Danielle Niedfeldt, J.D., RN, President and Chief Executive Officer of Carolina Donor Services, had been in her role a very short time when she got a letter from the MPSC asking her OPO to address a recent incident. “This was among the first official correspondence I got as a new CEO,” she said.
Reflecting later on that initial experience, she said, “I find myself really grateful that we were put on this path. It would have been my tendency to focus first on ‘softer’ workplace culture improvements with the staff around employee engagement and work schedules, not this.”
Further correspondence with the MPSC highlighted several ways her OPO could improve. “Getting that response really made us take things very seriously and want to do a much deeper root cause analysis,” Niedfeldt said. “We wanted to make a culture change in our organization.”
Based on the issues brought to their attention, Carolina Donor Services established a series of staff focus groups to identify areas of improvement. Some issues could be addressed immediately, while others required longer-term and more complex solutions.
“Some of the feedback centered on how the staff was multitasking,” Niedfeldt said, “and there were some opportunities to look at those roles and break them down a little bit. That was in the short term. We really felt we needed to do something immediately to make sure we didn’t have any further incidents. Then knowing our long-term solution was not a quick fix, we developed other focus groups. They worked on what we call our thematic goals over an extended period of time, where we were focusing in on our staffing, our communication, our training and standardization.”
Collaboration is the key
“From the beginning, we took the approach of seeing this as a collaborative process,” Niedfeldt said. She cited Melinda Locklear, M.S., Chief Information and Quality Officer at the OPO, as a key asset. Having previously served as a member of the MPSC, Locklear was able to explain the MPSC’s process and expectations to the OPO staff. “Her experience is really invaluable,” Niedfeldt added, “and I can’t imagine what the process would have been like without it.”
Locklear recalled, “When questions would come up about what the process was or what something meant, I could shed a lot of light on that. I could say, ‘I’m not on the MPSC right now, but when I was there, this is what the process was.’”
Niedfeldt acknowledged how intimidating it can be to appear before the MPSC. “It almost has this ‘trial room’ feel. It’s a large number of people there and all the formalities. But in our experience, we got some really great compliments that we were on the right track. The interview itself was very validating of the work that we had done. We left with the feedback being extremely positive, with a few suggestions that we took back and continued to look at things a little bit deeper in some areas.”
Locklear added that because of her experience and the OPO’s commitment to improvement, “We came in with relatively low levels of defensiveness. Rather than being defensive about the issue, we, with Danielle’s leadership, accepted that yes, we need to do something about it.” In her MPSC experience, she found that the process goes better for both members and the MPSC when the member understands that the MPSC’s ultimate goal is to help the member improve. When she has participated on site visits, she said, “My intent is to help the organization see the holes in their processes so they can figure out ways to fill those gaps. The most crucial piece is to know that that’s the overall intent.”
What you can do
Niedfeldt and Locklear both recommend that members who are involved in MPSC reviews contact UNOS Member Quality staff to learn more about the process and clarify any potential misunderstandings. “I’ve learned that picking up the phone to UNOS and asking a question or talking through something even before a response is very beneficial,” Niedfeldt said. “You hear the collaboration coming across. None of those conversations ever has come across the same way an official letter can sound with the regulatory terminology and formality in it.” Interacting with peer organizations who have dealt with similar issues can also be helpful.
Locklear also notes improvements to the MSPC processes in the last few years that have provided more useful feedback to members. “Under the old process you never heard back from UNOS unless it was bad news, not good news. That system often left organizations feeling kind of powerless and without closure. I think that fostered some of that mentality of ‘us and them.’ I’m really thankful that that process has changed, and I think that was instrumental in beginning to change the rest of the culture between UNOS and the members that they necessarily have to hold to certain standards.”
Importantly, Niedfeldt notes, the organization continues to focus on quality issues initiated through the review process. “The focus groups we created were a big part of what we’ve done in the last year or so.” Her staff continue to be engaged in learning and improving based on the work begun in that process. “The journey for us has continued well after MPSC.”