Building and keeping a quality RT program requires clear goals, short-term and long-term protocols, and good communication. Keeping the staff happy helps, as well.

How does a manager/director survive today when faced with decreasing numbers in staffing, increasing numbers of more acute patients, and a focus on quality of care for patients? Several factors play into the solution. Since our department has been successful in overcoming most of these problems, we will share some of the things we have done to accomplish being on target with our benchmark goals, making our 90% level of customer satisfaction, and consistently adding quality therapists to our staff. We also evaluated our local college respiratory therapist program for improvement opportunities.

First, we had to decide what we wanted to accomplish. Our department was faced with more work than we could get done, fewer applicants in our local community college program, and some dissatisfied staff members. We had to apply immediate quick fixes, while we also set our long-range goals to address the bigger picture.

Second, we had to adjust how our work was done to get it all accomplished. As our hospital is in a southern state and protocols were not in wide use here yet, we knew we had to get those in place to begin to meet the demands of the increasing numbers of patients. Also, we had to focus on doing the best job for those patients, as our average length of stay was a key factor in outcomes and reimbursement, as well as staff satisfaction.

Third, we knew we had some staff members who were not on board with what we wanted to do. We had to either change the mind-set of those individuals or get them out of here. Quality of the care we provide is non-negotiable.

For the immediate fixes, we implemented a triage system to provide direction in the acuity of our patients. That way, if treatments were missed, at least the therapists knew they were not missing those patients who were the “sickest.” We also implemented self-administration and MDI conversions.

Protocols
Protocols were one of our biggest obstacles, but one that offered the greatest impact on how we do things. It took us several rounds of going to committees to get approval from the medical staff—and we started with a simple oxygen protocol—but we finally got approval. Then, to make certain it was successful, we allowed only a couple of therapists we knew would do a fantastic job to do them. We really wanted our physicians to buy into our oxygen protocol.

Staffing was its own obstacle. How do you get people to change minds and habits that had years to develop? We were very honest with them. We told them “either you get on board with what we are trying to accomplish, or you will stick out like a sore thumb compared with the rest of the staff who are on board.” Peer pressure and pride in the quality of the work played a huge role in making this a success.

We became active members of the advisory board of our local college. We attend all meetings and speak truthfully about our concerns—and also about things that are done well. The admission criteria needed to be revamped and interviews for potential students more directed to ensure that accepted candidates were right for the profession.

School work
In our department, we have dedicated one of our best clinical specialist therapists to work with our students. We took more ownership of the training and clinical competence of the students who do their clinical rotations in our hospital. We made certain their rotations included all pertinent areas within the organization, ie, bronchoscopy laboratories, pulmonary function studies, neonatal and pediatrics areas, post-acute areas, durable medical equipment (DME) and home health care, and sleep laboratories. In addition, we rotated students through various areas, eg, cardiac catheter laboratories, noninvasive cardiology, and radiology. This not only gave students more ideas about what respiratory therapists could do, but also kept them busier and taught them new things. One of the biggest mistakes an organization can make is fail to give enough to students to keep them interested. We knew we would want to recruit from within our local program and to get the best of the best by introducing them to everything available to them.

By dedicating the same clinical specialist therapist to our students, with more therapists involved in helping, the students found a more structured world in which our department and the school program worked together. This year, we have hired almost all of the graduates and feel that we got the best graduating class. We ask our graduates to evaluate their clinical experience, and try to improve with the information provided. This year we had only positive remarks from all graduates.

All of these actions have led to a more productive and happy department for us. We miss less than 1% of our total medication treatments, and these are due to patients not being available. Rarely do we miss a treatment because a therapist is not available. We have multiple protocols in place, giving our therapists the opportunity to be decision-makers rather than task-oriented workers. We involve our staff in decisions and ask for their input about implementations. We change things according to what they tell us. When you involve the staff, you tend to hear information from their perspective and generally will have a better result and an outcome of acceptance.

The management team in our department is vital to our success. We meet each week, on Tuesday mornings at 7 am, to discuss anything and everything. No one is in charge at that meeting, and talk is noncensured—meaning there is no bad idea. Once we leave our meeting and have made decisions, we are all supportive of those decisions. We never use “administration” as an excuse for anything. To do that implies the decisions are not ours. Fortunately, in our organization, the decision generally is ours. Certainly we need approval for specific things such as capital equipment, but that is not a topic of discussion with our staff. Rather we always show support and loyalty to our organization, which then filters out to the staff.

Stay active
Since 1996, when I became the director of this department, we have been using every effort to enhance what the department does and the success it has sought. We are on a continual journey, as is every respiratory department in the country. The question each supervisor, manager, and director should ask is, “What have I done today to improve the way we do things?” If you cannot name anything, then you need to get busy and do something. To remain stagnant in today’s health care profession is sticking your head in the sand. You need to have a method to attract a continual feed of therapists and graduates into your department. You need to review how things are being done in your department and look for ways to improve. You need to network with others in the profession. A great way to do that is by membership in AARC. Certainly, active membership on the local level is important. Network to see what others are doing that you could incorporate into your department. Engage with staff members not only to get their opinions and suggestions, but also to let them know you care. Be visible and helpful. Do floor therapy when possible. Be available to the staff and make the effort to know what is important to them.

Opportunities are knocking at our door every day. Are we ready? We think we work every day to be ready. Do you?

Joan Nowell, BS, RRT, is director of respiratory care services at Jackson-Madison County General Hospital in Jackson, Tenn.