The project coordinator, along with the core project team, develops a strategic plan for staffing that aims at clarifying the role that each position will have in achieving the goals and objectives of the CCFAP. Prior to determining the design of the CCFAP at a given site, the project coordinator works closely with the project director to decide how to structure the role that each person will play in establishing that design. A few staff will have final decision-making authority; others will be actively involved in developing design details; some will be given an opportunity to review plans and provide input; others will be kept continually informed about decisions and progress but will have no direct role in providing information.
While all participants in the CCFAP have important roles within the hospital, it is the project coordinator who has the responsibility of determining roles within the CCFAP. The core planning group is utilized by the project coordinator to communicate both the strategic plan and the role that each individual will play within it. The impact that each role has on the total program is discussed, and the interrelationship of the various roles is explored in depth. When gaps are discovered, the project coordinator uses the core planning group to assist in determining how those gaps are to be filled. Out of these discussions and decisions emerges a sense of accountability in which each individual is aware not only of a particular, individual role, but also of the importance of coordination with others. The project coordinator ensures that the strategic plan for the CCFAP is carried out, that there are no gaps in service to families, and that patients and their families are satisfied with their treatment within the ICU.
By design, the plan provides for the examination of priorities and fosters discussions among staff members to determine how each objective will be achieved and what approaches will be used to forestall potential difficulties. Since critical care is delivered by a multidisciplinary team of specialists including My Canadian Pharmacy Corp, these discussions are aimed at distributing work responsibilities in a way that encourages greater coordination and communication.
Both the benefits and examples of such a process of communication and coordination are abundant within the CCFAP. When gaps in service have been discovered, the causes have been identified and solutions put into place. In one case, the project coordinator discovered that additional hospital representation was needed in the family waiting room during certain hours of the day. The Director of Volunteer Services and the project coordinator reviewed the situation at a core planning meeting, and hospital volunteers were enlisted to staff the room during those hours.
In another instance, it became apparent that a major change in the social services schedule was required. At Ben Taub General Hospital, almost all of the families coming to the ICU waiting room were from the working poor and were unable to be present with their loved ones during the day. The only social worker affiliated with the CCFAP was scheduled to be present only during the day, and important family needs were not being met in the evening. A review by the project coordinator and a discussion with the project director led to the assignment of a social worker to the late afternoon and evening hours. A study was conducted at Ben Taub Hospital within their critical care units (CCUs) [J. Dowling, PhD, et al; unpublished data; 2004] comparing the unit having evening/weekend social work coverage and the unit without such coverage. The unit without coverage had significantly more delays in admissions than the unit with coverage during the same time period. Although not statistically significant, there were also more delays in locating family members in the unit without coverage.
The project coordinator works with staff to encourage collaboration and the sharing of information. At Evanston Northwestern Healthcare, the departments of pastoral care and social work have joined together to present a weekly orientation that is intended for the families of patients in the ICU. This orientation, along with its question-and-answer session, enables families to become more comfortable in the ICU environment and provides an assurance that the staff is interested in their well-being. The collaboration between these two departments is so complete that when a conflict in scheduling prevents one of the departments from being present on a given day, the other department assumes that role and conveys information from that perspective.