OR Manager - December 2019 - 8

Process improvement
Continued from page 7
this huddle is that as the members develop
as a team, trust grows. "
Initially, she says, there was some
concern about " getting each other in
trouble. " Now, working as a team, they
can really talk about issues and the
facts, and get beyond the emotional
aspects.
" It's not about placing blame, it's
about making things the best they can
be for our patients and caregivers, "
she says.
Another benefit of the huddle is
being able to see all of the managers
every day, connect with them, and get a
read on how their day is going.
Tier III
Tier III is made up of directors, associate
chief nursing officers, chief nursing
officers, and the chief operating officer
(COO). One person from the Tier II huddle
goes to the Tier III meeting.
" Tier II meets from 9:00 to 9:20 am,
and then I walk across campus to the
Tier III meeting, which gives me about 5
to 10 minutes to decide what concerns
or issues to take from the perioperative
area to my colleagues who are inpatient
nursing directors and fellow associate
chief nursing officers, " says Pehotsky.
" I have to think about what would have
meaning for them and what would not.
In other words, what to escalate and
what not to escalate. "
The Tier III standard content consists
of 10 items; Pehotsky notes that
the perioperative area most often reports
any emerging patient experience
issues or any issues that have safety
implications outside of the perioperative
space.
In terms of staffing: " Our ORs and
PACU have closed staffing, so I would
only report staffing issues in the Tier III
huddle if they were such that we would
be challenged to meet the demand of
the day's surgical schedule, " says Pehotsky.
8
OR
Manager | December 2019
She does escalate any hospital
throughput issues or any challenges her
areas anticipate in terms of inpatient
beds needed throughout the day.
Tier IV
Pehotsky then attends the Tier IV meeting.
" Because of the size of our main
campus, all of the issues discussed
from the 30-minute Tier III huddle are
reviewed, and the most pressing concerns
are selected to be presented to
the executive chief nursing officer at the
Tier IV huddle for escalation at Tier V, "
she explains.
Tier V
For Tier V, the executive chief nursing officer
leads a telephone call during which
executives from each of the hospitals
and other facilities in the system have a
few minutes to present their most pressing
issues from the standard list and to
share what's going on in their facilities.
This lasts about 40 minutes.
" It's a brief opportunity for them to
call out some things they need help
with, what's being resolved, or what
they need further resolution with, " says
Pehotsky.
The call includes locations across
northeast Ohio and Florida and covers
66,000 caregivers.
Tier VI
Tier VI involves the executive chief nursing
officer, the chief executive officer,
and other executive leadership. " They
have to boil down what they heard in
Tier V to 10 minutes of the most important
issues, " says Pehotsky.
They then have to decide which
items require action or help with correcting
or simply need greater awareness.
Sometimes leaders go directly from the
meeting to a unit or another location
and ask to hear more about an issue.
" It has been really refreshing to see
an executive leadership team go directly
to where the issues are and listen and
help resolve them, " she says.
Going forward
" Once the leadership starts talking, everyone
starts talking, and you never
want to shut that off, " notes Pehotsky.
" At some point, you will wonder how
you can keep track of all the issues
people are bringing you as well as the
solutions, " she says, adding that they
had to convert their paper issue log to
an electronic log. Issues are entered
into the electronic log along with a very
brief description and who identified the
issue.
They considered having the huddles
on Saturday and Sunday as well as
weekdays, but Pehotsky says they decided
not to. Instead, concerns about
what happened over the weekend are
discussed on Mondays, which makes
the Monday huddles longer.
" When the huddles began, staff
feared there would be finger pointing or
they would be 'thrown under the bus,' "
says Pehotsky. However, she says,
" it was our job as leaders to explain
to them that we weren't focusing on
blame, but rather we were elevating an
issue that needed to be resolved and
wanted to let them know how we were
working on it. "
As issues started getting resolved
and staff and managers saw the returns,
they began cheering the executive
leadership, says Pehotsky. They
realized the huddles were about trying
to make things better. ✥
-Judith M. Mathias, MA, RN
References
Cleveland Clinic Tiered Huddles
Have 25,000 Daily Participants.
https://www.youtube.com/
watch?v=VgnO2FWlz-I
How Tiered Huddles Improve Quality
Across Cleveland Clinic. https://
www.youtube.com/watch?v=XXrHmwTjxQ.
Pehotsky
C, Salamon D. Perioperative
problem solving while you wait: Huddling
as a team to elevate care. OR
Manager Conference. 2019.
www.ormanager.com
https://www.youtube.com/ http://https:// http://www.youtube.com/watch?v=XX http://www.ormanager.com
OR Manager - December 2019

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