goals for the session: have beginning understanding of next level of the documentation framework ...
TRANSCRIPT
Goals for the session:
Have beginning understanding of next level of the Documentation Framework
Support introduction of Safety & Education documentation changes as next building block of Documentation Framework
Have begun a unit-specific implementation plan
Know proposed rollout schedule, especially go live date for your unit.
Knowledge of resources available to support this work
Falls/Safety Documentation Changes: Implementation Planning
◦ We began to implement changes to our Nursing Documentation Framework in October, 2010 with the rollout of Priority Problems.
◦ Based on feedback from nurses and from recent Magnet and JCAHO Surveys, this change has been the catalyst for dramatic improvements in documentation. “My documentation reflects how I impact patient
outcomes” (typical Staff Nurse comment when speaking about Priority Problems).
Intro
◦ We are now ready to begin the next phase of the Nursing Documentation Framework change with implementation of the Falls/Safety Section and changes to Education Tab.
◦ As with Priority Problems, this is less of a technical change, more of a practice change.
◦ This is a huge ongoing culture change
Intro. (cont.)
◦ CAPS will sit with participant(s) from their unit(s) the extent possible but we want to work in teams, even if it’s not your unit team.
◦ We will begin to craft a unit-specific Implementation Plans
◦ We ask that you honor timeframes
◦ Jot down questions and “ah-ha’s” as you go so you don’t lose them. If there are any issues we are not able to address today, we will put on Parking Lot for follow up after the session.
Logistics
Falls expert brought in to address high Falls rate said our emphasis was on screening for rather than preventing falls. Our old screen had been modified to the point that it was NOT evidence-based.
Historical approach to a new regulation or problem – ADD a NEW Documentation section◦ Increases documentation burden on nurses◦ Nurses spend time documenting about instead of preventing
problems◦ Our goal to help with increasing staff satisfaction – standardize
and simplify documentation. The hospital is a dangerous place for patients. “First do no harm” (Hippocrates). Organizational Goal --
Culture of Safety
Kotter’s 1st Step:
Increasing the Sense of Urgency
At your table, identify 3-5 common safety risks for patients on your unit. 1. _____2. _____3. _____4. _____5. _____
Kotter’s 1st Step:
Increasing the Sense of Urgency
Finding our way together….
Kotter’s Step Two: Form a Powerful
Coalition
As the Nursing Leaders of VUMC, we must actively LEAD this transformation of practice & documentation
Requires strong leadership & visible support
We cannot “manage” change from the sidelines
“Managing change isn’t enough – you have to lead it.” (Kotter, 1996)
Managers create order & predictability, while leaders establish direction, vision, motivate & inspire people. (Weber & Joshi, 2000)
◦ Nursing Leaders & Nursing Educators
◦ Staff Nurses (novice to expert)
◦ SuperUser Champions
◦ SSS CAPS
◦ HED Builders
◦ Key Stakeholders: Medical Director, Physicians, Nurse practitioners
◦ Engage Opinion Leaders early & engage as Champions
Building a Change Coalition
Work as a TEAM
Build ongoing urgency & momentum for the need for change
Change Coalition will…
Vision Statement Safety Documentation, including
assessment, interventions, teaching, and notification, will result in a safer environment for our patients and will prevent or minimize injury.
This will improve patient care and clearly define nursing’s contributions to patient care and the team.
Kotter’s Step 3: Create a Vision
If documentation is a reflection of our care – does it show that nurses make a difference?
Physiological◦ Cardiac◦ Bowel/Gastric◦ Life cycle (pregnancy)◦ Metabolic (glucose)◦ Physical Regulation (infection)◦ Respiratory◦ Skin Integrity◦ Tissue Perfusion◦ Urinary◦ Medication
Psych/Behavioral◦ Cognitive/Neuro◦ Coping◦ Health Behavior◦ Role Relationship◦ Self Care◦ Self Concept
Functional◦ Activity◦ Fluid Volume◦ Nutrition◦ Safety◦ Sensory/Pain
21 CCC Categories
Building an Outcomes Oriented
Documentation Framework
A Home for Evidence Based Nursing Care
Assess * Care * Teach * Manage Priority Problems
According to Albert Mehrabian’s research study in 1968 how much of the message is the actual words used?
◦ 38%◦ 7%◦ 55%
Kotter’s Step 4:
Communicating the message
Email Group meetings One-on-one communication Company publications High level and executive storytelling
delivered company-wide
Which of the following delivery methods is the most effective?
One-on-one face to face discussions that are honest and straight forward and that offer details of the change on a personal level
Cascading small group meetings to share information, brainstorm solutions and implement new processes
According to the 2005 Change Management Best Practice Report….
Communicating to Different Generations
Baby Boomers born 1945 – 60
Traditionalists born before 1945
Generation X – children of boomers
Millenials – grandchildren of boomers
Traditionalists
Baby Boomers
Generation X
Millenials
Make decisions based on what has worked in the past
Consistency is important
Show Me generation--Body language is very important
Favor top-down decisions
Value respect
Will fight for a cause
Highly Collaborative
Optimistic
Prefer messages presented from positive standpoint
Value work and life balance
Shaped by a culture of instant results
Multi-taskers
Avoid unnecessary meetings
Baby Boomers
Blog
Face to Face communication
PowerPoint Presentation
Styles of CommunicationMatch the Generation to a Style Preferred by that Generation
Generation X
Millenials
Traditionalists
Web Site E-mail updates Monthly updates for leadership to communicate
to staff Newsletters
You can expect to see some/all of the following strategies used to communicate additional Documentation Framework Changes:
For the next 5 minutes discuss:
Who should be included in your unit’s coalition for change? List names and/or titles
Begin to identify your unit-specific communication plan – be specific and include timeframes
Area Specific Coalition and Communication Plan
Obstacles are generally in 3 categories
People
Processes
Structure
Kotter’s Step 5:
Removing Obstacles & Empowering Action
1. Leadership: Commit to change & voice consistent
message
2. Educators & Super Users: Communicate advantages
of new process
3. Curmudgeons: Listen to their feedback but don’t leave
true resisters in leadership positions
4. 5 positive encounters to overcome 1 negative
5. All Leaders demonstrate their belief that the change
will improve patient care & continuity of care
People
o Can’t be too complicated
o Must be fairly easy to learn
o Must fit into workflow
o CQI: Looping process…education,
implementation, evaluation, reeducate or
change, reevaluate, reeducate/change
Process
o Commit to overtime pay: for SuperUsers to be
available during implementation
o Change takes time: hard-wiring to new processes
can take up to 4 weeks
o Adequate Education: Educators, Superusers, Staff
o Identify competing projects: other quality/safety
initiatives; policy/product changes… Anything that
will require extra time
o Watch out for staff and Manager overload!
Structure
Take 5 minutes to:
Identify obstacles to success & develop action plans to address
Include prior commitments that might influence timelines for Priority Problem rollout on your unit
Removing Obstacles & Empowering Action
9 North experience
1. What were improvements experienced with use of modified Falls/Safety documentation approach?
2. How did you hard wire the change?
3. What were the challenges to adoption?
Kotter’s Step 6:
Create Short Term Wins
Identify 2-3 successful changes they have experienced in VUH over the past 2-3 years
◦ During any of these changes, did you identify short-term wins during the change process?
◦ How did you celebrate these wins?
◦ What techniques did you use to hardwire the change?
Kotter’s Steps 7 & 8:
Build on the Change & Anchor the Change in culture
Team completes Implementation Worksheet
Educator, Leadership Team member, CAPS partner to create unit-specific plan and begin training
Utilize your CAPS and watch for communication updates
NEXT STEPS