TY - JOUR
T1 - Management strategies to effect change in intensive care units
T2 - Lessons from the world of business - Part III. Effectively effecting and sustaining change
AU - Gershengorn, Hayley B.
AU - Kocher, Robert
AU - Factor, Phillip
PY - 2014/3
Y1 - 2014/3
N2 - Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, butwould be easily transferable and potentially beneficial to ICU managers and clinicians alike. Similarly, activities focused on improving teamwork are commonplace outside of health care. Simulation training and classroom education about key components of successful team functioning are known to result in improvements. In addition to creating anICUenvironment in which individuals and teams of clinicians perform well, ICU managers must position the ICU to function well within the hospital system. It is important to move away from the notion of a standalone ("siloed") ICUto one that is well integrated into the rest of the institution. Creating a " pull-system" (in which participants are active in searching out needed resources and admitting patients) can help ICU managers both provide better care for the critically ill and strengthen relationships with non-ICU staff. Although not necessary, there is potential upside to creating a unified critical care service to assist with achieving these ends.
AB - Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, butwould be easily transferable and potentially beneficial to ICU managers and clinicians alike. Similarly, activities focused on improving teamwork are commonplace outside of health care. Simulation training and classroom education about key components of successful team functioning are known to result in improvements. In addition to creating anICUenvironment in which individuals and teams of clinicians perform well, ICU managers must position the ICU to function well within the hospital system. It is important to move away from the notion of a standalone ("siloed") ICUto one that is well integrated into the rest of the institution. Creating a " pull-system" (in which participants are active in searching out needed resources and admitting patients) can help ICU managers both provide better care for the critically ill and strengthen relationships with non-ICU staff. Although not necessary, there is potential upside to creating a unified critical care service to assist with achieving these ends.
KW - Organization and administration
KW - Program sustainability
KW - Quality improvement
UR - http://www.scopus.com/inward/record.url?scp=84898737426&partnerID=8YFLogxK
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U2 - 10.1513/AnnalsATS.201311-393AS
DO - 10.1513/AnnalsATS.201311-393AS
M3 - Article
C2 - 24601653
AN - SCOPUS:84898737426
SN - 2325-6621
VL - 11
SP - 454
EP - 457
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 3
ER -