1. Encourage Shared Decision-Making
Shared
decision-making between members of an emergency department team, including
input from the patient, is key to delivering an accurate diagnosis as well as
high quality treatment and care.
“When teams share mental models of a
situation and communicate effectively, they can be collectively vigilant,
observant, curious and present,” says Prof. Ronald Epstein—a family physician
at the University
of Rochester Medical Center in New
York.
Colloborative active thought within a department team—including physicians, nurses, dietitians, psychologists and other staff—is just as important towards shared decision-making as sharing expertise and clinical data.
“There is
tremendous potential for driving value-based care in the emergency setting
through shared decision-making,” wrote Edward Melnick, MD, assistant professor
of emergency medicine at the Yale School
of Medicine
and Erik Hess, associate professor of emergency medicine and research chair for
the Department of Emergency Medicine at the Mayo
Clinic.
By including the
patient in this decision, the patient becomes more engaged in his/her recovery
and will be more inclined to adhere to the treatment plan. This approach can
also reduce the likelihood for unnecessary hospital admissions in the ER
setting.
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2. Treat Departments as Small-Medium Scale Enterprises
Dr. Marc Noppen, managing director at University Hospital Brussels, says: “we have some departments which we treat as if they were small or medium enterprises. We have departments in which we allow whole, eclectic, very decentralised self-steering governance…It's a variety of measures, not a single answer, which will solve all the question. It's a multi-layered approach.”
In this way, each
department is enabled to focus on its strengths and weaknesses, whilst leaving
the majority of the budgeting and top-level strategic decisions to the
director.
“We allow them to manage their own business,
but our role is to be sure that we create the framework that they can still
use—the success formula of their centre. This is really hard, focused on
research and a very powerful translational mechanism where they bring their
research very quickly to the bedside and continuously improve this reflex and
culture of continuous improvement and innovation,” says Dr. Noppen
3.
Build a Positive Working Culture
There are many elements involved in the hospital culture, and each hospital is different.
“I've worked in
maybe 15 hospitals in my career and I can tell you that every hospital is
different. There is another atmosphere, another culture, another way to do
things, another way to talk to each other, another way of hierarchical
organisation, and this reflects in the way you manage patients. You cannot
avoid that and that is why I think this has to come from the top. You have to
lead by example,” says Dr. Noppen.
A Vanderbilt-led study published in JAMA
Surgery indicates
that surgeons who are rude and disrespectful to patients are more likely to
make mistakes in the operating room. Researchers found that patients treated by
rude or disruptive doctors had 14 percent more complications in the 30 days
after their surgeries than patients who were treated by surgeons who had better
bedside manners.
“If you take those numbers and distribute them across the United States where
27 million surgical procedures are performed each year, that could represent
more than 350,000 surgical site infections, urinary tract infections, sepsis —
all kinds of things that we know can be avoided when surgical teams work well
together," said Gerald Hickson, MD, senior vice president for Quality,
Safety and Risk Prevention at Vanderbilt University Medical Center (VUMC).
The results also show that disruptive doctors also impact the ability of other
surgical team members to do their work.
“A thing that we
work hard on here is the culture of the relationship amongst ourselves and
between us and the patients. A point we focus a lot on is that we really want
to welcome the patient in an empathetic, warm, friendly, polite manner. This
sounds very obvious and very low profile and stuff, but it really makes a
difference,” says Dr. Noppen.
Image Credit: Pixabay