Uncategorized•
on November 29th, 2010•
One simple tool – a checklist – is known to reduce the risk of costly mistakes, strengthen patient care, and improve overall patient health outcomes. A recent study in the New England Journal of Medicine found that using the World Health Organization’s (WHO) “Surgical Safety Checklist”– which requires surgical teams to complete certain tasks before “sign-in”, “time-out”, and “sign-out”– can reduce both post-op complications and death rates by about 36%. Surgical patients are not the only ones who benefit from checklists. HMC Partner hospitals have demonstrated success with checklists for hourly rounding and whiteboard content among others. It’s safe to assume that checklists of all varieties are in wide usage throughout hospitals, right?
The best answer to that question might be “maybe”. HMC Partner hospitals use a wide variety of checklists including surgical safety checklists (see “The Checklist” Survey for details). Only 20% of US hospitals, however, are known to be using the WHO checklist. Some hospitals have embraced checklists and others are using them while working through resistance and pushback, stemming from another step added to an already confusing array of patient care. Still others are in various stages of developing, implementing, and/or monitoring checklist usage. In a recent article, checklist advocate Dr. Peter Pronovost notes: “I am heartened by the growing use of checklists in hospitals, and flattered to see that leading medical journalists, such as Atul Gawande, are supporting our work and helping us spread the word”.
Checklist Questions and Caveats
In the same Huffington Post article cited above, Dr. Pronovost goes on to mention that checklists alone will fail at improving anything if there is poor communication between doctors and nurses. A paper checklist will work best for a well organized, cohesive patient care team that fosters open communication and encourages input from all members. In this setting, the checklist serves as a reminder to those doing patient care and takes the burden of remembering everything off the individual(s) performing a procedure, rounding on patients, or any other task that can be written up as a checklist. Without a checklist, the individual performing any action must remember all the steps associated with that action. With a checklist, pressure is removed as steps that formerly had to be committed to memory are now committed to paper (or electronic records). In addition, more than one person sees the steps written out on the checklist, reducing the room for errors.
HMC Partners can find additional information and checklist successes in this related HMC white paper.
Michelle Gray-Bernhardt is a Knowledge Manager at HMC. Reach her at mgray@HMCCentral.com or 262-242-9471 for information about joining the HMC KnowledgeWeb for Nurses.
Uncategorized•
on November 23rd, 2010•
By Michelle Gray-Bernhardt
“Solution-oriented”: have you heard this term? A solution-oriented approach focuses on outcomes over challenges. It works backward – it starts with an ideal situation, and then determines steps necessary to attain the ideal situation. A problem-focused approach analyzes the problem itself in detail before taking action. A solution-oriented approach dwells on solutions; no detailed analysis of the challenge is necessary other than the knowledge that things can improve.
In a traditional approach, be it budget, staffing – really, any common challenge in healthcare – managers often delve into every aspect of a problem, analyzing it from all angles. While such analysis may be prudent for some challenges, what would happen if it were simply acknowledged that improvements could be made? In this model, visualizing the ideal outcome leads the improvement process, without getting mired in details. While it sounds simple, it is a real change in mindset for many people to relegate the problem to the background and the solution to the forefront.
Ask “What would make things better?” around a specific challenge. Visualize the ideal outcome (not always an easy task), and work backward from there to identify steps to bring about the desired outcome. When you are approached to tackle quality improvements, cost savings initiatives, or the implementation of new clinical practices, what will your reaction be? Will you be tempted first to justify the status quo, thinking that new ideas or practices won’t mesh with your hospital culture or your current budget, that your staff won’t react kindly? Might the next reaction be to over-analyze the problem in an attempt to make it go away with minimal change? With this approach, it’s easy to get mired down in the details of a challenge — and the subsequent gathering of data to defend oneself from ultimately addressing that challenge. This mindset discourages innovative solutions.
Try working backward. Strip your challenge to its fundamentals: “What would improved patient satisfaction look like, feel like – what would be different?” A focus solely on improving patient satisfaction scores on an assessment tool in a low-scoring area (room cleanliness, as a random example) might miss the soul of the issue – relationships with people. An ideal outcome might be identified as happier patients, people who feel less vulnerable and more in control of their hospital visit, improving their perception of their care. This is very different than simply focusing on room cleanliness, reminding nurses and housekeeping staff to pick up debris from patient rooms and empty trashcans in a timely manner. While clean rooms are certainly one piece of the puzzle, there is a larger goal to work toward.
With budget adjustments: “What would an ideal budget look like? How much do you have to work with, and how close to the ideal can you be with what you have? Your ideal budget probably contains significantly more dollars for things like additional staff, continuing education/training/certifications, etc. What might it take to make that happen — are there any grants or other outside funding opportunities? Could you partner with local universities/schools to start an internship program? Could hospital volunteers work in a non-traditional capacity to help your unit or department? These ideas may not occur to the person solely seeking to eliminate line items from the budget. Solution-focused problem solving requires a forward-thinking mindset with the ability to visualize an ideal outcome and recognize that this ideal will be reached in steps both large and small.
Want to see what steps others have taken to improve? Check out HMC’s KnowledgeWeb (www.hmccentral.com). We have compiled over 8,000 ideas from your peers to help you move forward!
Uncategorized•
on November 8th, 2010•
By Shelley Burns
One promise of the Internet was that it offered a Utopian vision of collaboration – a community of truth-seekers motivated by their desire to improve. But somehow, it came about that the Internet Utopia was only possible through anonymous commentary. That meant that people’s names must be hidden, shielded to promote the free exploration of ideas, and protected against the burden of an identity.
Has web anonymity been a boon or a bust for collaborative idea exchange?
The anticipated power of the Internet was that it would create a platform for the masses who previously lacked a broad medium to communicate and debate. The dream was that it would drive communication exchange in heretofore unimaginable ways and complex issues would be more readily and comprehensively resolved. It meant that enhanced understanding and compromise would rule – even the thoughtful give-and-take at the local diner could be shared beyond the participants. There would be a wide-ranging, universal diner conversation to improve the world.
This Utopian idea exchange requires that each truth-seeker modify their position based on the voices of other truth-seekers. They integrate their concerns and worries into their solution and repeat it back. Similarly the other truth-seekers do the same with their own issues and concerns. It is not a zero-sum, winner-take-all game, but a process that acknowledges the situational complexities and the diverse experiences of others. Through the threaded back and forth conversation – “What if …?” “What about …?” – issues surface and are dealt with, and each participant shifts their perspective until a solution emerges. The collaborative result is a step forward, an improvement of the status quo, an aggregation of the best ideas.
However, Internet anonymity required truth-seekers to find another method to organize and distinguish their comments. They developed online personae, which they promptly name using words representative of their new images. Internet identities abound with characterizations contained within the name itself – political leanings, lifestyle choices, job aspirations and more.
But the problem is that once your persona is defined by your name, you lose your ability to shift your point of view. Imagine two commentators, “Red or Dead” and “2Blue4U.” Will they be able to really collaborate around a situation or idea? Will true exchange occur or will their debate be a furious, noisy volley of increasingly polarized and ad-hominem remarks? Similarly, how likely is anyone to consider a response, no matter how well thought out, from “CrazyCarrieRN” or “WillWork4Beer”?
No, anonymity on the Internet hasn’t progressed to the truth-seeking, collaborative Utopia we envisioned when Al Gore “invented” it. The Internet identities we circumscribe for ourselves inhibit our capacity to change our point of view. When our point of view doesn’t change, we can’t grow intellectually. And without forward movement on individual thinking there will be no collaborative improvement of the whole.
That’s why you’re encouraged to be yourself on the HMC KnowledgeWeb. Your name. Your title. Your hospital. Because we want your views, not your Internet persona.
Shelley Burns is head of knowledge management at HMC.
Uncategorized•
on November 1st, 2010•
By Michelle Gray-Bernhardt
Do nurses take their breaks? We asked them in the survey titled: “Nurses – Give Me A Break.” Results to date are mixed. A handful of nurses and nursing leaders feel break policies are working well. Others note that break policies are not working at all. The majority feel that while allocated break times are fair, nurses may not take breaks. That’s because of patient load and other variables, including the daily staff mix and the desire to shorten a shift by skipping an unpaid 30-minute lunch break.
The benefits of breaks are well documented in current literature. A nursing administrator echoes this in the survey results: “They [RNs] come back more prepared emotionally to handle their patients’ needs when they totally get away from the unit and take a real break.” One nurse who noted that there is a policy in place for breaks at her facility said: “You [RNs] make the time to get a break – it isn’t guaranteed. We signed up to be tough.”
Is this just the way it has to be? Or are there some solutions for making break time more accessible and more appealing to nurses? Survey responses ranged from the theoretical (create a culture where nurses want to take breaks) to the logistical (offer a call ahead or pick-up service at the cafeteria). Broad categories included:
- Culture change – Create a culture where nurses WANT to take breaks off the unit.
- Add structure to break times – Schedule break times, take away pagers, require nurses to sign off the unit, etc.
- Add staff – Use SWAT nurses, PRN staff, or some type of additional staffing.
- Improve access – To cafeteria and food (especially for night shift); improve access to staff lounges, staff bathrooms, etc.
- Offer paid lunch breaks – Or other financial incentives for nurses to take lunch breaks.
Given budget constraints and government regulations, adding staff or paying for lunch breaks may not be an option. Adding structure to break times may feel draconian to some RNs. Creating a culture where nurses want to take their breaks is a tall order. Has your facility done anything to encourage nurses to use break time? Provided any incentives for nurses to use their breaks?
We welcome your comments.
Michelle Gray-Bernhardt is an HMC knowledge manager
