Five Ways to Build or Improve Your EP Practice

In my time as the manager of a dynamic and lively EP lab at Riverside Hospital in Columbus, Ohio, I have learned many things. In my opinion, these are the five things that have contributed to our department’s success. 1. Shared governance. Having staff involved in the unit decisions dramatically increases staff morale and increases the staff’s feeling of autonomy. Every staff member is encouraged to be on a committee. We have yearly sign-up and rotation of committee chairs and co-chairs. Who else better to make the suggestions for change than the people doing the work? The committees include work life, scheduling, education and research, practice and customer service. Each committee sets goals and has subcommittees that work on projects. We also participate on all hospital committees, such as staff nurse leader, safety coaching and magnet champions. Our customer service subcommittee makes post-procedure phone calls to follow up with patients. Since phone calls have been started, customer service scores are routinely over 80%, which is our goal. Before the calls, scores were 40–50%. We also have a committee that maintains the schedule. We have a set schedule that rotates on a four-week basis, and it is the committee’s responsibility to make sure vacations are accounted for and to follow up with management if changes need to be made. The work life committee is improving our uniforms by creating a logo to be placed on jackets so the staff has a more uniform appearance. The education and research committee is constantly working on staff and patient education and initiating evidence-based practice. A great example of this is the deep sedation manifold created by one of our nurses (her article1 was published in the December 2007 issue of EP Lab Digest). We show community involvement by attending nursing conferences around Columbus, educating about the deep sedation manifold. 2. Constant review of process. We have a process excellence project leader that is integrated within the hospital. She does the data collection and analysis to determine if best practice is occurring. She reviews the results during staff meetings. Together with our director, we make attainable goals. We also recognize the challenges to reaching goals and provide recognition when goals are met. For example, we were having difficulty getting our first patient ready by the 7:30 am start time. When reviewing the process, the patients were coming to the pre-op area unprepared. A work team was designed to review the process of patient readiness. We found many processes were broken, from the patients being added onto the schedule incorrectly, to the patients not having H&P’s on their chart upon arrival to the hospital. We shared this information with the staff and shared what was being done to fix the problem. The staff was more aware of the process and strived to achieve a 7:30 am patient ready time. The process excellence team also divided out the issues we could fix and control versus the issues we could not control. When the information was divided out, we could really see the effort the staff was making, and our patient 7:30 am readiness improved to 100%. 3. Biweekly staff meetings. Staff meetings give the staff a chance to be updated and discuss issues. It is also a chance for the staff to interact with upper level organizational leaders. Our department went through a large change with some electrophysiologists leaving our organization and new electrophysiologists joining us. During this transition we had our director, VP of Heart Services, the VP of Operations as well as the CNO and president of the hospital attend staff meetings lending support and reassurance to the staff. It is the visual presence of high-level administration that staff need to see during difficult times. They need to know they are valued. Fortunately, in our hospital the teachings of John C. Maxwell and the 360 degree leader is alive and well. Staff are encouraged to contact high-level administrators when they need support. As a manager, this support was appreciated and vital to our program rebuilding. 4. Equipment ‘super users’ that take responsibility of new technology. Our staff has the opportunity to go to advanced education and training, such as “train the trainer” courses. We are also supported by the organization to send staff nurses to the Heart Rhythm Society conference every year. Our staff feel involved and responsible for their own education. Yearly unit competencies with the designated clinical educator allow the staff to demonstrate knowledge of all used equipment. It provides private time with the clinical educator to ask questions and clarify issues. This decreases intimidation and increases staff’s knowledge, therefore improving patient care and safety. 5. Be a working management team. The clinical manager and I do not ask staff to do what we are not willing to do ourselves. If we ask the staff to transport patients to and from the lab, then we will transport patients as well. If we ask them to decrease turnaround time between cases and work with fewer nurses, then we are willing to work in the lab on a busy day. We also relieve nurses for lunch and take charge periodically to keep in touch with the staff. We feel visibility increases staff’s confidence and credibility in their leadership team. The management team consists of more than just a manager, it includes a clinical manager, an inventory supervisor, clinical leaders and a dedicated biomedical engineer. Our department has grown and changed over the years, but through teamwork and support, we continue to grow, adjust and thrive. For more information, please visit: www.acp-online.org/ www.ohiohealth.com/riverside