3/6/2012 Session Five Connections: Nursing Communication Kelly McCutcheon Adams, MSW, LICSW, IHI Director Barbara Balik, RN, EdD, IHI Faculty March 7, 2012 2:00 – 3:00pm EST David Kim David Kim , Institute for Healthcare Improvement (IHI), is responsible for managing and coordinating a variety of programs based on Key Processes on the IHI Improvement Map. Mr. Kim is a graduate of Boston University. He has been with the IHI for 2 years. He enjoys sports, food, and travel. 2 1
3/6/2012 WebEx Quick Reference • Welcome to today’s session! • Please use Chat to “All Raise your hand Participants” for questions • For technology issues only, please Chat to “Host” • WebEx Technical Support: 866-569-3239 • Dial-in Info: Communicate / Join Teleconference (in menu) Select Chat recipient Enter Text 3 When Chatting… Please send your message to All Participants 4 2
3/6/2012 Kelly McCutcheon Adams, MSW, LICSW Kelly McCutcheon Adams, MSW, LICSW, Director, Institute for Healthcare Improvement (IHI), has served in this capacity for eight years for a variety of IHI Collaboratives and programs, particularly those focused on critical care. She is a medical social worker with experience in hospice, nursing home, sub-acute rehabilitation, emergency department, and ICU settings. She has also served as faculty for the US Department of Health and Human Services Organ Donation Collaborative and for the Gift of Life Institute. 5 Barbara Balik, RN, EdD Barbara Balik, RN, EdD, Principal, Common Fire Healthcare Consulting, is also Senior Faculty at the Institute of Healthcare Improvement. Her areas of expertise include leadership and systems for a culture of quality and safety, including patient- and family- centered care, patient experience, systems to improve transitions in care, and transforming care prior to or with optimization of an electronic health record implementation. She works with leaders to develop adaptive systems to excel and innovate in complex organizations, and to ensure sustained improvement and innovation every day. Ms. Balik's publications include the book, The Heart of Leadership , and the IHI white paper on “Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care,” among others. Previously, she served in senior leadership roles at Allina Hospitals and Clinics, United Hospital, and Minneapolis Children's Medical Center. 6 3
3/6/2012 Overall Objectives At the end of this program, participants would be able to: • Articulate key foundational elements in support of all domains of patient experience improvement • Share specific testable ideas for improving nurse communication, pain management, and cleanliness • Plan small tests of change to try during the Expedition 7 Session Agenda • Homework – We did you learn? • Patient Experience Change Package ─ Our focus today • Perspectives from the Field: ─Nancy Melcher, CNO, Lee’s Summit ─ Nancy Hilton, CNO, St. Lucie & Barbara Edwards, Clinical Nurse Leader, St. Lucie • Time for Q&A 8 4
3/6/2012 Homework from prior session • Complete these activities: ─ Assess your organization on one of the 4 Improvement Infrastructure Key Change Ideas from 1 (low) to 5 (high) ─ Use the attached PI assessment tool to complete an assessment • Share what you learned from the assessment with team members at your organization 9 Improvement Infrastructure – Key Change Ideas •Daily Improvement •Measurement System •Reliability •Patient Journey 10 5
3/6/2012 PI System Assessment Capacity Description Our Organization’s Performance Improvement (PI) system is ……… What I learned when I put HCAHPS data on a run chart … Percent of leaders who can successfully use small tests of change every day … How do I demonstrate PI skills in my work? 11 Patient Experience Change Package: Overview Key areas for improving specific domains of patient experience: Nurse Commun unicat ation, Today’s Session Cleanliness, and Pain Management Staff and Physicians Connection Patient and Family Improvement/ Leadership Engagement Infrastructure Foundational Elements for Improving Patient Experience 6
3/6/2012 Our Focus Today • Why the Connection? ─ Cycle of Communication between all staff and physicians and patients/families is core to patient experience ─ Examples of where Connection shows up in HCAHPS results: Nursing Communication Cleanliness Pain Management 13 Patients and Families as Detectives • Clinical: The what of service ─ Technical quality; competence of providers; reliability; coordination; pain • Relationships: How interactions occur ─ Respect; empathy; address emotional needs ─ Nurse/Team Communication • Environmental: Physical aspects of how the service is provided ─ Cause stress or offer calm and healing ─ Cleanliness » Berry and Seltman, Management Lessons from Mayo Clinic 7
3/6/2012 Connections – Key Change Ideas • Introductions and Understanding Patient Comfort Definitions • Bedside Connection + White Boards • Shared Care Plan • Multi-disciplinary Rounding • Pain Management • Narrate Care • Prepare for Transitions • Health Literacy Competency and Reliable Communication 15 Patient/Family- Key Change Ideas • Family Presence vs. Visiting Restrictions ─ Family Presence at Events and Procedures • Patient Information Access • Shared Care Plan 16 8
3/6/2012 Lessons from the Field • Nancy Melcher, CNO, Lee’s Summit • Nancy Hilton, CNO, St. Lucie • Barbara Edwards, Clinical Nurse Leader, St. Lucie 17 Lee’s Summit HCAHPS data: Top Box answers for Nurse Communication Domain 18 9
3/6/2012 St. Lucie HCAHPS data: Top Box answers for Nurse Communication Domain 19 NURSE COMMUNICATION • Bedside Report Staff video One on one training for sustainability Patient feedback to staff Ongoing auditing 10
3/6/2012 NURSE COMMUNICATION • Communication Boards Multidisciplinary use Large and visual Ongoing audits NURSE COMMUNICATION • Three Never Statements We are short-staffed You are not my patient That’s not my job 11
3/6/2012 NURSE COMMUNICATION • Patient Experience Fair “Through the Eyes of the Patient” Reinforced use of communication boards, AIDET, medication communication NURSE COMMUNICATION • Nurse Huddles Fire Starter Champions PDSA trials 12
3/6/2012 Nurse Communication Bedside Shift Report Nursing Care Discharge and Boards/ Phone Calls for Patient Care Calls Nursing Excellence TLC Hourly Rounds SLMC Strategy for Improving Nurse Communication 1. Leadership is key, engage senior leadership. Words need to match actions. Rounding for Influence - I nspect what you E xpect 2. Develop a process that compliments the staff workflow patterns. This aids in obtaining staff buy in. Encourage staff to view process from patient perspective. Engage staff in change process, utilize patient stories to emphasize the need for change and also to celebrate early success. As much as possible limit variation from unit to unit. 13
3/6/2012 SLMC Strategy for Improving Nurse Communication 3. Focus on the Patient Partnership – tailor each patient’s care to what is most important to that individual. At the end of bedside shift report nurse asks patient: “ What is the most important thing that I can do for you today that will make you satisfied with your care?” The patient response to this question is written on the care board as the #1 call for nursing, and referenced throughout the day by the entire care team. 4. Ensure reliability – nights, weekends, holidays. Can the patient rely on our system 24/7? 5. Evidence-Based Care – Initiatives should be linked to evidence and introduced as a best practice. Talk about the impact nurse communication has on the patient experience and the overall outcome. This allows staff to take pride in the work as opposed to “ one more thing ”. 27 Homework for the next session • Identify 1 lesson from the field in Nursing Communication to test in the next 5 days • Share what you learned from the test at the next session 28 14
3/6/2012 Next Call Session 6 - Pain Management Date: Wednesday March 21, 2012 2:00 PM - 3:00 PM Eastern US time 29 Listserv • Patient_experience@ls.ihi.org • Send and receive questions and comments to/from faculty and participants • To be added to the listserv please email dkim@ihi.org 30 15
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