New staff and a team approach boost morale

Patient satisfaction numbers also climb higher

New staff physicians, a reduced workload, and a team approach to department endeavors have not only improved morale in the ED at Samaritan Hospital in Troy, NY, but they also boosted patient satisfaction scores from between the 70th and 80th percentiles into the 90s.

The new physician contract started three years ago, says Orion Colfer, MD, FACEP, medical director of emergency services and a member of Emergency Medicine Physicians, an emergency physician partnership group based in Canton, OH. "Many members of the previous group stayed with us through the transition, but over the last three years, most have left for a variety of reasons," he says.

Thus, he says, he faced the dual challenges of hiring physicians to fill the staff and building an ED team. "The nursing and support staff were really a strong and cohesive team already and survived the transition," Colfer recalls. "I spent two years recruiting aggressively and added seven full-time physicians over the last 2½ years." This, he says, transformed the ED from a department that had too few doctors to one that has "more than enough."

The department sees about 40,000 patients a year, reports Colfer. "We went from six doctors working 200 hours each to 11 working 120 hours each, which eliminated what was a completely overstressed working environment," he says. "We found that we became much nicer people to work with and be around, while at the same time adding efficiency to the department."

Judy Quinn, RN, the ED nursing director, agrees. "We've been doing employee opinion surveys for seven or eight years; and historically, we've had high scores, but each time we've done them [since Colfer arrived], it has improved," she says. The department scores "above four" on a scale of one to five, Quinn reports.

Teamwork pays

Since there already was "a cohesive nurse team with little turnover" when Colfer arrived, Quinn wanted to increase the Press Ganey patient satisfaction scores. "I had done all I could do with the nurses, but I needed someone to work with the physicians," she says.

The team approach "took off very quickly with the infusion of [new physicians] and Orion's philosophy," Quinn notes.

Colfer has taken an aggressive approach to creating a unified team front. "For example, whenever we added a doctor to our group, we had catered events at our homes, to which 15 or 20 nurses were invited," he says. The purpose of the invitations was "to tear down doctor/nurse barriers and make the ED staff a team," he says.

This approach dovetailed nicely with what Quinn already had been doing with the nursing staff. "You need to value the people who work for you," says Quinn, who has been in the department for 19 years. "For example, we give them time off when there is something special they need to do with their family," she says. While Quinn doesn't personally handle the scheduling, "I have created an environment in which people are not made to feel bad about [asking for time off] or feel pressured to find their own coverage," she says. The result of this approach "is that when I need to fill sick call, there is no problem, because the nurses know I will be there when they need me," Quinn says.

Creating this type of environment takes time, she emphasizes. "It's not a 'light-switch' event," she says. "It takes a couple of years."

Creating a cohesive team also pays off when new initiatives are implemented, says Colfer. "We are in the ninth day of an entirely new patient evaluation process, Physician in Triage [PIT]," he notes. "I have been extraordinarily blown away by how the group has come together."

Like Quinn, Colfer notes this is an attitude that takes time to develop. "I couldn't imagine trying to do this at the beginning of the process — before we developed a relationship of trusting each other," he says. [Editor's note: Do you have an idea for boosting staff morale that you'd like to share? Contact Steve Lewis, editor at (770) 442-9805 or via e-mail:]


For more information on creating teamwork in your ED staff, contact:

  • Orion Colfer, MD, FACEP, Medical Director of Emergency Services; Judy Quinn, RN, Emergency Department Nursing Director, Samaritan Hospital, 2215 Burdett Ave., Troy, NY 12180. Phone: (618) 271-5045.