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Mayo Clinic focuses on staff to improve service
Is it possible to have happy patients but unhappy employees? Administrators at the Mayo Clinic in Rochester, MN, don’t think so. That’s why employee satisfaction became the focus of a special project to improve service at the Mayo Clinic’s division of general thoracic surgery.
By addressing everything from workload concerns to the physician-nurse relationship, the general thoracic surgery unit at St. Mary’s Hospital improved morale as employee satisfaction soared. Patient satisfaction rose with it to an astounding 100% excellent rating.
"Service, from the patient’s and family’s eyes, is all the things that happen when someone talks to them, someone helps them. It’s a thousand things a day," says Victor Trastek, MD, former chairman of the division of general thoracic surgery in Rochester, who is now chairman of the department of surgery at the Mayo Clinic in Scottsdale, MN. "[We felt that] if the staff were well-supported and worked together well, they would have a better chance of providing service."
The project began in 1997 when the general thoracic surgery unit at St. Mary’s Hospital set up a quality improvement (QI) team, then joined a collaborative with the Institute for Healthcare Improvement in Boston to improve service. Their aim: "To significantly improve the delight’ of both employees and patients on Francis 5C."
"If you don’t have employees who feel they’re valued, that their work is worthwhile, it doesn’t matter how many processes you refine and perfect, it’s still not going to be the best service to your patients," explains Stephanie Sveen, RN, a staff nurse who is on the QI team.
The effort required a substantial commitment. More than a year after the project began, the team still meets two days a week for at least an hour. "We felt very strongly that this is a part of running our business," says Trastek. "Now it’s just part of my daily work. It’s just like going to the operating room."
First, the general thoracic surgery team (dubbed Francis 5C for the wing of the hospital) needed to know how employees felt about their jobs. Everyone who had patient contact received a survey: physicians, nurses, patient care assistants, housekeepers, and respiratory therapists.
The surveys asked employees to list both what they enjoy about their work and their frustrations, and answer other questions such as how much independence they felt they had to make decisions for the patient’s well-being. They also rated their overall satisfaction with their jobs.
The survey had a response rate of about 50% to 60%. Overall, employees gave the unit a score of 68 out of 100. "When this initiative started, the staff saw this as a flavor-of-the-month type of thing," says Sveen. "They didn’t trust that we were going to make any huge changes. There was a reluctance to participate."
Still, the response allowed the team to identify five major areas: workload, relationship building, communication and information, recognition, and physical comfort/environment. The team began to brainstorm about those areas and showed that they were willing to attack even hard problems by conducting rapid QI cycles.
Team tackled workload worries
After about two months, a group of nurses came into one of the team meetings with a concern. The floor had been renovated, and new monitoring equipment allowed the integration of both general care and intermediate care (sicker) patients. The unit cares for lung and esophageal patients, including a large percentage of lung cancer patients.
The nurses complained that staffing was inadequate to deal with the greater needs of some patients and still provide the emotional caregiving they felt was a vital part of their jobs.
While workload is a tough issue, "it was clear that the group had to deal with it, because that’s what we said we will do," says Trastek. The QI team, which included the nursing manager, increased the nurse-per-patient ratio, even though it meant the unit would be over budget. After the staff became more accustomed to the new patient mix, the unit was able to regain a staffing level that was within budget.
That swift response brought the QI team a new sense of respect. "It solved the staffing problem immediately, and they got a tremendous buy-in from the nursing group," says Trastek.
The Francis 5C team also addressed the difficult issue of relationships with a "gap analysis." Nurses complained that they didn’t feel valued by the surgeons, and the team wanted to know where the communication breakdowns occurred.
They surveyed a sample of 20 nurses with a questionnaire that asked nurses to circle the names of the five surgeons who: "listen to your concerns about patient care," "value your contributions to patient care," "expressed their appreciation of what you do for their patients," and "have made progress in developing good rapport with FR5C nursing staff."
The surgeons received a similar questionnaire, with a yes-no version of the questions, such as, "Do you listen to the nurse who expresses concerns about your patient?" They were taken aback when they received their results. "The surgeons thought they were doing wonderfully when, in fact, there were significant gaps," says Sveen.
The issue was a touchy one, but the effort paid off. Within a week of the surveys, the nurses said they could tell a difference in how surgeons responded to them. Surgeons were more likely to express appreciation for a job well done, and nurses felt like a valued part of the team, Sveen says. "We’re the eyes and the ears for those doctors. We’re the ones who spend so many hours with the patients. They trust what we’re telling them, and they’re listening more. It gets to the point where they actually ask for our input. In the past, we were basically not acknowledged at all."
The team repeated the gap analysis between nurses and nursing assistants, the nurse manager and nurses, and nurses and physician assistants.
The team took other steps to improve communication. It placed a white board in each patient room with a dry erase marker. That became a tool for sharing information among the patient, family, doctors, and nurses. Physicians and nurses would write critical lab values and reminders, and patients could write questions. The staff and physicians also now have special forms to jot a note or comment to each other. And the team began a Francis 5C newsletter with employee information.
After the team’s actions, the employee satisfaction rating rose as high as 84 out of 100, and 100% of patients gave Francis 5C a rating of excellent.
Other units at Mayo are now looking at the Francis 5C model. And the team continues to meet and address both staff and service issues. "Instead of wondering what they can do about it, [employees] have a place they can go with concerns and issues," says Sveen. "We can’t promise to solve everybody’s problem, but we’re working in the right direction."