Next crisis? Prepare with a systems approach

Whether it’s a rare flu epidemic like H1N1, a natural disaster or a major hospital technology overhaul, hospital employee health departments can just about predict the arrival of something unpredictable every year or two.

The key is to apply a systems approach to any project or crisis that takes attention away from daily challenges and priorities.

Hospital occupational health nurses (OHNs) are very good at juggling many priorities, but it is all too easy to get bogged down in the details, says Linda Meuleveld, RN, COHN-S, CCM, occupational health consultant and trainer at Med Manage Consulting, LLC, in Salem, OR.

"The best managers are people who don’t lose that human touch and who are able to look at their work from a systems approach," Meuleveld says.

When a hospital OHN is asked to take on new work, it’s important to think about the end game, Meuleveld says.

"What is it you are trying to achieve today? What is the end game here?" she says. "Kind of work backwards to see how you are going to achieve that."

When a crisis occurs or when the hospital starts a project that promises to be time-consuming, an OHN will need to carve out time even when every minute of the work day has been covered already. One way to do this is to identify the essential functions of what has to be done and break these down into steps that can be followed, Meuleveld says.

"Network with people and find out everything you can about the project or crisis and who it’s going to influence," she advises.

"You don’t work in a silo; you may be employee health, but there are layers of management you are working with and upstream and downstream contacts," she adds. "The more people you know through networking, the easier your job will be."

Meuleveld suggests each new crisis or project be approached systematically, following these steps:

Step 1: Identify your objectives and synch those with your manager: Research is part of identifying objectives, Meuleveld says.

"You have to give it thought to decide your plan of action," she explains. "In the first blush of a new project, not everyone really knows where it’s going to go."

So the hospital OHN should clarify the employee health office’s goals and align these with management’s goals.

"That’s a step that nurses do not always do," Meuleveld notes. "When they’re given the task of getting something done, they will have lots of ideas and experience and then just go for it."

If the plan isn’t successful then it’s probably because it wasn’t in synch with management’s goals, she adds.

"If you want to have a successful project you always have to have a good discussion with your boss," she explains. "Set a meeting, saying, Hi, I have some ideas and would like to see what you think.’"

It likely would take only 15 minutes to make sure a plan agrees with management’s objectives, Meuleveld adds.

Step 2: Identify the key players: Determine key players and whether it’s necessary to ask other nurses for help, Meuleveld advises.

"Do you need to ask industrial hygiene or safety to become involved?" she says. "This project may not be a concern for all hospital employee health nurses, but it is for many.

Email communication is fine for setting up short meetings, Meuleveld says.

"You can make it a stand-up meeting, saying, Hey, we’re going to get together and talk about this after our next team meeting, so if you could stick around for 15 minutes that would be great,’" she suggests. "Then get their buy-in."

The goal is to give key players a heads up, letting them know that you’ll need their help down the road, Meuleveld says.

Step 3: Work on the details: Projects and crises might require new schedules, new products, reserved rooms, and marketing.

"If you’re doing flu shots for something like H1N1 then you will need a flu shot schedule, a room, personnel, and supplies," Meuleveld explains.

After writing a detailed plan, show it to a manager or colleague so someone else might catch anything left out, she adds.

Step 4: Implement: If implementation runs into trouble it could be the result of incomplete steps one through three.

"Some of the things I’ve seen go wrong are people getting so involved in details that they forget to publicize the project," Meuleveld says. "The marketing is very important."

Or someone might have shortchanged the research part in step one.

A flu project will require research into the Centers for Disease Control and Prevention’s latest advisories and health care professional guidance. Each hospital also has its own data and this information should be researched and found.

Step 5: Assess and report: OHNs should assess the work done to handle the crisis or project and create a final report, Meuleveld says.

"Hospital employee health nurses might not always do a final report, but they will have to do a tally, and within that little report they can make recommendations for next year or the next time this occurs," she explains. "Learn from your experiences and pass on the things you’ve learned to other nurses."