Key Tactics to Build Stronger Teamwork

By Jessy Thomas, PharmD
July 17, 2018

Every member of a patient-care team has a vital role to play, but individual perspectives can interfere with that mission. Here are some recommendations for leaders from a voice on the front line. 

According to a 2013 industry survey, more than half (54 percent) of health care executives place patient experience and satisfaction in their top three priorities — unsurprising, given that patient satisfaction is tied to a hospital’s finances. Since the introduction of the Hospital Consumer Assessment of Healthcare Providers and Systems Survey, in which patients rate their hospital stays, improving the patient experience has been a serious focus for many hospitals. As documented in a 2011 Press Ganey Pulse Report, hospitals with the highest HCAHPS scores were, on average, the most profitable.

Because patients now have more control over the potential revenue flowing from Medicare and other payers into hospitals, health care executives have been exploring various strategies and tactics to improve their patients’ experiences and boost their hospitals’ bottom lines.

For an interprofessional medical team at a hospital or a similar organization, a frequent tension point involves pharmacists and nurses. Leaders must find ways to bring all perspectives together for the good of the patient and the organization itself.

A growing body of research points to a link between front-line staff members who actively engage with patients and deliver care, such as nurses and physicians, and the impact they have on patient satisfaction. The clear correlation between staff satisfaction and patient satisfaction has resulted in hospital executives and leaders placing a more concentrated effort on employee engagement.

Improving interprofessional relationships within a hospital or other health care organization to promote a positive working culture for staff and patients is a sensible place to start in this effort.

One relationship leaders can focus on is that of the pharmacy and nursing departments, where tension and frustration between the two disciplines — commonly cited through internal feedback — can have a negative effect on the patient experience.

Individual Viewpoints

One of the biggest causes of conflict between these two professional disciplines revolves around the production, management and delivery of medication to the patient.

Nurses often deal directly with patients suffering from serious pain or urgent medical needs requiring immediate treatment. It is often the nurse who must manage patients’ expectations and try to keep them calm until medication arrives; any delay can exacerbate an already-stressful situation. Pharmacists sometimes are located away from the “action” within a hospital setting, which can increase the frustration of nurses (and sometimes physicians) as well as any belief that pharmacists don’t understand a patient’s pain level and thus don’t respond urgently enough.

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From a pharmacist’s perspective, there often is a lack of understanding by other members of the clinical team about how long a drug might take to prepare. For example, certain compounds must rest for a specified time before being administered, for reasons of either patient safety or quality assurance. Many health care professionals can relate to this scenario, and while both disciplines are aligned in their goals of delivering quality care to the patient, a breakdown in communication or a delay in medication reaching a patient can have serious ramifications outside of an individual staff member’s frustration. Such a set of circumstances could lead to medication errors or delays in treatment that all could result in a serious adverse patient event.

Some Proposals

To help alleviate some of the interprofessional tension that can arise — not just between nurses and pharmacists, but among broader medical and hospital teams — here are five strategies that leaders might consider implementing to not only help improve staff satisfaction, but also ensure the quality of patient care:

Decentralize operations. According to a recent survey by the American Society of Health-System Pharmacists, most U.S. hospitals use a traditional pharmacy setup, in which the pharmacy (often in a remote location) receives a medication order, processes it, fills it and sends it to the nursing unit. Because the pharmacist isn’t interacting directly with patients, it reinforces a common notion for nurses and physicians — that pharmacists don’t appreciate the urgency of a situation.

Some industry research suggests this arrangement is present in up to 80 percent of U.S. hospitals, but industry literature notes a trend toward a decentralized model. Having a designated pharmacist on the floor not only improves patient outcomes and minimizes medication delays, but also strengthens the relationship among physicians, nurses and other members of the medical team. Being physically present helps pharmacists identify priority cases, ensure medication is dosed and dispensed quickly, accurately and efficiently, and respond to questions or find resolutions to issues immediately. (The pharmacy itself must remain fully staffed.)

Floors that benefit the most from a designated pharmacist usually are the neonatal intensive care unit, pediatric intensive care unit, oncology and cardiology. Having a pharmacist in the emergency department also can be helpful, given the higher acuity of patients. Pharmacists can take medical histories directly from the patient, and, given the sense of urgency, can help improve response time for medication delivery.

Host multidiscipline meetings. To help promote a collaborative, team-oriented environment, set regular meetings on the floors and invite more than one discipline to join, whether it is during the morning bed meeting or at another time that better suits the hospital’s routine. Having nurses, pharmacists, physicians, lab technicians and other members of the health care team all in one meeting can allow staff members to troubleshoot issues and listen to updates on staff resourcing or repeat concerns.

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Such meetings might also serve as an opportunity to conduct brief staff training and educational sessions, which also can improve employee satisfaction and ultimately benefit the patient.

Communicate constantly. Much of the friction among colleagues stems from poor communication. Between pharmacists and nurses, this is especially true for medication preparation and delivery. From a nurse’s perspective, medications are not delivered fast enough. From a pharmacist’s perspective, certain medications need more time to prepare. Leaders from all areas of the health care setting should encourage staff to keep an open dialogue, discuss issues face to face, and find resolutions together instead of letting issues fester.

Part of improving open communication is taking a minute to understand a colleague’s stressors. Each medical and clinical professional in any health care setting has a different, but vital, role in a patient’s overall experience. And each also faces unique daily challenges. Taking the time to listen and appreciate a colleague’s challenges can go a long way in building respectful and solid relationships across the team.

Investigate technological solutions. Introducing new systems or processes that address instances of miscommunication throughout the organization can help maintain strong interprofessional relationships. Using the example of medication management, technology can track an event from order to administration, allowing nurses and other medical staff to see in real time where a drug is in the process.

Knowing exactly where a medication is can alleviate anxiety and eliminates uncertainty — as well as the need for multiple calls to a pharmacist to check the progress of the drug, which can, itself, cause inefficiencies and interruptions, and compound delays.

YOUR TURN

Even though team-based care is a way of life for many health care organizations, it doesn’t guarantee good interprofessional relationships. What efforts have you or your organization made to help your patient-care teams work cohesively? Has the process been more difficult than you initially figured? Easier?

Share your thoughts with your fellow physician leaders. We welcome letters, commentaries and researched manuscripts on this and other health care leadership topics. To send a letter for publication, or to request a copy of our manuscript guidelines, email us at journal@physicianleaders.org.

Seek feedback. Regularly survey team members to determine how others and their departments are performing. To extend the medication management example, leaders should ask nurses to rate pharmacists and the department on how effectively the team responds to nursing/patient needs, whether medications are delivered in a timely manner, and how well the pharmacy provides expertise to nurses when there is a difficult problem to be solved. Findings can ensure the team is providing adequate support and optimal patient care.

This is an important exercise and one that can help identify processes that need improvement or streamlining, ensure high-quality regulatory compliance and safety are met, and allow staff members to work together as a unified team. By encouraging the pharmacy department to shift its focus to be more service-oriented, nurses and other hospital staff members are more likely to have the resources needed to provide the best patient experience— for potentially higher patient satisfaction scores and increased reimbursement.

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These strategies can put your organization on the path to a more positive and collaborative culture and working environment, ensuring that staff members are more satisfied and ultimately improving the patient experience and securing the profitably of the organization.

While the nursing and pharmacy staff relationship is an important one to nurture, a hospital always will be more successful when its entire staff works together. A positive culture and patient-centered values start from the top; all health care leaders have a responsibility to regularly demonstrate, promote and communicate a multidisciplinary, collaborative team culture, reinforcing that each department plays a critical role in the overall health of the patients and hospital performance.

Inevitably, things don’t always go according to plan in an interprofessional environment, but the nature of how staff members and teams respond to each other to rectify issues is critical to maintaining a positive working environment. It also creates a happier workplace and improves overall patient care and satisfaction.

Jessy Thomas, PharmD, is pharmacy director for Texas-based CompleteRx, one of the nation’s leading pharmacy management companies. She also has been pharmacy director for Driscoll Children’s Hospital in Corpus Christi, Texas, since 2013.

Topics: Leadership Journal

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