Skagit Regional Health: A Case Study on Team Dynamics and Patient Care
Summary
Skagit Regional Health's team dynamics were negatively impacting patient care and team collaboration. The organization sought ways to improve the unit's psychological safety and operational effectiveness.
A multi-step approach was undertaken, including the creation of a multi-disciplinary Working Team and a Physician-Nurse Leader Dyad. These teams identified barriers, provided structure for the work, focused on individual growth through assessments and coaching, and implemented team learning sessions.
The team dynamics improved significantly, even amid the challenges of the COVID-19 pandemic. Culture metrics showed an improvement in staff Net Promoter Agree/Strongly Agree scores by 16%. Various new initiatives were effectively implemented, enhancing both the care process and team cohesion.
Challenge
Skagit Regional Health faced significant cultural and operational barriers that hindered both patient outcomes and staff satisfaction. These issues were exacerbated by a lack of clear communication and leadership, which contributed to low morale among staff and less-than-optimal patient experiences.
“I have been part of the SVH Family Birth Center Team for more than 13 years. The recent cultural transformation is rewarding. The nurses and providers have moved from independent practices to a “team” collaborating on patient focused best practices. Our communications focus on moving us forward, acknowledging our opportunities and learning to celebrate our strengths. I am excited for the future of our team and what we will be providing for our community.”
Kelly Lowry, RN Nurse Manager
Approach
We implemented a four-step approach:
Step 1: Streamlining challenges
For any dysfunctional team, challenges can appear overwhelming. J3P helps make these challenges both comprehensible and surmountable, giving hope to team members.
Establish a shared vision with well-defined goals.
Identify, categorize, and prioritize barriers to team success.
Motivate team members by affirming that achieving the vision is possible if everyone puts in the work.
“This work helped us put words and structure to our goals of building a safe, standardized unit with excellent patient outcomes and patient experience at the forefront. It gave each of us, individually, and the entire our unit, the tools to create an environment of psychological safety and transparency.”
Trisha Halverson, M.D., Ob/Gyn Department Chair
1. Shared Vision
Collaboratively, physicians, nurses, and staff outlined a dual-purpose vision:
To provide exemplary care and a positive patient experience that makes everyone proud.
To create a work environment that values, respects, and fulfills each individual.
“The surveyors noted a remarkable difference in the team. They stated, “This group of people are proud to work here, and the change is palpable” This is what valuing people and giving them hope, and a plan, does for individuals, teams and organizations.”
Danie Turpin, CPXP, Regional Director, Patient Experience
2. Understand Barriers
Organizational Barriers
Limited funding, staffing shortages, and a blend of independent and employed physicians were identified as external constraints.
Process and Operational Barriers:
The team pinpointed:
Absence of a clear improvement plan.
Inconsistencies in clinical procedures.
Gaps in standardized training across different roles.
Example: Inconsistencies were particularly evident in the adoption of standard protocols, such as Quantification of Blood Loss (QBL) and activation of Postpartum Hemorrhage (PPH) procedures. While some guidelines were in place, the lack of uniform communication led to frequent, real-time disagreements among the team members.
Team, Leadership, and Communication Barriers
The main obstacles here included:
Erosion of trust due to disagreements affecting patient safety.
Lack of role clarity, collaboration, and psychological safety.
Leadership roles were ambiguous, causing friction between nursing and medical staff.
Step 2: Establish a Structured Framework for Progress
Formation of a Multi-Disciplinary Working Team:
Endorsed by the SRH Executive Team, a specialized, multi-disciplinary "Working Team" was assembled. This empowered group was explicitly tasked with identifying challenges, setting clear objectives, and driving actionable solutions. To showcase the magnitude of organizational commitment, the Chief Medical Officer and the Chief Nursing Officer stepped in as executive sponsors, thereby cementing top-level engagement and support.
The Role of the Physician-Nurse Leader Dyad:
Integral to the operational structure was the creation of a clinical leadership dyad, consisting of the Chair of the Ob/Gyn Department and the Nursing leader on the unit. This partnership was vested with comprehensive oversight of the initiative. To ensure strategic alignment and effective execution, a meticulously designed work plan was formulated. In addition, the organization allocated resources by providing expert guidance from its organizational development and process improvement departments.
Step 3: Personal Growth Through Self-Awareness
Advanced Behavioral Assessment:
Participants embarked on a journey of self-discovery through the J3P Healthcare and Physician Success Assessment. Unlike rudimentary personality tests like the MBTI, this is a sophisticated, scientifically validated tool. Specifically tailored for healthcare professionals, it delves into various dimensions of personality tendencies and motivational attributes, providing insights aimed at elevating executive-level performance.
Individual Coaching Sessions:
Upon completion of the assessment, each participant engaged in one-on-one coaching sessions with specialized nursing and physician coaches. These dialogues served as catalysts for constructive conversations, allowing individuals to understand how their unique behavioral tendencies impact team dynamics and personal performance.
Building Collaborative Leadership:
The Physician-Nurse Leader dyad, which was central to this initiative, initiated regular coaching sessions focused on collaborative leadership skills. Through these engagements, they not only refined their leadership approaches but also developed a synergistic methodology for managing the overall initiative, which proved to be a significant factor in its ultimate success.
Step 4: Embedding Team Learning for Long-Term Impact
Customized Six-Month Learning Plan:
J3P experts worked closely with the team to design a comprehensive, six-month learning plan. This was not a generic, one-size-fits-all program; rather, it was meticulously tailored to meet the unique needs and challenges identified by the SRH team. Each monthly session was structured around two hours of concentrated, interactive learning and application.
In-Depth Leadership and Team Building Modules:
The first hour of each monthly meeting was dedicated to expert-led, interactive training modules. These modules covered critical topics such as leadership skills, conflict resolution, team dynamics, psychological safety, and constructive feedback. The goal was to provide the team with the skills needed not just to survive but to thrive in a challenging healthcare environment.
Real-Time Application and In-the-Moment Coaching:
The second hour of each meeting pivoted from theory to practice. Facilitated by seasoned J3P consultants, the team discussed real operational issues and began applying their newfound knowledge. This wasn't mere theory; these were actionable insights that could lead to immediate improvements. With 'in-the-moment' coaching, team members started taking greater ownership of the meeting dynamics and pinpointing ways to improve both communication and overall team cohesiveness.
Strategic Planning for Implementation:
Beyond merely identifying operational issues, J3P’s approach challenged the team to present comprehensive recommendations that included the solution itself, the communication strategy, stakeholder education, and a roadmap for overcoming resistance. This holistic focus ensured that team members were not only identifying problems but were also empowered to solve them effectively.
Applying the Psychology of Team
Effective teams share common attributes: clear purpose, role clarity, future optimism, trust, and psychological safety. Open discussions on behaviors contributing to or eroding these characteristics are essential for progress.
By following this four-step plan, Skagit Regional Health transformed its team dynamics and operational efficiency, fostering a work environment conducive to both excellent patient care and job satisfaction.
Results
Our program cultivated a resilient and high-performing culture. Here are specifics.
Resilience Amidst COVID-19
Just two months into our six-month plan, the Working Team faced the unexpected challenge of the COVID-19 pandemic. Despite this, the team only missed two monthly meetings and quickly resumed their work. The already improved team dynamics proved invaluable during this critical period.
Impressive Culture Metrics
Even while navigating the complexities of the pandemic, the team achieved remarkable results. Staff Net Promoter Scores in the "Agree/Strongly Agree" category surged by 16%. Additionally, two pivotal culture survey metrics improved by 14%, reversing a longstanding trend of stagnant or declining scores.
Employee Testimonials
Staff responses indicated greater confidence in questioning authority and a firm belief that executive actions prioritize patient safety.
Accelerated Progress
Within three months—after an 18-month period of stagnation—the team had fostered an environment conducive to multi-disciplinary meetings marked by high levels of psychological safety. Physician leaders across various specialties were fully engaged and took the lead in exemplifying desired behaviors.
Pioneering Initiatives
The team was not just meeting but exceeding expectations. They made substantial headway on multiple fronts, including:
Category II tracings and protocols for quantitative blood loss
Integration of new hospitalist and midwifery programs
The launch of a real-time department dashboard
New processes for real-time feedback
Implementation of a fetal heart monitor certification program
Telehealth initiatives
Cross-disciplinary continuing medical education
Community engagement programs
The Road Ahead: Building Cohesion Through Structure
Most people inherently want to be part of a team; they seek a sense of community. They're willing to adapt their behaviors, but they need the right framework and support to make it happen.
Without this structure, healthcare teams risk falling into dysfunction. This not only hampers patient care but also erodes a sense of value and connectedness among physicians, nurses, and staff.
Teamwork isn't just a buzzword—it's a skill set. Simply telling people to collaborate or communicate better won't cut it. These are skills that require teaching and ongoing practice, both individually and collectively.
“Staff and providers can be heard, and we can all work together for our common goals of excellent patient care. Culture change is hard work, but the progress we’re making is real and it’s been amazing to witness.”
Trisha Halverson, M.D., Ob/Gyn Department Chair
