharge dates for each admission. In addition, our experience shows that team-based admission assessments are major timesavers for the organization.
       5. Create 12-week team plans. For most of the organizations we consult, we design a “master team” to help deal with any pressing issues. This master team creates and guides a goal-orientated plan over a 12-week process. Because 12-week teams have a specific goal and, further, a specific time to accomplish that goal, we have found that these teams maintain the vigor and energy necessary to attack the problem. Theses teams have proven successful for revenue enhancement efforts, survey improvement, and staffing/retention, just to name a few issues. We have seen amazing results when a team is given an assignment against a goal-orientated plan. We found that the 12-week teams set real-time teaming in motion because there is a need to get something done now. There is no dragging it out and analyzing it to death.
       Through this process, there have been opportunities to see a 7:1 return on investment. In other words, for every dollar you spend to develop, implement, and produce an effective 12-week team, you will see a return of 7 back in expense reduction, quality improvement, or revenue. We found that most teams generate something in excess of 7:1, but you should be able to generate this at minimum if you run teams effectively and smoothly (ie, start and end meetings on time and hold meetings that have purpose and structure, etc.).
       Another key ingredient to creating successful 12-week teams is garnering senior-level support. When you create your 12-week plan, make sure that your organization’s governing authorities sign off on it and help with the effort. In addition, giving a series of weekly reports (which we recommend) to the governing authorities creates accountability and pushes the team toward the goal.
       6. Tap into the power of one. The “one-great-unit” concept is a way to create cohesive teams on a specific unit in a long-term care organization. This can be tied to the overall 12-week team as I mentioned above, or it can be run separately. For example, a team on the unit designs a set of 4–6 goals that it is going to work on for a period of time, usually 1–2 weeks. This team then creates a scoreboard, which is placed in a high-traffic area for everyone to see. The goals are written on the scoreboard, and each day the one-great-unit team discusses how it is doing against the goals, which could be things like floats, vacancies, pressure ulcers, weight loss, turnover, agency use, pain management, and falls. Each day, the team measures how it is doing toward those goals for a 24-hour period. Whenever a goal is reached, the team is recognized and rewarded.
       Due to the short timeframe one-great-unit teams maintain, there is an opportunity to give frequent rewards and recognition. And while these teams are enjoying their success, the organization certainly benefits. Positive results and leading-edge practices accomplished by these teams can be shared throughout the organization. Different units and departments can take this information to foster change among their own groups. Persons have a vested interest in this process because there is a reward and recognition structure in place. This concept also allows for change initiatives to occur at a faster pace on the unit or department because there is an interest by the staff members to accomplish the goals as quickly as possible.
       Lastly, it is worth repeating that the publicity of the scoreboard is key for the unit. Remember, because everything is in plain sight, you can measure how the team is doing. You can also determine who is helpful and who is not contributing and take the appropriate action to recognize or give feedback to the individuals, accordingly. This particular element leads directly back to item number 3 previously discussed (using huddles and self-reporting techniques to address the individuals who have not been contributing).
       7. Hold productive meetings. Yes, we know it is a no-brainer. But as you are probably already well aware, healthcare meetings can be a big waste of time. Many organizations are still stuck running a stand-up morning meeting or a periodic department meeting in which individuals report each of their particular areas of concentrated work effort. This around-the-table report process usually ends up with limited action or outcome. A real-time teaming meeting is very different from these stale, dry, informational meetings; it has a purpose. Priorities are set, and employees are assigned tasks and goals with specific time frames attached to them. Executing these types of meetings allows your organization to focus on its painful issues or opportunities using a more immediate process for action. For example, if the problem of revenue shortfalls is the issue, it is the main agenda for the meeting. You should only discuss the issues of revenue shortfalls, not everyone’s individual areas. If your issue is staffing, an upcoming survey, or a visit by the home office, that is the main topic of discussion. Whatever the topic is, it becomes the topic for everyone.
       The next step to achieving real-time teaming meetings is to come to the meeting prepared. You should aim to get something on the table that can be assigned to the rest of the team. The assignments should be directly tied to alleviating the pain or problem. This approach sets in motion a sense of teaming for everyone. This type of meeting also sends a message to senior management that you are intent on getting things done—and now.

Conclusion

       Healthcare organizations must deal with everyday situations in a manner that allows real teams to make real decisions and realize real results real fast. While there are probably dozens of methods to achieve real-time teaming, the 7 items above are the best ways with which we have been able to achieve team-based improvement in healthcare organizations. We have also found that each of these particular suggestions can reap between a 2:1 and 4:1 return on investment. However, if you use any 3–4 of these suggestions, you might get a 7:1 return. Above all, we have found that healthcare organizations need the energy, focus, and concentration of real-time teaming to make success happen.