relationship & results oriented healthcare® revisited
Post on 03-Dec-2021
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Today’s Agenda
Our team
Review : what is RROHC?
Why RROHC?
More indepth about RROHC
Field Results
RROHC Implementation
Q & A
www.RROHC.com
Hansten Healthcare PLLC Team
www.RROHC.com
We share your passion for patient/family
centered care delivered through expert
professional practice.
Faculty: Ruth Hansten, RN PhD FACHE
Consultant with > 175 organizations
Author of 6 books
Delegation & supervision , teamwork at bedside
Doctoral research focused on critical thinking and clinical judgment
Care delivery model and philosophy called Relationship and Results Oriented Healthcare® (RROHC)
Faculty: Kimberly McNally, RN MN BCC
Certified executive coach
The Nurse Executive’s Coaching Manual
(McNally & Cunningham, Sigma Theta Tau, 2010)
Worked with leaders & teams in 75 organizations
Previously held clinical, education, & leadership roles
Past-President - Healthcare Educators Association
Past-chair, Board of Trustees - large AMC
Chair, AHA Committee on Governance
RROHC development
Formerly the Vice President of Patient Care Services at Marion General Hospital, Marion, OH
30 + years combined clinical and administrative experience, including critical care staff nursing and director of ancillary services
Community faculty member at Marion Technical College and Tri-Rivers School of Paramedicine
RROHC Master Coach and began working with Hansten Healthcare as faculty in 2009.
Faculty: Linda Pullins, RN MS
What is RROHC?
Acronym for Relationship & Results-Oriented Health Care
Pronounced like “ROCK”…our symbol to visually describe the concepts
Way of working…set of principles & bundle of best practices to make your job easier
Organizational approach to improving patient outcomes
www.RROHC.com
RROHC
Method to clarify & teach a shared structure of care for all disciplines
Simplifies & makes sense of complex work
Embeds caring as a daily routine
Implement bundle of 10 best practices
Basics MUST be done accurately, consistently & expertly to achieve improvements with quality and safety initiatives
“We must
become
brilliant at
the basics
to become
world class.” Roger Dow and
Susan Cook
www.RROHC.com
Why was RROHC developed?
175 organizations (then >100)
Teamwork processes ? at the point of care
Omissions, clinical results, and/or poor pt/staff satisfaction
10 practices most often missed
Delegation/supervision gaps
RN/pt. relationship suffering from not knowing pt or team
Shared mental model or map helps for improved results!
www.RROHC.com
Gaps
Step 1: Assignment
Step 2-4: Shift report with SMM shorthand of 4 Ps,
planning w/team including checkpoints, and introduction, and rounds
Assignments do not reflect pt needs, staff needs, and lines of authority
Shift handover at the bedside can accomplish all of these, plus set up delegation for shift
www.RROHC.com
Gaps
Step 5: Focused interview at bedside
Step 6: Communicate plan and update w/team
Step 7: IDT Rounds
Nurses are often unclear about healing presence and listening skills, focusing on patient results
Nurses and UAPs parallel practice w/o teamwork
Nurses and other disciplines not in sync w/pt/family
www.RROHC.com
Gaps
Step 8: Checkpoints
Step 9: Feedback, celebration and debrief
Step 10: Plan assignments and give report based on pt/fam 4 Ps
Nurses and UAPs uncertain re: tasks and roles and don’t update or evaluate
Best teams recognize results and offer +/- feedback
Critical thinking from debrief used to inform next shift’s plans
www.RROHC.com
The RROHC® philosophy & method of delivering care combines patient & family-centered communication with high impact team practices to create positive health outcomes.
We believe that when healthcare team members understand the results patients & families want, they operate from a common purpose to create a shared picture of success & an effective interdisciplinary care plan which clearly outlines the critical part of each member of the team.
RROHC integrates…
Practical & realistic…grounded in real world
Intentional decision to care/healing presence
Critical Thinking & Clinical Judgment
Delegation & Teamwork competencies
Neurobiology
Adult Education Principles
Change Theory & Culture development
Patient/family Outcomes – 100% of the time!
Three Major Elements
1. Knowing the Patient
2. Critical Thinking/Problem Solving to get to preferred outcomes
3. Transdisciplinary teamwork
Bundle of 10 Best Practices to address the 3 elements
Implemented via 3 Levels of Training & Certification
Why an OUTCOMES Orientation?
Outcomes or Results = vision of preferred future Encourages Critical Thinking
Seeing Big Picture (purpose/picture)
Ability to Prioritize
Engagement of all to move more quickly toward that result
Includes patient engagement in healing
84% of the variance of satisfaction with treatment outcome had to do with eliciting the patient’s most important reason for undergoing treatment. (Hudak)
Why are Shared Mental Models Necessary?
Shared mental models help teams focus on common goals…
“filter and fuse an overwhelming amount of information and make
critical decisions under time constraints”
Purpose for nursing
Guides education, research
3 Elements of RROHC™ Philosophy
1. Fundamental Relationship between the Professional & the Patient/Family
Skills/Behaviors to achieve this element:
• “Knowing” & partnering
• Introduction process & language
• Focused listening process
• Outcomes/results focus
3 Elements of RROHC™ Philosophy
2. Critical Thinking & Problem Solving to get to preferred outcomes
Skills/Behaviors to achieve this element:
Logical, Analytical, Creative &Intuitive thinking
Emotional Intelligence
Problem solving 6 Steps
3 Elements of RROHC™ Philosophy
3. Transdisciplinary Teamwork
Skills/Behaviors to achieve this element
4 Ps (purpose, picture, plan, part) known by all team members
Coordination
Communication
Conflict Resolution
Giving feedback
5 Rights of Assignment & Supervision are Incorporated into the 10 Steps of RROHC
RROHC Steps
Assignments
Initial Direction
Checkpoints
Celebration and Feedback Checkpoint
7. Interdisciplinary
Rounds
3. Plan with Team &
Give Initial Direction: CT
5. Focused Interview
at Eye Level: Plan
8. Checkpoints
9. Feedback
& Celebration
Debrief
RROHC 10. Plan assignments &
Give report based on 4Ps
1. Fundamental Relationship w/ Patient/Family
2. Critical Thinking & Problem-Solving
3. Transdisciplinary Teamwork
6. Communicate Plan
& Patient’s 4Ps
4. Introductory
Rounds
2. Shift Report,
Hand offs (4Ps)
1. Make assignments
Based on 4Ps
Bundle of Best Practices
http://RROHC.com
Cost Effective Care
& Resource Mgt
7. Interdisciplinary
Rounds
3. Plan with Team &
Give Initial Direction: CT
5. Focused Interview
at Eye Level: Plan
8. Checkpoints
9. Feedback
& Celebration
Debrief
6. Communicate Plan
& Patient’s 4Ps
4. Introductory
Rounds
2. Shift Report,
Hand offs (4Ps)
1. Make assignments
Based on 4Ps
Staff
Engagement
Quality Safety
Patient
Satisfaction Team
Satisfaction
And Joy
Teamwork
Across the
Continuum
10. Plan assignments &
Give report based On 4Ps
Results
Clinical Outcomes
Staff Engagement
Nurse Satisfaction
Patient Satisfaction
Physician Satisfaction
Problem Solving Processes
Pre and Post RROHC Delegation Skills
Pre RROHC
473 Responses
Post RROHC 264 Responses Change
Clear Team Plan 0.88 0.98 0.10
Give Initial Direction to Members 0.94 0.98 0.04
Give Routine Feedback 0.78 0.87 0.09
Shift Report Contains 4Ps 0.58 0.87 0.29
Confident in Assigning Tasks 0.79 0.91 0.12
Comfortable Delegating Post Report 0.79 0.96 0.17
Use Planned Checkpoints 0.31 0.59 0.28
Ask for Team Feedback 0.59 0.87 0.28
Plans Based on Critical Thinking 0.65 0.90 0.25
Accountability Awareness 0.96 0.98 0.02
Evaluate Delegated Care 0.82 0.93 0.11
Clear about Roles 0.79 0.92 0.13
Pre and Post RROHC® Delegation Skills Education
Employee Engagement
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Nu
mb
er
of
Emp
loye
es
Enga
ged
P
er
Each
Em
plo
yee
Dis
en
gage
d
Oakwood Health System Gallup Data on Employee Engagement
2007
2008
2009
www.Hansten.com
MD Perceptions of Nursing Care Overall
0
10
20
30
40
50
60
70
80
90
2001 2002 2003 2004 2005 2006
12 15
17
8
37
82
Perc
entile
Rankin
g "
Exce
llent"
www.Hansten.com
At 4 Years: Press Ganey
Marion General Hospital
Inpatient Overall
(Percentile Ranking)
0
20
40
60
80
100
120
Q1'01
Q2'01
Q3'01
Q4'01
Q1'02
Q2'02
Q3'02
Q4'02
Q1'03
Q2'03
Q3'03
Q4'03
Q1'04
Q2'04
Q3'04
Q4'04
Q1'05
Q2'05
Q3'05
Q4'05
Q1'06
Q2'06
Q3'06
Q4'06
Overall
Inpt Nursing
*
* Implementation – RROHC
Amazing Consistency!
RN Recruitment
15
33
57
51 50
63
0 0
50
40
35
22
0
7
11
15
41
0
10
20
30
40
50
60
70
2001 2002 2003 2004 2005 2006
Total
New Grads
Experienced
*
* Through 09/09/06
Pressure Ulcer Hospital Rates
0%
5%
10%
15%
20%
Pressure Ulcer 8.1% 17.7% 10.3% 7.8% 9.9% 4.5% 6.5% 4.9% 3.3% 3.9%
Hospital Acquired 3.4% 9.5% 6.4% 1.7% 4.2% 0.5% 4.0% 1.8% 1.8% 2.7%
Unit Acquired 2.1% 7.9% 6.2% 1.2% 2.6% 0.2% 3.2% 1.2% 1.1% 2.7%
1st Qtr
2008
2nd Qtr
2008
3rd Qtr
2008
4th Qtr
2008
1st Qtr
2009
2nd Qtr
2009
3rd Qtr
2009
4th Qtr
2009
1st Qtr
2010
2nd Qtr
2010
Data Summary: Data above is from the quarterly pressure ulcer studies which are performed on all adult inpatient units by the
Wound Care representatives. Quarterly data is submitted to the National Database of Nursing Quality Indicators (NDNQI).
Both hospital acquired and unit acquired pressure ulcers rates have been decreasing since 2nd Quarter 2008.
Patient Falls: 4 South
4 South
0.00
1.00
2.00
3.00
4.00
5.00
6.00
Falls per 1,000 pt days 5.06 4.52 3.62 4.34 1.77 1.50 2.71 4.06 2.23 2.20
# of falls 15 13 10 12 5 4 7 10 6 6
Falls with injury per 1,000 pt days 1.01 2.09 1.09 1.08 0.35 0.00 0.39 1.22 0.37 0.36
# Injury falls 3 6 3 3 1 0 1 3 1 1
1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09 4Q09 1Q10 2Q10
Situations on Unit Last Shift: 4 South
Had enough time with patients
0
20
40
60
80
100
Hospital All 65 72 79 82
4 South 50 88 72 91
2006 2007 2008 2009
The higher the score the more positive the rating.
% Yes
Think about the last shift that you worked.
Did any of the following situations occur?:
3. I had enough time to spend with each patient.
Response options: yes, no, not applicable.
4 South’s score for “Had enough time with
patients” is above the 90th percentile for adult
step-down units in Magnet facilities that
participated in the 2009 NDNQI RN survey.
Implementation
www.RROHC.com
Assessments (online & onsite)
Workshops
On-unit practicums
Expectations for follow-up with assessment & measurement
RROHC Specialist Course
RROHC 2 Day Facilitator Course with on-unit practicum
On-going Support to Sustain Results
Organizational Coaching - phone & on-site sessions Online education (learning.Hansten.com) (Level 1 Professional Practice Specialist self-study) January and June www.Hansten.com/blog Facebook: Hansten Healthcare PLLC Linked In: Ruth Hansten Twitter: @Rhansten Newsletters with videos/news/research New online education delegation product
www.RROHC.com
www.HanstenRROHC.com
OUTCOMES MEASURES
Ongoing unit progress skill & process measurement
Progress Measures
Ongoing individual staff skill & process measurement integrated into evaluations
For more information about our
Relationship & Results Oriented Healthcare® Certification Program
See www.Hansten.com, www.RROHC.com
Ruth@Hansten.com or Kathy.Watkins@Hansten.com
T: 360 437 8060
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