2/24/2016 Improving Care Through a Change of Shift Bundle Mary Del - - PDF document

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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

Improving Care Through a Change of Shift Bundle

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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.

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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

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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.

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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

Communication with Nurses Domain‐ HCAHPS (% Rank)

22% 19% 29% 9% 27% 41% 39% 16% 13% 43% 26% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2QCY11 3QCY11 4QCY11 1QCY12 2QCY12 3QCY12 4QCY12 1QCY13 2QCY13 3QCY13 4QCY13

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The Nursing Culture: Present and Future

Fearful Suspicious Secure/trusting

• f leadership

Unstructured Defined Culture Personal vs. professional Identity Disengaged/lack

• f accountability

Fully engaged and empowered and accountable for Practice. Unprofessional Professionalism No shared Vision Integrated and defined process to vision Stagnant/Status quo/ resist change Progressive/open to change

Silos Multi- professional integration

Self Centric Patient Centric

Hierarchical Shared Governance 8

Discover the Talent…Build the Structure

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Keep the Main Thing the MAIN THING!

Strategy Cultural Transformation Organizational Goals

Delivery of Care System Self Centric Patient Centric No Shared Vision Defined shared vision Shared Governance Hierarchical- Shared Governance Disengaged- Engaged Fearful /suspicious Trusting Leadership The Patient Care Network Self Centric- Patient Centric Multidisciplinary Rounds Silos Colleagiality/collaboration Satisfaction and Engagement: The Patient-The Staff-The Physician ALL ALL 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

Safety Employee Satisfactio n Finance Quality Patient Satisfactio n

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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

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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

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What’s In A Name?

• H‐ Holistic
• E‐ Evidence Based Practice and

Research

• A‐ Advocating
• R‐ Resourcefulness
• T‐ Teamwork

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Primary Nursing Bundle

The Anatomy of Our Work:

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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

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Rapid Cycle PDSA

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HCAHPS- Nurses Explain Things in A Way You Understand

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HCAHPS-Communication with Nurses

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Falls with Injury

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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

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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.

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The Nursing Culture: Present and Future

Fearful Suspicious

Unprofessional Professionalism No shared Vision Integrated and defined process to vision Disengaged/lack of accountability Fully engaged and empowered and accountable for Practice.

Hierarchical Shared Governance

Unstructured Defined Culture Personal vs. professional Identity

Self Centric Patient Centric

Silos

Multi- professional integration Stagnant/Status quo/ resist change Progressive/open to change

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Current Culture

Patients First at the Nation’s First

Through the HEART Bundle