Perceptions of Quality and Collaboration Go Hand in Hand

Most people who work in health care have so many demands on their time that they are hard-pressed just to care for patients, enter data into the electronic record and race off to yet another meeting. Despite the findings in studies of quality, safety, efficiency and service excellence that teamwork and collaboration result in better outcomes, health professionals tend to restrict their professional circle to those with similar responsibilities and backgrounds. They just don’t have the time to devote to broadening that circle.

A recent article I wrote in Press Ganey Partners magazine profiling the culture of collaboration at Baptist Health, which is headquartered in Jacksonville, Fla., has drawn a lot of discussion. The genuine professional respect that Baptist physicians and nurses have for each other is readily apparent. Baptist developed that culture over many years and multiple generations. I was still surprised when I was told that the chief nursing officer at each of its hospitals was going to be co-signing the cover letter for the physician surveys. “Why not? Our nurses want our physicians to be satisfied with practicing in our hospitals,” they said.

I was also struck by Baptist’s exceptionally high scores on both quality of nursing and collaboration between physicians and nurses. I wondered; do those two questions usually move together on physician surveys? So lately, I’ve been doing a comparison of the nursing quality and collaboration questions by specialty as part of my physician survey consulting. It’s remarkable to me – the two dimensions march right down the graphs together. Physician specialties that give high scores to nursing quality tend to also have high scores on nursing collaboration. When the means are medium on one dimension they tend to be medium on the other. When they’re low, they’re almost always low on both.

I asked Press Ganey’s research and analytics gurus to run the correlation on these two questions in our national database of physician partnership results. Here’s what they found: The highest single correlation to “quality of nursing” is “overall rating of physician/nurse collaboration.” It ranks above even such powerful issues for physicians as “staff’s concern for patients” or “staff reports changes in patients’ conditions.”

Perceived quality and collaboration seem to move together – why? Is it the chicken or the egg? Are physicians more willing to collaborate with nurses if they perceive them as a highly skilled resource? Are nurses more willing to collaborate with physicians whose professional expertise and behavior they respect?

Does physician respect for nursing quality improve when they have increased contact through joint rounding, educational presentations and collaborative decisions about a unit’s functioning? Are nurses more willing to round or attend a physician-led lunch and learn when doctors treat them as full professionals in shared patient care rather than order-takers?

Fundamentally, if you have minimal contact with another person, you’re not likely to have high levels of trust, respect and collaboration. We know that physicians place a high value on great nursing care and that it’s closely related in their minds to the overall quality of care a facility provides. What are the implications for health care leaders who want to build recognized quality and encourage multi-disciplinary collaboration in their facilities?
  • Have professional codes of conduct that you believe in and live by for physicians, nurses and other staff.
  • Relentlessly pursue improved quality and competency, focusing on the care provided by physicians, nurses and other professional staff.
  • Have senior leadership – particularly CEOs, COOs, CMOs and CNOs – insist on and model collaboration.
  • Make multi-disciplinary rounding, particularly of physicians and nurses, the preferred model of care delivery.
  • Utilize collaborative decision-making whenever possible for clinical and operational management; never spring major decisions on physicians, nurses or others directly affected without their input.
  • Become intolerant of sweeping put-downs of other professionals. “You know how impossible doctors are.” “What can you expect from a new nurse these days?” 
  • As leaders, provide clear channels to report problems and quickly intervene in matters of competency or unprofessional behavior. Don’t expect a recent nursing graduate to personally confront a physician’s questionable skills. That’s the CMO’s territory. Don’t tolerate a physician screaming at a nurse because of a perceived mistake. Re-direct safety concerns to nursing leaders. And have the CMO address the screaming.

Collaboration is about both culture and achieving a mission. Whether your goal is to rapidly improve service excellence, have better quality outcomes, reduce adverse incidents or avoid patient lawsuits – collaboration is your key. Want an electronic medical record that meets the needs of nurses, physicians and other users? Involve them all in tailoring the product. Simply want a more harmonious workplace where people can put their energy toward great care? Build that culture of collaboration to truly put the health in health care