Apart as Three but Together as One --Dividing a Family Centered Care Unit

Background: The Family Centered Care (FCC) unit is located on three different floors, in two separate buildings with 91 beds for over 11,000 deliveries annually. There was only one Patient Care Director (PCD) and four Management Coordinators for more than 210 FTEs. Data from 2005 RN satisfaction survey demonstrated that the top three lowest scores were all related to the management issues. As a result of this data, several focus groups were performed to further understand the staff’s concerns related to management. One of the recommendations was to divide the leadership of FCC into three separate units, based on the different locations of the units. This would allow for more access to management from the staff.

Purpose: the purposes of the splitting FCC units into separate leadership teams are to: (1) increase the management visibility and accessibility (2) improve the communication between staff and management team (3) improve the RN job satisfaction

The Program: splitting the FCC units included the changes in the following aspects

• Management Structure: The current resource structure had been reviewed. The result included creating two additional PCD and Management Coordinator support positions.
• Splitting the staff: A difficult decision to separate the staff into three separate units had to occur. Multiple meetings were held to facilitate the process of separating the staff. Each of three units is different by their design. The plan for splitting the units was communicated in multiple forums to staff. Based on the staff’s choices and proportion of seniority for each unit, staff were evaluated and assigned to their unit. Common activities are provided among the three units to maintain the network among staff and the integrity of FCC as a whole.

Major outcomes

• RN satisfaction survey: The 2006 RN satisfaction survey showed that the overall individual job satisfaction improved for all three units, especially for the unit with original PCD. Team work between coworkers represents the highest improvement among all three units.
• Unit-based opinion survey: A survey regarding “availability and communication of management team”, “relationship with coworkers”, and “personal perception of belonging” has been distributed to all FCC staff. With a scale of 1 (not satisfied) to 5 (extremely satisfied), the results showed significant increase after splitting in satisfaction in all three aspects (2.1, 3.4, and 3.2 before VS 3.9, 4.0, and 4.2 after, respectively). Overall, 92% of staff agreed the action of splitting FCC unit was beneficial.
• Patient satisfaction survey: The results of patient satisfaction scores indicated that the unit with original PCD has been increased compared to before splitting. The scores of the other two units fluctuated and were associated with the availability of PCD.

Conclusion: The separation of FCC into three units had been a success for the staff’s satisfaction, as well as, for the management team. Both feel there is more access to each other. Each unit is starting to develop their own “unit culture” as the staff and management team are being placed.