Transforming Practice Through a Model Based on Caring Relationships

Infrastructure• Formed a Results Council to steer adoption of RBC• Collaborated with Community Relations graphic

designer to develop Memorial’s RBC schematic Infrastructure

Evidence – Patient Satisfaction

• Reduce pain; facilitate rest and sleep Non-pharmacologic interventions

• Lavender aromatherapy, guided imagery, music, hand and back massage

‘Turn down’ regimen • Offer warm face cloth and back or hand massage Rate Hospital

Evidence – Patient/Staff Satisfaction

RBC VisionEvery patient/family experience will provide

personalized, respectful care and communication in a healing environment fostered by exceptional

• Held initial Reigniting the Spirit of Caring (RSC) Workshop facilitated by CHCM Consultants

• Identified RSC facilitators/attended Practicum • Caring and Healing Subcommittee assessed

environment of care and recommended changes

massage • Dimming of lights, closure of doors• Pagers placed on vibrate, phone volume down Transformed a storage room into an admission

room for nighttime admissions Clustered care – vital signs, toileting, lab draws,

respiratory treatments• Strengthen therapeutic care & relationships 66 0

68.070.072.074.076.078.0

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Rate HospitalData is by Discharge Date Satisfaction

• “It is a great feeling to know we were both cared for physically, mentally, and spiritually by the entire time.”

• “Everyone I came in contact with was professional and personable. I truly felt I was in excellent care and confident of a very good recovery.”

• “The act that meant the most to my wife was thein a healing environment fostered by exceptional nursing practice, care continuity, and

interdisciplinary collaboration resulting in measureable quality outcomes.

Goals• Improve the patient/family experience through

• Improve communication with patients/family Installed white boards in all patient rooms Record patient goal for the day RN, PCT, Environmental Services phone numbers

• Strengthen therapeutic care & relationships Instituted Family Pet Visitation Program Annual Night of Remembrance for family

members of patients who died on Oncology Unit 2010Q3

2010Q4

2011Q1

2011Q2

2011Q3

2011Q4

2012Q1

2012Q2

2012Q3

2012Q4

2013Q1

2013Q2

Memorial Units 71.7 73.0 70.5 71.1 71.9 72.1 71.8 74.3 69.7 70.6 77.0 74.6All Database 67.4 67.5 66.9 67.6 68.3 68.8 68.7 69.1 69.3 69.9 69.3 70.2

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The act that meant the most to my wife was the assistance I received to bring her six pound silky terrier [to visit].”

• “Coming to Memorial is not at all like going to a hospital. It is like visiting friends.”

• “I just love that they call to see how I am doing.”• “I felt like I was a part of the family when I was done

with Home Care ”p p y p gmeaningful caring interventions

• Improve Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) scores for Rate hospital Recommend hospital Communication with nurses

Adopted bedside shift report to include pt/family 5 minutes at the bedside at eye level each shift

Education• Management day of inspiration and education Ceremonially shred barriers to RBC adoption Invited leaders to sign RBC schematic as a pledge

of commitment74.0

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Recommend HospitalData is by Discharge Date

with Home Care. • “ The day that I became a patient was the day I was

most proud of our staff.”

Evidence – Nurse Engagement

Communication with nurses Pain management

• Strengthen the professional practice environment through a framework of greater

• respect, communication, and teamwork• Increase staff engagement

I i ti

5 minutes at the bedside at eye level each shift Maintain continuity of care through assignment of

same nurse consecutive days Provide pt/family with daily plan of care Developed discharge education booklet Formed a Patient/Family Advisory Council

• Improve team work and communicationI t di i li h ddl

of commitment • Nurse Practice Council (NPC) RBC Orientation

facilitated by CHCM Consultant RBC Implementation Guide provided structure &

processes to empower direct care staff Leader team and/or educators provided ongoing

support of manager & UPC chairU i i il (UPC) i i f i i

2010Q3

2010Q4

2011Q1

2011Q2

2011Q3

2011Q4

2012Q1

2012Q2

2012Q3

2012Q4

2013Q1

2013Q2

Memorial Units 76.8 77.0 73.6 75.4 73.3 76.6 76.4 79.7 74.1 73.7 80.8 77.5All Database 69 9 70 2 69 6 70 0 70 5 70 9 70 8 71 2 71 2 71 5 70 8 71 5

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2012 Organization Level RN Engagement

Inspiration• Conducted literature review of nursing theorists Determined Dr. Jean Watson’s Theory of Human

Caring aligned with our vision, mission & values• Introduced to Relationship-Based Care (RBC) book

by faculty consultant from local university• Initial consultation with Mary Koloroutis CHCM VP

Interdisciplinary huddles Telemetry unit elimination of geographic patient

assignment in favor of patient acuity/skill of nurse• Reduce noise Nearly eliminated overhead paging Asked physician preference for text or beeper White noise around nurses station to mitigate

• Unit practice council (UPC) orientation for inpatient and outpatient units, in waves Invited non-nursing departments to develop UPCs

and conducted UPC orientation• Respiratory Care, Sleep Lab, Radiology, Cardiac

Catheterization Lab & Facilities Management• Incorporated RBC principles in

All Database 69.9 70.2 69.6 70.0 70.5 70.9 70.8 71.2 71.2 71.5 70.8 71.5

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Communication with NursesData is by Discharge Date

Engaged Content Ambivalent DisengagedMemorial Median 38% 44.10% 14.50% 3.50%301-400 Bed Benchmark

Median 28.30% 41.90% 20.50% 7.80%

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References• Caruso, E., Cisar, N., & Pipe, T. (2008). Creating a Healing

Environment: An Innovative Educational Approach for Adopting Jean Watson’s Theory of Human Caring. Nursing Administration Quarterly, 32(2), 126-132.

• Felgen, J. (2007). Leading Lasting Change: I2E2.

• Initial consultation with Mary Koloroutis, CHCM VP• Attended RBC Leader Practicum environmental sounds

SHHH (Silent Hospitals Help Healing) Campaign signage reminders on walls/in elevators

Facilities Management measured noise decibels• Placed sound baffling ceiling tiles and wall

coverings around drug dispensing units• Replaced hallway threshold transitions with flat

Hiring Process Orientation Preceptor Program/ Mentorship Program

• Communication Workshop for Practice and Quality Council members

• Transformational Leadership workshop facilitated by Mary Koloroutis, CHCM VP 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013

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g ( ) g g gMinneapolis, MN: Creative Health Care Management.

• Koloroutis, M. (2008). Relationship-Based Care: A Model for Transforming Practice. Minneapolis, MN: Creative Healthcare Management.

• Watson, J., (2008). The Philosophy and Science of Caring. Boulder, CO: University Press of Colorado.

ep aced a ay es o d a s o s aones to minimize med cart noise entering room

• Replaced squeaking, squealing carts, chairs and refuse containers with quiet wheels

Mary Koloroutis, CHCM VP 2010Q3

2010Q4

2011Q1

2011Q2

2011Q3

2011Q4

2012Q1

2012Q2

2012Q3

2012Q4

2013Q1

2013Q2

Memorial Units 78.4 78.2 78.3 79.7 81.6 80.7 79.9 83.3 78.8 79.4 82.4 83.2All Database 76.4 76.4 76.1 76.6 77.4 77.8 77.8 78.1 78.2 78.4 77.9 78.8