1 The Orca Institute Governance for Patient Safety TM Leading Practice Board to the Patient Bedside and Caregiver Work Area Leading Practice Impact HIGH

1The Orca InstituteGovernance for Patient SafetyTM Leading Practice

Board to the Patient Bedside and Caregiver Work Area Leading Practice

Impact HIGH - Time SHORT - Cost MINIMAL

Contents

Practice Overview

Success Stories

Objectives

Practice Flow

Practice Steps

Practice Guides and Templates

Executive Summary Guide

Patient, Family and Caregiver Selection Guide

Pre-visit Briefing Template

Patient Discussion Template

Caregiver Discussion Template

Post-visit Debriefing Template

Board Briefing Template


Board to the Patient Bedside and Caregiver Work Area Leading PracticePractice Overview


Board members seldom lack the information, data and statistics needed to support their work. What too often is missing is the opportunity to connect boardroom information with bedside experiences and work environment complexities. The “Board to Bedside ” Leading Practice provides the knowledge, process, guides and templates required to facilitate board member visits with their patients and families at the bedside, and to observe and discuss the work environment with their caregivers. When board members can connect the statistics they view routinely, with “real” patient experiences and caregiver work they have the opportunity to make significantly more effective decisions in the boardroom.


Board to the Patient Bedside and Caregiver Work Area Leading PracticeSuccess Stories

Riverton Memorial, WY; “We were very reluctant at the beginning, concerned the trustees would believe it waste of time, and that senior leadership would see it as micro-managing. After one trial run, and two board member visits, everyone was thrilled.” [Assistant to the CEO] Virginia Mason Health System, WA; “I was concerned about the staff time commitment and overall value added. We found patient and caregiver feedback was extremely positive and the visits really connected the board member to the work.” [Patient Service Manger]


Board to the Patient and Caregiver Work Area Leading PracticeObjectives



Board to the Patient Bedside and Caregiver Work Area Leading PracticePractice Steps

1. GAIN BOARD APPROVAL DEVELOP THE CASE – If judging it to be of value to fellow board members and the CEO, assume the lead for advocating board adoption and implementation. The case is developed utilizing the Practice Overview, the Leading Practice Steps, and accompanying resources.

RECOMMEND BOARD ADOPTION – The recommendation is discussed with the board chair and/or CEO to; a) gain concurrence to place the Practice on the board agenda, b) solicit guidance on materials to be forwarded in advance, and c) determine who should lead the board conversation.

Make the case, provide your recommendation and support the board conversation. If the board determines;

•To adopt - proceed on the Flowchart process •Not to adopt at this time - consider the feedback, address the concerns and revisit later


2. ALIGN THE PRACTICE ALIGN THE PRACTICE – The board may ask you, or assign a small task force or committee to; a) align the Practice to the organization’s operating environment, b) establish responsibilities, and c) coordinate a pathfinder group to refine the process and demonstrate the value of the Practice. The team must have broad support, represent the diverse interests of the stakeholders, and continue in a coordinating role until the Practice becomes routine. The Leading Practice and supporting guides and templates in the power point format can be easily modified to meet the specific needs of the organization. ASSIGN THE ROLES - The task force selects and recommends individuals for the roles noted below. The human resources required to effectively coordinate the Practice tasks are minimal, and in many organizations roles can be merged and combined:

•An Administrative Lead to coordinate scheduling and communicate with board members and staff. These tasks will typically require 3-4 hours per month, considering a board size of ten and quarterly visits.

•A Staff Lead to; a) establish and coordinate the visit, b) participate in the briefings and conversations, c) take inconspicuous notes, and d) follow-up on assigned post-visit action items. Logical candidates for this role are members from patient service or quality and safety departments. The tasks for each visit can be accomplished in two hours.

•A Visit Lead to; a) select the patients, families and caregivers, b) apprise the stakeholders, c) lead the pre and post-visit briefings, d) facilitate the patient and caregiver conversations, and e) follow-up on assigned action items. Candidates for this role are physician department heads, nurse floor leaders, etc. This responsibility will typically require an hour and half commitment per visit. •Board member expectations; a) participate at a minimum of four times per year, b) commit to two hours per visit, including one hour in conversation, c) provide a briefing on knowledge learned at the next board meeting. Those that utilize this Practice, based upon the positive feedback received from all stakeholders, often expand and open the frequency of visits to the desires of each board member.


COORDINATE THE PATHFINDER GROUP - The task force establishes a pathfinder group to verify the process and demonstrate the value to board members, the CEO, patients and families and caregivers. Pathfinders are selected for their; a) representative roles, b) interest in the Practice, c) commitment to advocate and “train” others, and d) willingness to dedicate the time. In a working session prior to the first visit the pathfinders are guided through the Practice, participate in a final Practice alignment and schedule their first Board to Bedside visit. The task force participates with the pathfinders during each Practice step to coach, observe and note feedback. The observations and feedback are reviewed shortly after the visits and the Practice is refined accordingly. The task force, with pathfinder endorsement, offers their perspective on the merits of the Practice and provides a brief training session at the next board meeting. It is recommended that the CEO describes the Practice and it’s importance to the organization in a brief memo.

3. THE PRE-VISIT BRIEF - observe patient confidentiality requirements

The Visit Lead has previously selected the patients and the caregivers to visit, utilizing the Selection Guides, and has advised the caregivers of the upcoming visit. Allowing 15 minutes for the pre-visit, the board member, Staff Lead and Visit Lead (in many organizations the Staff and Visit Lead roles can be combined) meet at an agreed upon location near the visit area. All parties are introduced with brief comments and the Visit Lead utilizes the Pre-Brief Guide to provide an overview of the visit, add details to the Guide and answer questions. The sequencing of the visits is driven primarily by the availability of patients and caregivers.


4. HAVE THE CONVERSATIONS; observe patient confidentiality requirements PATIENT AND FAMILY - The conversations need to be informal, casual, caring and respectful of the patient’s condition and space. If possible the board member should dress “business casual”. In the hour and half available an attempt should be made to visit with 3-4 patients and families, spending no more than 10 minutes with each. The setting should be in an area where others cannot overhear the discussion. The conversations address the points in the Patient Conversation Guide, without being over structured. CAREGIVERS – The conversations need to be informal, respective of work demands and include appreciation for the work being performed. The majority of the time available should be dedicated to caregiver conversations. The knowledge gained by the board member will be significant. The impact on caregivers by seeing that the board is taking the time to understand the work, and hearing directly about the board’s quality and safety focus is immense. The board member is introduced “in the hallway” to those in the work area that the Visit Lead believes should be recognized one-on-one or in a small group. The primary focus is on meeting with small group(s) of physicians, nurses and other caregivers that are available to excuse themselves from their work for five to ten minutes and meet in the break room or small meeting area. Ideally the “performance bulletin board” would be on the wall, to support the discussions. The conversations address the points in the Caregiver Conversation Guide, without being over structured.


5. THE POST-VISIT DEBRIEF Allowing 15 minutes for the post-visit debrief provides an opportunity to reflect on what was learned during the visits, what could have been handled more appropriately and to note action items that need to assigned for follow-up. The inconspicuous notes taken by the Staff Lead and the recollections of the Visit Lead and board member are recorded on the Post-Visit Debrief Guide for appropriate follow-up actions.

6. THE BOARD BRIEF - observe patient confidentiality requirements The board meeting agenda should provide five minutes at the beginning of the meeting for board members who have visited with patients, families and caregivers to share their learnings with the board, utilizing the Board Briefing Template as a guide. In addition to the educational value for all board members, the conversation assists in putting the patient and caregiver “in the boardroom” for later board agenda discussions.


Board to the Patient Bedside and Caregiver Work Area Leading PracticeExecutive Summary Guide


Overview The “Board to Bedside ” Leading Practice provides the knowledge, process and template guides required to facilitate board member visits with their patients and families at the bedside, and to observe and discuss the work environment with their caregivers. The success stories are compelling. Our Objectives • Board members gain a better understanding of patient and family needs, and caregiver work environment• Knowledge is shared for benefit of all members at next meeting• CEO works with better-informed board members, with a board commitment to not micro-manage• Patients are pleased to hear from the “top” of the organization• Caregivers appreciate the opportunity to be heard, and to hear that the board cares, and that quality & safety is

important• A win for all - at minimal cost - with more effective quality and safety decisions in the boardroom• Organization specific: _________________________________________________________________________________ Our Plan • Briefly review and reference the Flowchart• Identify lead team: ____________________________________________________________________________________• Identify their time commitment; ________________________________________________________________________• Estimate out of pocket costs; ___________________________________________________________________________• Member time commitment; minimum of two hours plus travel time each quarter• Organization specific: __________________________________________________________________________________


Board to the Patient Bedside and Caregiver Work Area Leading PracticePatient and Family / Caregivers Selection Guide

Observe patient confidentiality requirements

Patient and Family Selection Guide • Willingness to have a conversation• Family in attendance if possible• Been in the care setting for more than a day• Ability to participate in conversations without a health or safety risk• Representative of a cross section of satisfied and dissatisfied patients• Value-added opportunity for the board member • Your organization criteria; ___________________________________________________________________________

Caregivers Selection Guide • Available without risk to patients• Representative of various roles and responsibilities • Representative of a cross section of satisfied and dissatisfied caregivers• A coordinate/integrated care team conversation is a great opportunity• Value-added opportunity for the caregiver(s)• Value-added opportunity for the board member• Your organization criteria: ___________________________________________________________________________


Board to the Patient Bedside and Caregiver Work Area Leading Practice Pre-Visit Briefing Guide


Visit Lead • Personal introduction• Thank you; for taking time to visit• Provide patient confidentiality refresher• Section overview; who we are, what we do, _______________________________________________________________• Section specific; performance summary, challenges, initiatives underway,

____________________________________________________________________________________________________• Review the Patient Conversation Guide; discuss, add the specific details• Review the Caregiver Conversation Guide; discuss, add specific details• Personal comments: __________________________________________________________________________________ Board Member • Personal introduction• Thank you; for coordinating the visit, for work performed ___________________________________________________• Personal comments:___________________________________________________________________________________• Q & A: ______________________________________________________________________________________________ Staff Lead • Personal introduction• Personal comments:__________________________________________________________________________________


Board to the Patient Bedside and Caregiver Work Area Leading PracticePatient and Family Discussion Guide

Observe patient confidentiality requirements Visit Lead • Personal introduction• Introduces and thanks the patient and family; Patient ______________________________________________________• Introduce each visiting member: Member __________________________ Staff _________________________________• Ask how the patient and family are doing; comfortable, have what you need• Briefly explains purpose; committed to quality care, need to hear how we are doing, what we can do better, our board

members are dedicated to improvement• Assists with board member conversation and patient and family questions• Organization specific: ________________________________________________________________________________ Board Member – select your highest value topics, considering time availability • Thank you; for your time, choosing our organization• Brief introduction; personal background, time on board, areas of focus, the board’s role• Like to hear from you; are we meeting your needs, and what can we do better• Ask if not offered about; timely access, admittance process, communication with doctors and nurses, response time

to requests, pain control, noise, food, quality & safety concerns• Ask if not offered about feedback on specific initiatives the organization may have underway• Family member specific; important part of the team, how can we improve your ability to support your loved one • Thank you for your time, We will follow up on your suggestions• Pre-brief additions: _________________________________________________________________________________• Organization specific: _______________________________________________________________________________• Other notes: _______________________________________________________________________________________ Staff Lead • Assists with board member conversation and patient and family questions• Feedback and follow-up notes: ________________________________________________________________________


Board to the Patient Bedside and Caregiver Work Area Leading PracticeCaregiver Discussion Guide


Visit Lead • Introduce each visiting member: Member _________________________ Staff __________________________________• Introduce the caregivers: ______________________________________________________________________________• Thank you; for breaking away to join us, special recognitions, _____________________________ • Briefly explain purpose of visit: committed to quality care, valuable to our board to “see and hear” your views on

how we are doing, how to get better, how they can facilitate improvement• Organization specific: _________________________________________________________________________________ Board Member – select your highest valued topics • Thank you; for all that you do, taking time to join us, special recognitions from pre-brief • Brief introduction; personal background, time on board, areas of focus, • Brief overview of board role: not here to check-up on management, are here to learn how the board can best support

management and your work in improving care• Like to hear about your area – what is working well, what challenges are you facing (review charts on wall if

available)• Like to hear from you about our patient care; how are we serving our patients, what is foremost on their need list,

what worries you the most, what can we do better• Like to hear from you about your needs; how are we doing supporting you, what is on your need list, how can we

make your job more satisfying, how can we make your work more effective in improving care • Provide updates on organizational issues of interest;

_______________________________________________________• Pre-brief specific:

_____________________________________________________________________________________ • Organization specific: _________________________________________________________________________________ Staff Lead • Assists with board member conversation and caregiver questions• Feedback and follow-up notes: _____________________________________________________________________________________________________________________________________________________________________________


Board to the Patient Bedside and Caregiver Work Area Leading PracticePost-Visit Debriefing Guide


Visit Lead, Board Member, and Staff Lead together • Using Patient & Family Guide; what did we learn________________________________________________________

___________________________________________________________________________________________________

• Using Caregivers Guide; what did we learn ____________________________________________________________

___________________________________________________________________________________________________ • Other observations: _______________________________________________________________________________

• What could have been handled more appropriately_____________________________________________________

Follow- up action items • Issues of significant importance that need to be communicated by board member to the CEO

___________________________________________________________________________________________________ • Board member notes for board report-out _____________________________________________________________

___________________________________________________________________________________________________

• Patient and family action items and responsibilities _____________________________________________________ • Caregiver action items and responsibilities ____________________________________________________________


Board to the Patient Bedside and Caregiver Work Area Leading PracticeBoard Briefing Guide


Utilize the Conversation Guides, and Debrief Guide to provide the board with your 3-5 minute review of the knowledge gained during your most recent visit

• Your Staff Lead and Visit Lead _________________________________________________________________________ • The area(s) visited ___________________________________________________________________________________

• Patient and family learnings: __________________________________________________________________________ • Caregiver learnings; _________________________________________________________________________________ • Issues of significant importance that were communicated to the CEO ________________________________________ • Major action items ___________________________________________________________________________________

• Practice Objectives metMember __________________________________________ Patients __________________________________Caregivers _______________________________________ CEO _____________________________________Board ___________________________________________

• Recommendations:

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Documents

1 The Orca Institute Governance for Patient Safety TM Leading Practice Board to the Patient Bedside and Caregiver Work Area Leading Practice Impact HIGH