Finding focus through consensus☆☆☆
Article Outline
Abstract
J Vasc Nurs 2003;21:35-6.
Investor's Business Daily has spent years analyzing leaders and successful people in all walks of life. Most have 10 traits1 that, when combined, can turn dreams into reality. In each issue of the Journal of Vascular Nursing, one trait is highlighted. Those traits are described in the following:
Last week, a patient, CF, was discharged from the hospital where I work. He had been with us for almost 2 months, having undergone several surgeries. He had been a patient in our surgical intensive care unit and then was on one of our surgical floors. He had a large open left-leg wound that we were initially treating with whirlpool therapy followed by a normal saline gauze dressing. After about 1 month, CF was discharged to our intensive rehabilitation unit. Just before discharge, we decided we would continue whirlpool therapy but also add vacuum-assisted wound closure (VAC) therapy to his wound care regimen. This therapy, which was still relatively new to our institution, would aid in removing drainage from this large wound and promote granulation tissue development as well as wound contraction. Initiating this therapy afforded me the opportunity to work with young physical therapists in our Department of Physical Medicine. Together, we provided wound care, taught the nursing staff and physical therapy staff about the system, coordinated dressing changes with other therapies, and taught the patient about his wound care. We continued VAC therapy for 4 weeks in the hospital and worked with care management and the VAC manufacturer so that VAC therapy could be continued at home. CF's other problems, including management of diabetes mellitus and anticoagulation and antibiotic therapy and attention to all of his physical therapy and occupational therapy needs, were skillfully managed by doctors, nurses, advanced practice nurses, and physical and occupational therapists. The teamwork here made all the differences, and I am sure this exists everyday in hospitals everywhere. What can we do to capture these moments and create “experiences of caring for our patients?”
Finding focus through consensus
A talented team without consensus is like a sports car without gas. A high-performing team is measured by direction and energy, wrote executive coach Christopher Avery2 in his book, Teamwork Is an Individual Skill: Getting Your Work Done When Sharing Responsibility. Shared direction, however, does not come from bullying the minority into agreement, nor is it about getting your entire team to link arms and chant in unison. Consensus is not 100% agreement. Consensus is 100% agreement to move forward together toward what I like to think of as a common vision. How might consensus be fostered?
Consider more, not fewer, choices
A common myth when it comes to decision-making is that having just a few possibilities makes choosing easier; however, limiting choices can inhibit creative thought. Avery poses the question, “If you were planning to make a fantastic meal, would you shop at 7-Eleven, or at the largest supermarket that you can find in town?”
Gather more people and get more points of view
Different points of view emerge when a large number of participants share their ideas. Generating a lot of ideas does not have to mean chaos. Team meetings occur several times a week on the intensive rehabilitation unit, allowing for team sharing and the participation of health care workers from several disciplines who provide care to patients. The plan is shared with all team members and the patient/family.
Avery suggests the following exercise: "Take five minutes in a staff meeting or some other kind of meeting and pass out little 3-by-3 sticky notes and ask staff to spend five minutes of silence considering a particular question, e.g. ‘How can we improve patient flow in our department?’' Each staff member writes 1 idea per note. The notes are then sorted, and common themes emerge. This exercise takes away the individual nature of posing an idea and the whole list becomes the group list.
Get other departments involved
There were many disciplines involved in CF's care. When caring for patients, get other disciplines involved, when appropriate. It is unrealistic to think that in today's complex health care environment, one care provider can know all things and be able to provide the patient with all that is needed for recovery.
Use the brainpower of experienced staff
Ask your seasoned staff for advice and insight. Chances are they have faced a similar situation before. Professionals with years of experience and those with months of experience cared for CF. I believe that we learned from each other.
Take action
Taking action is important, even if it means making a few mistakes along the way. When it came to providing care for CF, we did not always have the right answers or know the correct way to manage every issue that arose. What was key was that we talked about the issues and came up with what were determined to be the best solutions. According to Avery, “A smart consensus-focused leader will build in time for hearing minority voices, and then, if a consensus doesn't emerge in a reasonable amount of time, the leader calls for group action on the alternative with the best chance of succeeding.”
What if your team makes the wrong move? No one likes to make a mistake, but the knowledge and experience that come from making a mistake can be extremely valuable. Focus on learning instead of always being right, and your team won't be as likely to be stopped in its tracks.
References
☆ Address reprint requests to Anne Aquila, MSN, RN, CS, Bridgeport Hospital Department of Cardiology, 267 Grant Street, Bridgeport, CT 06610.
☆☆ 1062-0303/2003/$30.00 + 0
PII: S1062-0303(02)74504-4
doi:10.1067/mvn.2003.4
© 2003 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.
