Hagstrom, J. Nathan, MD, MHCM

Hahn, Toni A

Herr, Courtney

Steidinger, Josephine

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationChildren’s Cancer Center as a ClinicalMicrosystem: EngagementCourtney HerrCourtney.Herr@lvhn.orgToni A. HahnToni.Hahn@lvhn.orgJosephine SteidingerJosephine.Steidinger@lvhn.orgJ. Nathan Hagstrom MD, MHCMLehigh Valley Health Network, j_nathan.hagstrom@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtHerr, C. Hahn, T. Steidinger, J. Hagstrom, J.N. (2019, August). Children’s Cancer Center as a Clinical Microsystem: Engagement. PosterPresented at: LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.Lehigh Valley Health Network, Allentown, Pennsylvania• A clinical microsystem is the smallest functional unit within the healthcare system and is composed of the patient, a provider, and information.1• The Children’s Cancer Center (CCC) outpatient clinic functions as a microsystem within the LVRCH mesosystem and LVHN macrosystem.• The main purpose of this project was to assess and identify areas for quality improvement in work engagement within the Children’s Cancer Center staff.• Colleague, or work, engagement requires an employee’s vigor, dedication and absorption.2• Prioritizing engagement can decrease employee turnover and burnout while increasing well-being, performance, productivity, and patient satisfaction.3• Assessment tools:– Staff interviews, including twelve questions about identifying the CCC’s purpose, staff morale, effectiveness of communication, etc.– Clinical Microsystem Assessment Tool and engagement surveys– Daily morning huddle surveys• The themes found from initial assessment were streamlining communication, increasing morning huddle efficiency, providing continuing education tools, and fostering a supportive atmosphere.  • Countermeasures:– Restructure of morning huddle– Provided continuing education materials, or “mini projects”– Marbles corresponding to the staff’s daily stress levels  – Patient and peer-to-peer encouragement notesDedication Absorption VigorColleague EngagementIntroductionMaterials and MethodsResults DiscussionConclusionsChildren’s Cancer Center as a Clinical Microsystem: EngagementCourtney Herr, Toni Hahn, Josephine Steidinger, J. Nathan Hagstrom, MD, MHCMDepartment of Pediatrics4.0954.3033.8144.0573.4542.5 3 3.5 4 4.5 5Children's Cancer Center Engagement Survey ResultsResources Teamwork Stress Understanding of Role Communication• Initial assessment:– The high level of engagement seen in the CCC could be due to working within a rewarding clinical microsystem with high patient satisfaction and appreciation.– The CCC engagement assessment showed opportunities for improvement through better support, including trauma. stewardship, staff training, more organized quality improvement, which includes the involvement of all staff.• Countermeasures:– New huddle structure showed need for improvement in ensuring only pertinent information is reviewed.– Marbles as stress indicators showed less stressful shifts over time.• Final assessment:– Repeated staff engagement survey with additional questions showed mixed results, which is likely due to lack of time from shifting culture.– Additional survey questions regarding countermeasures were very positive and suggest they will have a positive impact.– Responses showed more value in huddle after implementing the new structure.• Limitations:– Some results in quality improvement can only be expressed qualitatively.– Results are dependent on multiple variables: patient volume, outcomes, external circumstances, etc.REFERENCES1 Likosky, Donald S. (2014). “Clinical Microsystems: A Critical Framework for Crossing the Quality Chasm.” The Journal of ExtraCorporealTechnology. 2014;46:33–37.2 Schaufeli WB, Salanova M, González-romá V, Bakker AB. The Measurement of Engagement and Burnout: A Two Sample Confirmatory Factor Analytic Approach. Journal of Happiness Studies. 2002;3(1):71-92.3 De Carlo, N. A., Dal Corso, L., Falco, A., Girardi, D., & Piccarella, A. (2016). “To Be, Rather Than to Seem”: The Impact of Supervisor’s and Personal Responsibility on Work Engagement, Job Performance, and Job Satisfaction in a Positive Healthcare Organization. TPM: Testing, Psychometrics, Methodology in Applied Psychology, 23(4), 561–580. • The Children’s Cancer Center showed that it is a highly reliable clinical microsystem with overall good engagement.• Implemented countermeasures have shown some improvements to fostering positivity, productivity, and continuing education.• Future Directions:- Continue with current countermeasures in place and repeat staff interviews.- Administer support for staff in the event of negative patient outcomes.- Provide more structured training for new hires; add languagetraining to continuing education materials.- Design a huddle board with daily staff engagement metrics.Figure 1: implemented daily huddle checklist.Figure 3: Initial engagement survey results, divided into themes.Figure 4: Number of good, okay, and bad marbles found daily.Figure 2: Colleague Engagement Survey.Figure 5: Final engagement survey results,before and after countermeasures.Figure 6: Final engagement survey results,regarding countermeasure effectiveness.

Children’s Cancer Center as a Clinical Microsystem: Engagement

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Children’s Cancer Center as a Clinical Microsystem: Engagement

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