Collaborative Effort Transforms Culture and Care in Rapid City Regional's ICU
By: Alex Strauss
In 2014, only a third of the nurses surveyed in Rapid City Regional Hospital’s Intensive Care Unit felt that they had the support they needed to do their jobs well. And they weren’t the only ones suffering. Patient satisfaction scores were less than desirable as ICU staffers labored to care for them in what the Nursing Director now calls a confusing and disjointed environment.
“Because of the open model of care we had at the time (any physician could admit into the ICU), everyone was having to go to the charts to try to figure out what to do,” says Angie Mills, RN, Nursing Director of the ICU. “Everyone worked in independent silos and it was very confusing.”
Based on feedback from focus groups, the decision was made to close to ICU and dive headlong into an effort to completely overhaul how the department was run.
“We decided that we needed to change the culture, so we started with the physicians,” says Mills. “We only wanted physicians who were willing to support the culture we were trying to create, including supporting nurses, working in collaboration, and conversing with families.”
Nurses, too, were made aware of the new vision and expectations for department-wide cooperation and collaboration. “We drew a line in the sand,” says Mills. “Now, the medical director and I come together and make unified decisions. We do not always agree, but we always come away ready to offer mutual support.”
“The ultimate goal of the new model is to improve patient care,” says Sri Gangineni, MD, Medical Director of the ICU. “There is typically a hierarchy in healthcare where the physician gives the order and expects it to be implemented. But we now know that if you don’t work as a team, it is very difficult to improve patient care or obtain good patient satisfaction.”
Today, physicians, nurses, pharmacists,
nutrition support, case managers, and others work collaboratively in a
patient-centered ICU. To facilitate better two-way communication, upper level
administrators were invited to get a first-hand look at the workings of the ICU
by rounding with providers. Morale-boosting initiatives like “Notable
November”, which offered a movie ticket to any ICU worker who reported on a
co-worker’s act of compassion, served to further solidify the new team
“Another thing we have done to improve collaboration throughout the hospital is write collaborative working agreements with all of the specialties that see patients in the ICU,” says Mills. “We rarely have any conflicts now because we have already set expectations and we are all on board.”
Regional’s ICU has been selected by the Society of Critical Care Medicine as one of 63 ICUs in the nation working with the Patient Centered Outcome Research Institute. The ICU is also one of the few in the country that rounds with patient families present and even offers video conferencing for those who can’t be there. Physician and caregiver collaboration scores have improved from the lower third to the 90s and the monthly service line meetings typically have more than 15 physicians involved. Hospital-acquired infections have even decreased.
Mills and Gangineni say the next goal is to take their success system-wide with collaborative quality initiatives to improve both culture and care throughout all Regional facilities.
“Our bar is always set very high,” says Dr. Gangineni. “All of these things are part of a continuous process. It’s not a one-time thing. It takes a lot of hard work and team work to sustain the culture that has been created.”