Shared governance and teamwork—myth or reality - Statistical Data Included

AORN Journal, March, 2000 by Helen Mary Bell

In the mid-1990s, budgetary constraints and patient expectations demanded that workplace reform and productivity increases be undertaken and achieved if organizations were to survive and be profitable. Operating room managers at Dandenong Hospital, Victoria, Australia, responded to this demand by developing a teamwork model that allows team members to achieve significant workplace reforms, have ownership in how they deliver patient care, and, in turn, experience job satisfaction. Team members tie, nurses, anesthesia care providers, surgeons, support personnel) work together to decide how to achieve their goals and those of the organization.

Dandenong, a major trauma center, is a teaching hospital for undergraduate and graduate medical and nursing students. It is a 350-bed facility and one campus of the Southern Health Care Network, composed of tour major hospital campuses and numerous community centers. The OR suite has a 10-bed postanesthesia care unit and six ORs in which approximately 1,000 procedures are performed each month in all specialties except cardiac. The demand on Dandenong's resources necessitates efficient and productive service.

The innovative team model developed is a dramatic change from the traditional management models tie, top officials telling employees what to do with little regard for employees' needs, wants, or values). One management model is described as being a political environment where "who" is more, important than "what," and the boss' ideas are taken seriously but ideas from other people are ignored.(1) This contrasts with our model. We value each team member and what each person contributes to our unit. Our experience shows that by involving team members in problem solving and actively seeking their ideas, we made changes and implemented many of their suggestions. By advocating this philosophy, leaders help improve employees' performances and perspectives, which can be achieved only if leaders care for the people building the caring environment.(2)

IMPLEMENTING THE TEAM MODEL

The team model was implemented using specific strategies tie, concept sharing, service configuration, team leader training, remuneration, career path).

Concept sharing. Nursing and medical managers developed a shared vision of how we wanted to develop and implement our plan. Our vision was to achieve significant workplace reform and empower team members to achieve job satisfaction.

As leaders, we familiarized ourselves with our goal and purpose. We knew how to implement strategies to achieve our vision. We also firmly believed in the team's ability to achieve the goals.

Next, we shared our plan with team members. This was a vital step if we were to succeed. We scheduled a series of meetings at convenient times for all team members and discussed our plans and ideas. We asked for feedback from team members and made some alterations.

We sent a letter outlining our proposal to OR medical staff members to ensure that they accepted and participated in our model. The model also was discussed at the OR management group meeting when hospital administration members were present.

Service configuration. In the traditional model, appointed charge nurses were responsible for specific ORs. We changed responsibility to a team concept. Each OR has a designated team leader--a rotating position--for each session tie, morning sessions from 8:30 AM to 12:30 PM, afternoon sessions from 1:30 to 5:30 PM, daylong sessions front 8:30 AM to 6 PM).

Sessions comprise elective and emergency components. For example, a general surgery session may include a laparoscopic cholecystectomy, appendectomy, and major bowel procedure. Sessions may be extended or elective procedures may be cancelled for an emergency procedure (eg, ruptured aortic aneurysm). In addition, nursing and support team members' work hours changed from eight-hour to 10-hour shifts, allowing daylong surgeries to be scheduled and limiting cancellations. Team members schedule themselves and usually obtain their desired shifts and days off of work. The possibility of working half shifts of five hours is available, as well.

We perform a large number of elective procedures in addition to emergency procedures. The team leader, anesthesia care provider, and surgeon decide how to schedule elective procedures (ie, work through lunch, work overtime) and how to allocate additional emergency procedures. Team members undertake patient care delivery as they choose. Such empowerment gives pace and energy to the work and makes people feel significant.(3)

Each day at 8 AM, all OR team leaders, the anesthesia care provider, and nurse shift leader meet to discuss issues affecting the day's schedule. The anesthesia care provider and the nurse shift leader provide reference and support to team leaders. To streamline procedures, ORs are divided into clusters, with additional assigned team members available to provide relief and set up trays and extra supplies.

Similarly, an OR team leader coordinates surgical technologists' activities. This is a significant change for these team members because traditionally a charge nurse supervised them and they had no input in decisions.