Flash of inspiration becomes burst of change
Flash of inspiration becomes burst of change
Brainstorming session stresses immediate results
At Columbia Rosewood Medical Center in Houston, managers have learned the art of listening. They let their staff do the talking, the decision making, and the problem solving.
Administrators have engendered such staff empowerment and accountability with the help of a process called the Osborn-Parnes Creative Problem Solving Model. The process is a six-step brainstorming session that lasts about 30 minutes and results in an improvement plan that can be acted on immediately. The managers guide the group but let the staff come up with the solutions, which facilitates teamwork and buy-in.
"It’s a learning experience as far as keeping quiet," explains Connie Esposito, vice president of operations at the 231-bed hospital. "We can’t provide a solution to the problem. You have to be patient and let them come up with the solutions."
Rosewood has used the system for about four months and has already implemented a dozen ideas that boost efficiency and please patients and staff on the medicine unit of the hospital. (See related story, p. 67.) They plan to expand the program to all units of the hospital.
"You can use this process for anything. It’s a universal problem-solver," says Duke Rohe, a health care consultant with Holland & Davis, Inc. in Houston, who introduced the process to Rosewood.
Here Rohe shares the system with the readers of Patient-Focused Care:
To begin, you need a team composed of eight to 10 people who are affected by the problem and its solution, including nurses, doctors, aides, and administrators.
"You really don’t want more than 10," Rohe warns. "You would think that with more, there would mean more creativity. Rather, if the group is too large, it’s too quiet. People get intimidated."
At Rosewood, the day shift on one unit has eight members on the team, and the evening shift has four.
The session is run by a facilitator, typically a key hospital leader at first. But as the team grows comfortable with the process, Rohe encourages other team members to be designated facilitators, while the manager or administrator provides background support.
To prevent wasting time, everyone should have researched the issue of discussion before the session begins, Rohe adds.
The half hour session consists of six phases, each broken down into two sections. In the first section, the group writes down every idea, no matter how absurd. In the second phase, the group reviews each idea and chooses the best.
"Volume is important," Rohe says. "The faster they go, the more likely they’ll come up with beneficial, unique ideas."
The facilitator’s job is to notice when creative juices are running low and shut down that phase and move on to the next phase.
In addition to generating solutions, the task of narrowing choices down to two becomes a team building exercise, Rohe says.
The six phases and their respective goals are:
• Objective Finding: Single out one problem or goal.
• Fact Finding: Gather data and information to better understand the objective.
• Problem Finding: Identify the problem and its underlying problems. Note how the problem can be turned into an opportunity.
• Idea Finding: Brainstorm possible solutions.
• Solution Finding: Choose most viable solutions.
• Acceptance Finding: Design an action plan. Identify resources and actions that will support implementation of the solution. Identify barriers to implementation and ways to minimize them, such as reducing staff resistance to change.
During brainstorming, the group should write ideas on Post-it notes (Rohe prefers the 3 x 5 size) which the facilitator slaps on the wall for everyone to see.
"When one person is trying to write down all the ideas as people shout them out, you get a delay, and it slows down creative processes," Rohe says. "Here you have eight to 10 people all writing down ideas at the same time."
To send the message that the exercise should be fun, Rohe suggests using crayons for writing.
Malene Farrell, RN, director of medical nursing services, who has facilitated these sessions, advises beginning with simple problems, then as the team grows comfortable with the process and each other, tackle more complicated issues.
At the end of the session, the group takes its action plan and presents it to the others who must accept it, such as the evening shift on the unit. The process continues until both sides like it.
"Acceptance gets easier because each shift has something they want the others to adopt," Rohe says.
You can conduct these session as often as needed. At Rosewood, the teams meet once a week, but they expect to reduce the frequency to once a month as they progress.
Rohe says the system is a learning experience for both staff and managers. He says everyone learns the concept of team. The managers’ opinion is no more important than any other member of the team. The system keeps managers from making decisions, and the team learns how difficult it is for managers to make decisions while trying to please everybody.
What the managers do
Throughout the process, the manager is present but keeps a low profile. The key to success is a manager who can relinquish control to staff.
"As managers, we need to improve our skills in this area," Esposito says. "We can’t give out the answers. We just have to make sure the process continues."
Farrell says she gets the session moving by asking the group "What do you think?" when a problem or solution is brought to the table.
If she gets no response, she’ll throw out a suggestion to spark a debate.
"You keep saying OK come on guys. You can do it.’ You keep encouraging them," Farrell says.
Farrell says she had to learn to choose her words carefully when facilitating the session.
"It can’t look as if it’s my idea," she explains. "I’ll play devil’s advocate. I’ll ask, what if this happens? Sometimes I take it to extremes. But I try to be realistic. Be patient, and let them learn from mistakes."
The most important task of the manager occurs after the session. The manager must follow up with the team to make sure they are following through with their plan.
"You have to ask them how they are doing. Are they complying with changes?" Farrell says. "You don’t want it to drop."
Some staff or team members will feel threatened by the change. To reduce this threat, keep staff informed of the progress of action plans, and address their unique concerns. For example, Esposito says staff were skeptical at first, fearing a program to improve systems must result in staff cuts. Physicians, meanwhile, wanted to know whether the changes implemented were helping patients. To show staff systems improvement is not always driven by financial considerations and can help patients, she showed the staff that besides analyzing whether the changes reduced the budget, they also measured patient, physician, and staff satisfaction regarding the changes.
Esposito and Farrell both say the program is too new to determine its effectiveness. They are measuring the outcomes of several of their projects. Nevertheless, the two are optimistic.
"It’s only been a couple of months, but from the administration’s standpoint, we see hope," Esposito says. "Right now, from the manager’s standpoints, it’s more time-consuming than putting out fires. But in the long run, it will be better. We need to continue moving in this direction."
[For more information about the creative thinking model, contact Duke Rohe, Holland & Davis Inc., 3355 West Alabama, Suite 1050, Houston, TX 77098. Telephone: (713) 877-8130 or Connie Esposito, vice president of operations, Columbia Rosewood Medical Center, 9200 Westheimer, Houston, TX 77063. Telephone: (713) 780-7900.]
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