Magazine article American Nurse Today

A Bold Move to Improve Collaboration: One Hospital System Is Empowering Frontline Clinicians in All Disciplines to Move the Quality Journey Forward

Magazine article American Nurse Today

A Bold Move to Improve Collaboration: One Hospital System Is Empowering Frontline Clinicians in All Disciplines to Move the Quality Journey Forward

Article excerpt

Interdisciplinary collaboration is the cornerstone of high-quality patient care. Several years ago at Orlando Health (Florida), we made a bold move and flipped the existing hierarchy to improve collaboration. The goal was to empower frontline clinicians in all disciplines to push innovative patient safety and quality improvement ideas to the forefront. In this article, we share our successful experience in the hope that other organizations can use a similar model.

To bring the vision of improved collaboration to life, Jamal Hakim, MD, chief quality officer, partnered with us and other likeminded leaders in the organization. Together we created a forum--the Collaborative Quality Advisory Committee (CQAC)--where nurses, physicians, and allied health team members could develop and send quality suggestions to the medical executive committee for approval.

Building the team

Our hospital system consists of eight hospitals with more than 14,000 team members and 2,000 physicians. It was important for the CQAC to represent all hospitals, specialties, and professional disciplines, so it was a daunting task to select members for the committee.

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CQAC members needed to have certain personal attributes to make the group's dynamic succeed--respect, teamwork, and consistent demonstration of patient safety behaviors in clinical practice. Members also needed good listening skills and the confidence to offer justifiable opposing viewpoints to discussions. We wanted two patient and family representatives for the group as well. Each hospital's leadership team recommended members; the list of potential members was refined to ensure appropriate representation from hospitals and specialties.

Frontline nurses were well represented on the CQAC and included staff from medical telemetry, orthopedics, pediatrics, labor and delivery, critical care, and intermediate critical care areas. Later, we added a clinical assistant nurse manager, nursing operations manager, and chief nursing officer to partner with their frontline colleagues in the group's initiatives.

Selecting allied health team members for the committee was especially challenging because of the number of potential participants. This large group includes staff from the cardiovascular, clinical nutrition, imaging, laboratory, pharmacy, respiratory care, and therapeutics (physical, occupational, and speech therapy) departments. To chair our allied health executive council, we added an administrator to be the voice of all the disciplines. Interestingly, we learned we hadn't been using the correct terminology for some of our colleagues. (See A name isn't just a name.)

Once our clinician members were in place, we asked them for recommendations of patients and family members from their clinical practice to consider for the committee. Through an interview process, we identified two valued individuals who shared many of the same attributes of the clinical members. The final committee consisted of about 40 regular attendees.

Establishing structure and priorities

Structured to be nimble and bureaucracy-free, the CQAC meets every other month. Official officers are limited to a chairman (our chief quality officer) and vice chairman. The director of patient safety, who traditionally has been a nurse, rounds out the group's leadership. The director is instrumental in planning the agenda and promoting discussion during meetings.

It was important to the group's leadership for members to establish their own strategic priorities. Before their first meeting, members received an email asking, "What keeps you up at night?" related to patient safety. These issues were compiled and used to form meeting agendas.

It became clear ineffective communication was the root of many problems. During interdisciplinary discussion, the team learned that communications that should be exchanged directly from physician to physician were being abdicated to nursing. …

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