Forum Focus – Creating exceptional physician-nurse partnerships: Using collaborative partnerships to raise the standard of care and improve the overall patient experience

By Alan J. Conrad, MD, MMM, CPE, FACHE, Medical Director of Palomar Health (http://www.palomarhealth.org/) and Tracy Duberman, PhD, FACHE, CEO & Founder of The Leadership Development Group (www.tldgroupinc.com)

Introduction

To lead today, health care organizations require a fundamentally different approach to care giving, one that is patient-centric with a strong focus on the patient experience, quality and safety, clinical integration, care coordination and waste reduction. In order to be best positioned for the future of value-based care, health care organizations must develop their clinical (physician and nurse) leaders as partners in team-based care delivery. Leaders in health care must work under an interdependent, rather than an independent, leadership model.

To that end, physician and nurse leaders must work collaboratively with open communication and trust in order to achieve common goals. Successful partnerships work together to set goals, create operating and capital budget, implement initiatives, and oversee operating and clinical performance. The focus of the partnership is shared responsibility, and equal accountability. In our recent webinar, we shared a case study of a health care system that has successfully developed its clinical leaders toward effective partnership.

Palomar Health’s Approach

Palomar Health, a 3-hospital system based in San Diego, California, recognized the need to develop physician leaders as partners to meet system, operational and clinical performance goals. Prior to intervention, Palomar lacked formal physician leadership (CMO) on their senior management executive team, and lagged on HCAHPS scores. Palomar sought a partnership with The Leadership Development Group (TLD Group), a recognized leader in physician leadership development, to design and deliver their Academy for Applied Physician Leadership (AAPL) based on TLD Group’s Applied Physician Leadership Academy (APLA©), a multi-faceted physician leadership development program entirely customized to deliver high value and high impact to health care and life sciences clients. The customized physician leadership development model addresses the need for collaborative partnerships between physicians and nurses for enhanced patient satisfaction, engagement and outcomes. The program utilizes multiple learning strategies including 1:1 assessment and coaching, learning and application modules, and action learning projects.

A key component of Palomar Health’s AAPL was, a Partnership Activation Process, an action learning-based experiential learning platform to enable clinical partners to enhance their collaborative leadership skills while tackling issues on their unit. The process enabled partnerships to identify solutions to problems that provide immediate, measurable impact and organizational results. Participants were broken into Partnership Activation groups consisting of physicians and nurses from both inpatient hospital units and outpatient clinics. Groups were facilitated by an Action Learning Coach and were asked to pick a project that would impact their units in a positive way. Groups met on a monthly basis over a 4-month period to work on their projects.

Participants were led through a project planning approach where they identified the problem to be solved, considered potential obstacles or challenges to implementing a solution, formulated a vision of success and desired state to be achieved, and determined the best solutions and actions to achieve success. Projects included: enhancing the physician/nurse rounding process, expansion of acute rehabilitation services, improving the mother-baby discharge process, and several others. The Partnership Activation Process also included a peer coaching/action learning Model, which led participants through reflective listening, active questioning, challenging assumptions, and giving/receiving feedback while taking their projects from concept through to solution and implementation.

Results

Palomar Health’s AAPL program led to significant results that surpassed the desired goals. Press Ganey scores increased considerably. Overall physician ratings increased from the 30th to the 66th percentile, overall nursing ratings jumped from the 33rd to the 82nd percentile, and overall system ratings from 14th to 76th percentile. There was also an increase in HCAHPS scores for the question item entitled “My physician listens carefully to me” suggesting that patients recognized an improvement in physicians’ listening communication skills.

Participants of the AAPL program also developed learning competencies including an understanding of how their emotional intelligence impacts others, knowledge of their role as a clinical leader, identification of a clear purpose for their partnership relationship, and the ability to drive patient satisfaction and physician engagement.

Summary

Palomar Health’s customized Academy for Applied Physician Leadership was designed for physician leaders, nurse leaders, and administrators to drive alignment on the system’s goals, build leadership competencies, and facilitate a team-based approach to care giving. The Partnership Activation Process helped to strengthen trust, build relationships, and enhance communication between the physician and their nursing partner to establish collaborative partnerships which raise the standard of care and improve the overall patient experience.

To view the webinar, please visit http://www.ahaphysicianforum.org/webinar/2014/dyad-leadership/index.shtml.

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