Saturday, June 14, 2003

The Staff took Over the Meeting! They changed my Agenda! Wow, am I Proud of Them!

retreat (n)- A period of group withdrawal for prayer, meditation, or study[1]

The best retreats involve a getaway to a location with an atmosphere conducive to both group synergistic interaction and individual reflection. Good meals are key. Our physician staff met at the Brooklyn Marriott for one day with breakfast and lunch and after lunch they discarded my agenda in favor of their own. For an instant I bristled, but fortunately our facilitator took charge and the afternoon—indeed the whole day—came off rather well.

It was the largest gathering of our physician staff probably ever in the history of the department. We minimized staffing for the day; brought in as many per diem staff as we could and got almost three-quarters of the department together. Pretty tough for those of us in emergency medicine since we need to keep the doors open 24x7 and folks do have to sleep.

We’re in the process of transforming the Department of emergency medicine from a purely clinical service organization to a clinical service, teaching and research organization. We’re in the first year of our provisionally approved emergency medicine residency program and many of the emergency physician staff came to work at Maimonides only to care for patients and otherwise get on with their lives. Residency program development hadn’t been part of their plans. Others, mostly recent additions, had joined specifically to participate in the development of a new residency program.

We met in retreat contemplating this transformation and considering the effects upon the physician staff. These women and men had listened to me and other departmental leaders during recruitment and during various departmental meetings talk about the requirements for core faculty and the opportunities engendered by the new residency program, but uncertainty reigned. What did the change mean about the kind of work, scheduling of work, compensation, the clinical environment of the ED. Our helpful facilitator, working with me and our departmental administrator had helped structure a day in which we would address these issues and organize to further explore them and the ramifications of our evolution.

After lunch, the group rebelled. Much to my surprise, they were far less interested in talking about compensation than they were in talking about scheduling and operations improvements. Fortunately our facilitator helped the group articulate its interests and determine a way of proceeding. First by proposing splitting the group into two and then acquiescing to their preference for remaining together as a single group and getting their scheduling issues under discussion. I was encouraged to stay quiet—and I did.

At the closing of the afternoon and of the retreat, we all committed to next steps: working groups on the issues of concern. The coherence of the physicians and their evident satisfaction at the plan was thrilling to me. I learned a lot about what was going well—or well enough: our compensation program—and where improvements were needed: scheduling and continued focus on clinical operations improvements.

The lesson about scheduling was instructive. For the group present, fairness was not defined by evenly sharing nights and weekend shifts. Rather, the unmarried physicians present universally volunteered to work more weekday nights so as to have more weekend time off. The married physicians by and large seemed amenable to this approach; the particular day or night off mattered less to them than that they could organize their time for family activities. We’ll sort the details out on this and other scheduling concerns through a working group of the staff who will develop a plan and present to a staff meeting.

Similarly—and after discussing the scheduling issues—the group moved onto a discussion of various clinical operational issues. Urine specimen collection processes and hemolyzed blood specimens were variously denounced, but several of the more junior staff spoke to the need for flowcharting and understanding the process steps. They were bringing the performance improvement ethic and idea to the group as a whole—an approach that has been somewhat neglected in our department this past year as we implemented our electronic medical record. Though we have used continuous quality improvement techniques within each project; the group was recognizing that our ED Improvement Committee was no longer meeting and neither were any project oriented task forces working on improvements in the clinical center itself.

Perhaps your group has no issues and you as the leader have no concerns; but most of us live in a real world where perceptions vary. Our retreat was a grand opportunity for learning the depth of belief in the fundamental fairness of our department’s operational decisions that most directly affect the physician staff. It also energized me because of the broad participation of our physician staff and because the energy coming out of the room was for building and maintaining improvement efforts around the issues of greatest concern to the physicians themselves. Less than two weeks later, at the regularly scheduled departmental staff meeting, task force membership and charters were confirmed and the groups began working together.

As a department, we’ve felt overwhelmed at times with all the non-clinical work required for function in the hospital; I’m sure you have felt the same from time-to-time. Our retreat, planned in conjunction with and facilitated by a professional facilitator not only identified opportunities for improvement in our department, but created the working groups who will lead those improvements on behalf of the department.

Yes, physicians from our staff took the lead in both defining the issues and organizing to accomplish the work. They pushed my leadership aside; they seek only my support and not my direction. Wow—they are doing me proud.

[1]The American Heritage® Dictionary of the English Language, Fourth Edition; Copyright © 2000, Houghton Mifflin Company.