Issues that were discussed in focus groups varied.

I will DISCUSS the issues that were repeated by other areas, demonstrating issues that may be affecting more than one group and touch lightly on issues that were particular to one group as appropriate. Lastly I will propose a section with any problem solving ideas the staff had. Interestingly enough one statement was made by three of the four groups that demonstrated a breakdown in communication. This statement was We are always the last to know. The only group that did not make this statement was the OR staff. Issues across all the areas The biggest issue that was mentioned was the schedule. As mentioned earlier this is not solely a communication problem but also a problem of power and policy. This was addressed in the OR executive meeting. A policy has been developed and hopefully this will alleviate the problem. However, the issue of all of the areas being unaware of schedule changes and add-ons is a communication problem. The current method (from my understanding) is that the front desk calls the PACU, and then the message gets relayed from there either through a phone call or written on the white board. However, since all areas mentioned that there is often a lack of communication and add-ons or schedule changes come as a surprise, the message is often not being relayed to everyone. All areas mention they get busy. It is possible sometimes the information is just forgotten somewhere in the chain. Also, everyone may not see the board(s), or maybe it is being written on one board and not the other Voice eras will help (especially if front desk gets info to nurses.) Also very helpful would be a computerized board that is available in a very open place viewed by all, similar to the Main hospitals OR which has been discussed by management. Overall communication: All work places need better communication. People often forget to repeat what they hear or know to others (especially outside of those they directly work with.) Stop and ask yourself would this be beneficial for _____________ to know? Forward the message. Use white board , verbal or voice areas. The means doesnt matter as much as long as its consistent. So decide what works most effectively or easily. People will develop habits. Policies being followed. A couple areas mentioned policies not being followed this was mostly meant for the schedule issue. However, a few particular issues were discussed. This is a policy, communication and possible a power issue. Talk about policy "policy is a consistent guide to be followed under a given set of circumstances." The key word here is guide. A good policy will not lock you into rigid procedures or decision making. Rather, it will provide guidance for handling a wide range of organizational and programmatic issues, and will establish a framework for both management and staff decision making. Example-One issue brought up was patients having rides. The issue encompasses policy in that if it indeed patients are required to have a ride then the requirement may not be clearly communicated (understood) or blatantly ignored. If it is being ignored then it may be a power issue. As with the schedule, if this problem occurs often, a policy needs to be developed that has the support of executives. A preventative measure should be developed so that patients arent having surgery that have no ride. This may require going beyond asking the patient or the clinic but speaking with or seeing the driver. Ideas on how to best deal with this would be appreciated.

Shortage of anesthesia tech. Three of the areas discussed the difficulty of having just one tech, with the exception of the front desk. This has also impacted Oscar, who feels he is not being able to assist all the areas as much as he would like. Issues that were specifically addressed were after Oscar leaves, also running back and forth between both areas. This has been mentioned and Laurel said she would see what she could do, until then this becomes a teamwork issue. People get caught up in whats my job, I shouldnt have to do that, etc. Create a company culture is to make sharing and assisting others an important and integral part of what the company does. Being rushed: Another issue that arose in three of the four meetings was being rushed by physicians. The employees discussed that when they are doing what they are supposed to do to prepare patients they feel pressured to rush. This issue probably lies in communication and a misconception of how long it takes to get a patient ready. One area said that the doctors see the patients name on the board and interpret that as the patient is ready. Suggestions, keeping curtains closed, develop a practice. Communicate reality the patients name on the board does not indicate patient is ready. Dont be afraid to speak up and communicate that patient care is top priority. Privacy was an issue. Suggestions from staff: continue 2:30 pm meeting-great opportunity to communicate the days events (changes, issues) If curtain is closed that means dont walk in-ensure patient privacy, allow 5 minutes extra on turnover, cross-train more staff, writing physicians preference changes on charts as they happen, Solution: a part time tech in the evenings may be a possibility, better form of communicating schedule, changes (voice eras or electronic board). Issues unique to each area: PACU: More team work attitude and understanding of PACU duties. PACU nurses feel close as a group but less close and understood by the other areas. CRNAs not having an immediate person they feel is a supervisor for HR issues, etc. Because they are hired by the main they feel they dont have one person who they answer to. OR: better communication between OR and techs, implementing some communication standards about certain procedures, etc. Front desk: Under staffed, not able to communicate with the patients.