Advancing Professionalism and Clinical Excellence at Vanderbilt with Dr. Bill Cooper

0:00This is where health care leadership comes together. Becker's 16th annual meeting brings more than 3500 hospital and health system executives and nearly 800 speakers to Chicago April 13th through the 16th. This series of events includes keynote conversations with Dallas Cowboys legend Troy Atman and former president George W. Bush. For the agenda and event details, visit Becker's Hospital Review.com and click on the events tab in the upper right. We're looking forward to hosting you. Welcome everyone to the Becker's Health Care podcast series. I'm Mariah Muhammad, writer and moderator of Becker's Health Care and I'm thrilled to have with me today, Dr. Bill Cooper, senior vice president for professionalism and clinical excellence at Vanderbilt University Medical Center and professor of pediatrics and health policy. Dr. Cooper, welcome to the podcast. Welcome back to the podcast. We're very excited to have you join us again today to get us started. Would you mind please introducing yourself a little bit more and telling us about your system?

1:00Absolutely. Thanks. Thanks, Mariah. So I'm a pediatrician. I practice in our children's hospital in the North Carol, junior children's hospital in Vanderbilt and also lead our health systems, professionals and efforts. So we are a large academic health system. We have a downtown campus in Nashville and then we have several affiliate hospitals in our local region and we serve a pretty large catchment area, both in Tennessee as well as many states I'm surrounding us. Wonderful. Thank you so much for giving us that background. So today, I know we wanted to talk a little bit about professionalism and obviously this is well within your area of expertise. So I guess we're a good baseline to start our conversation. How does your hospital, our health system support clinicians and developing self-regulation skills? Do you have any specific programs or initiatives put in place right now? We really ascribe to the notion here at Vanderbilt that if we can understand and model

2:01our credo behaviors, and those were sort of a set of behaviors that our employees identified several years ago, I take ownership, I'm committed to my colleagues, I behave professionally, I communicate clearly, those things which are basic tenets of what it means to be a good member of a health care team really serve as our newer star for how we behave. We include our credo in all of our employee orientation, our new clinician orientation. We talk about it regularly, we recognize those who have excellence in credo behaviors with credo awards that we really publicize widely throughout the medical center. We also 25% of my evaluation as a leader at Vanderbilt is dependent on do I consistently model the credo behaviors, but it's also actually every single employee in our health system gets evaluated in the same way around how are we modeling those things that are the best part of who we are as a part of Vanderbilt? Oh wow, that is definitely very good to hear and I don't think I've talked to executive

3:04who's kind of had this system put in place or I've had a conversation with them about it. What role does feedback play in maintaining professionalism within your organization? I know you was talking about evaluation and how is feedback typically delivered and received among clinicians? One of the key things is we have to recognize that nobody's perfect and some of us may have a bad day. We may go crosswise with the patient. We may have a challenging interaction with another clinician. So what we have in place is a system where we talk with each other and not about each other. And what we've trained thousands of our employees to do is to have as much as possible in the moment a conversation that we call a cup of coffee conversation. It might just be, hey, Collie, you know, I was talking with you about this new admission to your unit and it sounds like that when you asked me, you know, if I was lazy or just hate my job, that just kind of didn't seem like what we're trying to accomplish in terms

4:06of our credo values. And I'm just hoping the next time you and I talk about a potential admission, it might go differently. It's a 60 second conversation where we're just asking that person to consider how they might be a better version of themselves. We also have, however, system level programs for those times where it may not be possible to talk in the moment, either because there's hierarchy or it's a threat to patient safety or the person speaks to the individual, but they go ahead and, you know, fail to follow one of our safety procedures or protocols. In that case, if they enter an electronic report into our event reporting system, 90 plus percent of the time we have peer messengers trained for nurses and surgical texts and medical assistance and physicians and advanced practice professionals as a part of the coworker observation reporting system. And within a couple of days, someone within that person's profession and hopefully within their sort of area of work, we'll just pull them aside and have the same cup of coffee.

5:06But the reason for the cup of coffee is to say, gosh, tell me how your night went there the night. Sounds like it was kind of stressful. Any interactions that didn't go all that well. And we got this report about this interaction and I get it. Sounds like that there was a lot of things that may have contributed to the tension there. I'm just curious, colleague, could that go differently next time? What's really amazing, Mariah, is that 97% of the time, if we'll have that cup of coffee as soon as possible after the event, it does not happen again. That's definitely amazing to hear. And it does sound like very calm conversations, very respectable conversations. And it seems like these overall go really well. And are you able to kind of share an example of a successful peer to peer intervention? That's help address professional behavior in a clinical setting. And I think more importantly, what made it effective for you? Yeah, really, really great examples.

6:08So one of the things that we do also, knowing that most will respond to that initial cup of coffee, we have a tiered intervention that if you are one of those two percent individuals who don't respond to the cup of coffee, we up the stakes a little bit and keep moving up with higher and higher consequences to where we're going to do that. So one of the times I can think of here Vanderbilt, where this worked really well, was an individual who had had repeated interactions that weren't all that professional with nursing colleagues. And the peer physician sat and talked with them and said, gosh, it looks like that compared to your colleagues here at Vanderbilt, as well as in a national benchmarking that we run, that Vanderbilt runs as a part of the center I lead. For some reason, your practice is different than others, both locally and nationally within your specialty. And I just thought you'd want to know. And here's the types of behaviors that we're seeing. Well, after that, the physician, on their own, went and approached the manager for the unit where they do most of their work and said, gosh, I'm on the list.

7:10Can you help me understand why I'm on it and what I need to do to get off it? And I heard actually from the nurse leader who said, you know what? I didn't know what the list was at the time, but I did know he needed to be on it. As every time my nurse is called with questions, he would say things like, you know, don't call me with stupid questions. It's in the orders. Can't you read the chart? And so when he asked me this, the nurse manager said, I just said, hey, look, when we call with questions, it makes it difficult for us to complete our tasks. And also some of my younger nurses are afraid to call you back with subsequent questions. The nurse manager said it was almost like a light switchless flipped. But that individual took that to heart and figured out that what they were doing, which they were frustrated sometimes when they would get phone calls, was actually getting in the way of really good patient care. And the nurse manager said not only did that person improve their performance, that physician, it actually improved the culture of the entire unit.

8:12Manager said there was a couple of nurses who told me that if that person was working a shift in the unit, they would call out sick because they just were so bothered by being around them. And after the physician improved their performance, nurses didn't have to call out sick anymore. So it actually helped the engagement, the retention, and the overall culture of the unit so positively. Wow. That is definitely an amazing example. And I think that the example beforehand in this example is definitely a stark contrast between not just the coffee and what obviously helped him kind of get his emotions and actions in order. But overall, I'm going to thank you so much for those final thoughts has definitely been a very informative discussion. So again, I want to thank you so much for coming back on Becker's Health Care podcast. And I look forward to connecting with you again soon. Thanks for having me. Great conversation.