The "silo effect" can be very damaging to a hospital system. It occurs when hospital staff members strictly focus on their function (e.g., social work, discharge planning, utilization management) and forget how their function influences other healthcare professionals. When this happens, communication between disciplines becomes very difficult.
When Grace Dotson, RN, MS, CMAC, CPUR, joined Greenville Hospital System (SC) as the director of outcomes management, the first matter she wanted to address was improving communication and eliminating the facility silos.
One example of the problem Dotson saw was that case managers spent their valuable time playing phone tag, waiting for e-mails, and searching the halls for coworkers. As a result, efficiency suffered. The average length of stay (LOS) at Greenville was high, and avoidable days were numerous.
Greenville needed a better system for communicating with staff members in other departments, so Dotson came up with a daily flash rounds meeting.
Not your typical meeting
The daily flash rounds meeting structure is simple: There is no structure. Dotson feels that the informal nature of the meeting makes it more likely people will attend and also makes the meeting quicker.
Keeping with the informal attitude, Dotson tells staff members to come to the meeting "with their sense of humor and their census."
Staff members who can attend include some of the following:
- Utilization nurses
- Case managers
- Social workers
- Well Vista (a medication assistance program for the indigent population)
- Business office employees
- Physicians (particularly hospitalists)
The meeting is early—10:30 a.m.—and quick, only lasting 15 minutes. "I like to compare it to speed dating," Dotson says.
Once in the meeting, attendees are free to roam around the room and mingle. They typically make small talk before asking for information about one of their patients. After a case manager tells a utilization nurse about a potential discharge, he or she can head over to the Well Vista staff member to talk about that patient's medications.
The casual atmosphere has also made it easy for new staff members to get to know colleagues. This face-to-face contact has now been incorporated into everyone's daily work flow at Greenville, and people enjoy it, Dotson says.
As a direct result of the flash rounds, Greenville has:
- Met its goal for reducing LOS
- Increased the number of patients referred to the Well Vista program by 50%
- Improved timely delivery of the Important Message from Medicare
Tips to implement flash rounds
Initially staff members were not excited about the idea of another meeting. However, they now believe the 15 minutes spent at flash rounds have saved time overall.
If you choose to implement a flash rounds meeting at your facility, consider these tips for combating staff resistance:
- Excuse: I can't attend because I don't have time.
Response: Everyone can spare 15 minutes out of their workday, hence the 'flash' title for these rounds.
- Excuse: 10:30 a.m. isn't a good time.
Response: A time that is universally good for everyone does not exist. However, by 10:30 a.m., staff members have had the chance to return calls, print their census list, and participate in unit discharge rounds.
This article was adapted from one that originally appeared in the February 2010 issue of Case Management Monthly, an HCPro publication.