How Many $100 Bananas Does Your Organization Have?

By June Fabre

A hospital patient asks for a banana. The nurse calls the dietary manager, who says, “not without a doctor’s order.” After talking to two nearby managers who commiserate with her, the nurse mentions it to a senior VP passing through the unit. The senior VP intervenes and the patient, unhappy about the long wait, finally receives the banana. The cost of the banana exceeds $100. This wasted money, due to miscommunication and failure to integrate department systems, is an example of why medical care costs have escalated.

Similar situations occur in many healthcare facilities. Patients experience unnecessary delays, and nurses are forced to waste time and money because they are unable to satisfy patient needs. Nurses and other healthcare providers must constantly reassess situations due to rapid changes in census and patient acuity. They need quick and accurate action from others, but they often encounter obstacles and delays.

Suppose, instead of asking for a banana, the patient experienced an emergency. Delayed responses can harm patients. The National Patient Safety Foundation attributes the medical error crisis to an inability to overcome systems problems, exacerbated by the growing complexity in healthcare systems, which requires improved communication and cooperation among healthcare professionals.

Frontline healthcare providers – including call center triage nurses – need greater power, increased mutual respect, and adequate communication to overcome these systems problems. A lack of courtesy and respect can chip away at a practitioner’s sense of self, destroying his or her energy level and motivation. Organizations that provide supportive environments where staff can perform at their best attract and retain the best people excel. Positive relationships among healthcare professionals generate energy and raise productivity. Clinicians who can make decisions at the patient level save management time and increase patient satisfaction.

Whether you are a manager or a nurse, you can save money, improve patient satisfaction, and reduce medical errors by using the following tips:

Empower frontline staff to solve patient problems on the spot. Then, they must support them. When frontline staff hesitates to make the independent decisions related to critical thinking, it’s because they have been reprimanded for doing so in the past. They have learned to wait for specific directions from their managers rather than functioning as autonomous professionals fully capable of delivering high-quality, patient-centered care.

Since their experiences have taught them that waiting is safer than taking a stand, this ingrained habit is difficult to break. The best way to slowly change this habit is to build trust by giving your staff consistent support. Don’t let your chain of command become a ball and chain that keeps frontline staff from solving patient problems on the spot. When you empower direct-care staff, you save money, patients are more satisfied, and productivity increases.

Build trust. When your staff trusts each other, they save time and money because people who trust others can act quickly and decisively. How do you build trust? By respecting yourself and others. You build it by being a role model, by courteous communication, and by demonstrating sensitivity to the needs of others. Staff members pay attention when you seek them out and ask for their input. Then, they begin to trust you when you make consistent decisions according to what is right rather than what is easy.

Build a positive work environment. Organizations should provide environments where clinical staff can perform at their best attract and retain the best people. Long-term strategies, such as effective communication and staff-friendly cultures, enable organizations to achieve the best results. A positive culture promotes employees’ understanding of organizational values so that they can make the right clinical decisions. For example, a 2002 Harvard University study on a nurse’s role in patient safety found that there are three specific aspects of work environments that interfere with nursing outcomes:

  • Nurses have too little time to resolve the problems
  • They lack effective communication channels with people who can help
  • Nurses, as well as other frontline staff, have lower status relative to doctors and administrators

Insist that staff collaborate instead of compete. Everybody is able to accomplish more when departments work together. Good communication and collaboration save time and money and increase productivity. For instance, the ER staff repeatedly works with the lab, radiology, pharmacy, blood bank, the OR, and clinical units. If each of these interactions is a struggle, patient safety becomes compromised, and costs begin to soar.

Brainstorm about the opportunities that lie beyond the challenges. Dedicate a portion of your staff meetings to list current challenges. Then, talk about ways to transform these challenges into opportunities. For example, before the subacute industry was born, nurses and social workers were upset that some patients had no place to go after acute hospitalization. A few progressive thinkers created subacute facilities to fill this need. Now many hospitals also have subacute units, but they could have been the first ones had they paid attention to ideas presented by their frontline staff.

Communicate respectfully. Poor communication is one of the leading causes of serious medical errors. As the $100 banana illustrates, poor communication is also expensive. Healthcare organizations often use the SBAR model to improve communication. This model structures communication as follows: situation, background, assessment, and recommendations.

The intent was that the SBAR structured communication would improve communication, especially during crises. SBAR works well in positive work environments, but staff still finds ways to engage in power struggles in negative environments. For instance, a physician may say that a nurse’s background description is incomplete or have a different version of the situation assessment. Even good tools are rendered ineffective when staff manage to find new ways to sabotage one another in negative cultures.

Solve the root causes of problem. The previously mentioned Harvard study explored how nurses solved problems during their shifts. One of the researchers’ findings was that work environments prevented nurses from solving the root causes of any problems that they encountered.  This means that the best the frontline staff could do was create temporary fixes day after day. This wastes huge amounts of staff time, costing significant amounts of money. More importantly, unresolved root causes of problems may cause over 100,000 preventable patient deaths every year.

Smarter care-giving practices assist people in working together. Using conceptual communication and leadership approaches enables you to leverage scarce healthcare resources and to do more with less. The wisdom behind these strategies is that they blend healthcare knowledge with business expertise. Core values of providing smart care cost nothing; however, they are essential for patient safety and quality. More than helping to maximize the care-giving process, using these tips will address the bottom line for managers. The dollar difference between the present level of staff productivity and full professional capacity are the number of $100 bananas you can save.

June Fabre, MBA, RN-BC, is author of Smart Nursing: Nurse Retention and Patient Safety Improvement Strategies, and owner of Smart Healthcare LLC. She has worked as a clinical nurse, educator, and manager in many specialties such as medical surgical, psychiatry, home care, long-term care, ambulatory care, and managed care.

[From the October/November 2010 issue of AnswerStat magazine]