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    Matthew Deneberg
    Matthew Deneberg, MD
    Michelle McCleerey
    Michelle McCleerey, PhD, MA, MED, MBA, RN

    Effective care team collaboration is essential to each healthcare organization’s transition to value-based payment models. Implementing secure communications technology supports a standardized process for patient care coordination across the enterprise and geographically beyond, possibly encompassing multiple provider organizations. But what is the process for enabling timely, focused communication between colleagues and the broader care team?

    Communication and collaboration across the care team depends on automatic and immediate connection to the right team member who can act at the right time — regardless of location. Along with a clinical communications platform that enables care team coordination, shared governance and collaborative leadership are critical to overcoming the historically entrenched care team communication hierarchy. This article focuses on standardizing organizationwide care team coordination protocol at the operations level. 

    Building a culture of communication and collaboration

    Communication is the backbone of every initiative in every healthcare organization. In fact, The Joint Commission has identified communication breakdowns as the single greatest contributing factor to sentinel events and delays in care in hospitals. 

    According to a study on the nursing domain of clinical informatics governance, “effective communication within an organization is critical. Specifically, top-down communication must clearly delineate strategies and tactics for achieving system standardization, processes for change management decisions, the capability of the EHR and expectations for professional competencies. Bottom-up communication must include transparent processes for patient-safety issues, change management requests, end-user requests and workflow requirements.”

    The governance model must include care team members across disciplines and support standardized processes for communication across the continuum. As hospitals and health systems build broader networks to ensure value-based care, organizations must create efficient and reliable communication practices connecting acute to post-care community providers, such as skilled nursing facilities, home health agencies, assisted living communities and specialty physician practices.  

    Connection to the broader care team is critical to achieving true teamwork. While healthcare has previously identified the need for interdisciplinary collaboration, efforts to facilitate it have not been fully successful as they have relied on changing long-standing behaviors and practices. Consequently, the successful implementation of a standardized communication and collaboration protocol requires enabling technology to make it possible.  

    As the foundation for sound decision-making and ethical practice, governance is required for healthcare organizations to ensure technology is consistently incorporated into the communication protocol. This structure is needed to engage providers in user adoption and to hold them accountable.  

    Setting standards is first priority spectrum Health, a not-for-profit health system based in West Michigan, sought a more efficient way to maintain dozens of physician schedules that relied on real-time information. In 2014, an integrated, enterprisewide communication solution — securely connecting all care team members across in-patient and outpatient settings — was implemented as the “gold standard” for contacting the right doctor on call (those responsible for covering particular patients in the moment). At the time of deployment, there were no standard protocols in place to guide utilization across the enterprise. Within the first six months, management realized that physicians were customizing use of the solution to meet their unique communication-driven workflow needs. Undoing and restructuring the process required backtracking — resulting in additional time, costs and resources — to establish standards that would be consistent for everyone. 

    Setting and enforcing standards ensures that utilization, expectations and accountability are known upfront by every care team member. With the governance structure in place, the protocol can be modified and improved for all rather than building a different practice for every user. Governance ensures all care team members understand the requirements for using the tool to support the standard process. For example, Spectrum Health’s nonemployed physicians must use the secure communication platform — not just the employed physicians.   

    For Spectrum Health, the biggest lesson learned was the importance of establishing governance and standards prior to technology implementation.
    Spectrum Health communication and collaboration

    Streamlining direct communication through technology and governance

    The right combination of technology and governance creates the foundation for secure and seamless communication and care coordination. Spectrum Health’s standards set the expectation that physicians will directly communicate with colleagues, nurses and other members of the care team. That means using the application to reach the right person at that moment. Unless standards are in place, there is no way to drive compliance with improved processes. 

    Traditionally, communicating a message to a provider required going through a receptionist or posting a note and then waiting for a callback. The cultural shift involves the concept of direct communication, which is difficult for some physicians to accept. Physicians at the beginning of their career are more open to immediate connection with the right person for the right reason, in the moment. 

    To that end, Spectrum Health designated its communication and collaboration technology as the standard tool for clinical care team communication among physicians, nurses and staff. Physicians who fail to follow this mandate are at risk of suspension from clinical privileges. Administrative suspension leads to full suspension for those who refuse to comply. This represents ultimate governance — a board of governors and medical staff willing to support decisions made in the interest of safe, high-quality care.

    Engaging leadership and physicians in cultural change

    Healthcare organization leaders at all levels must take an active role in establishing criteria needed for high-level adoption of new tools. Technology installed under weak leadership and lack of governance does not become the standard. Providers need leadership endorsement to build it into all protocols and policies, and have a means to enforce established standards. Ongoing measurement and reporting to leadership supports successful implementation. Best practice is to identify providers who are nonadopters and take action to ensure compliance. Otherwise, the benefit of improved communication processes will not be attained.

    One of the more effective ways to engage physicians is to frame technology and governance initiatives from their point of view.

    Every level of leadership in the organization is held accountable for ensuring teams and departments are in compliance with established practice. Visibility into who is participating and who is not is essential for accountability. Expect some physicians to resist compliance — a key obstacle for leadership that can be overcome through well-crafted, well-supported communication and mandates for participation.  

    One of the more effective ways to engage physicians is to frame technology and governance initiatives from their point of view. Emphasizing how the right technology makes their jobs easier in caring for patients improves adoption. For example, show advantages and value for their practices and patients, which can vary across stakeholder groups. Highlight risk management — how the ability to connect immediately to the right person can reduce the potential for malpractice, patient safety issues, delayed care and transitions, HIPAA noncompliance and more. Tying the use of technology to regulation encourages provider participation, stronger leadership and overall accountability. 

    Best practices to build governance standards 

    Here are best practices to help organizations create and implement governance standards: 

    • Establish a governance committee, supported by the board of directors, through your medical executive committee or medical staff leadership. Make certain members support the governance structure and standard of work before you present it to physicians. 
    • Identify a physician champion to assist with securing buy-in from their colleagues. Cite safety and quality issues to entice and engage physicians. Share true-life stories about negative outcomes of critically ill patients when no one knows who is on call or if the call schedule is outdated — meaning the inability to contact the right person in the moment. 
    • Ensure clinician-backed governance is in place before implementing new technology. 
    • Once the technology is launched, ensure standards are communicated to users — a critical step to avoid backtracking and rework. 
    • Build into governance the flexibility to go back and make changes in the moment to address unanticipated issues. 
    • Don’t skimp on technology. Investing in a comprehensive, secure and flexible platform is well worth the expense. As the application evolves, providers must be ready and expect to make workflow changes align with upgrades. Maintain a comprehensive tech infrastructure that evolves with your organization. 
    • Establish a formalized, reliable chain of command. If the first level fails, what is the escalation process? Ensure redundancies are in place if needed. 
    • Create a charter involving all the right interconnected stakeholders, with influence and support of the board through medical staff leadership. Include representatives who will operationalize communication tools: 
      • Medical staff leadership
      • Nursing or operational leadership
      • Executive leadership
      • Information technology and systems
      • Privacy and security team
      • Regional leadership (for large systems)
      • Legal, risk and compliance team
      • Disaster planning/management team
      • Marketing team
      • Technology vendor (ad hoc)
    • Once the charter is written, meet monthly for a while and then quarterly. Build the charter into a governance structure for all communication tools. 

    The underlying reasons for an enterprisewide governance initiative that standardizes communication protocol are compelling. The risks of poor clinical communication are clear. Inefficiencies can cause delays in care, jeopardize patient safety and lead to regulatory noncompliance. 

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