How can unit-based leadership improve performance metrics?

by Review of article by Michael R. Grey, Gagandeep Sign, Danyal Ibrahim, et al.
Published on Jan 24, 2021

The Journal of Hospital Practice released an article on, Impact of a hospital unit-based leadership triad on key performance metrics.   The team of researchers follows a triad unit that was created at Saint Francis Hospital and Medical Center in Hartford, Connecticut.  The triad team consists of the already established dyad- a clinical nurse manager and a lead case manager.  They added a hospitalist medical director with the goal to see how this trio could improve various markers such as,

  • Observed over expected length of stay.
  • Patient experience
  • Hand-washing compliance
  • All-cause 30-day readmissions
  • Percent of discharges by noon
  • Percent of discharge to a skilled nursing facility

Interdisciplinary rounds (IDR) are a successful model for improving the care delivery process for patient management and throughput in the progression of care.  IDRs ensure that all members are on the same page and speaking the same message to the patient, each contributing their relative discipline.  However, rarely do we look at how a leadership-based model could impact with functionality of IDR.  In the article, staff participated in morning IDR on the unit and then in the afternoon another IDR was held with leadership present. 

The results were as they had hoped.  Length of stay decreased, CMI increased, discharge by noon increased, and the discharge to SNF decreased.  The other markers are believed to have been not significant due to already having high levels of compliance in hand hygiene and patient experience. Readmissions worsened but were not statistically significant.  SFMC should be commended on instilling a positive culture in their care delivery process.

So, how did they do it, because just putting the positions into the role does not make the difference.  We are not recommending every hospital follow this same model but there are key components that highlighted to SFMC’s success and should be considered in your own case management and progression of care model. 

  • They added physician leadership into the team process and all members had aligned goals and incentive metrics.  Meaning each position is moving in the same direction with the same objectives.
  • They empowered leadership to address any concerns and ideas brought to their attention related to patient care, safety, or unit workflow. Decisions were not top down but arose from the realities of the front-line worker experience. 
  • Leadership and the units were encouraged to innovate locally in any way they felt would achieve operational improvement. Teams had freedom to work creatively to achieve objectives through trial-and-error models.
  • The IDRs were focused with an am huddle on barriers to discharge that day and in the afternoon, they huddled for the prep work for the next day and to discuss additional patient insights related to the progression of care. Having leadership involved in the afternoon allowed for support to identify and triage any problems that arise.

 If your hospital is interested in discussing further how to incorporate IDR, the triad model, or how to build an ACU.  Feel free to contact us for a consultation.