How a Patient Tragedy Fueled a Culture of Joy _______________________________________________________________________________ June 20, 2018 Linda Talley, BSN, MA, RN VP and Chief Nursing Officer
NO DISCLOSURES Or Conflicts of Interest
Framework for Patient Safety • 2007 IHI Triple Aim improving patient experience of care improving the health of populations reducing the per capita cost of health care • Healthy Work Environments • Promoting joy in the workplace • Link to patient safety
Quadruple Aim • Linking quality of the workplace to patient outcomes • Quadruple Aim: Attaining joy in work • Improvements in the life of healthcare workers is foundational to achieving the Triple Aim • Focused on interventions to address burnout and promote joy in work 4
Burnout in the health care environment • Time pressure • Lack of control over work processes • Role conflict • Poor relationships between professional groups and/or with leadership • Lack of support for staff • Violence in the workplace • Moral distress 5
Consequences of Compassion Fatigue • Emotional distress • Work days lost • Safety risk • Apathy • Desire to quit • Loss of empathy • Poor judgment 6
Compassion Satisfaction • Caring • Feelings of contribution • Patient satisfaction • Energized moments 7
Healthy Work Environments A workplace that is supportive of the whole human being, patient-focused, and joyful, where providers of care are able to meet the needs of their patients and their families, as well as the goals of the unit and the organization (Shirey, 2006) 8
Healthy Work Environments “The creation of healthy work environments is imperative to ensure patient safety, enhance staff recruitment and retention, and maintain an organization’s financial viability.” (AACN,2016) Skilled communication • True collaboration • Effective decision making • Appropriate staffing • Authentic leadership • Promoting professional practice of nursing in • meaningful and effective ways Meaningful recognition • 9
Leadership Strategies to Promote Joy in Work Townhalls • Listening to staff and communicating regularly • Visibility of leaders • Promoting Wellness and Self Care • Healthy Lifestyle – physical activity, nutrition, sleep, stress • management, mental and behavioral health, purpose driven life (your why) Comfort Corner • Mindfulness • Attunement • Tell stories • Recognition • Staff support • Have fun! • 10
Meaningful Recognition A powerful form of positive feedback, meaningful recognition acknowledges how a person’s actions affect the life of another, is relevant to the recipient, and is equivalent to his or her contribution.” (Lefton, 2012 ) “If you want to treat people like just employees, they’ll be just employees. If you want to treat them the best, to reward and recognize them, they’ll be engaged.” (Tony Armada, CEO of Advocate Lutheran General Hospital) Be creative • Think of different ways to celebrate – Penguin story • Do it often and make it surprise • It’s not about the money, and not about meeting a company metric, it’s about • exceptional or unusual behaviors – that, when recognized, inspire others to duplicate those behaviors we aspire to see in all of our employees Find ways to tell these stories – publicize the stories and the recognition that • was received 11
Framework for Professional Practice Partners in Care Shared Quadruple Patient/Family Decision Aim Marking Professional Development 12
Quadruple Aim Improve Health of Populations Quadruple Decrease Joy in Work Aim Costs Patient Experience Quality/Safety 13
Joy In Work Framework Quality safety, employee engagement, Joy in Staff Work Healthy Retention Work Staff Environment Engagement Meaningful Recognition Professional Practice of Nursing 14
Children’s National Medical Center Washington, DC 15
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“Please, God, save me.” 17
A Patient Tragedy
Conceptual Framework for Professional Competency Critical Thinking Technical Interpersonal 20
Meaningful Connections bring Joy to Work We all have a choice to make We all have a choice to make what we do meaningful and important. We can choose to do something that makes a difference for our patients. Find that purpose in your work, the thing that brought you to this profession, and live it out in your work. Focus on what you can do, not on what you have to do. We have an opportunity to build connections and relationships with both coworkers and patients—which is what brings meaning to our work. 21
IHI Framework for Joy in Work Physical and Psychological Safety • Meaning and Purpose • Choice and Autonomy • Recognition and Rewards • Participative Management • Camaraderie and Teamwork • Daily Improvement • Wellness and Resilience • Real Time Measurement • 22
Surgical Care Unit at Children’s National Health System DAISY Team Award 2017 • Children’s National Core • Values Award 2018 IHI/NPSF DAISY Award 2018 •
Leaders Promoting Meaning and Joy in Nursing Practice Fulfilling Purpose – I am a nurse • Meaningful connection • Impact, the “wow” factor • The practice environment • 25
Questions? 26
References Fitzpatrick, B, Bloore, K, Blake, N. Joy in work and reducing nurse burnout: From triple aim to quadruple aim. AACN Advanced Critical Care, 30(2), pp185-188. Galuska, L, Hahn, J., Polifroni, EC, Crow, G. A narrative analysis of nurses’ experiences with meaning and joy in nursing practice. Nursing Admin Quarterly, 42 (2), pp 154-163. Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work . IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. 27
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