Latest / Becker’s Healthcare Podcast / Advancing Professionalism and Clinical Excellence at Vanderbilt with Dr. Bill Cooper

Transcript

Advancing Professionalism and Clinical Excellence at Vanderbilt with Dr. Bill Cooper · Becker’s Healthcare Podcast

• 0:02
  This is where health care leadership comes together.
• 0:04
  Becker's sixteenth annual meeting brings more than 3,500
• 0:07
  hospital and health system executives and nearly 800
• 0:10
  speakers to Chicago April.
• 0:14
  This year's event includes keynote conversations with Dallas
• 0:17
  Cowboys legend Troy Aikman and former president George
• 0:20
  w Bush. For the agenda and event details,
• 0:22
  visit beckershospitalreview.com
• 0:25
  and click on the events tab in the
• 0:26
  upper right. We're looking forward to hosting you
• 0:29
  in Chicago.
• 0:31
  Welcome everyone to the Becker's Healthcare podcast series.
• 0:34
  I'm Mariah Muhammad, writer and moderator of Becker's
• 0:36
  Healthcare, and I'm thrilled to have with me
• 0:38
  today doctor Bill Cooper, senior vice president for
• 0:41
  professionalism and clinical excellence at Vanderbilt University Medical
• 0:45
  Center and professor of pediatrics and health policy.
• 0:48
  Doctor Cooper, welcome to the podcast. Welcome back
• 0:51
  to the podcast.
• 0:52
  We're very excited to have you join us
• 0:54
  again today. To get us started, would you
• 0:56
  mind please introducing yourself a little bit more
• 0:58
  and telling us about your system?
• 1:00
  Absolutely. Thanks. Thanks, Moriah. So I'm a pediatrician.
• 1:03
  I practice in our, children's hospital in Monroe
• 1:05
  Carell Junior Children's Hospital of Vanderbilt
• 1:08
  and also lead our health systems
• 1:11
  professionals and efforts. So we are a large
• 1:13
  academic health system. We have a downtown campus
• 1:16
  in Nashville, and then we have,
• 1:18
  several affiliate hospitals in our our local region,
• 1:21
  that we serve a pretty large catchment area,
• 1:23
  both in Tennessee as well as many states,
• 1:26
  surrounding us.
• 1:28
  Wonderful. Thank you so much for giving us
• 1:29
  that background. So,
• 1:31
  today, I know we wanted to talk a
• 1:33
  little bit about professionalism,
• 1:35
  and, obviously, this is, well within your area
• 1:38
  of expertise.
• 1:39
  So I guess for a a good baseline,
• 1:42
  to start our conversation,
• 1:44
  how does your hospital,
• 1:46
  or health system support clinicians in developing self
• 1:49
  regulation skills?
• 1:50
  Do you have any specific programs or initiatives
• 1:53
  put in place right now?
• 1:56
  We really ascribe to the notion here at
• 1:58
  Vanderbilt that if we can understand and model
• 2:01
  our credo behaviors, and those were sort of
• 2:03
  a set of behaviors that our employees identified
• 2:06
  several years ago. I take ownership. I'm committed
• 2:08
  to my colleagues. I behave professionally.
• 2:11
  I communicate clearly.
• 2:13
  Those things, which are basic tenets of what
• 2:15
  it means to be a good member of
• 2:17
  a health care team, really serve as our
• 2:19
  North Star for how we behave.
• 2:22
  We include our credo in all of our
• 2:24
  employee orientation, our new clinician orientation.
• 2:27
  We talk about
• 2:29
  it regular. We recognize those who have excellence
• 2:31
  in credo behaviors with credo awards that we
• 2:34
  really publicize widely throughout the medical center.
• 2:37
  We also 25%
• 2:39
  of my evaluation as a leader at Vanderbilt
• 2:41
  is dependent on do I consistently
• 2:44
  model the Credo behaviors. But it's also actually
• 2:47
  every single employee in our health system gets
• 2:49
  evaluated in a same way around how are
• 2:52
  we modeling those things
• 2:54
  that are the best part of who we
• 2:55
  are as a part of being a build.
• 2:58
  Oh, wow. That is definitely,
• 3:00
  very good to hear. And I I I
• 3:02
  don't think I've talked to,
• 3:04
  executive who's kinda had this system put in
• 3:07
  place,
• 3:08
  or I've had a conversation with them about
• 3:09
  it. What role does feedback play in maintaining
• 3:13
  professionalism within your organization?
• 3:16
  I know you was talking about evaluation.
• 3:18
  And how is feedback typically delivered and received
• 3:21
  among,
• 3:22
  clinicians?
• 3:24
  One of the key things is we have
• 3:25
  to recognize that nobody's perfect, and some of
• 3:28
  us may have a bad day. We may
• 3:29
  go crosswise with the patient. We may have
• 3:32
  a challenging
• 3:34
  interaction with another clinician.
• 3:35
  So what we have in place is a
• 3:37
  system
• 3:38
  where we talk with each other and not
• 3:40
  about each other. And so what we've trained
• 3:43
  thousands of our employees to do is to
• 3:45
  have as much as possible
• 3:47
  in the moment
• 3:48
  a conversation that we call a cup of
• 3:50
  coffee conversation.
• 3:51
  And it might just be, hey, colleague. You
• 3:53
  know, I was was was talking with you
• 3:55
  about this new admission to your unit, and
• 3:57
  it sounds like that when you asked me,
• 3:59
  you know, if I was lazy or just
• 4:00
  hate my job, that,
• 4:03
  that just kind of didn't seem like what
• 4:04
  we're trying to accomplish in terms of our
• 4:06
  credo values. And I'm just hoping that next
• 4:08
  time you and I talk about a a
• 4:09
  potential admission, it might go differently.
• 4:12
  It's a sixty second conversation where we're just
• 4:14
  asking that person to consider
• 4:16
  how they might be a better version of
• 4:18
  themselves.
• 4:20
  We also have, however,
• 4:22
  system level programs
• 4:24
  for those times where it may not be
• 4:25
  possible to talk in the moment, either because
• 4:27
  there's hierarchy
• 4:29
  or it's a threat to patient safety or
• 4:31
  the person speaks to the individual, but they
• 4:33
  go ahead and, you know, fail to follow
• 4:35
  one of our safety procedures or protocols. In
• 4:37
  that case, if they enter an electronic report
• 4:40
  into our event reporting system,
• 4:42
  90 plus percent of the time, we have
• 4:45
  peer messengers trained for nurses and surgical techs
• 4:49
  and medical assistants and physicians
• 4:51
  and advanced practice professionals
• 4:53
  as a part of the coworker
• 4:55
  observation reporting system. And within a couple of
• 4:57
  days, someone within that person's profession and hopefully
• 5:01
  within their sort of area of work will
• 5:03
  just pull them aside and have the same
• 5:05
  cup of coffee. But the reason for the
• 5:07
  cup of coffee is to say, gosh. Tell
• 5:08
  me how your night went the other night.
• 5:10
  Sounds like it was kinda stressful.
• 5:13
  Any interactions that didn't go all that well.
• 5:15
  You know, we got this report about this
• 5:17
  interaction, and I get it. It sounds like
• 5:19
  that there was a lot of things that
• 5:20
  may have contributed to the tension there. I'm
• 5:22
  just curious, colleague. Could that go differently next
• 5:25
  time?
• 5:26
  What's really amazing, Mariah, is that 97%
• 5:30
  of the time, if we'll have that cup
• 5:32
  of coffee as soon as possible after the
• 5:34
  event, it does not happen again.
• 5:37
  That's definitely amazing to hear. And it does
• 5:40
  sound like very
• 5:42
  calm conversations,
• 5:43
  very respectable conversations,
• 5:46
  and,
• 5:47
  it seems like these overall go really well.
• 5:50
  And,
• 5:51
  are you able to kinda share an example
• 5:54
  of a successful peer to peer intervention
• 5:56
  that's helped address professional behavior in a clinical
• 5:59
  setting.
• 6:01
  And I think more importantly,
• 6:03
  what made it effective for you?
• 6:06
  Yeah. Really, really great example. So
• 6:09
  one of the things that we do also,
• 6:11
  knowing that most will respond to that initial
• 6:13
  cup of coffee, we have an a tiered
• 6:15
  intervention that if you are one of those
• 6:17
  two percent of individuals who don't respond to
• 6:20
  the cups of coffee, we up the stakes
• 6:22
  a little bit and keep moving up with
• 6:24
  higher and higher consequences to, you know, where
• 6:26
  we're gonna do that. So one of the
• 6:28
  times I can think of here at Vanderbilt
• 6:30
  where this worked really well was an individual
• 6:33
  who had had repeated interactions that weren't all
• 6:35
  that professional with nursing,
• 6:37
  colleagues.
• 6:39
  And the peer physician sat and talked with
• 6:41
  them and said, gosh. Looks like
• 6:43
  that compared to your colleagues here at Vanderbilt
• 6:45
  as well as in a national benchmarking that
• 6:48
  we run that Vanderbilt runs as a part
• 6:50
  of the center I lead,
• 6:52
  for some reason, your practice is different than
• 6:54
  others, both locally and nationally within your specialty,
• 6:56
  and I just thought you'd wanna know. And
• 6:58
  here's the types of behaviors that we're seeing.
• 7:01
  Well, after that, the physician,
• 7:03
  on their own, went and approached the the
• 7:05
  manager for the unit where they do most
• 7:07
  of their work and said, gosh. I'm on
• 7:08
  the list. Can you help me understand why
• 7:11
  I'm on it and what I need to
• 7:12
  do to get off it? And I heard
• 7:14
  actually from the nurse leader who said, you
• 7:16
  know what? I didn't know what the list
• 7:18
  was at the time, but I did know
• 7:20
  he needed to be on it.
• 7:21
  Because every time my nurses called with questions,
• 7:24
  he would say things like, you know, don't
• 7:26
  call me with stupid questions. It's in the
• 7:28
  orders. Can't you read the chart? And so
• 7:31
  when he asked me this, the nurse manager
• 7:33
  said, I just said, hey. Look. When we
• 7:35
  call with questions, it makes it difficult for
• 7:37
  us to complete our tasks.
• 7:39
  And, also,
• 7:40
  some of my younger nurses are afraid to
• 7:42
  call you back with subsequent questions.
• 7:46
  The nurse manager said it was almost like
• 7:48
  a light switch was flipped,
• 7:50
  that that individual
• 7:51
  took that to heart and figured out that
• 7:54
  what they were doing, which they were frustrated
• 7:56
  sometimes when they would get phone calls, was
• 7:58
  actually getting in the way of really good
• 8:00
  patient care.
• 8:01
  And the nurse manager said not only
• 8:04
  did that person improve their performance, that physician,
• 8:07
  it actually improved the culture of the entire
• 8:10
  unit.
• 8:11
  Manager said, there was a couple of nurses
• 8:13
  who told me that if that person was
• 8:15
  working a shift in the unit, they would
• 8:17
  call out sick because they just were so
• 8:20
  bothered by being around them. And after the,
• 8:23
  the physician improved their performance, nurses didn't have
• 8:25
  to call out sick anymore. So it actually
• 8:27
  helped the engagement, the retention, and the overall
• 8:30
  culture of the unit so positively.
• 8:32
  Wow. That is definitely an amazing example. And,
• 8:37
  I think that the example
• 8:39
  beforehand
• 8:40
  in this example is definitely a stark contrast
• 8:42
  between, you know, just the coffee
• 8:44
  and,
• 8:46
  what, obviously helped him kinda get his, emotions
• 8:50
  and actions in order.
• 8:52
  But, overall, I wanna thank you so much
• 8:53
  for those final thoughts. It's definitely been a
• 8:56
  very informative discussion. So, again, I wanna thank
• 8:58
  you so much for coming back on Becker's
• 9:00
  Healthcare podcast, and and I look forward to
• 9:02
  connecting with you again soon. Thanks for having
• 9:04
  me. Great conversation.