Relationship Based Care:
Impact of specific process changes on patient
satisfaction, staff teamwork satisfaction and clinical
outcomes in a new 30 bed Medical-Surgical Unit.
Michelle Rennolds, R.N., Med/Surg Clinical Coordinator
(816)347-4738 ● krennolds@saint-lukes.org
Megan Smith, R.N., M.S.N., Clinical Educator
(816) 347-4456 ● mfsmith@saint-lukes.org
Gloria Solis, R.N., M.S.N., M.B.A., Chief Nursing/Chief Operating Officer
(816) 347-4881 ● gsolis@saint-lukes.org
Tylaine Solomon, R.N., M.S.N., Med/Surg Clinical Nurse Manager
(816) 347-4747 ● tasolomon@saint-lukes.org
Saint Luke’s East - Lee’s Summit
100 N. E. Saint Luke's Boulevard, Lee's Summit, MO 64086
saintlukeshealthsystem.org
Situation
• The opening of a new 30 bed Medical-Surgical
Unit in October 2008 presented the opportunity
to implement Relationship Based Care (RBC)
concepts and evaluate the effectiveness of
specific behavioral changes.
• With the hospital’s vision of “The best place to
get care, the best place to give care”, RBC could
be the foundation to improve patient satisfaction,
teamwork and quality outcome scores.
Timeline
•
MAY 2008
– Relationship Based Care (RBC) Committee formed
•
OCTOBER 2008
– VHA Return to Care retreat with Med Surg staff and leadership
•
DECEMBER 2008
– Launched Hourly Rounding
– Standardized report tool completed
– Team huddles initiated
– Secretary pages RN when physician arrives on unit
– RN and physician round together
•
JANUARY 2009
– Celebration of self, team, and patient relationships
– Circle time introduced
– Education on bedside report and SBAR communication tool
– Mock Bedside report provided by RBC committee
– Addressed staff concerns in open forum setting
Timeline
• FEBRUARY 2009
– Ongoing Education
– Five minute Compassionate Conversation with Patient
(CCP)
– Individual patient goal-setting written on white boards
each shift
• MARCH 2009
– Bedside report starts with RN, PCT and patient
– Letter to patients describing bedside report
• APRIL 2009
– Ongoing staff support to continue momentum by
management
– Continuous refinement of all components
Results
• Specific behavioral changes such as hourly
rounding have a direct correlation to a decrease
in call light usage, falls and pressure ulcers.
• Commitment to My Coworker Survey has shown
an increased relationship with Team attributed to
multidisciplinary communication and
collaboration.
• Staff satisfaction survey shows that nurses are
more satisfied with the changes of bedside
rounding enabling more quality patient
interaction.
Results
• Significant increase in patient satisfaction
are attributed to meeting patient needs
through hourly rounding and involving the
patient in their care through bedside
report.
• Patient Care Technicians (PCT) have a
higher accountability and show a decrease
satisfaction with bedside rounding.
Recommendations
• Communicate evidence based research
supporting behavioral changes
• Focus on benefits of staff first, then benefits to
patients
• Create staff buy-in with coworker champions
• Staff involvement in the decisions and
modifications through Shared Governance
• Make implementation a priority for several
months
Recommendations
• Optimal staffing to practice behavioral changes
• Communicate bedside rounding to patients
• 100% leadership commitment and modeling of
behavioral changes
• Continued momentum with support and
education to team
• Celebrate the accomplishments and never give
up!
References
Banner Health. (2004). Staff satisfaction survey.
Koloroutis, M., Wright, D., Felgen, J., Person, C., &
Manthey, M. (2004). Commitment to My Coworker
Healthy Team Assessment Survey. In M. Koloroutis
(Ed.), Relationship-based care: A model for transforming
practice. (pp. 257-258). Minneapolis, MN: Creative
Heath Care Management.
Koloroutis, M., Felgen, J., Person, C., & Wessel, S. (2007).
Relationship-based care: Visions, strategies, tools and
exemplars for transforming practice. Minneapolis, MN:
Creative Heath Care Management.
Welcome to Saint Luke’s East- Lee’s Summit. Our mission is the
“Best Place to Get Care and the Best Place to Give Care.” Keeping
this in mind, our goals are to keep you informed and provide you with
EXCEPTIONAL care. That is why our unit does “Walking Report.”
Walking Report provides a way for your nurses to share information
regarding your progress at shift change. This is done at your bedside
so that you may take part in your care and help set goals to get
better. The nurse will provide an update on what treatments you have
had, what test results have returned, and other important information.
This will give you a chance to meet the oncoming nurse, ask
questions about your care, and discuss any issues you may have.
If you have family or visitors present during report, you will be given
the choice to have them stay in your room or to step out into the hall.
Our shift change is typically between the hours of 6:45 - 7:15 AM and
PM. Your privacy is very important to us so please let us know if there
are any concerns.
Once again, welcome to our unit. We are here to help you heal.
Please let any member of our team know if you have any questions,
comments, or suggestions.
Respectfully,
Tylaine Solomon, RN
Med-Surg Nurse Manager
Office # 816/347-4747
Michelle Rennolds, RN
Med-Surg Assistant Nurse Manager
Office # 816/347-4738
Saint Luke’s East
Lee’s Summit, MO 64086
RN Report Sheet: Days - PCU/MS (2 Vertical)
Patient Label
Admit Date
Patient Label
D/C Plans:
Admit Date
______________
D/C Plans:
______________
Consults:
Suicide/Abuse
SS / PT-OT / RT / NUTR
ASSESSED: YES NO
Consults:
Suicide/Abuse
SS / PT-OT / RT / NUTR
ASSESSED: YES NO
Code:_________ Isolation:_________
Fall Risk:_________ Restraints:_________
Allergies:
Code:_________ Isolation:_________
Fall Risk:_________ Restraints:_________
Allergies:
Diagnosis:
Diagnosis:
Surgery/Date:___________________________________
Surgery/Date:___________________________________
Labs Pending:
Labs Pending:
IV Site:____________________ Date:_________
IV Fluids:_______________________________________
IV Site:____________________ Date:_________
IV Fluids:_______________________________________
9 SMT PMP-TPN / PPN / PICC / SL
9 SMT PMP-TPN / PPN / PICC / SL
Additional IVs: __________________________________
PCA:___________________________________________
Additional IVs: __________________________________
PCA:___________________________________________
Accucheck: 0800_____ 1200_____ 1700_____ HS_____ Other:_____
Accucheck: 0800_____ 1200_____ 1700_____ HS_____ Other:_____
Insulin: 0800_____ 1200_____ 1700_____ HS_____ Other:_____
Insulin: 0800_____ 1200_____ 1700_____ HS_____ Other:_____
0800, 0900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800,1900
0800, 0900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900
VS:__________________________________________ DW:_______
VS:__________________________________________ DW:_______
Diet:
Diet:
I&O:
Cont / Incont / Foley / Ostomy / Brief / Urinal
Activity: BR / AdLib / BRP / BSC / Turn2
TEDS / SCD / AVI
BM:_______
Chair / Amb / Assist
TID / BID / QID / Meals
I&O:
Cont / Incont / Foley / Ostomy / Brief / Urinal
Activity: BR / AdLib / BRP / BSC / Turn2
TEDS / SCD / AVI
BM:_______
Chair / Amb / Assist
TID / BID / QID / Meals
Neuro:
Musculoskeletal:
Neuro:
Musculoskeletal:
CV:
Tele:
Skin:
CV:
Tele:
Skin:
Pulm:
O2:
IS:
GI/GU:
History / Comments:
Wounds/Drsg:
Drains:
Pulm:
O 2:
IS:
GI/GU:
History / Comments:
Not a Part of the Permanent Medical Record
Page 1 of 1
SLE-NS-631 (Rev. 01/30/09)
Wounds/Drsg:
Drains: