Training Rx'es

What can a hospital take from a hotel training initiative? Baptist Health Care learned that the answer is plenty. Baptist’s president and CEO Al Stubblefield was at a retreat at the Ritz-Carlton, where he was able to learn about the hotel's daily lineup, a 10-minute worldwide meeting that covers a variety of topics and reinforces the hotel's service-driven culture. Pam Bilbrey, president of BHC's Leadership Institute in Pensacola, Fla., says Stubblefield was excited about the prospect of implementing the lineup, and when she had the opportunity to visit a Ritz-Carlton a few weeks later, she was amazed by what she experienced.

"It struck me that there were all of these execs who were going through a 10-minute briefing. It was exactly the same briefing that the front-line [employees] were going through," she says. "It dawned on me how aligned and consistent the organization was in their approach to serving their customers."

So, despite the obstacles of providing 24-hour care across Florida and Alabama, both she and Stubblefield agreed they had to find a way to implement the program. So in February 2001, BHC's daily lineup kicked off.

A lineup a day

A committee with representatives from each Facility is responsible for meeting monthly to determine the scripts that are then personalized by 500 different leaders through BHC. The eight- to 10-minute-long briefings held around the clock to accommodate three shifts include a corporate message, updates and a discussion question that revolves around a weekly topic, which can range from communication to financial stewardship. The session ends with an inspirational quote. And so things don’t get stale, the lineups feature everything from skits to survey questions to the Hokey Pokey to Trivial Pursuit board game questions.

Often, Bilbrey says, staff members share personal stories or stories about something standout that their co-workers have done, which fosters healthy competition. "It really sets the tone and in a lot of ways sets the bar because if you’re telling stories about people who are doing extraordinary things, it sends the message, 'Well, I need to be doing extraordinary things, too.' "

The lineups also have proven a lifesaver in an area that’s seen its share of severe weather. In fact, just weeks before Hurricane Ivan hit in 2004, Bilbrey says the lineups focused on hurricane preparedness. "We felt like that contributed to people’s health and safety," she says.

The lineups also contribute to improved patient care, Bilbrey says, adding that daily lineups total 40 annual hours of training and development. Bilbrey says there are many staff-wide benefits from the daily lineup, including reinforcing the hospital’s mission, values and core competencies. "[There is a] greater engagement of staff and an enhanced sense of ownership to the organization because they feel like they are more knowledgeable. It reinforces our values; it reinforces our approach to serving our customers. It reinforces our approach to being a colleague in our healthcare system."

The endeavor has been so successful that BHC has taught the lineup to other hospitals, including DeKalb Medical Center in DeKalb, Ga., and Lowell General Hospital, Lowell, Mass. “We teach hospitals all over the country how to use this as a tool for communication because hospitals are particularly difficult organizations [at which] to have good, consistent communication and get everyone aligned.” BHC also built software for other hospitals to use to create scripts.

If you TEACH them

Clinical educators at Children's Healthcare of Atlanta serve in not only teaching roles but in student ones when they attend the hospital’s monthly TEACH (Team Educators At CHildren’s) sessions. These are meetings, held since February 2001, at which members of the clinical staff development team lead participants from the system's two facilities (Egleston and Scottish Rite) in a forum that allows for not only informative updates on procedure and policy changes, but also for roundtable discussions on current issues.

"It brings all of our clinical educators together once a month," says Nancy Lloyd, manager of clinical staff development for the hospital system. "We need to interface with them so they’re aware of what’s going on." And those 60 or so clinical educators—many of them nurses—then bring that information, which can range from legal issues to soft skills to accreditation strategies, back to their staffs.

TEACH's structure has a number of benefits. "It's really a knowledge-sharing opportunity," says Gail Klein, Children’s director of clinical staff and physician development, who explains that educators can meet before or after the meeting with their peers to start or continue a discussion. Additionally, these educators can bring their or their staffs' concerns directly to those with the authority to act. "We have a chance to hear them out and go to the source of the problem and see if we can’t find a solution," Lloyd says.

And the forum has been an idea factory. "It’s a good brainstorming time," Lloyd says. Ideas from TEACH sessions include an information-packed Teach-n-go cart available to hospital staff around the clock. That’s a handy resource for a nurse who is on a late shift and unable to access the information otherwise. The idea for a listserv that allows educators to communicate with each other through threaded discussions also emerged from TEACH. Lloyd says a clinical staff development Web site lists announcements and other items that educators would be interested in, and a chat room is in the works. "They can hardly wait," she says of the technologically forward ideas coming to fruition.

One important evolution TEACH is undergoing is an emphasis on job application. Klein says it's important to have an answer to: "It was nice information, but what do I do with that?" And when they know that, "they feel more value in the meeting because they know exactly what they are supposed to do with this education when they leave."

Building Bridges

"Medical errors are something that haunt you every day at a hospital," says Loubna Noureddin, director and coach of staff and community education at Miami Children’s Hospital, Miami. But those errors are haunting the
hospital staff much less these days. To combat the overwhelming number of medical mistakes that happen in the U.S. annually—between 44,000 and 98,000 according to a 1999 report from the Institute of Medicine—the hospital launched a major performance improvement initiative that included a bedside barcode scanning system developed by Solana Beach, Calif.-based Bridge Medical. MCH implemented it in November 2003.

The system makes it virtually impossible to administer the wrong medication, as now the nursing staff has been trained to scan the barcode to ensure the patient's identity and to verify the medication that needs to be given. "There is no room for error because the system does not allow it," Noureddin says.


The system also enables the hospital to not only determine when the most mistakes—now near-misses—are being made but also what conditions are most likely to cause an error. Noureddin says major causes include patient volume and miscommunications between physicians and pharmacists. "It boils down to communication. It's amazing how powerful communication is," she says.

Prior to the system's implementation, reports of errors were anecdotal, Noureddin says, but this system puts concrete numbers out there. Though one might think the system would instill relief among the staff, such was not the case, she says. "[Nurses] got more worried once we started the system because then they could see [when they were making errors]—they could see the data."

And the hospital also can see bottom-line results. Noureddin says the hospital has saved more than $1 million since implementing this system, which cost $850,000. But the lives saved and the lawsuits avoided are immeasurable.

"It is an amazing concept because once you give a child the wrong medication or an overdose… there is no going back," Noureddin says. The Bridge system "holds us true to patient care, to the essence of patient care. To me, it’s as good as it gets."


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