Robert Wood Johnson Barnabas Health (RWJBarnabas Health) in New Jersey has been faced with the issue of staff shortage in the cardiovascular ICU (CVICU), which has led to poor communication and coordination among staff in the department. In healthcare environments, staff shortage is a significant issue as healthcare professionals work long hours to deal with high-stress levels in their departments, which can result in burnout. When such professionals are overstressed and overworked, they can miss important details or make medical errors, which can endanger patient safety and reduce the quality of care. Therefore, this problem requires interdisciplinary collaboration to improve coordination and communication in the healthcare organization to improve patient outcomes.
Objective
The proposal plan aims to test how the PDSA cycle could inform an interdisciplinary solution to address the staff shortage problem that has led to ineffective communication and coordination in the organization. The primary goal is to ensure interdisciplinary collaboration among teams in the department to boost communication and coordination, thus promoting patient safety and improving the quality of care. This objective aligns with the organization’s goal of fostering team-based care, and if the plan is successful, it should improve patient outcomes by enhancing communication and team collaboration whereas reducing the likelihood of medical errors.
Questions and Predictions
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How will the PDSA cycle help to address staff shortages in the CVICU department?
The PDSA model will likely address this problem by determining the specific issues that contribute to the problem, like the lack of qualified candidates, brainstorming possible solutions, and developing an action plan to implement selected solutions.
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How will the PDSA model inform an interdisciplinary solution to improve communication and coordination within the department?
The PDSA model can provide a structured approach to identify, test, and refine a potential solution to the problem causing poor communication and coordination. The model will possibly identify the issues contributing to poor communication and coordination, like inadequate team collaboration or staff shortage, identify a solution, and create an action plan that includes timelines, roles, and responsibilities, as well as outcome measures.
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Which resources are required for a successful implementation of the plan?
In order to successfully implement the plan, various resources such as time, human, and financial resources will likely be required. Adequate staffing is necessary to achieve the desired staff level, while financial resources may be required for implementing some solutions. Further, adequate time is necessary for planning, implementing, and evaluating solutions.
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What are the perceived benefits of a successful implementation of the plan?
If the plan is successfully implemented, it will probably result in various benefits like improved patient outcomes. If there is an improvement in communication and coordination, healthcare professionals can better work together, resulting in increased efficiency and enhanced collaboration.
Change Theories and Leadership Strategies
In order to address the staff shortage issue and communication and coordination problems, various things need to change. Leadership is vital in change implementation and creating buy-in from interdisciplinary teams. This issue requires the use of the PDSA change model, which is a quality improvement framework that guides the implementation process. The model provides an iterative and structured approach to managing change through four stages, plan, do, study, and act (Prybutok, 2018). In the context of RWJBarnabas Health, the planning stage involves the interdisciplinary team working together to determine the issue, establish goals, and develop a plan for change implementation. This stage is an opportunity for the team to share ideas and collaborate towards a shared vision and also develop a sense of ownership and buy-in for the change plan. In the “do” stage, which involves the actual implementation of change, the interdisciplinary team works collaboratively to carry out the plan and is also an opportunity to coordinate their efforts and address arising challenges that can inhibit change in CVICU department. During the study stage, the team evaluates the effectiveness of the plan by comparing results (during the staff shortage and after implementing an action plan) and determining areas of improvement. Furthermore, the act stage involves the interdisciplinary team taking action to polish and improve the plan. Involving the interdisciplinary team in this stage enhances collaboration, enabling the interdisciplinary team to create new strategies and implement improvements (McNicholas et al., 2019). Besides, this creates buy-in for ongoing project plan success.
Leaders in RWJBarnabas Health should adopt the situational leadership strategy by providing a flexible leadership style. Providing necessary guidance and support is essential in helping the interdisciplinary team to implement the plan successfully. This may include coaching and training team members like cardiologists, physicians, nurses, and staff from other departments. Situational leadership enables leaders to foster communication and collaboration by encouraging open communication, helping interdisciplinary teams work together, and developing a sense of shared responsibility and ownership for the plan (Belrhiti et al., 2018). Adapting leadership style to meet the needs of the interdisciplinary team can create buy-in to the plan. For example, some team members from other departments may be highly experienced, which requires the leader to take a delegating approach. Such experienced members can train less qualified nurses. Besides, a more directing approach can be adopted for the less experienced and qualified nurses from other departments in the organization.
Team Collaboration Strategy
For the change to work, health professionals from different departments need to be assigned roles and responsibilities. The CVICU department head will be responsible for overseeing the entire plan and ensuring successful implementation. There are three shifts in the department, each having nursing personnel in charge of other staff and supervising the particular shift patient care activities. The organization’s quality personnel are also tasked with assessing quality improvement (QI) initiatives and ensuring they improve patient outcomes at a sustainable budget. While not every health professional can participate in the project plan, the selected interdisciplinary team will also play a crucial role in training and coaching less experienced and trained staff to meet the needs of the CVICU department.
The interprofessional education (IPE) collaboration approach emphasizes the importance of training health professionals from diverse disciplines together to nurture team-based care and collaboration. IPE can help interdisciplinary teams in this organization to create common goals and values, which can enhance coordination and communication (Rosen et al., 2018). In RWJBarnabas Health, this approach can involve bringing together professionals from the pharmacy, nursing, social work, and medicine to learn and develop shared competencies in team-based care. While the CVICU department requires qualified nursing staff to address staff shortages, IPE can be achieved through observation, shadowing, and supervised interprofessional practice. The IPE approach is applicable in this facility as it promotes a culture of collaboration and enhances understanding of different roles and responsibilities in the CVICU department, resulting in effective teamwork and better patient outcomes.
The team strategies and tools to enhance performance and patient safety (TeamSTEPPS) is an approach is an evidence-based framework that integrates teamwork tools and principles to foster mutual support, effective communication, and situation monitoring in healthcare teams. TeamSTEPPS training helps interdisciplinary teams to practice using such tools to improve their performance. This may involve the use of standardized communication protocols like situation-background-assessment-recommendation (SBAR) to ensure vital information is effectively communicated and also use tools such as briefings and checklists to foster shared situational awareness (Rosen et al., 2018). By enhancing communication and collaboration among interdisciplinary teams, TeamSTEPPS aids in optimizing the use of available staff resources in the healthcare facility and promotes cross-training, delegation of tasks, and effective workload management. Therefore, RWJBarnabas Health can better utilize available health professionals and ensure patient care needs are effectively met even with staff shortages in the CVICU department.
Required Organizational Resources
Staff shortage is a severe problem at RWJBarnabas Health as it hinders effective communication and coordination, which can result in medical errors, hence jeopardizing patients’ safety. Since the organization has been constantly hiring, it has been challenging to get qualified staff to meet the staffing needs in the CVICU department. While an interdisciplinary solution is imminent, inadequate training is an issue that requires addressing. As a result, to proceed with plan implementation, human and financial resources such as staffing, training, and budgets should be considered. Besides, other resources like equipment and technological resources should also be addressed.
The staffing needs for RWJBarnabas Health entail additional healthcare professionals to increase staffing levels in CVICU and reduce workload. In addition, staff requires training and education to attain the qualifications needed for the department. Various supplies like training tools and educational materials for training staff from interdisciplinary teams, such as simulation labs, are needed. While this simulation center is available, it requires some upgrades for $50,000. Since interdisciplinary teams are responsible for training, there are no costs associated with education resources or payments to training staff. For nursing personnel experiencing stress and burnout, an employee assistance program will be made available at $50 per employee for one month (estimated ten employees). Technological solutions like the electronic health record (EHR) system can facilitate task delegation and communication, and since this is available, it only requires some modifications for $15,000. Furthermore, the facility will require additional digital communication tools like video conferencing software, costing $2,000. Access to patients and also their records and medical histories are required to assess their needs and ensure accurate and coordinated care. Also, access to departmental leadership ensures the changes are communicated and also to gain support for the plan proposal. Further, accessing technological systems like EHR and communication tools will facilitate coordination and communication among interdisciplinary teams. Overall, the estimated budget for the plan amount to $67,500.
In case the plan to address staff shortages and enhance communication and coordination in the organization is not undertaken or successful, it may result in various negative impacts on organizational resources. Due to heavy workload and burnout, staff may leave, leading to increased hiring and training costs to replace them. Besides, poor communication and coordination can lead to duplicate procedures, unnecessary testing, and other inefficiencies that increase costs. In the CVICU department, staff shortages can further result in delayed procedures, longer wait times, and patient dissatisfaction. With poor communication and coordination among available staff, the problem can escalate misdiagnoses and medical errors, which can harm patients and also increase the organization’s liability risks.
References
Belrhiti, Z., Nebot Giralt, A., & Marchal, B. (2018). Complex leadership in healthcare: A scoping review. International Journal of Health Policy and Management, 7(12), 1073–1084. https://doi.org/10.15171/ijhpm.2018.75
McNicholas, C., Lennox, L., Woodcock, T., Bell, D., & Reed, J. E. (2019). Evolving quality improvement support strategies to improve Plan-Do-Study-Act cycle fidelity: A retrospective mixed-methods study. BMJ Quality & Safety, 28(5), 356–365. https://doi.org/10.1136/bmjqs-2017-007605
Prybutok, G. L. (2018). Ninety to nothing: A PDSA quality improvement project. International Journal of Health Care Quality Assurance, 31(4), 361–372. https://doi.org/10.1108/IJHCQA-06-2017-0093
Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. The American Psychologist, 73(4), 433–450. https://doi.org/10.1037/amp0000298
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