The Department of Health and Emergency Services is a state regulatory agency dealing with a variety of health care professional issues. Its roles include credentialing emergency medical service (EMS) personnel, providers and educational institutions; developing and enforcing administrative code; and serving as a primary collection point for statewide EMS data. Among its most important roles is responding to requests for information about credentialing requirements for health and EMS personnel. These requests come from physicians, hospitals, EMS providers, city and county governments, and other organizations.
The agency has one main office and three regional offices. The main office has thirty staff; each regional office is staffed by five to seven staff. Each regional office has a regional manager reporting to the Operations Section Chief. Since each regional office serves approximately one-third of the state the volume of requests can be overwhelming. Each staff member is responsible for serving as primary contact for 8 to 14 counties.
The agency recently learned that a significant amount of inaccurate information has been distributed by regional staff. The agency learned about this problem from complaints that inaccurate and contradictory information had been given out. For example, a hospital requested information about how nurses could challenge the EMS exam. The hospital was informed that nurses could challenge the EMS exam when in fact agency policy prohibits any healthcare provider from challenging a credentialing exam.
In response to this problem, the agency Director formed an Education/Credentialing team with one liaison in each regional office and the team leader in the main office. The team’s goals included improving consistency among the three regional offices, ensuring accurate information distribution, and educating regional staff on agency policy. In addition to the team leader and regional office liaisons, the team also included members representing each specialty within the agency. These specialists would provide technical information about their particular specialty and serve as primary contact for regional offices in their area of expertise.
The team met monthly for twelve months to discuss issues and develop policy. One of its first tasks was to determine the underlying reason(s) for its information dissemination problem. The team obtained information from its membership and through discussions with other staff in the state and regional offices, EMS providers, physicians and educational institutions. Information was obtained through formal and informal discussions, surveys, and through a web-based forum.
Among the team’s discoveries was that staff did not have clear channels of communication with senior management, and were not informed about changes in regulatory requirements. The team also learned that regional office staff were trying to be “experts” in too many different fields.
The team suggested a number of changes, including:
· Assigning each regional staff member an area of specialization where they would serve the entire region instead of 8 to 14 countries. For example, a provider specialist that would be the primary point of contact for all provider issues for the entire regional office.
· Each of these specialist will serve as the regional office representative on all statewide and intra-agency committees that focus on that area of specialization
· Each regional manager will serve on a committee with senior management that will meet monthly to ensure that up-to-date information is distributed to each regional office
These changes were implemented at the state and regional offices. Mandatory committee attendance was difficult because of statewide travel restrictions and budget shortfalls. These obstacles were overcome by using advanced computer technology and telecommunications. Other obstacles included changes in job descriptions that were resisted by several “old timers.” Their fears were eased by giving them an opportunity to assist with writing their job description.
Six months after these changes were put in place, the distribution of incorrect credentialing information dramatically decreased. Specialists in the regional offices actively consulted other specialists to learn about current policy in their area. An informal telephone survey found consistent information dissemination from each regional office. Among the most successful strategies was formation of teams. This promoted consistency in information exchange and developed interagency communication between all regional offices and the main office. It was also felt that success was attributed in large part to the manner in which team members were selected and how it functioned.
The team concept has continued to grow within the agency and currently every staff member within the agency serves on at least one team. Some members serve on several teams and have taken on additional work responsibilities because the team approach has provided them the opportunity to have a strong voice within the agency. Senior leadership was careful not to push the team approach too fast and did not force anyone to join a team right away. Since the education team was formed first, management emphasized the work that team performed and allowed the education team to provide monthly updates to staff. This helped show that voice is important within the agency and that if staff work together as a team the team will have significant influence on agency policy as well as administrative code.
Continuous Quality Improvement in Health Care: Theory, Implementations, and Applications, Third Edition. Curtis P McLaughlin & Arnold D Kaluzny. 2006. (pg 174-176)