Intervention Title: Better M.D.-R.N. Collaboration Through Unit Meetings – Cedars-Sinai Medical Center; Los Angeles, Calif.

Goal:
Identify ways to better coordinate patient care by engaging an interdisciplinary team, including physicians and nurses.

Innovation:
Staff matched doctors and nurses for more collaborative care activities that centered on M.D.-R.N. unit meetings and M.D.-R.N. patient rounds.

Result:
The matching system increased employee and physician satisfaction, strengthened relationships between physicians and nurses, renewed interest of physicians to engage in educational activities and act as teachers, and increased patient control over recovery. Anecdotally, results included improved quality of care.

Institution:
Cedars-Sinai Medical Center
8700 Beverly Blvd.
Los Angeles, CA 90048
P: (310) 423-3277

From the experts:
“Communication and relationship building are the cornerstones for successful collaborative care. The tone and culture of our units have changed and we have seen employee and patient satisfaction improve.”

Ray Hancock, R.N., M.S.N.
Director of Medicine/Surgery & Rehab, Cedars-Sinai Medical Center

Profile:
Cedars-Sinai Medical Center is a 952-bed, tertiary-care teaching hospital in Los Angeles.

Clinical areas affected:

• Medical/surgical units

Staff involved:

• Physicians
• Nurse Manager
• Nurses

Timeline:
The program was tested for 12 months and later spread to 47 inpatient and outpatient units.

Contact:
Peachy Hain, R.N.
Nurse Manager
P: (310) 423-6747
Peachy.Hain@cshs.org

Innovation implementation:
As part of efforts to improve the quality of care delivered to patients, Cedars-Sinai Medical Center established a new model of collaborative care involving physicians and nurses. To initiate the new process, a nurse manager worked with a physician to identify top areas where both parties felt the need to improve. One result was a plan for physicians and nurses to make rounds and hold unit meetings together to better discuss and coordinate patients' care plans. The nurse manager matched the physicians with nurses for joint rounds.

This “M.D./R.N. unit meeting” has become a central piece of doctor-nurse collaborative care activities. It creates a sense of free and open communication that makes relationships between physicians and nurses more comfortable and less stressful. Physicians are more willing to act as teachers and engage in educational activities. Physicians involved in conferences ensure that nurses are invited and participate actively. Additional joint physician-nurse efforts include working together on patient education packets, developing preprinted order sets and devising new policies. Grand rounds even include collaboration between nurses and surgeons to discuss surgical procedure and nursing care.

Social activities helped establish a basis for better relationships by convening gatherings at the beginning of the collaborative care process. Holiday gatherings with nurses and physicians have also become a regular activity to foster strong relationships. The Women's Health Services department has a once-a-year cookout where physicians cook for the nurses.

Advice and lessons learned:

1. Turn the physician into a champion. Explain that collaboration will make a physician's life easier by saving time and increasing patient satisfaction.
2. Listen to what physicians need to make the collaboration beneficial to them. Elicit feedback to understand what is most beneficial to physicians.
3. Be consistent. By sticking with the original process and not trying numerous new methods, consistent processes evolve that doctors and nurses understand and adhere to.

Cost/benefit estimate:
Turnover rate decreased by approximately seven percent. The hospital also reported reductions in length of stay and 30-day readmission rates.