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Dome - All for one care-delivery system

April 2011

All for one care-delivery system

Date: April 6, 2011

An initiative to unify service standards for clinical employees taps into the power of teamwork.


JHHS employee Willie Myers, a clinical associate in the outpatient urology clinic, and clinic supervisor Patricia Young, a JHU employee.
JHHS employee Willie Myers, a clinical associate in the outpatient urology clinic, and clinic supervisor Patricia Young, a JHU employee.

Ten years ago, Johns Hopkins Department of Medicine administrator Patti Engblom merged two management policies into one set of guidelines for health system and university frontline clinical and scheduling staff. Her goal was to upgrade patient service in the department’s Adult Medicine and Moore clinics. To Engblom’s delight, the staff overcame their differences to embrace the change. 

In fact, the employees, including patient service coordinators and certified medical assistants, endorsed Engblom’s initiative with a mission statement of their own that promoted the importance of smiling, appropriate eye contact and a host of other patient-friendly gestures.

Today, the mission statement remains in the Department of Medicine employee handbook, a reminder that the delivery of compassionate patient care depends on teamwork, and that teamwork depends on consistent management policies.

Now, the Johns Hopkins University Clinical Practice Association is gearing up to establish a common set of service excellence standards for all clinical employees, whether they’re employed by the university or Hopkins Hospital.

Under the new management policy, written by the CPA Staffing Task Force, all employees involved in direct patient care will be held to the same high standards set by the Johns Hopkins Health System for performance and attendance. As another part of the initiative, all prospective employees will be screened through a Web-based assessment tool currently used by the Health System to gauge their patient service skills and aptitude for teamwork and other performance qualities.

Eventually, every clinical staff member will clock into work using an electronic time-keeping system called Kronos, which places identical expectations for attendance and promptness on all clinical employees. Also on the horizon are enhancements to the orientation program for new employees on the university side.

Although these changes are still a work in progress and undergoing review by the university legal team, they eventually will be incorporated into the new patient- and family-centered care model shaping treatment across numerous Hopkins entities and in the new clinical buildings. “It’s designed to enhance patient care and improve the patient experience,” notes orthopedic surgeon Lee Riley III, a member of the staffing task force and the CPA Practice Management Committee.

All about the patient

The plan to adopt a single, consistent set of management policies for all clinical employees grew out of recommendations made by the Practice Management Committee, based in part on a 2008 faculty survey that found ample room for improvement in health care delivery across the health system. One of the responses that frequently appeared on the survey as a chief hindrance to better care was the separate management systems that divide Johns Hopkins School of Medicine and Hopkins Hospital employees, many of whom work side by side and perform similar clinical duties.

For example, the university has vague attendance policies, whereas the health system has well-defined attendance policies. The difference becomes crucial, says Kelly Cavallio, administrator for Johns Hopkins’s East Baltimore Ambulatory Services, “when you’re running a clinical operation, and, say, need patient service coordinators to check in a patient: You have to have people who are there when they’re needed.”

During last year’s blizzards, the distinctions between university and hospital policies were on stark display. University employees could opt to stay home or receive time-and-a-half pay for coming in. Meanwhile, their colleagues hired by Hopkins Hospital were required to come to work or lose Paid Time Off hours. The two policies made for tension rather than teamwork under arduous conditions.

“It’s very difficult,” says Engblom, “to be fair and equitable when there are two approaches.”

Internist John Flynn, who, like Riley, is a member of the staffing task force and the CPA Practice Management Committee, carries around a thick sheath of patients’ stories of poor service that serve as his inspiration for this initiative. One account concerns a staff person who left a recorded message on a phone line used by patients that went like this: “I’m having a bad day. I’ll get back to you when things get better.”

Then there was this from a family member: “My 90-year-old mother was brought into the presurgery prep room and treated impersonally, and referred to as ‘her.’ This treatment made my mother feel more apprehensive than she already was about the impending procedure.”

“All of us in some form come to work to serve, care and offer comfort to the patient,” Flynn says, “That’s what we need to keep focused on throughout this process.”

Managing the change

Before any policy shift takes place, the staffing task force is compiling a list of different job titles that will be affected by the change, and from this creating a master list of some 250 new job descriptions that will apply across the university and hospital clinical workforce. Each description will outline job function as well as patient service essentials, such as proper phone etiquette, teamwork and empathy that are presently missing from university descriptions. All employees “will be measured on that as part of their annual performance review,” Cavallio says. “Those are core values we’ll expect of every employee no matter what their position is.”

Fortunately, Cavallio says, managers on both sides who will have to monitor patient service standards, evaluate staff and carry out discipline have been very supportive of the reasons behind the change.

Most affected by the policy shift will be about 2,250 school of medicine employees, including medical office coordinators, nurses, patient service coordinators and medical assistants—anyone who has a direct impact on a patient when they come into a clinical outpatient setting. Gloria Bryan, school of medicine senior director of human resources, recognizes the challenges ahead. “It’s important to note that transition management experts are on the task force,” she says, “and they’ll use their resources to help university staff through this and to make them aware of what assistance will be there for them.”

To ensure as smooth a transition as possible, task force members are planning a series of workshops, focus groups and meetings where affected employees will learn about the new management policies, receive training in customer service skills and have an opportunity to voice questions and concerns.

One positive outcome for university employees adapting to the policy is newfound clarity about their responsibilities, Bryan says. ”Most everyone prefers to know what the expectations and consequences are,” she says. “That’s an advantage that a health care management model brings.”

Ultimately, the transition to a standardized management policy will raise service standards for all clinical employees across the hospital and the school of medicine, and it will place the welfare of patients and their families at the forefront of all they do. By erasing the barriers between university and hospital employees, the policy encourages teamwork and can give each person a renewed sense of purpose, affirming, in Bryan’s words, “I am part of something important.”

—Stephanie Shapiro
Linell Smith and Jamie Manfuso
 contributed to this article.

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