Imagine running a company where customers show up at your door day or night wanting immediate service. Every order is customized, with almost infinite options, but your responses must be by-the-book because everything you do is highly regulated. And when it comes time to pay, a third party — not the customer — foots most of the bill.
That’s the hospital business in a nutshell. It’s no wonder business guru Peter Drucker said that no organization in society is more difficult to manage than hospitals.
At Indiana University Health, our 33,000 team members are re-inventing their jobs as we learn better ways to manage this complex business.
IU Health’s workforce is hardly alone as it transforms itself in the quest for quality. But allow me to share some insights – and struggles – from IU Health’s deep dive into transforming its work culture in the name of improved patient care.
• Adaptability and flexibility. Hospitals are the ultimate 24-7 business. (Many patients can’t leave if they want to.) But hospitals are admittedly expensive and not easy for everyone to access. So we’re opening more physicians’ clinics, urgent care centers and even telemedicine services to offer patients more affordable, convenient care.
To staff a growing statewide system of 15 hospitals and hundreds of other care facilities in Indiana, we need team members who are more diversely trained than ever. Beyond that familiar pairing of doctor-nurse, today’s healthcare jobs have expanded to include such essential new roles as physician assistants, nurse practitioners and patient financial navigators. At the same time, traditional jobs have broadened in scope. Housekeepers, for instance, are key members of infection control teams.
• Zero defects. My 30 years in healthcare have seen a transformation away from accepting errors as inevitable. At IU Health (like at other health systems) we strive to get it right every time.
We’re going to unprecedented lengths to train our team members to avoid causing infections and medical errors. Metrics and quality dashboards tell us about every patient harm event and measure safety efforts (something that didn’t exist years ago).
It’s working. In 2016, patient harm events dropped 18 percent systemwide. At some individual hospital nursing units, teams have cut patient harm incidents to zero for a year or more at a time.
• Every frontline worker is critical to success. Tracking patient satisfaction scores, we realize that everyone who works with patients must do their job correctly every time. Housekeepers, patient transporters and others who don’t have an MD or RN behind their names need to follow protocols as strictly as those who do. That means robust training and constant checkups to be sure every patient encounter is handled right.
I first learned that lesson as a teen working at a corner grocery in Knightstown, Ind. As a stockboy who didn’t face customers like the butcher or cashier did, I was told by my boss to keep an eye out for shoppers who needed help reaching an item high on a shelf or toting groceries to their car.
• Breaking down silos. This is a special passion of mine. Employees can’t stay in their occupational silos anymore, concerned with just therapy, nutrition, anesthesia or whatever specialized work they do. Our business of healthcare, like others, has become too complex to think narrowly. So, using the theories of complexity science, we are teaching our work teams to self-organize around value streams to meet the demands of the moment.
Our hospitals and other care sites now are the setting for hundreds of daily work huddles, where teams brief and prep for the new day, react to unexpected issues during the day or handoff their work (and daily learnings) to a new team at the end of a shift. The goal: to perform flawlessly for those they serve, no matter the time of day or personnel on hand.
We’ve made great strides transforming our workforce to deliver more value in the face of unpredictability and complexity. But I know we are still in the intense part of our learning journey.
In the months ahead we at IU Health look forward to sharing more about this journey in this space. After all, this quality journey never ends and we’re all in it together.