Better Together

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Collaboration between nursing and support services brings big benefits.

With all the attention being focused on coordination of care in the healthcare reform debate, many hospitals are searching for the right prescription on their own. Some are finding that relatively simple communication and measurement techniques between nurses and support services can benefit both patient satisfaction and quality.

When Laura Caramanica was named senior vice president and chief nursing officer at Westchester (NY) Medical Center two years ago, nurses and support services workers solved problems as they came up. Among the hospital's 1,400 nurses, that led to a lot of head-scratching about who was responsible for what, from changing bed linens to cleaning diagnostic equipment. Those are simple tasks, but when roles are not clearly defined, the confusion over who's responsible for what can not only lead to costly delays in room readiness, but also can delay critical patient care and contribute to poor patient satisfaction scores. Besides that, misperceptions can lead to resentment between members of both staffs.

"They were solving problems as they came up, but there was not a proactive, systematic plan to put the services together," she says. Caramanica came from Hartford (CT) Hospital, which had implemented a lot of the communication guidelines for collaborative care developed by the American Organization of Nurse Executives and ARAMARK Healthcare and brought that experience with her. Along with her colleague, Damon deChamplain, Westchester's vice president of support services, she developed a bilateral solution to the challenge, including periodically surveying nurses and support services staff to determine where the logjams were and setting up a leadership committee structure with representatives from both disciplines to help figure out best practices.

The Joint Patient Care Leadership Committee now meets monthly to review seven guiding principles and keeps a balanced scorecard on several different collaborative activities.

"It's a great team, and they want to work together," she says, "but they were just used to doing things on their own. We know that's not the best thing for patients."

Now, the two groups work to make each other's lives easier and more productive. Representatives from both groups help develop better processes for such tasks as cleaning, setting room temperature, and making sure patients get tests on time.

"If we can make the nurse's life wonderful, then the patient has a wonderful experience and the data bears that out," says deChamplain.

Some things, such as patient safety, are everyone's responsibility, and the committee has helped ensure that support staff feels comfortable alerting nurses and others of potential patient safety or quality problems. Further, Caramanica and deChamplain make sure to model collaborative behavior for the employees to ensure that the program is not seen as "the initiative of the month."

"Laura and I round together," he says. "When you go in at 3 a.m. and visit the staff and bring them a snack or word of encouragement, it does so much for morale and they enjoy this kind of program."

Philip Betbeze

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