MANAGING OB RISK

Clinic Soa: culture in action The large-scale hospital setting has been an excellent proving ground for Fairview Southdales emphasis on a positive culture, but its a focus that can translate to the clinical setting, as well. Clinic Soa OB-GYN, PA, based in Edina, Minn., is an excellent example of a new model for practice. It was founded 14 years ago by Donna Block, M.D., who decided to ll what she saw as an existing need for a new type of clinic. Patients wanted an environment in which they did not feel rushed, where the staff and physicians seemed committed to them and where they could feel the healthiness of the organization, she says. In response, Dr. Block went back to school, earning an MBA from the University of St. Thomas and then opening the clinic, which is named for the goddess of womens wisdom. Debbie Schumacher, R.N., was there at the beginning, and the nurse manager has been instrumental in maintaining Clinic Soas healthy culture. Its evident from the moment someone walks through our door, Schumacher says.

are there, communicates at all levels, uses healthy behavior with each other and has a consistency of infrastructure, Block says. Huddle up The Clinic Soa team meets every Monday morning for what they call the huddle, with a goal of bringing all aspects of the clinic together front line, lab, providers, ultrasound, medical assistants and managers. We make announcements for the week, take the time to problem-solve processes and remind everyone of the standards for our team, says Block. She views the weekly sessions as a chance to emphasize that the most important person in the clinic is the patient who walks through our front door. Service recovery Even with an organizational focus on quality, its important to remember that services are delivered by human beings, and humans sometimes make mistakes. Even with the best of intentions, quality can slip or an error can occur. Block acknowledges, We occasionally trip. While we strive to do the best we can, when that doesnt happen, we regroup, go over the scenario, perform patient-employee recovery, get help and strive to go back to our mission for those inside and outside the organization. Pechacek elaborates on the impact of relationships and patient attitudes when it comes to service recovery. If the patient is experiencing you as not listening or not caring, they wont cut you any slack if

a mistake is made. Patients tend to be more litigious when they feel they arent listened to, but, on the ip side, they will feel loyalty to a caregiver who genuinely cares, she says.

How they do it
The high-performing cultures at Fairview Southdale Hospital and Clinic Soa are the product of a genuine commitment to new ways of working. Some of their practices include: Look inward: It all begins by taking a realistic look at your own behavior, says Fairview Southdale Hospitals Pechacek. Keep at it: Youre never nished with culture in the true spirit of continuous improvement, theres always room for improvement. Communicate, communicate, communicate: Clinic Soas regular Monday-morning huddles keep communication open among all areas of the clinic. Hire for the culture you want: The right team members can make all the difference. Debbie Schumacher, Clinic Soas nurse manager, often brings candidates back two or three times, and makes sure that other staff members have a chance to meet them before hiring decisions are made.

by Julie Kendrick There was a time when the word culture, used in a medical setting, could only refer to something growing in a Petri dish. But for many forward-thinking organizations, culture refers to the way teams and individuals work and relate to one another. A strong and positive culture can, in fact, be a key factor in reducing risk and increasing patient safety. How we treat each other directly impacts how patients experience care, says Judy Pechacek, R.N., DNP, CENP, vice president of care and chief of nursing at Fairview Southdale Hospital, a 390-bed licensed hospital based in Edina, Minn. If we have high-functioning teams, they will produce outstanding care, she adds. And for those who wonder what all the talk of culture really means, Pechacek has an easy answer: Its how things really get done in a workplace. Its the ground we walk on. To reach its goals for creating a strong culture, Pechaceks organization has been using a model called the
18 / Brink / Spring 2013

Healthy Environment Initiative (HEI). More than 80 percent of the organizations departments have completed the process. Its not charm school For all the positive impact that an improved culture can have on patient outcomes, there is one thing Pechacek is adamant about: This is not charm school. Its about xing issues that are underlying in the culture that trigger negative behaviors. Most people are good people who want to do well, but when the process fails a staff member isnt prepared, or theres miscommunication, for example then thats when the bad stuff happens, and someone gossips about a co-worker, throws a scalpel, or is passive-aggressive and wont return phone calls, she says. Pechacek is quick to point out that embracing this new kind of culture doesnt instantly transform every staff member into a saint. In our units, when harmful stuff

happens, people will say, We dont do that here. It helps when everyone uses a common language to address issues. MMICs perspective According to Laurie C. Drill-Mellum, M.D., MPH, chief medical ofcer at MMIC, Imperfect communication is a contributing factor or cause of loss in 80 percent of malpractice claims. As a provider of professional liability insurance, we know that its imperative to address this issue not only for our policyholders, but also for all of us who receive health care. We are committed to shining a light on this topic and providing resources such as TeamStepps. The good news is that with focused intention and commitment, there can be real improvement in measureable ways. Employee and patient experience metrics can improve, as can patient care and safety, Dr. Drill-Mellum says.

The physical space is calming, and the staff exhibits a genuine feeling of concern for each individual. The leadership connection On the operational side of things, Schumacher is quick to point to the importance of a caring leader, and she credits Block for setting an example that the staff strives to follow. She was the rst physician Id ever worked with who went so far above and beyond for her patients. She really listened to them, and that makes such a difference in the quality of care, she says. Block is clear on the importance of a healthy work environment. A team functions more effectively and accurately in an environment that has expectations, empowers everyone to be the best that they can be, understands the mission and why we

JULIE KENDRICK
Julie is a freelance writer in Minneapolis, Minn.
FOR INFORMATION ON PROGRAMS THAT CAN HELP TRANSFORM BEHAVIOR AND TEAMWORK IN YOUR WORKPLACE, PLEASE CONTACT LAURIE C. DRILL-MELLUM AT LAURIE.DRILL-MELLUM@MMICGROUP.COM.

Brink / Spring 2013 / 19