When competition for top talent is tight, it’s even more important to keep your current providers and staff happy, because the true cost of employee turnover is high – from recruiting costs to the loss of institutional knowledge.
At Sutter Delta Medical Center, where I’m the emergency department (ED) Medical Director, we’ve struggled with provider turnover. Our challenges stem in part from our somewhat remote geographic location; there are more centrally located hospitals in the San Francisco Bay Area that offer better compensation. And when it comes to recruiting top nurses, we compete with another hospital just down the road.
In today’s post, I’ll talk about how we addressed these challenges by focusing on our culture.
A Wake-Up Call
When a new Regional Director came on board, he began working a few shifts in the ED to get a sense of how things worked at Sutter Delta. During one of our monthly meetings, he asked for permission to speak frankly. He told us that we were very efficient in seeing our fairly high patient load, but that our culture left something to be desired. A 15-minute “culture” agenda item turned into a candid 90-minute discussion.
As physicians, we were a bit surprised to hear that feedback. We all got along fairly well with one another, but came to realize that our relationships with our physician assistants, nurse practitioners, and licensed vocational nurses needed some TLC.
We looked at what we could do to improve interactions among our providers and nursing staff. The biggest issue we identified was the need to stamp out negativity. We immediately rolled up our sleeves and got to work.
Be a Fountain, Not a Drain
As a department, our team embraced the old adage, "Praise in public, criticize in private." If staff or providers heard negative comments on the floor, they were empowered to remind their colleague to change the conversation or take it private.
One of my Assistant Medical Directors shared a wonderful story about a conversation she had with an EKG technician. The tech came to her for a signature on an EKG, rolling her eyes and saying, “I don’t even know why the PA ordered this. The patient doesn’t even have chest pain, and they’re young.”
The Assistant Director reminded her to watch the negativity, saying, "Let’s be a fountain, not a drain."
The EKG tech stormed off and came back about 20 minutes later. She said, "I thought about it, and it sounds silly when you say, 'Let’s be a fountain, not a drain,' but it’s really true. It starts with one person, and I shouldn't have said those things. I apologize, and I won't do it in the future."
Not a Quick Fix
Culture change doesn’t happen overnight. We’re making progress, but there is still room for improvement in eliminating negativity. From building our management team to hosting team-building events, we’ve tackled negativity from a variety of angles:
Strong site management team: Sutter Delta is fortunate to have experienced leadership from providers who have been here for a very long time. They know the history of the site and are dedicated to improving the culture. One of our Assistant Directors in particular has been instrumental in spearheading the majority of our culture initiatives.
Check your title at the door: We constantly reinforce the idea that everyone has ownership of the department, regardless of rank. It’s everyone’s workplace, and we need to work together to make it the best it can be. So, a phlebotomy tech should feel comfortable approaching a physician with a question, issue, or reminder to speak positively.
Delta Force events: Our nursing staff established "Delta Force" events, which are social gatherings and spirit days. We’ve gone bowling and met for drinks after work. At work, we’ve had crazy sock day, team jersey day, and Star Wars day. These events have helped build a strong sense of community in the department.
Shout-out board: The board is an opportunity to recognize someone for doing something great during a shift with a simple handwritten note. It’s nice to walk by the board and read some of the things your colleagues have done, whether it was placing a tough IV or saving a coding patient.
PA/NP Job Satisfaction Collaborative
Our culture work built upon a recent Vituity learning collaborative focused on PA/NP job satisfaction in which Sutter Delta participated. As one of seven sites in the collaborative, we explored best practices, assessed our strengths and weaknesses, and developed an action plan at a kick-off meeting. Over a period of six months, we worked with frontline providers to implement our plans.
By the conclusion of the collaborative, many teams had begun including the PA and NP leadership in meetings and key decisions. Having greater input into practice matters raised PA and NP morale and satisfaction. Several of the Medical Directors and Lead Advanced Providers also noticed that their department had experienced a cultural shift after they began working as one team.
Satisfied Patients, Providers, and Staff
During the same timeframe we focused on our culture, Sutter Delta also made improvements to our front-end process, including putting a physician in triage.
Our culture and operational initiatives combined have achieved impressive results:
- Time to provider averages 20 minutes.
- Turnaround time to discharge (TAT-D) decreased by 62 minutes over 2.5 years, from 189 to 127 (better than target).
- Turnaround time to admission (TAT-A) decreased by 112 minutes over 2.5 years, from 416 minutes to 304.
The real payoff has been better working relationships among providers and between providers and the nursing staff. And that makes for a better shift for everyone.
And the Award Goes to…
Despite our challenges, including a staffing shortage, encouraging positivity in the workplace has led to improvements in process, performance, and finance. Most importantly, it’s created a more unified staff.
And our work didn’t go unnoticed. Vituity awarded the Sutter Delta Medical Center ED the 2016 Practice of the Year for our commitment to improving the internal culture. Receiving the award was absolutely incredible and one of my most memorable experiences at Vituity.
I don’t think winning Site of the Year was ever on anyone’s mind. We knew we had made great strides with our culture but had no idea it would be recognized Vituity-wide. I am so proud of the work our team has done to improve our culture and flow metrics. All of our progress would not have been possible without the support and enthusiasm of our providers and staff.