2/24/2016 Improving Care Through a Change of Shift Bundle Mary Del Guidice, MSN, BS, RN, CENP Chief Nursing Officer Penn Medicine, Pennsylvania Hospital Assistant Dean, Clinical Practice University of Pennsylvania, School of Nursing Jessie Reich, MSN, RN, ANP-BC, CMSRN Professional Practice Consultant Penn Medicine, Pennsylvania Hospital Learning Objectives Identify the four parts of the practice bundle that was implemented to improve the patient’s perception of care in a meaningful and sustainable way. Identify the value of both operational changes to care practices and the emphasis on relationships and meaningful connections with all patients. Implement the structures required to sustain practices and achieve sustained gains in patient experience over time. 2 ABOUT PENN MEDICINE The University of Pennsylvania Health System was created in 1993 and consists of five hospitals (Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Pennsylvania Hospital, Chester County Hospital, Lancaster General Hospital), a faculty practice plan, a primary care provider network, multi-specialty satellite facilities, home care, hospice and a nursing home. Licensed Beds 1,893 Total Employees 24,293 Total Revenue $4.9 Billion Admissions 83,994 Outpatient Visits 2,837,864 Physicians 2,846 Nurses 5,563 3 1
2/24/2016 Pennsylvania Hospital- The Nation’s First ♦ The Nation’s first hospital founded by Benjamin Franklin and Dr. Thomas Bond. ♦ 520-bed acute care facility that provides a full range of diagnostic and therapeutic medical services. ♦ 2,633 Total Employees ♦ 980 Registered Nurses ♦ Over 29,000 inpatient admissions and 115,000 outpatient visits each year, including over 4,708 births. ♦ Expanding programs for cancer, cardiac care, bloodless medicine and surgery. 4 The Purpose of Our Work Eliminate variations in practice Hand off with transparency and consistency • Promote confidence • Promote safety • Promote patient involvement Improve safety on the units Increase awareness about outcomes 5 Communication with Nurses Domain ‐ HCAHPS (% Rank) 100% 90% 80% 70% 60% 50% 43% 41% 39% 40% 29% 30% 27% 26% 22% 19% 20% 16% 13% 9% 10% 0% 2QCY11 3QCY11 4QCY11 1QCY12 2QCY12 3QCY12 4QCY12 1QCY13 2QCY13 3QCY13 4QCY13 2
2/24/2016 The Nursing Culture: Present and Future Fearful Defined Culture Secure/trusting of leadership Suspicious Personal vs. Unstructured professional Identity Self Patient Unprofessional Professionalism Centric Centric Integrated and Multi- No shared defined process Vision Silos professional to vision integration Fully engaged Disengaged/lack and empowered Stagnant/Status Progressive/open of accountability and accountable quo/ resist change to change for Practice. Shared Hierarchical Governance 7 Discover the Talent…Build the Structure 8 Keep the Main Thing the MAIN THING! Strategy Cultural Transformation Organizational Goals Self Centric Patient Centric Delivery of Care System No Shared Vision Defined shared vision Satisfactio Employee Satisfactio Quality Patient Finance Safety n Shared Governance Hierarchical- Shared Governance n Disengaged- Engaged Fearful /suspicious Trusting Leadership The Patient Care Network Self Centric- Patient Centric Multidisciplinary Rounds Silos Colleagiality/collaboration ALL ALL Satisfaction and Engagement: The Patient-The Staff-The Physician Strengthen UBCL Structure Silos Colleagiality/collaboration Self Centric Patient Centric Professional Image Unstructured- Personal vs. professional Leadership Development/ Succession Planning Stagnant, status quos, resistant to change Progressive& open to change 9 3
2/24/2016 Additional Points of Assessment Committed to both Relationship Based Care and Modified Primary Nursing Structure was needed to support both Needed consistent nursing practices across all units in order to define the patient experience Individual initiatives were not making the desired impact 10 10 The Foundation for Our Work Expectation were tied to both Relationship Based Care and our Primary Nursing Model Accountability was established early • Qualitative and Quantitative 11 11 What’s In A Name? • H ‐ Holistic • E ‐ Evidence Based Practice and Research • A ‐ Advocating • R ‐ Resourcefulness • T ‐ Teamwork 12 12 4
2/24/2016 Primary Nursing Bundle The Anatomy of Our Work: 13 13 Methodology for Implementation: Started with the WHY; the burning platform Small interactive groups Education provided by nursing leaders including educators All RNs, modified for all Nursing Assistants Role Play Videos of expected hand offs Scope of the education was well defined 14 14 Rapid Cycle PDSA 15 15 5
2/24/2016 HCAHPS- Nurses Explain Things in A Way You Understand 16 16 HCAHPS-Communication with Nurses 17 17 Falls with Injury 18 18 6
2/24/2016 Revitalization Therapeutic Relationship Sessions 120 staff members from November 2014 through March 2015 • Focused on 4 inpatient units to maximize impact • Managers and Facilitators conducted follow up session Began in November with another cohort of 250 • Includes the ED, Oncology, Critical Care, and Women’s Health 19 19 PDSA Continues HEART Bundle Clinical Nurse Champions • Representatives from each of the units – Review Current State – Explored Areas for Growth and Opportunity – Developed Refresher Curriculum and Partnered with Leadership to Educate the Nursing Body. 20 20 The Nursing Culture: Present and Future Defined Culture Fearful Personal vs. Unstructured professional Suspicious Identity Self Patient Professionalism Unprofessional Centric Centric Integrated and No shared Vision defined process to Multi- Silos professional vision integration Disengaged/lack of Fully engaged and Stagnant/Status quo/ Progressive/open to empowered and accountability resist change change accountable for Practice. Shared Hierarchical Governance 21 21 7
2/24/2016 Current Culture Patients First at the Nation’s First Through the HEART Bundle 22 22 8
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