5 questions on emergency department consulting with JoAnn Lazarus of Philips Blue Jay Consulting

There are many factors that determine whether consulting projects will have a lasting effect on a hospital's day-to-day operations, but staff involvement is the most crucial component, this experienced consultant says.

JoAnn Lazarus, MSN, RN, CEN, FAEN, principal and practice operations lead for Philips Blue Jay Consulting which focuses on emergency department optimization, spoke with Becker's Hospital Review about the unique challenges hospitals face when trying to improve their emergency departments.

Ms. Lazarus has served as national president of the Emergency Nurses Association and earned her bachelor's and master's degrees in nursing from Natchitoches, La.-based Northwestern State University. Prior to joining Blue Jay Consulting, Ms. Lazarus worked as a clinical services consultant at Cardinal Health.

Editor's Note: Answers have been lightly edited for length and clarity

Question: What are the most significant challenges in terms of improving performance in an ED?

JoAnn Lazarus: I would have to say because the environment itself is stressful and controlled chaos, it really creates a higher level of anxiety for patients, families and even staff, so it's important when consultants go into a project to keep that in mind. It helps that all of our consultants have a strong ED background and strong leadership skills, so we understand the environment and understand the nature of the work and its challenges.

Nurses are a little skeptical when an outsider comes in, and the fact that we do have the background gives us that street credibility quickly because we talk their talk and understand their concerns.

Q: What tips do you have for others to ensure a team-based approach really works and is not just false acceptance which will not remain long-term?

 JL: Buy-in is one of the key factors in being successful with any kind of project, whether it's work we do with a client or it's a hospital trying to make changes themselves. The people who are directly impacted by the process changes or procedure changes have to be involved in that process. It can't be a top-down approach with leadership saying 'Here's the change we're going to make,' because when that happens you'll automatically get push back.

At the end of the day you will always have a few people who think they want to go back to the way things were, so it is critical to have staff participate in the change process.  We may be the experts in process change but the staff are the experts in their environment and they are the people who will be living these changes. It's important to include them in the process and also have change management initiatives in place to support the change process throughout the organization.

As important as buy-in is communication and accountability are equally as important. Communication needs to happen from the top down, and senior leaders must communicate with others in the organization for the changes to be most impactful. The staff - frontline and management - must be held accountable to the new processes to ensure improvement is sustained long-term.

Q: You mentioned change management and accountability — how do you ensure that staff teams who are providing quality patient care on a daily basis embrace the changes and don't view change negatively?

JL: I think that goes back to the fact that the staff must be on board with those processes. We, as consultants, have a particular methodology, and we have a phased approach to consulting. The process starts with assessment of environment, looking at data, understanding key metrics, and interviewing staff so that we understand key stakeholder perceptions. Having the staff involved lets them know that they are essential to process change. We listen to them and make appropriate changes so everyone feels their voice has been heard.

Q: How do you feel the Quadruple Aim has impacted ED nursing and your business?

JL: The fourth aim is about improving the experience of the workforce. We've always focused not only on patient experience in part of Triple Aim but staff experience also as it's important to us because we are leaders who live in that environment and are very passionate about the work we do. We also work with teams to enhance their environment which includes safety protocols for patients and them, new education programs, communication with leadership, and more. Staff sees our passion and understands that their buy-in is important and that the changes are beneficial to them also. Another piece is they might have sufficient resources but not always good resource allocation. We help analyze patient and staffing data to make changes which help address such issues to get everyone on the same page to improve the experience.

Q: Any final thoughts to share?

JL: I would emphasize how important staff involvement is in any change process. As leaders we see the problem and we want to fix it, but we don't always get key stakeholders involved, so when we try and roll out a new program it fails. The solution fails for the very reason there was a problem in the first place, which is that not enough of the right people were involved. Change programs need input and support from all levels, especially those who are dealing with the issue daily. Their involvement is key to solving the issue.

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