From chaos to teamwork: Revamping was difficult

Efforts beginning to pay off

The massive reorganization effort at Memorial Hospital in Gulfport, MS, was physically and emotionally exhausting, but Karen Clarke, RN, MSN, rehab division manager, wouldn’t hesitate to do it again.

In the months after the reorganization plan was unveiled, a number of staff resigned, including the director of rehabilitation, the director of speech and language pathology, and the director of occupational therapy.

"When we started talking of breaking up the therapy departments and putting therapists on a team with nursing, the staff thought it was blasphemy," Clarke recalls.

Now, a year after the departments were abolished, the therapists and nurses work closely together. They seem to relate to the team first and discipline-specific issues second, she adds.

"The premise we had to repeat throughout the process was ‘patient first, discipline second.’ It was the most difficult process I’ve been through," Clarke says.

The departure of seasoned staff was also an opportunity for younger therapists who now have a chance to shine and are happy with their new roles, Clarke adds.

Each week, the staff from the day and night shifts hold a "team huddle" and talk about what is going on with the patients. Communication has increased between the disciplines and nursing.

"Our philosophy is to recognize that there are going to be problems, and we have to relate to them. We are an organism, and the strength of an organism is pulling everybody together, not the individual pieces," Clarke says.

Since the reorganization was implemented, outcomes have actually improved and the rehab unit received its second three-year CARF accreditation.

The average daily census was 10 in the inpatient rehab unit. It has now jumped to 15.7 on a 20-bed unit.

Clarke attributes the changes to listening to their potential customers and changing the way things were done to accommodate their wishes. For instance, the admissions process was changed to become more user-friendly to physicians. Now patients can be pre-screened seven days a week, 12 hours a day. The hospital admits patients five days a week and is working toward seven-day-a-week admissions.