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: