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Communication & Marketing: A Discussion with Case Studies Tanya Island, CRNA, MS, BS, BSN Leadership Seminar Presentation March 13, 2015 Topics of Presentation • Key points of Harris readings • Key points of O’Grady readings • Case study A & B with evaluation of health care strategies • Evidence-based literature review • Role of the DNP • Interactive Activity (time permitting) Harris Readings (Ch 3, 7, 10) • Managing a project • Project manager is… – Task orientation – Motivator – Management – Bookkeeper orientation – Visionary – Leadership – Salesman orientation • Barriers to • Team Dynamics communication • Forming – storming – – Fatigue norming – performing – Workload – adjourning – Time – Hierarchy O’Grady Readings (Ch 4) • CRITICAL NEED for….massive paradigm shift in health care delivery • Mismatch exists between fluid dynamics of care delivery and compartmentalized “metrics” of health care outcomes • Elements of motivation: – Internally generated – Aligns with personal values – Engagement – Ownership – Mutually beneficial • Challenge assumptions Situation & Background • 74yo female presents to preop with +UTI during preop testing, scheduled for TKA • Multiple allergies and comorbidities • Rescheduled twice already • Orthopedic surgeon – “Green light” • Anesthesia – “Green light if we can initiate IV antbx prior to cut” • Pharmacy – “Delay until I can sort out allergies and select appropriate antbx” Case #1 Assessment • Preanesthesia testing +UTI, normal WBCs, afebrile • Pt adamantly asymptomatic, “I know what a UTI feels like..” • Good historian and regular FU with PCP • BBSE, RRR, A&O, VSS, all others WNL. • SMH moment ortho had ordered a straight cath the night before. Neg UA. Report discovered in back of chart after 90min delay and admin of antbx Case #2 • 34yo male, Spanish speaking, gen surg. • PMH, PSH, physical exam and preanesthesia assessment with interpreter. WNL. • Uneventful GETA – PACU. Delayed emergence, prolonged somnolence (>6hrs). • SMH moment different family member (English speaking) arrives to pick up pt and relays history of “slow wakeup” Recommendations • ASA (2012) Practice Guidelines for Preanesthesia Testing • UA recommended due to prosthetic implantation “In asymptomatic or nonselected patients, abnormal findings for urinalysis, not including pregnancy testing, were reported in 0.7– 42.0% of patients…led to cancellations or changes in management in 2.3–75.0% of the cases with abnormal findings” Communication Mishaps • Lingard et al. (2004) – 30% of team exchanges result in communication failures – Occasion: situation or timing error – Content: inaccurate or insufficient info – Audience: wrong people present – Purpose: unclear or inappropriate speech • Leonard et al. (2004) – safe care depends on team dynamics and effective communication. – >70% of RCA – communication failures Role of the DNP • Propose and advocate for open communication • Empower all staff to “stop the line” • Teach assertiveness to surgery department • Assist director in developing critical action safety checklist books for each OR Key Point Knowledge Check • https://www.onlineexambuilder.com/co mmunication-marketing/exam-19289 References • • • • • American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. (2012). Practice advisory for preanesthesia evaluation. Anesthesiology, 116(3), 1-17. Harris, J.L., Roussel, L., Walters, S.E. & Dearman, C. (2011). Project Planning and Management: A guide for CNLs, DNPs and Nurse Executives. Jones and Barlett: Sudbury. Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(sup 1), i85-i90. Lingard, L., Espin, S., Whyte, S., Regehr, G., Baker, G.R., Reznick, R., …& Grober, E. (2004). Communication failures in the operating room: an observational classification of recurrent types and effects. Quality and Safety in Health Care, 13(5), 330-334. th O’Grady, T. & Malloch, K. (2015). Quantum Leadership, 4 ed. Jones and Bartlett: Burlington.