what type of leadership works best for implementing ou
I need a plan for 6 months? what type of leadership works best for implementing our evidence-based practice? I will add the week 5 PowerPoint example plus our original work. focus on doing the slices 7 and 8 only based on my original PowerPoint.
Improving Hand-off Report
Student Names
Team Name and First/Last Names of Participants
Problem
Report (timing and hand off errors): The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes. In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete. Our task is to propose a change that will address these issues.
Report (timing and hand off errors: Unit managers observed that there was miscommunication between staff during shift report. Often times leaving out important patient information as well as taking a significant amount of time to relay the information. Our goal it to offer a change that will address these issues.
Now here is our SWOT analysis starting off with Derrick talking about the strengths.
Majka
"Communication failures compromise patient treatment, care quality, and safety. It also leads to medical errors, the third leading cause of deaths in the United States" (Ghosh, et all., 2015)
"The varying parties and large amount of complex information included in patient handoff reports frequently contribute to informational gaps and omissions in the handoff report that can lead to sentinel events and patient hard" (Staggers & Blaz, 2013)
"Research has identifed handovers as a risky time in the care process, when information may be lost, distorted or misinterpreted (Borowitz et al 2008, Owen et al. 2009, Philibert 2009)
Report (timing and hand off errors): The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes. In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete. Your task is to propose a change that will address these issues.
Increase of errors during patient hand-off report leading to missed information and incomplete tasks
Hand-off report time is taking a greater deal of time
Our task is to implement the use of SBAR as the standard hand-off report between shifts in order to reduce errors and decrease the time spent giving report.
2
SWOT
| Strengths: Multidepartment focus addressing handoff report problems(Robins et al., 2017) Solutions shorten time taken in report while increasing quantity of pertinent information. (Stewart & Hand, 2017) SBAR is supported by the Joint Commision (Stewart & Hand, 2017) Proven error reduction due to use of SBAR tool. (Stewart & Hand, 2017) SBAR is an evidence-based hand-off tool (Eberhardt, 2014) | Weakness Use of the tool requires education to reduce user error (Stacey Eberhardt 2014) Medical personnel have personal bias on giving report (Ghosh et al., 2018) Some staff are unreceptive to change (Robins & Dai, 2017). Evaluating execution of report can be affected by observer bias (Robins & Dai, 2017) |
| Opportunities SBAR is inexpensive as a tool and will earn its cost in education by the reduction of sentinel events (Stewart, 2017) Improve patient handoff by implementing an evidence-based handoff tool in SBAR format (Eberhardt, 2014) For continued nursing education in standardizing hand-off report (Ghosh et al., 2018). | Threats Due to the variety of the change-of-shift reporting process, the findings of the study may not be applicable across similar settings (Ghosh et at., 2018). Some staff are unreceptive to change (Robins et al., 2017). Evaluating execution of report is subject to observer bias (Drach-Zahavy, 2014) Small sample sizes from 2 studies: only one randomized control study (Stewart, 2017) |
Strengths:
Multidepartment focus on addressing problems with handoff report (Robins et al., 2017)
Solutions manage to shorten time taken to give report while increasing the amount of pertinent information given in that time frame. (Stewart & Hand, 2017)
SBAR is supported by the Joint Commision (Stewart & Hand, 2017)
Error reduction due to use of SBAR tool. (Stewart & Hand, 2017)
SBAR is an evidence-based hand-off tool (Eberhardt, 2014)
Weakness (Wendy)
Use of the tool requires education for all staff to reduce user error (Stacey Eberhardt 2014)
Medical personnel have personal bias on how they want to give report (Ghosh et al., 2018)
Healthcare worker disinterest in changing how they give report. (Robins et al., 2017).
Subjective approach to measuring a handover’s strategies might be subject to bias, as participants may behave differently in the presence of an observer.
Opportunities (ashley)
SBAR is inexpensive as a tool and will earn its cost in education by providers by the reduction of sentinel events (each of which carries a high expense). (Stewart, 2017)
Improve patient handoff by implementing an evidence-based handoff tool in Situation Background Assessment Recommendation (SBAR) format (Eberhardt, 2014)
For continued nursing education in standardizing hand-off report (Ghosh et al., 2018).
Threats (Alma)
Due to the variety of the change-of-shift reporting process, the findings of the study may not be applicable across similar settings (Ghosh et at., 2018).
The acuity of patient injury and medical history can increase the amount of time for patient hand-off (Robins, 2017).
Small sample sizes from 2 studies: only one randomized control study (Stewart, 2017) and sample size of 200 handovers in 5 wards in another study(Drach-Zahavy, 2014)
3
Assessment
Inefficient communication during hand off report is a challenge to patient care. (Ghosh, et al., 2018)
Communication error given during report increases risk of poor patient outcomes. (Stewart, 2017)
Hand off communication between medical personnel leads to an increase in medication errors, incomplete tasks, disorder, and eventually poor patient outcomes (Robins et al., 2015)
According to The Joint Commission, communication errors have been among the top three leading root causes of reported sentinel events every year since 2004. (Stewart, 2017)
The information we had gathered from our assessment on giving report overall was -
1. Poor communication leads to poor patient outcome
2. The Joint Commission has stated communication errors has been the top 3 leading root causes of unanticipated major events in the healthcare setting that results in death or serious physical or psychological injury to a client which require immediate investigation by the health care facility since 2004
3. And now we will be talking about our Diagnosis.
Goal should comes from assessments (SMART (MEASURABLE))
Assessment will be bullet points of why is this a problem
Specific, measurable, attainable, realistic, timely
All RNs and assistive personnel will attend 1 or more in-services on the use of SBAR handoff report within three weeks.
During the same three week period, charge nurses and nursing management will include SBAR teaching in pre-shift meetings, encouraging staff to begin to practice using the SBAR template during report. Following the three week introduction of SBAR to the staff, SBAR will be implemented on the unit for a trial period of 1 month with the goal of receiving ideas of how we can improve it from the staff at the end of the 1 month period. At the end of the one month period, staff nurses and assistive personnel will be invited to discuss their experiences with SBAR, as well as any ideas they have to improve it, during pre-shift meetings, down-time during their shift, or via email with the nurse manager.
15 days into the trial month, as well as at the end of the trial month, the nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit.
At the end of the 1 month trial period, metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year. During the second month, a new SBAR form that includes select suggestions from staff will be used by those staff members while other staff members continue to use the known SBAR report. Communication errors, sentinal events, falls, nosocomial infections, et al will be compared between the two systems.
Majka
4
Diagnosis
Lack of standardization in report
Communication Barriers (Stewart & Hand, 2017)
Communication practices learned by various career stages of nurses (promise, momentum, harvest)
Different individual communication styles
Gaps in knowledge regarding lack of standardized reporting
A lack of standardization in report increases risk of error and poor patient outcomes
5
S.M.A.R.T. Goal
Use an evidence-based standardized hand-off report tool to reduce report times to less than 45 minutes while reducing report-based errors by 20% within 6-month period.
Precontempemplation: Nurse manager goes to charge nurses, harvest nurses, and harvest support staff with the SBAR template and asks them to sit with it for one week. He or she will ask for feedback from these individuals about implementing it on the unit.
Contemplation: Harvest nurses and support staff, and charge nurses spend a week with the SBAR template and consider its strengths, weaknesses, and or simply form an opinion around it. Preparation: nurse manager introduces in-services on SBAR and charge nurses begin introducing the template during pre-shift meetings.
Action: Nurses and support staff begin using the template during all hand-off reports for a one month period. Nurse manager seeks input from harvest staff on ways to improve the system and attempts to include their input on a trial period, thereby extending the practice of the original SBAR for another month with most staff, and offering a personalization to those interested in improving the system. Maintenance: Nurse manager compares statistics from the same time period one year ago, to the same length of time prior to using the SBAR report, and the data from the SBAR report compared with the modified SBAR report and presents the data to the staff at a staff meeting. At the meeting the nurse manager encourages public input and opinions on the SBAR report. If there is resistance, the manager asks that SBAR be continued in practice for a 3 month period in which he or she will personally receive report from individuals on their patients – helping those nurses who need it with ways to be more succinct. At this point, the report will have been used in practice for 5 months and will have become habit for many of the staff.
Alma
6
Full-Range Leadership Model/Theory
Definition: Focuses on the behavior of leaders towards the workforce in different work situations. (Marquis & Huston, 2011)
Three sub-types
Transactional
Transactions between leaders and followers
Leaders promote compliance to standard SBAR method through rewards and punishments
Transformational
Identifies needed change, inspires, and executes change
Emphasize the importance of reducing errors in patient hand-off through application of SBAR. Our goal is to enhance quality of care and thorough communication.
Laissez-faire
No standard rules
Used when nursing staff and PCTs are efficient with and advocating use of SBAR
Full Range Leadership: Promise, Momentum, Harvest
Wendy
Transactional: Promoting buy-in from nurses and PCTs through encouragement of ideas and discussion while also increasing of stakeholder support of the SBAR method
Theory should apply to what we are trying to accomplish
"this is how we plan to use this leadership style because…."
Why is this theory important for our outcome?
Using more then one theory, where is it applicable?
7
Plan
Following the three-week introduction of SBAR to the staff, SBAR will be implemented on the unit for a trial period of one-month with the goal of receiving ideas of how we can improve it from the staff at the end of the one-month period.
At the end of the one-month period, staff nurses and assistive personnel will be invited to discuss their experiences with SBAR, as well as any ideas to improve it, during pre-shift meetings, down-time during their shift, or via email with the nurse manager.
15 days into the trial month, as well as at the end of the trial month, the nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit.
At the end of the one-month trial period, metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year.
During the second month, a new SBAR form that includes select suggestions from staff will be used by those staff members while other staff members continue to use the known SBAR report. Communication errors, sentinel events, falls, nosocomial infections, et al will be compared between the two SBAR report templates at the end of a one-month trial.
8
3 Weeks
RNs and assistive personnel to attend 1 or more in-services on SBAR handoff report
Following in-service, SBAR teaching in pre-shift meetings, encouraging staff to begin to practice using the SBAR template during report.
1-month trial
SBAR will be implemented on the unit for a trial period with the goal of receiving ideas of how we can improve it from the staff at the end of the one-month period.
15 days into the trial month/ after the trial month
Nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit.
Post 1-month trail
Staff invited to discuss their experiences with SBAR, to share ideas to improve it
Second trial(1 – 3 months)
New SBAR form that includes select suggestions from staff will be used. Communication errors, sentinel events, falls, nosocomial infections, et al will be compared between the two SBAR report templates at the end of a one-month trial. Then again at the end of three months.
Metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year.
References
Drach-Zahavy A ; Hadid N. Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift. J Adv Nurs. 2015; 71: 1135-1145
Ghosh, K., Curl, E., Goodwin, M., Morrell, P., & Guidroz, P. (2018). An Exploratory Study on how to Improve Bedside Change-of-Shift Process: Evidence from One Hospital Using Technology to Support Verbal Reporting. HICSS.
Marquis, B.L., & Huston, C. (2011). Leadership roles and management functions in nursing: Theory and application (9th ed). Lippincott, Williams, Wilkins. ISBN: 978-1-4963-4979-8
Robins, H., & Dai, F. (2015). Handoffs in the Postoperative Anesthesia Care Unit: Use of a Checklist for Transfer of Care. AANA journal, 83 4, 264-8.
Stewart, Kathryn R., "SBAR, communication, and patient safety: an integrated literature review" (2016). Honors Theses. https://scholar.utc.edu/honors-theses/66
,
Patient Family-Centered Care
Group
Problem
Patient family centered care: The manager of a medical surgical unit has experienced a significant drop in patient satisfaction with the primary complaints being a lack of communication to patients and their family members. Our task is to propose a move towards a patient-family centered care environment that will address this issue.
| Strengths “Caregivers’ rating of nurses’ warmth of greeting as “excellent” improved from 62.5% at baseline to 75.0% post-intervention” (Bayer, 2021). Addressing families’ and patients’ complaint and concerns to improve family involvement in care (Jazieh et al., 2018). Multidisciplinary team reviewing family involvement in patient care (Jazieh et al., 2018). HowRU (ipads) closely simulates open and flexible visiting and ensures patient and family privacy, dignity, and security (Thomas et al., 2021). Virtually visits can be initiated by family, staff or patient at any time (Thomas et al., 2021). Include communication between patients/families in meetings with health care workers, inter-departmental communication, consults, and chaplains (Thomas et al., 2021). | Weaknesses Hawthorne effect Communication models may not be generalized, as they are developed to tackle a specific aspect of communication (Jazieh et al., 2018). Time consuming to identify the right family member to talk to about the patient’s condition (Jazieh et al., 2018). Lack of support (Thomas et al., 2021). Study only includes English-speaking family members, which may not fully reflect the patient population (Kalocsai et al, 2018). |
| Opportunities Implementing the intervention in other specialty units (Thomas et al., 2021). The standardized communication model is flexible for different individuals and setting to facilitate family’s participation in the plan of care (Jazieh et al., 2018). Patient and family education can be used to enhance patient-family centered care (Jazieh et al., 2018). Patient Satisfaction Staff Satisfaction | Threats Communication model has not been tested through a randomized control trial (Jazieh et al., 2018). A standardized communication model may not be suitable to families from all cultures (Jazieh et al., 2018). Cost of implementation, individual ipads and programs (Thomas et al., 2021). |
Strengths:
“Caregivers’ rating of nurses’ warmth of greeting as “excellent” improved from 62.5% at baseline to 75.0% post-intervention” (Bayer, 2021).
Addressing families’ and patients’ complaint and concerns to improve family involvement in care (Jazieh et al., 2018).
Multidisciplinary team reviewing family involvement in patient care (Jazieh et al., 2018).
HowRU (ipads) closely simulates open and flexible visiting while ensuring patient and family privacy, dignity, and security.
virtually visiting can be initiated by family, ICU staff or patient at any time by simply opening the family space. No planning is required
Include communication between patients/families in meetings with health care workers, inter-departmental communication, consults, and chaplains.
Weaknesses
Study measured subjective perceptions by the caregivers, Hawthorne effect should be considered
Communication models may not be generalized, as they are developed to tackle a specific aspect of communication (Jazieh et al., 2018).
It can be time consuming to identify the right family member to talk to about the patient’s condition (Jazieh et al., 2018).
Lack of support: Understanding value of the HowRU system will be challenging for hospital leaders looking to implement technological communication systems. Communicating and justifying “why” it is important
The study only includes English-speaking family members, which may not fully reflect the patient population nowadays which is very diverse in demographics and cultures (Kalocsai et al, 2018)
Opportunities
Implementing the intervention in other specialty units, and having the study longer to increase validity.
The standardized communication model is flexible for different individuals and setting to facilitate family’s participation in the plan of care (Jazieh et al., 2018).
Patient and family education can be used to enhance patient-family centered care (Jazieh et al., 2018).
Patient Satisfaction: This team was unable to collect data on the actual patient satisfaction levels. This would be a critical step proceeding
Staff Satisfaction: As the ICU staff will be the ones utilizing these devices on a routine bases, data on their opinions is necessary
Threats
The communication model has not been tested through a randomized control trial (Jazieh et al., 2018).
A standardized communication model may not be suitable to families from all cultures (Jazieh et al., 2018).
Cost of implementation: This article does not include the potential cost of implementation. However, the plan proposes the purchasing of an iPad for each ICU bed, purchasing of HowRU software, and having 24/7 support staff. The cost is significant. The return on investment is more patient-family-centered care, improved mental health of patients and families, and staff morale, and overall satisfaction.
Limitations and barriers: As stated the maximum benefit of the HowRU system is seen in an ICU with high acuity, with patients who are unconscious or dependent on ICU staff for communication. Therefore, in lower acuity ICUs where there are more patients able to use their own devices, the perception of the value of HowRU may be diminished.
Assessment
“It is evident that family members went from being care providers in the home to outsiders as the new institutional culture of hospitals developed” (Clark et al., 2017).
“Health-care providers (HCPs) may have to talk to multiple FMs repeatedly delivering same information. This current practice may lead to frustration and wasted time and may result in conflict between the HCP and demanding FMs or among FMs themselves” (Jazieh et al., 2018).
“Barriers to providing care have not been shown to occur, but rather family members more often serve to provide information, receive education, and facilitate communication between the patient and caregivers” (Clark et al., 2017).
“Families consider daily communication of clearly understandable information to be highly important, yet they rarely perceive adequate communication. As a consequence, patients’ unique values and preferences may often not be respected, and resource-intensive treatments prolong the dying process for many” (Scheumemann et al., 2011).
“Education level and background are major factors affecting communication between healthcare providers and families” (Jazieh et al., 2018).
“Miscommunication between healthcare providers and family members leads to conflicts and dissatisfaction with care” (Jazieh et al., 2018).
Diagnosis
Lack of communication to patients and their family members
Related to weak family-provider relationships
Evidence by
Time constraints
Lack of communication skills training
Unclear goals and processes
Challenging family dynamics
S.M.A.R.T. Goal
The use of a standardized communication model to guide communication between healthcare providers and family members would improve patient and family satisfaction with care by 30% within 6 months.
Leadership Model/Theory
Plan
References
Bayer, N. , Taylor, A. , Atabek, Z. , Santolaya, J. , Bamat, T. & Washington, N. (2021). Enhancing Residents' Warmth in Greeting Caregivers: An Inpatient Intervention to Improve Family-Centered Communication. Journal for Healthcare Quality, 43 (3), 183-193. doi: 10.1097/JHQ.0000000000000263.
Boulton, R., & Boaz, A. (2019). The emotional labour of quality improvement work in end of life care: a qualitative study of Patient and Family Centred Care (PFCC) in England. BMC Health Services Research, 19(1), 923. https://doi-org.resu.idm.oclc.org/10.1186/s12913-019-4762-1
Clark, A. P., & Guzzetta, C. E. (2017). A Paradigm Shift for Patient/Family-Centered Care in Intensive Care Units: Bring in the Family. Critical care nurse, 37(2), 96–99. https://doi.org/10.4037/ccn2017142
Jazieh, A. R., Volker, S., & Taher, S. (2018). Involving the family in patient care: A culturally tailored
communication model. Global Journal on Quality and Safety in Healthcare, 1(2), 33-37.
https://doi.org/10.4103/JQSH.JQSH_3_18
Kalocsai, C., Amaral, A., Piquette, D., Walter, G., Dev, S. P., Taylor, P., Downar, J., & Gotlib Conn, L. (2018). “it’s better to have three brains working instead of one”: A qualitative study of building therapeutic alliance with family members of critically ill patients. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3341-1
Kokorelias, K. M., Gignac, M. A. M., Naglie, G., & Cameron, J. I. (2019). Towards a universal model of family centered care: a scoping review. BMC Health Services Research, 19(1), 564. https://doi-org.resu.idm.oclc.org/10.1186/s12913-019-4394-5
Scheumemann, L. P., McDevitt, M., Carson, S. S., & Hanson, L. C. (2011). Randomized, Controlled Trials of Interventions to Improve Communication in Intensive Care. CHEST, 139(3), 543–554. https://doi-org.resu.idm.oclc.org/10.1378/chest.10-0595
Thomas, K. A. S., O’Brien, B. F., Fryday, A. T., Robinson, E. C., Hales, M. J. L., Karipidis, S., Chadwick, A., Fleming, K. J., & Davey-Quinn, A. P. (2021). Developing an Innovative System of Open and Flexible, Patient-Family-Centered, Virtual Visiting in ICU During the COVID-19 Pandemic: A Collaboration of Staff, Patients, Families, and Technology Companies. Journal of Intensive Care Medicine, 36(10), 1130–1140. Doi 10.1177/08850666211030845
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