Critical thinking tips from the happiest place on earth

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Emily Mongan
Emily Mongan

What comes to mind when you think about critical thinking? For audience members at a session held yesterday at the National Association of Directors of Nursing Administration's annual conference at Disney World, a few things were brought to mind right off the bat.

Critical thinking is learned, they told speaker Gina Zimmermann, executive director of business development–nursing care center services for The Joint Commission. It's ongoing.

Or, as one attendee offered and many agreed, critical thinking doesn't exist any more.

The fact of the matter is critical thinking is crucial to fostering performance and quality improvement in skilled nursing facilities, especially as federal performance-focused initiatives like QAPI continue to evolve. The future of quality improvement in the healthcare sector, Zimmermann said, might be one where safety protocols are on par with those of the air travel and nuclear power industries.

If that seems like a tall order in a day and age where regulatory pressure is mounting and critical thinking is viewed as scarce, let's scale it back a bit. Organizations can succeed in this environment, Zimmermann shared, with a focus on safety and quality. That focus starts with facility leaders.

Leaders who successfully embody safety and quality, she said, design work processes that focus on safety and quality issues, while keeping sufficient and effective staffing in mind. They also create a safety culture within their facilities, where employees feel empowered and safe to admit mistakes and bring up issues concerning them.

Without that culture communication failures can occur — whether an employee is reluctant to speak their mind because of a lack of knowledge, fear of retaliation or hierarchy issues — that can cause major resident safety issues down the line.

“People sometimes are afraid to say, ‘Something went wrong,'” Zimmermann said.

To combat that, collaboration is necessary. That's where critical thinking comes in, beyond the old standbys of brainstorming and flowcharting. Here, Zimmermann brought out some hands-on, interactive ideas for getting the entire staff involved with critical thinking and may make performance improvement fun.

First, get the conversation going with a quick icebreaker like, “What did you last binge-watch?” (Or a McKnight's job interview standby, “What animal would you be and why?” Editor's Note: We stand by that question.)

For more critical, expensive projects consider a charter that focuses the team and includes the project's goals, timelines and deliverables, or an elevator pitch that explains why an initiative is important (challenge mode for those attending NADONA this week — try this “elevator speech” while riding the elevator down Disney's Tower of Terror).

Another tip for providers looking to engage staff members and open up a conversation is what Zimmermann called “fist to five.” To reach consensus on a decision, have each meeting attendee raise their hand with anywhere between five (“This idea is the best!”) and no (“This idea is the worst!”) fingers raised. If everyone has more than three fingers raised, the decision can move ahead. Anything less than a two needs more discussion.

Communication can be continued through strategies like imaging the voice of the customer (in this instance, residents' needs, preferences and definitions of quality), cause and effect charts, and continually asking “why” something is the way it is.

With safety culture at the forefront, and employees knowing that their take on quality issues will be heard and valued, long-term care facilities will be well positioned to tackle quality and performance improvement. It may not be as fun as a trip to Disney World, but it'll make for a happier staff and facility overall.

Follow Emily Mongan @emmongan.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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