Taking on responsibility means letting details go
With five hospitals, 'small stuff' falls by wayside
When Rita Borowski, CHAM, took on the responsibility of overseeing patient access services at five hospitals, she quickly adopted a philosophy that can be simply paraphrased: Don't sweat the small stuff.
As manager of patient access services for two hospitals in the Milwaukee area, Borowski could afford to be detail-oriented, intimately involved in day-to-day operations, she says. All that changed, however, when she became patient access services director for Aurora Health Care's metro region - and the luxury vanished. "If you look at everything that comes across my desk as an A, B, or C [in importance], the C's don't get done anymore, and the B's sit there until they are A's, because there are so many A's," she explains.
When she assumed the position in July 1997, the corporation had identified straw models of what it expected the management structure would be, but allowed directors the final say, she says.
For patient access services, Borowski agreed, that meant no managers, a site supervisor at each of the five hospitals, and access staff at the two ambulatory centers and 10 clinics reporting to her through the site supervisors. Some, but not all, of the clinics had "lead" access positions, she adds.
One of the first things she did was to set up a weekly schedule dividing her time among the hospitals: Two half days at one facility, a half day at two others, and the remainder of the time at her primary office at the largest facility, St. Luke's Medical Center.
One of the facilities - about 40 miles away from Milwaukee - gets a visit only every other week, she notes. Her accountability at that hospital, where the manager of finance oversees day-to-day operations, is for planning, process improvement, and development, and to make sure access processes are consistent with those in the rest of the region, Borowski adds.
"My administrative assistant and I try to keep meetings at those facilities during those half days," she says. "It doesn't always work, but if a meeting is called on a day I wouldn't normally be there, we try to flip it. It's the most efficient use of my time, and it makes sure I actually get around to all the facilities."
While the patient access management structure solidified quickly, other areas of the newly reorganized health care system took longer to gel, notes Borowski. "There was so much movement and so many open positions that one of the biggest challenges was learning who was responsible for what [in other departments]," she notes.
Her advice for others in a similar situation is, "Don't be afraid to call. Sometimes the biggest mistake is to hold back and be frustrated. Make calls; talk to other people."
Hand-in-hand with distancing herself from daily operations, she says, came the need for a different trust level with her supervisory staff. "You have to remember that your focus is leadership. You need to direct the activities of staff and delegate in a way that helps them prioritize what's important."
An example of this kind of "letting go" was the recent institution of a regionwide dress code for access employees, she points out. Previously, with that kind of change, she would have met with the staff, explained what was going on, and walked them through the policy, Borowski says. With five hospitals to consider, that wasn't practical.
"I worked with the supervisors and they had to meet with the staff. I had to trust them at a higher level. In the past, there was no way I'd make that major a change without being part of it," she says.
One of the considerations that makes prioritization different than before, she notes, is that she's looking at five ways of doing things and deciding which should be standardized. "It's a new mindset. Every time you look to make a change, you ask, 'Should it be regional, or just at this site?' Some things need to be site-specific."
Patient identification bracelets and embossed plates, for example, will be the same at all five hospitals, because there's a financial advantage there, she says. However, the two facilities that are using computer-printed labels instead of embossed plates in some of their operations will be allowed to continue doing so.
"It would be silly to make them change because the process works well, and there's nothing financial to be gained," Borowski adds. "We don't want to interrupt processes that are working well in the name of standardization."
In the case of the dress code, on the other hand, there was a good reason to standardize, she notes. "As patients identify more with the Aurora organization, they learn that no matter which [facility] they go into, the access staff will be in navy. It's in the interest of customer service."
A key challenge for her supervisory staff, she says, has been recognizing the enhanced importance of various means of communication. "They need to [use] more telephone, more e-mail, vs. in-person contact," she points out. "They're used to seeing people in the hallway and getting things done. The potential still exists for that kind of contact, but it's not as likely it will be in a timely manner."
Also important has been providing supervisors with a venue for sharing information, Borowski says. "There are a lot of things they thought they were doing best, or uniquely. As we've had meetings to pull them together to talk, they're learning to call each other and say, 'What are you doing about this?' They're taking more of the problem-solving on themselves, and helping each other because they're finding that one has already dealt with [a particular issue]."
As for maintaining her own equilibrium in the face of what can seem overwhelming responsibility, she says one of the biggest helps has been "just to write it out. Realize that if you sit down and take it apart, you can make it work. If you let it overwhelm you long-term, you won't succeed."
Weigh everything from the perspective of "getting the biggest bang for your buck," she advises. "If you just keep doing and doing and not evaluating, you're on an endless roller coaster."
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