Working in the emergency department (ED) isn’t an easy gig. As Kristen Nordenholz, MD, MSc, points out, some days are “truly horrible.” Yet Dr. Nordenholz approaches each day with energy and enthusiasm, helping her teams find – and celebrate – wins at every level. (Dr. Nordenholz pictured on right)
Dr. Nordenholz’s approach to team management is why Patrick Kneeland, MD, medical director for patient and provider experience at University of Colorado Hospital (UCH), chose Dr. Nordenholz as a provider who embodies the UCH Standards of Excellence related to teamwork.
“In the face of complex problems, Kristen comes to the table with a positive and proactive approach. She works to bridge efforts across disciplines and specialties. She is truly a team player,” he said.
Dr. Nordenholz has been involved in a number of quality improvement projects in the emergency department, including a long-term collaboration between the emergency and radiology departments. Most recently, she’s been part of a team working to allow patients with low risk deep vein thrombosis (DVT) and pulmonary embolism (PE) to be discharged after beginning anticoagulation in the emergency department.
Jennifer Wiler, MD, MBA, vice chair for the Department of Emergency Medicine, said Dr. Nordenholz has been instrumental in creating the DVT/PE pathway. “This team has helped to decrease the rate of admission for these patients, allowing them to be cared for successfully in the community,” said Dr. Wiler. The DVT/PE pathway team includes ED and anticoagulation pharmacists, and Elaina Thompson, MBA, BSN, RN, manager of population programs for diabetes and anticoagulation.
For Dr. Nordenholz, creating cohesive teams is all about building strong relationships. And this starts with everyone on the team being face to face in the same room.
“That way, when an issue comes up, I can pick up the phone, and I know who I am talking to,” she said. “The problem gets immediate attention and we brainstorm a solution.”
Like any quality improvement initiative, the DVT/PE pathway project has been challenging. “It required buy in from the entire team, and significant work on the part of our patient educators,” she explained.
Dr. Nordenholz credits the entire team for the success of the project, explaining how the value of great relationships cannot be underestimated. “When your team believes in you and you believe in your team, everyone can come to the table to make things better,” said Dr. Nordenholz.
Listening to every person in the room is essential.
“To improve quality, you’ve got to understand the trials and tribulations of your front-line staff. You have to understand the barriers, and empower them to be part of the change,” she said. “Put yourself in their shoes and ask what they’d do to solve the problem.”
The DVT/PE pathway project has been a win-win for patients and hospital alike.
“It’s a much better solution for patients in terms of avoiding hospital admissions and it saves the hospital money as well.”
If there’s one thing she’s learned about working well on a team, it’s that a sense of humor is a must.
“You have to be able to laugh at yourself and the situation. A lot of what we do isn’t funny, but if we can’t laugh at some of the things, then it gets way too heavy. Humor keeps people engaged; people come to all the meetings and feel that they have a voice.”
Of course, being part of a team does come with its challenges—especially for someone as enthusiastic as Dr. Nordenholz. The hardest part for her is having patience.
“My tendency is to get excited and want to run out and get it done as quickly as possible, and I admit I’ve been burned by trying to do something too quickly,” she said.
“It’s a process, and I understand how important and valuable it is to empower people to be active in process change.”
Dr. Nordenholz is the assistant director of quality for the emergency department and serves on a variety of teams with goals of improving clinical quality. She’s contributed to numerous ED clinical pathway projects, including the ED redesign and improvement projects. She is currently engaged in collaboration with the Pulmonary Embolism Response team (PERT), the stroke team, diabetic advancement and the anticoagulation team, among others, to improve clinical outcomes.
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