The following Needs Assessment of Caduceus-Hampstead University Hospital was conducted through informal interviews and observation of representative key players from Administration, Doctors, Nurses, Laboratory Personnel, Human Resources, and Patients. A site interview was also conducted at Robomedics to determine the possibilities for a better integration of their products and the hospitals needs.

Based on the gathered information, key issues were grouped into two categories: Human Performance Issues and Technology/Process Issues.

Key Human Performance Issues

• Dysfunctional Interservice Teams
• Lack of cooperation between departments
• Lack of interdepartmental communication
• Low morale and negative attitudes generated by recent downsizing
• Perceptions of having too much work and too many responsibilities
• Perceptions of unfair compensation for time and duties
• Theory X management style trying to impose a Theory Y Mission and Goals
• Unempowered employees conscious of not having a voice in hospital issues
• Confused expectations of employees when Patient Care values conflict with Bottom-line policies

The underlying causes to the above symptoms (with the exception of unfair compensation which needs to be addressed by HR) appear to be lack of skills in both team building and problem solving. Presently teams lack the ability to remove barriers to individual and team effectiveness. The recommended intervention is to initiate Action Learning teams for a holistic solution to a multitude of issues, both major and minor.

Instructional Goals

Teams involving Interservice Patient Care teams (physicians, nurses, & laboratory personnel) and interdepartmental teams (managers or informal leaders from each department) should form Action Learning teams. Action Learning involves both self-development as well as organization development. Having teams act on real work problems changes both the problem and the team acting on it. Problem solving skills develop while improving the human relations within the organization. The challenging of basic assumptions and value clarification take place to align goals and values of team members, and identify obstacles to proper action. It allows those dealing directly with the problem to take ownership of it and implement its solution. There is a balance in the approach of Action Learning that does not minimize the worth of individual workers, but enhances their own self-development by using the problem as a catalyst to discover the power that lies within them to make a difference.

Action Learning requires the full support of the Administration to implement solutions that are in line with the mission statement, goals and objectives of the hospital. Additionally, the Administration must be ready to accept the teams solutions. Initially, training time (away from work) will be required to set up and develop specific team skills, but the time to tackle problems can be handled while teams are at their daily tasks.

Alternative Intervention

If the Administration can not at this time commit to Action Learning guidelines, the recommendation would be to conduct specific workshops on Team Building and Problem Solving skills, with the expectation that individual team members would apply the principles learned to daily barriers to efficiency. Those trained would be members of the Interservice Patient Care Teams composed of physicians, nurses, laboratory personnel.

Instructional Goals for Alternative Intervention

• Develop team cooperation
• Build consensus
• Develop a Problem Solving model for team use

• RBA:
  • Inconvenient physical locations
  • Constant modification
  • Poorly designed job aid
  • Out-of-date manual
  • Need for train-the trainers in order to standardize training misuse of STAT requests
  • Poor public relations
  • Inconsistent personnel using RBAs
  • Alternative procedures for lab work (paper vs. computer) lack of power backup in case of electrical failure lack of emergency procedures if short handed to run tests to lab

• TECHNOLOGY INTEGRATION:
  • Lack of strategic plan
  • Computer literacy varies among medical staff lack positive PR for technology
  • Under-utilized ethernet
  • Lack of communication vehicle and policy between departmental units
  • Lack of interpersonal communication skills (especially by physicians with nurses and patients)
  • Lack of systems integration of Mission Statement and Goals with current policies and Administrations actions

• RBA Intervention
  The Interservice Patient Care Teams would be the best change agents to affect the following issues:
  • Inconvenient physical locations
  • Misuse of STAT requests by physicians
  • Alternative procedures for lab work (paper vs. computer)
  • Lack of emergency procedures if short-handed to run tests to lab

  The above issues can be used by the Action Learning teams to seek root causes and then meet specific needs of the stakeholders. It is possible that they may request a specific workshop or training intervention to address an aspect of their solution (i.e., training on writing emergency procedures, how to obtain a computer report on lab results).

  If not Action Learning Teams, then recommendations for administrative consideration for implementation of appropriate solutions should come directly from the stakeholders.

  The issues of the RBAs constant modification and the out-of-date manual involve dealing directly with the vendor, Robomedics, to seek a contractual agreement to: 1) make scheduled modifications, two or three times a year (as best meets hospital needs and not at the discretion of Robomedics) and 2) redesign and update, with each modification, the accompanying manual for end-user comprehension, with modules for ease of updating with insertions.

  The current poorly designed job aid on RBAs can be redesigned in-house by using color-coded graphics for easy reading format even during emergencies. It should be laminated for durability and placed directly in line-of-sight for the user. . Also it should be updated in accordance with the scheduled modifications.

  To currently establish consistent, high quality training on the hospitals uses of the RBAs, it is recommended that a Train-the Trainers session be developed in-house. A future intervention strategy may include developing a computer-based training (CBT) program specifically on the use of the RBAs.

  In an emergency situation it is possible that any team member may be required to utilize the RBA, and this requires that all members of Interservice Patient Care Team be qualified, through hospital certification, that they have the basic skills to accurately and successfully operate a RBA for testing purposes.

  The current poor PR on the RBAs should be addressed by HR externally to alleviate public distrust and internally build support among employees.

  To address the RBAs system failure during electrical outages, the Administration should request that Robomedics install a backup power system within each RBA unit to eliminate downtime on the RBAs. In the meantime, runner(s) could be assigned to the night shift to alleviate critical personnel from having to run RBA tests in emergency situations to the lab when RBAs are inoperable.

• RBA Instructional Goals
  • Redesign RBA operating job aid with color-coded graphics for easy reading format
  • Design a Train-the-Trainers course, improving delivery skills of trainer and focusing content to meet participants needs
  • Develop a certification process that recognizes Interservice Patient Care Team members as having successfully passed training
  • Determine the feasibility of developing a CBT for the RBAs.

• Technology Intervention
  It is recommended that the Administration have available to the hospital employees a strategic plan identifying guidelines for integrating technology into hospital processes and procedures. This will alleviate the current confusion and scattered approach of the hospital units.

  Also it is recommended that the Administration reconsider the priority status of better integrating the ethernet with patient chart access and RBA result approvals. This would also allow more flexibility of use and location of the RBAs.

  To address the various levels of computer literacy among medical staff, it is recommended that informal leaders among the medical staff be identified and their support be enlisted in helping promote computer literacy. Also workshops should be designed with the expressed purpose of showing medical staff how the use of computers can save time on the job (i.e., charting, research, donor searches, etc).

  The issue of team building was addressed under Human Performance, but Communication also requires a vehicle and policy between departmental units to successfully break down interdepartmental barriers and establish a unified hospital culture. It is recommended that the Administration, along with HR, establish one or more communication vehicles (i.e., newsletters, Hospital TV, etc.) to disseminate hospital news, accomplishments, issues of interest, etc.; and a policy to govern it.

  The need to develop interpersonal communication skills (especially by physicians with nurses and patients) can be addressed through specific workshops that develop sensitivity to meeting the communication needs of staff and patients. It is recommended that all hospital employees be encouraged to participate in the workshops over the course of a year. Refresher courses or remedial courses can be developed to address specific communication needs through CBT or self-study.

  Though this intervention is cited last, it is a bedrock to the success of all the previously cited interventions. Confusion, inconsistency, and lack of employee motivation, can be attributed to the failure of systems integration of the Mission Statement and Goals with current policies and Administrative actions. It is therefore strongly recommended that the current Administration hone the necessary leadership skills that help realign the employees, policies, strategies and actions of unit and administrative leaders to be in line with the mission and goals of the hospital.

  An alternative to the above cited intervention could be establishing an Executive Steering Committee (ESC) following the guidelines of Total Quality Management (TQM) to address the alignment of mission statement, goals, and objectives with the policy practices.

• Technology Instructional Goals
  • Design a basic computer literacy course that shows the medical staff how the use of computers can save them time on the job
  • Design an interpersonal communication workshop that raises employee awareness to communication needs of team members and of patients
  • Follow-up assessment to determine if remedial or refresher self-study courses are necessary to address specific communication problems

Five training interventions have been recommended to the Administration:

• Action Learning/Team-Building
• RBA Training/Train-the-Trainers
• Computer Literacy
• Communications Workshop
• Leadership Skills Building

1. Action Learning teams can meet in hospital conference rooms since teams will be small.
2. RBA Training can be held within the units preferably around the RBA unit that will be used by the employees. The extra rooms could also be employed for this.
3. Computer literacy for doctors should take place on the computers within the hospitial units. They should be trained in extremely small groups or on a one-on-one basis.
4. Communication Skills classes could be held in the hospital and/or university classrooms and/or conference rooms.
5. Leadership development training for the Administration should be held in hospital conference rooms.