From chaos to teamwork: Revamp was difficult

Efforts beginning to pay off

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

In the months after 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. The hospital still has not filled all the full-time physical therapy vacancies and is using temporary staff.

"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 says.

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

The departure of seasoned staff also gave younger therapists a chance to shine, and they are happy with their new roles, she adds.

Each week, 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.

In the year since the reorganization was implemented, outcomes have improved, and the rehab unit received its second three-year accreditation from CARF...The Rehabilitation Accreditation Commission. The average daily census was 10 in the inpatient rehab unit. It now has jumped to 15.7 on a 20-bed unit.

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