Services
Collaboration Council
Our Collaboration Councils, A Deep Source of Pride and Purpose at Doctors Council.
No matter where physicians practice, the core of that practice is the patient-physician relationship.
In today’s world, physicians across the nation are deeply concerned about the erosion of that relationship. From increased time spent on our computers, to increased panel sizes and workloads, increasingly complex coding requirements, insurance company intervention in our practice as never before experienced, and more and more centralized decision-making about how to manage our practices, physicians everywhere believe that they are losing control of the profession they love.
Our Union, Doctors Council SEIU is a national leader in the promotion of physician voice. Along with our traditional role in collective bargaining, we have established a unique forum for problem-solving, heightened engagement, and improving that precious physician-patient relationship: The Collaboration Councils.
What is a Council?
A Collaboration Council has been established in each of the 22 facilities that comprise the nations’ largest public health system, NYC Health+Hospitals. A Collaboration Council has also been established by Doctors Council physicians in Cook County, Illinois. Each one is made up of top executives and frontline physicians who meet each month. Agendas are established jointly. Minutes are taken and reviewed.
The Councils have been established as a “safe space for open dialogue” which foster discussion and problem solving in the following areas:
Pebbles in our Shoes
Day-to-day administrative, operational, infrastructural, staffing, or other barriers to quality care. Examples include: resolution of staffing shortages in laboratories that delay pathology reports, shortages of supplies, inadequate signage in facilities for patient ease of access and directions, and other relatively easy-to solve problems that get lost in the day-to-day busy environment of our institutions
Business Literacy
Regular discussions about the financial, organizational, and competitive pressures that drive macro-decision making within the health system. Through this education, frontline physicians gain understanding and achieve buy-in for participation in improvement initiatives that improve patient experience and physician engagement. Such education also removes mistrust and barriers to joint understanding of challenges which fosters collaborative efforts to resolve issues.
Frontline-driven improvement
Frontline-driven improvement projects which align with system goals. Too often in healthcare today, improvement initiatives are top-down driven and as such do not achieve frontline buy-in. More important is that without input into the identification of quality improvement projects from the frontline, many opportunities will be missed entirely.
Quality improvement education
The Councils have become a center of learning where improvement science is shared by quality improvement experts who have received training from IHI, or the NYC H+H Quality Academy. Access to learning from one’s colleagues and peers is most effective compared to such training from external consultants.
Physician wellness
Many of our Councils have as standing subject matter, discussion about the importance of physicians taking the time to look after their own well-being, something that physicians are historically not good at.
Leadership development
In today’s healthcare environment, more and more care-giving are achieved through team efforts. Physicians can and must play a collaborative leadership role in the multi-specialty and multi-disciplinary team-based care we are a part of, a set of skills that must be developed over time.
How did it originate?
In 2013, the leadership of Doctors Council surveyed its membership about what union members wanted the Union to prioritize. The results of that survey were and remain central to the work of the Union.
Based on the results of that survey, Doctors Council members wrote a White Paper.
The White Paper was presented to the Mayor of New York City, the NYC Health Commissioner, and the CEO of the NYC Health+Hospitals Corporation just prior to collective bargaining negotiations in 2014. The concept of the Collaboration Councils was developed in collective bargaining based on the White Paper, and in the Spring of 2015, the hospital system and the union reached agreement on language setting forth the establishment of the Councils.
It is important to note that it was the testimony of frontline physicians in bargaining about their experience of exclusion from the many facets of healthcare improvement that lead to the Agreement.
“Frontline doctors must be involved. If doctors believe they will have real involvement in an on-going process they will be more likely to speak out and participate. The process must exist to allow doctors to believe that we will be asked for input, that it will be listened to and that we are a meaningful part of decision-making.”
— Dr. Roni Mendonca, Anesthesiologist, Metropolitan Hospital Center
Do you have any idea or input you want to share? Want to be part of the solution? Be involved in the FBCC!
The Facility-Based Collaboration Council is a pathway for Doctors Council members to work with H+H and admin.
For more information, or to be involved, please email fbccquality@nychhc.org and info@doctorscouncil.org
Projects
Think TB Initiative
Project
Think TB Initiative: Improving accuracy and rapidity of TB diagnosis in the inpatient setting
Strategic Alignment to Health + Hospitals Pillars
More accurate and rapid TB diagnosis will improve quality, outcomes, safety, and the care experience by reducing TB transmission and allowing patients return to home and work more quickly. The new process provides rapid access to the highest quality, evidence-based evaluation available. Because the GeneXpert ($50/test) is already being performed regularly at Bellevue, even if the total number of tests increase slightly, this cost would be offset by the much greater savings associated with decreased length of stay in airborne isolation.
AIM Statement
By 3 months, we aim to improve accuracy and rapidity of TB evaluation among hospitalized patients suspected of having TB by reducing time to completed TB evaluation and time in airborne isolation by at least 12 hours.
Measures
Reduction in hours to completed TB evaluation, reduction in hours to TB diagnosis and reduction in hours spent in airborne isolation before the change and at 3 and 12 months following the change.
Changes
1. Revision of the sputum induction policy to eliminate the NPO requirement and allow sputum to be induced every 8 hours for 24 hours rather than once a day for 3 days, 2. Creation of a bundled “TB Rule Out Panel” in the EMR, and 3. Healthcare provider education.
Progress to date
Steps 1-3 have been completed. Of 88 patients evaluated using the new process over 3 months, 9 were diagnosed with TB, 7 of whom were diagnosed within 24 hours. Time to complete a TB evaluation decreased from 54 hours to 24 hours, and time in airborne isolation decreased from 114 hours to 71 hours.
Comment on doctors’ engagement on FBCC
“Being a part of the Collaboration Council has been a transformative experience for me. It is incredibly empowering to have executive leadership championing our efforts to improve not only patient care but the financial health of our public health system.”
-Dr. Caralee Caplan-Shaw, MD, Doctors Council Member
MEETING TIME
November 2019
HOSPITAL
Bellevue Hospital FBCC
Project Leaders
Caralee Caplan-Shaw, MD and Nathan Link, MD
Executive sponsors
Nathan Link, MD
Team members
Caralee Caplan-Shaw (Director, Chest Service), Nathaniel Nelson (Resident in Internal Medicine), Susan Williams (Director, Respiratory Therapy), Lauren McVoy (Director of Microbiology)
Coler Palliative Care Program
Project
Status and achievement of Coler Palliative Care Program among care givers and residents
Strategic Alignment to Health + Hospitals Pillars
Care Experience
Improved quality of life for residents with life limiting illness
Access to Care
Increased compliance with the Palliative Care Act by providing palliative care services for residents with life limiting illness.
AIM Statement
Increased Utilization of the Palliative Care Program for residents with life limiting illness by 100% in 6 months.
Measures
120 % increase in utilization of Palliative Care Program.
Changes
Increased staff education on Palliative Care. Coler staff recognized at the Center to Advance Palliative Care (CAPC) conference for overall course completion of CAPC training modules.
MEETING TIME
November 2019
HOSPITAL
Bellevue Hospital FBCC
Project Leaders
Dr. Humphrey and Dr. Rahman
Executive sponsors
Robert Hughes, CEO
Team members
Dr. Rahman, Dr. Rajaram, Dr. Luo, Dr. Hossain, Dr. Tsuei, Dr. Oommen, Penelope Lambert and Julissa Cardona
Coler Rehabilitation & Nursing Care Center
Project
Coler Rehabilitation & Nursing Care Center
"A Great Way for Doctors to Be Engaged at Work"
Strategic Alignment to Health + Hospitals Pillars
A Great Place to Hear from the Chief Executive Officer, Chief Medical Officer, and Chief Quality Officer each Month about What’s Going On in NYC Health + Hospitals Across the System and at Coler Rehabilitation & Nursing Care Center. Frontline Doctors can ask questions and give input at monthly FBCC meetings as well as bring information back to their colleagues and share feedback at next meeting.
MEETING TIME
November 2019
HOSPITAL
Coler Rehabilitation & Nursing Care Center
Now more than ever the Collaboration Councils are a core element of the mission and work of the Doctors Council.
We are proud of our journey of collaborative problem-solving in our workplaces, which after all are the places where the health care system and the population we serve come together.
Through the establishment of these forums of dialogue, we feel proud and confident that we lead the nation in the establishment of such on-going and highly developed spaces for problem-solving…which after all ought to be the essence of the empowered voice of the physician.
Thank you for reading about our journey.