Transforming Care at the Bedside through a Leadership, Physician and Staff Partnership
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- Describe three sources of data that can be examined for potential quality and safety change projects on your nursing unit.
- Identify two multidisciplinary strategies to cultivate a shared value system and vision of success between staff and leadership.
- Indicate four action steps to promote successful department and unit transformation.
Upon review of significant events, regulatory requirements, nursing turnover, and patient satisfaction levels we determined that there were improvement opportunities for this large urban academic obstetrical department. Forging new safety and quality improvement directions are challenging due, partly, to silos among disciplines and lack of frontline staff engagement.
Proposed change:
To improve quality outcomes we must transform care at the point at which it is delivered. A tenet of successful and sustainable improvement efforts is the involvement of front line staff in redesigning models of care and systems.
Through a partnership between senior hospital leaders and the medical school faculty a journey toward improvement launched. The partnership would provide a model of collaboration.
Implementation, outcomes and evaluation:
A multidisciplinary group of physicians, nurse leaders and front line staff served to oversee these efforts. Ten areas of focus were identified. Over 40 staff members were mobilized to 10 discrete task forces. Task forces focused on safety (hand off communication, chain of communication), efficiency (triage turnaround times, discharge time of day), and informatics. Task forces were coached by a physician and nurse leader pair who inspired their team. A project manager and administrative support aided the effort to promote success. Each team developed charters, agreed upon measures of success and shared value system.
Department initiatives resulted in significant improvements. Efforts to improve efficiency resulted in 124% improvement in postpartum discharge time of day and 69% improvement in triage turnaround time. Nursing turnover decreased by 9%. The Safety Attitude Questionnaire reflected 18 to 22% increases for the domains of teamwork, safety climate and perception of management. Patient satisfaction increased 4 points.
Committed senior administrative and physician leaders are the cornerstone for improvement efforts. Engaged leaders with the ability to align and inspire teams with a shared value system enabled the journey toward improved patient care and work environment. Front line staff involved in identifying problems that impede care or negatively influence the work environment and who participate in the development of solutions are the key element to sustained success.
Implications for nursing practice:
Nurses can lead the way to break silos that develop between disciplines and leaders to identify and redesign safety hazards and implement safer, efficient care systems. Nurses can utilize this partnership to bring experiences to their unit and empower their group to solve problems. Informal and formal nursing leaders can be effective change agents.
Keywords:
Safety culture; leaders; strategies; implementation effectiveness; quality improvement.
