Patient Care: a Team Approach
By: Tammy McCausland
This blog post is based on “A Team Approach to Patient Care,” an article published in Radiation Oncology News for Administrators, Vol 31, No 2. The publication is an SROA member benefit.
In September 2020, Jana Grienke, clinical administrator in the Department of Radiation Oncology at the University of Iowa Hospitals, was recognized as a “Healthcare Hero,” and her team approach to health care was featured in an article.
“In radiation oncology, we’re always uber focused on the safety of patients and staff, but when the pandemic started, it really did force us to have a different perspective and approach with things in the clinic,” she said. “Due to the urgency, we needed to make decisions quickly and sometimes in real time.”
Team Decision-Making and Communication
Grienke and her team had to make quick decisions such as how to social distance in an open reception area, how to ensure all staff have the appropriate personal protective equipment (PPE) and what actions to take if a patient or staff member was suspected of having COVID-19. “We didn’t have workflows for these situations when the pandemic started, and all the questions that arose daily and weekly needed immediate answers, so we really did have to take a team approach,” she said. Staff from housekeeping, the front desk, nursing, radiation therapy and dosimetry, as well as physicians and researchers collaborated to ensure everyone’s safety.
In the early days, there was constant flux due to new and changing guidelines that required different rules and restrictions. “We wanted all of our staff to be empowered to share their ideas, issues and concerns with us,” she said. They set up open forums with staff to discuss how to make the main reception area and sub-waits for their treatment rooms less congested to allow for social distancing. “One of our staff members suggested we have a ‘flow facilitator,’ who would stand in the treatment hallway and direct traffic. The flow facilitator would lead patients one at a time to the sub-waits, and then when the treatment was completed, they would escort them out and then get the next patient,” she said. They “borrowed” a couple of medical assistants from family medicine to help. “I thought that was such a great example of not only collaboration within the department but also with other hospital departments, with that same goal of making sure that all of our patients were safe,” she said.
They have held open forums in their largest conference room, which allows for social distancing and the ability to communicate with everyone at the same time. Everyone wears PPE. They use roll-over rooms where staff listen socially distanced. They also have Zoom meetings for staff who are at off-site clinics or are on-site but are unable to leave their stations. “We also did daily huddles to check in. I would talk to the frontline staff because they had to respond to a lot of the immediate changes—asking about infection screening and making sure all patients had a mask—so being able to quickly relay some of those changes was very helpful,” she said. They still hold daily huddles.
Communicating with patients about changes in policies and procedures has been a top priority. They informed patients when face masks became a requirement, when the screening questions changed, and what parking options were available when the valet parking service stopped. They received a lot of positive feedback in their patient surveys. “In radiation oncology where you see patients every day, you build relationships with them. Since patients come every day, I can guarantee they didn’t travel to Asia the day before, but it was required to ask about travel. Patients started treating it like a game. They would laugh, ‘No, but I wish I could travel,’” she said. “We keep it lighthearted, knowing that this is not the best time because of their cancer and the pandemic. We keep it relaxed and try to create the best positive atmosphere we can for patients.”
Post-Pandemic Patient Care Safety
Post-pandemic, many of these safety practices will stay in place. “A switch won’t suddenly be flipped where everyone goes back to the way it was before, but I think there could be some gradual relaxation of some of the COVID-19 precautions that we currently have in place,” she said. They have relaxed some visitor restrictions where one visitor is again allowed to accompany a patient. The safety questions patients get asked have evolved and may change as people get vaccinated.
She expects masks will remain a requirement for the foreseeable future. “I think we’re living in the new normal, but I do hope we’ll be able to give those much-needed and deserved hugs to our patients who are finishing their treatment and be able to see the smiling faces of our staff and patients. I do have hope for that,” she said.
Leading by Example
Grienke said the pandemic has reinforced the importance of being an example for others. “I’ve heard about administrators who didn’t come to work, who worked remotely while the rest of the staff worked on-site. I know if I’m expecting people to work, I’m coming to work, too,” she said.
When the hospital implemented labor pool obligations where each department was asked to volunteer staff to work different shifts, Grienke volunteered. “For many months we worked 15 four-hour shifts every week for the hospital, and since we were running a full clinic, trying to get people to volunteer to come in at five in the morning or stay until nine at night wasn’t easy,” she said. “I took many of those volunteer shifts to show that it’s not just a few people that we expect to pull the team together. It really is everyone, and everyone did. We had physicians and physics faculty working the labor pool. It was a goal of mine to see that everyone was willing to put their titles aside and work together as a team.”
Grienke is proud of how her team has pulled together throughout the pandemic. “It is a testament of our culture that we live by in our department, that the entire team worked together to ensure all patients and staff remained safe during a worldwide pandemic. This really is the best place to work,” she said.
What important takeaways has your team taken from manage patient care during the pandemic?
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Related Content: Radiation Oncology News for Administrators, Vol 31, No 2
Links:
Society For Radiation Oncology Administrators (SROA)
Department of Radiation Oncology at the University of Iowa Hospitals
"Healthcare Hero"
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