Speaking with "One Voice": Strategy to Improve Communication on a Gynecology Unit

Purpose for the program:

  Recently, the Gynecology unit experienced several dramatic changes in professional skill mix of nurses and clinical technicians and a nurse manager restructuring.  Our patients, particularly the gynecology oncology patients voiced their concerns over the inconsistent and often conflicting information they receive.  This was evident in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores in communication not meeting our target and longer lengths of stay.  The purpose in creating the ‘One Voice’ project is to improve communication between all disciplines and improve the patient experience.

Proposed change:

The proposed change by the ‘One Voice’ initiative is to have every multidisciplinary team member give a consistent message to our gynecology (GYN) patients.  The foundation for the initiative was the establishment of a unit based Mission and Vision statement to refocus on what is important to the team and reestablish pride and a sense of belonging.  Involving the patient is the second aspect of the program. Development of an interactive ‘care path’ form for patients to review and track their recovery progress promotes independence and control over their care.   The third component of the program is changing how the clinical technicians conduct shift report. By incorporating them into the bedside handoff with the nurse and eventually with each other streamlines communication.  Finally, the fourth component of the ‘One Voice’ initiative is physician education on the care path and inclusion of the care team when physicians round on their patients.  The expected outcome is increased multidisciplinary communication as well as patient safety.            

Implementation, outcomes and evaluation:

Implementation of the ‘One Voice’ initiative occurred over a one month time period.  Multidisciplinary focus groups made up of GYN physicians, nurses and techs helped develop each component.  Education sessions were held at shift huddles and staff meetings on the details of the ‘One Voice' program.  The ‘One Voice’ interactive care path tool was initiated on the GYN minimally invasive surgical patient population. 

The evaluation of the outcomes are very positive.  99% of the care paths returned from patients report that the care path is helpful and they are better prepared for discharge.  Overall HCAHPS results exceeded the target goal for two consecutive months after implementation. 

Implications for nursing practice:

By a successful implementation of ‘One Voice’ nurses are able to efficiently improve care and enhance the safety of the GYN patient population through consistency in communication.

Keywords: Communication, Handoff, Gynecology