Vision, Leadership, and Creation of a Process Improvement Team

The first step in starting a project is having a core leadership team. These can be formal leaders within a department or someone who is designated, but three things are key: a true interest in solving the problem creatively, the ability to motivate and inspire coworkers, and the authority to drive change.

Change in this sphere is mandatory, but people naturally do not like change, and it will be up to the leaders to hold the course when there is pressure from all sides.

We believe the keys to successful leadership are as follows:

  • ? Being a servant leader. This means valuing the opinions of others, cultivating trust among the team, developing new leaders, and encouraging the team. A servant leader acts with humility.
  • ? Helping the team to set a vision.
  • ? Critical and out-of-the-box thinking. This is especially important in this field, where it will be critical to cross traditional boundaries. For instance, the ED team may need to reach out to law enforcement or community partners.
  • ? Embrace change and be a cheerleader for new processes. The leader will need to support the team as changes are operationalized.
  • ? Integrity at all times.
  • ? Lastly, we encourage having fun as you “fight the good fight.”

Once leaders are identified, it is time to create the “ED psychiatry flow team.” Before the team is recruited, there should be a meeting with hospital and ED administrators, and an agreement should be made that the team will have time to do this important work. Especially at the start, there will need to be at least weekly meetings and time for improvement events. The return on this investment will be found in decreased length of stay for patients, decreased quality issues, improved patient and staff satisfaction, and fewer workplace injuries.

The ED psychiatry flow team should be multidisciplinary, with physicians (ideally an ED MD and a psychiatrist), nurses, ED technicians, and therapists. This can be individualized depending on the resources in your ED. An ideal size is 7—10 main team members with an ad hoc contingency. It is key that everyone in this group is committed to moving the initiative forward and has a passion for ED psychiatric operational improvement.

Okay, so now we are on day one, what to do with this monumental task?

The first essential step is identifying the long-term vision of care for patients. This vision should not be small. It should be a stretch goal for what the group would design if they were in an ideal world with unlimited resources and were creating something from scratch. This vision is what every process improvement project along the way will be working toward; it will start to change the culture in the ED.

An example for this would be, “Our goal is to provide caring, compassionate, world-class care without delay to every patient with psychiatric needs in our ED. We want to set the standard for emergency psychiatry.”

This is just an example, but the goal should be lofty enough that it inspires everyone involved. Once a vision statement is developed, it should be shared with all staff and be posted prominently. Sharing the “why” with the staff with a patient story can also help with cultural change.

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