Take an IOP process and chart it

Rockingham VNA and Hospice in Exeter, NH, has an Improving Organizational Performance (IOP) committee that formed a special interdisciplinary communication team for the purpose of improving communication between the staff. Before the team could come up with suggestions for improvement, a process it still is working on, team members made this chart that outlines all of the communication problems that could be addressed:

Modes of Communication

I. Voicemail (VMX)

1. No communication standards.

2. Lack of communication between office staff and field staff.

3. Lack of communication between per visit staff and field staff.

4. Too much stuff.

5. Too many VMX messages.

6. Too many VMX boxes to access to communicate one fact to staff needing information.

7. Patients need to speak to a real person.

8. Better orientation of new staff.

9. Staff on too many general VMX boxes.

II. Case Conferences

1. Not enough.

2. Question outcomes/use of case conferences.

3. Lack of input from everyone involved in case — the actual care providers.

4. Communication standards — format for case conferences.

5. Timeliness of case conferences.

• start on time

• stay within time allotted

• timeliness relevant to issues involved

6. Site of case conferences — inconvenient for staff.

III. Document Communications/Clinical Link Communication

1. Communication standards/consistency.

2. Too much stuff.

3. QA updates or changes to the system are not communicated to staff before implementation.

4. New staff orientation.

IV. Beepers/Cell Phones

1. Safety communication was good.

2. Beeped too frequently, i.e., same message paged out twice within a few minutes.

3. Question increased use of cell phones for safety and timeliness.

V. Telephone

1. Frustration of staff calling in to get through to the asked-for person.

2. Office staff not available due to meetings.

3. Patients need to speak to a real person

VI. Staff-to-Staff Communication

1. More communication about discharge (D/C) dates, times, status — prior to D/C to all providers and departments.

2. Communication about changes in plan of care.

3. Written/verbal communication for all disciplines needs improvement.

4. Accountability of all disciplines to communicate needed information.

5. Don’t use document communication enough; therefore, there is no copy concerning communication that occurred.

6. Referring discipline needs to explain to patient the role of an added discipline.

7. Referring discipline needs to give specific informa- tion to added discipline about patient care needs.

8. More direct communication between staff about patient needs/issues — no middle person; i.e., ask- ing secretary to give messages to other disciplines.

9. Need for ongoing documentation by referring discipline about continued need for MSW.

VII. Staff Meetings

1. Review team meetings.

2. Meeting times change — no communication.

VIII. General Issues

1. Rate of speed (or lack of) that changes are communicated.

2. Lack of general plan.

3. Inconsistent expectations.

4. Labor "intensiveness" of communication.

5. Uniform way to communicate (standards, consistency).

6. Lack of communication between office and field staff.

7. "Detachment" feeling of field staff.

8. Time to communicate.

9. Lack of follow-up to communication.