ASQ - Team and Workplace Excellence Forum

Online Edition - January 2000

---Issue Highlight
---Peter Block on Meetings & Evaluations

"Evaluation is not about ratings, it is about
learning. It should be a conversation among

In This Issue...
Ken Blanchard

Year 2000 Recruitment

Teamwork at NASA
Team Effectiveness
----In Health Care

The Downside of

Peter Block Column
Views for a Change



Team Effectiveness Can Make The Difference Between Life Or Death
Redesign of Health Care Practices

--Is your industry a political game of volleyball in an election year? Is 50 percent of your revenue received from a single party? Is your industry process managed by its biggest customer? Is much of your revenue administered through a third party? Is your very existence dependent upon five people from an independent agency controlling your destiny? Does seeing less of your major customer make your firm more profitable?

--If you answered most of these questions in the affirmative, Stuart Jonap would bet that you are in the health care industry.

-- Jonap, director of Internal Communications and Quality Programming for Morton Plant Mease Health Care in St. Petersburg, Fla., explains that most health care income derives from the government and is subject to approval or changes dictated by the Joint Commission.

--Furthermore, insurance companies administer most health care revenue and its major link with patients is through the physicians who use its facilities. "This means that the health care industry is under constant scrutiny. It is responsible for a lot of paperwork that demands accurate reporting and a constant measurement of team effectiveness," Jonap explains.

Five Dreaded Words
"We are a four-hospital system, all within one large county," Jonap continues. "We have a total of 1,100 beds and 8,000 team members. Yes, I said 'team members.' We have no 'employees.' Our health system, on Florida's Gulf coast, is part of a larger ten-hospital consortium, the BayCare Health System. Medicare accounts for 65 percent of our nonprofit system's income."

-- In his emphasis on quality programming, Jonap works closely with Robin Lapham, manager for Product Improvement in the Morton Plant Mease Health Care group. She cites the pressures created by rapid change. "Before consolidations, we had competition between individual hospitals. Now, layers of management challenge us. Ours is limited to two management levels, so it is vital that team members be focused on continuing improvement. Yet, as new ideas are presented, what are the five words that we hear most often? "'Well, here we go again,' or 'It will make no difference.' Often it's 'What's in it for me?' or 'I don't have the time.' Yet, we are all facing cost reductions and consolidations.

--Fortunately, there are usable assessment tools for managers, but these tools must be user-friendly. "To succeed, there must be participation at all levels, and this is not always easy to bring about. Our industry employs many women; some are single mothers with a limited amount of time. Frequently, there may be language or literacy barriers. Our industry demands service 24 hours a day, seven days a week. There has to be a strong incentive for improvement and management awareness of possible team member problems."

Do it Better Tomorrow
"Top Quality Management, TQM, was a by-word in the 1980s, and we joined that movement in 1990," Jonap interjects. "The foundation of our effort is based upon three areas of concern: Service to the customer; outcome, in terms of the patient and Cost to our organization.

--These three concerns uphold, in triangle formation, three important goals: Quality Planning, Quality Assessment and Quality Improvement. In each of these, attitude is all-important. It must encourage everyone to 'Do it better tomorrow.'" Lapham concurs; pointing out that the Morton Plant Mease mission is directed toward the values of trust, respect, dignity, responsibility and excellence.

--"These are considered in deciding where we want to be three-to-five years from now," she says, adding that, "The vision is concerned with overall strategic directions as well as action steps toward continuing improvement. We have to find new ways of doing business. "We have customer needs and quality improvement goals as well as team goals and departmental goals that are set each year. In our process we call it Impact Care; all units, be they in the physical plant, pharmacy, nursing, therapy, rehabilitation - wherever - bear individual responsibility."

According to Jonap, the Morton Mease Plant Health Care system's organizational assessment tools lean heavily upon a variety of surveys. "We have a survey which treats the patient as a customer. Another survey treats the physician as a customer using our health care facility. We have a survey that regards our own team members as customers, as well as an internal survey indicating the degrees of cooperation between various departments.
We also consider assessments at the team level, assessments developed by the team for the team.

--"For example, at the patient level, we learned that, contrary to what one might assume, food is not a major concern. It's the quality of nursing care that always comes in first or second. Pain or medication management is also likely to be in the top five patient concerns. We conduct a random telephone survey of recovering patients quarterly, and it's important that team members know the results." Jonap goes on to report that in the physician-as-customer surveys, communication with management is most often number one.

--"Unless they are at the hospital everyday, physicians are likely to feel out of the management 'loop.' Other physician concerns involve new technologies, the environment and, of course, income figures." When it comes to the team-as-customer survey, Jonap says that communication also rates high. Of highest concern are benefit packages, while other team problems focus on being overworked, underpaid or shorthanded.

--Factors also involve senior management visibility, education and training possibilities, including the need for appropriate skills. Improved communication also rates high on the internal survey between departments. Picking up on survey issues and the importance of constant review, Lapham again aims at the process of change.

--"We were taught that we, the nurses, doctors or hospital staff members, know what's best for the patient. But there's been a shift in this thinking. Waking a patient for a bath at 5 a.m. may be the easiest for us, but it will not necessarily please the patient. Identifying customers and their needs helps to identify the key processes. We're inclined to say, 'Put yourself in the patients' shoes.'"

-- She cites other survey findings: patients being unable to sleep because of hallway noise, or medical staff members who question the length of time before receiving reports. "Teams are often afraid of what these surveys may reveal," Lapham continues, "but the answers in these surveys help to establish indicators and determine baselines.

--From them, goals for improvement can be set. This is how an impact care plan can be developed. "We suggest that teams begin with only three to five goals, and our philosophy is not to sacrifice any one of the foundation points - service, outcome and cost - at the expense of another." Jonap recalls that after 1991 it took another five or six years of fine-tuning, with goals measured on a quarterly basis, before the assessment process really took hold. "It's vital that it be understood that what we are measuring are our errors," he emphasizes. We don't conduct the surveys to learn how good we are, but to find out how we might be better. Looking for problems is what improvement is all about.

--"By looking at the negatives, the smaller percentage in nearly all cases, we can try to reduce that figure even further. However, it's vital that we receive truly honest numbers." Jonap also warns against ever using these numbers as a measuring stick. "If we want honest reporting, we must not penalize negative results." He also advises against setting the team goals too low. "Stretching to achieve goals leads to greater satisfaction as the goal grows closer."

Communicate to Eliminate Errors and Provide Rewards
According to Jonap and Lapham, communication plays a major role in performance appraisal at Morton Plant Mease Health Care. Monthly staff meetings offer opportunities to speak with team members, and the plan involves senior managers as well. Discussing goals and reviewing steps toward improvement is a continuing education and training process, they say.

--As an example, Lapham cites the manner in which surveys have helped the airline industry. "Airlines urge their customers to report any dissatisfaction with the service. The result - improvements. However, health care involves such a multitude of responsibilities that it's difficult to track the errors. Sometimes, a mere misunderstanding of an order may be responsible for an error in judgment. Still, it needs to be reported and discussed.

-- Errors cannot be allowed to snowball. We have to 'walk the talk' for honest reporting." Both Lapham and Jonap stress the importance of rewards and recognition for successful team assessment. "For a team award, we say that every team member must have participated in the effort and that participation should include at least two documented improvements having been achieved." What are the rewards?

--According to Lapham, they may vary widely. "Some firms give the winning team members boxes of Cracker Jacks in recognition of a Cracker Jack effort. More appropriate to our industry are rolls of Lifesavers. Movie passes or coupons are popular awards. One of the most meaningful can be a simple 'Thank You' from a respected supervisor."

--Other possibilities include Quality Kudos certificates or, if there is an internal newsletter, a write-up featuring the improvement. Recognizing the team members may not only be rewarding for them, but may have an exemplary effect throughout the system, as well. In summary, Stuart Jonap reports that the Morton Plant Mease Health Care system currently has 95 quality improvement corporate goals and eight strategic directions under consideration.

--"For us, putting impact care into action requires having involved the team in action planning, having accurately measured the changes and then celebrating the improvement."

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