Foster collaboration
When Canose gets up in the morning, there’s very little he can control for the day.
“I’m the first to confess that there’s not much that I control around this hospital,” he says. “I control how I act. I control how I react, and I control what clothes I wear when I come in in the morning, but aside from those things, there’s not a lot we can control.”
Because of this, instead of trying to control everything himself, he works to promote collaboration within the organization by knowing the right questions to ask and the right people to bring in to help solve a problem and achieve the hospital’s goals.
“It’s not a whole lot unlike when you’re practicing medicine and you recognize that there are people with specialty expertise who you need to consult to come in and help with the care of your patient, especially when they have a lot of complex co-existing medical conditions going on at the same time,” he says. “That’s my mental schema for how you identify what’s going on. You make an initial diagnosis. You figure out what kind of problem are we trying to solve. Then you decide who you need to bring in to that conversation in order to be able to solve the problem and create a sustainable solution and then move on.”
This is the approach he took when he realized that, at one point, the hospital had more than 90 committees. He knew he had to get that down to between 30 and 40, because far too much of his people’s time was being spent in meetings, so he brought in all of the involved parties and started a dialogue, asking what committees will help them achieve their priority goals and objectives and move the strategic plan forward. There are also others that are required by law. If a committee didn’t fall into either of those two buckets, it was gone.
In addition to having a team approach to reducing committees, he also took a team approach to changing the patient experience in the emergency room by creating three teams of front-line employees to redesign the whole experience. He started by bringing the right people together for those teams.
“We were looking at getting people involved who were sort of the doubting Thomases,” he says. “We wanted a number of them to participate directly in the process, because we wanted them to own it, and we wanted them to feel empowered to change it. We needed to know what their doubts were as we were going through this redesign project.”
He says to also look for your top talent, as well, so he found the high-performers across multiple disciplines but left management out. These people worked as a team to look at all of the processes and make recommendations to the management about how to improve. The implementation process took about 12 to 15 months to complete, and the result speaks for itself: The national average time from when you walk into an emergency room door to when you walk back out is four hours and nine minutes. At Texas Health Plano, it’s two hours and 30 minutes. At most hospitals, it takes hours of sitting in the waiting room until you’re assigned a room and seen by a doctor, and again, Canose can brag that his team does it in 18 to 20 minutes. Lastly, the average time it takes once you’ve been seen to get your discharge instructions and prescriptions is 67 minutes, but Canose’s team does it in 10 minutes.
“We didn’t try to make little incremental process improvements and see if we could make things 5 or 10 percent better. We made sure that we knocked Humpty off the wall, smashed him into 1,000 pieces and then put together three teams of front-line employees to put Humpty back together again and do it in a way that was focused on the patient’s experience and how we could help patients get in and out of the emergency room or get admitted up to the hospital as quickly as possible,” he says.
Canose has also seen other improvements that show he’s on the right track to raising the level of excellence. For more than a year, patient satisfaction scores in the emergency room have been consistently running in the top 5 to 10 percent in the country. Physician satisfaction scores are between the 82nd and 97th percentile, making the hospital in the top 20 percent in all categories and the top 10 percent in the country in things like the quality of care provided.
“That combination of patient, physician and employee engagement doesn’t happen by accident,” Canose says. “That means we spend a lot of time focusing on the kind of culture we have here in the organization, and I think it says that we’ve created an incredible environment for our professional staff to be engaged and empowered and energized to go do their professional best every day at the bedside, and it shows by the kinds of outcomes we’re seeing.”
But it’s not just the numbers that tell him he’s on the right track. He receives letters all the time, and the most meaningful one was from a Navy SEAL who Canose says was the size of an offensive lineman and as rough and tough as they come. He wrote a beautiful letter thanking Canose and his staff for the way they seamlessly worked together and didn’t panic and kept him calm when his wife had complications during the birth of their child. Both his wife and child were fine, but he was amazed at how the staff handled the one-chance-to-get-it-right situation.
“This can never be a command-and-control environment — the success of patient care depends on collaboration and recognizing interdependency,” he says. “Some people would just come out and say that health care is a team sport, then my role as the head coach on the sidelines is once again to make sure everybody’s prepared when we go onto the field and to make sure that we’re communicating very clearly with each other and that everybody knows everything that they need to know and that they get that consistently, and we create that environment where they can do their professional best.”
How to reach: Texas Health Presbyterian Hospital Plano, (972) 981-8000 or www.texashealth.org