Relationship & Results Oriented Healthcare s 10 Best Practices at the Point of Care

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1 Relationship & Results Oriented Healthcare s 10 Best Practices at the Point of Care

2 Today s Agenda Our team Review : what is RROHC? Why RROHC? More indepth about RROHC Field Results RROHC Implementation Q & A

3 Hansten Healthcare PLLC Team We share your passion for patient/family centered care delivered through expert professional practice.

4 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)

5 Relationship & Results Oriented Healthcare Program & Care Model

6 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

7 Faculty: Linda Pullins, RN MS 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.

8 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

9 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

10 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!

11 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

12 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

13 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

14 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.

15 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!

16 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

17 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)

18 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

19

20 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

21 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

22 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

23 5 Rights of Assignment & Supervision are Incorporated into the 10 Steps of RROHC RROHC Steps Assignments Initial Direction Checkpoints Celebration and Feedback Checkpoint

24 Bundle of Best Practices 5. Focused Interview at Eye Level: Plan 4. Introductory Rounds 6. Communicate Plan & Patient s 4Ps 7. Interdisciplinary Rounds 3. Plan with Team & Give Initial Direction: CT 2. Shift Report, Hand offs (4Ps) 1. Make assignments Based on 4Ps RROHC 8. Checkpoints 9. Feedback & Celebration Debrief 10. Plan assignments & Give report based on 4Ps 1. Fundamental Relationship w/ Patient/Family 2. Critical Thinking & Problem-Solving 3. Transdisciplinary Teamwork

25 Quality Safety 5. Focused Interview at Eye Level: Plan 6. Communicate Plan & Patient s 4Ps Team Satisfaction And Joy 4. Introductory Rounds 3. Plan with Team & Give Initial Direction: CT 2. Shift Report, Hand offs (4Ps) 7. Interdisciplinary Rounds 8. Checkpoints 9. Feedback & Celebration Debrief Patient Satisfaction Teamwork Across the Continuum 1. Make assignments Based on 4Ps Cost Effective Care & Resource Mgt 10. Plan assignments & Give report based On 4Ps Staff Engagement

26

27 Results Clinical Outcomes Staff Engagement Nurse Satisfaction Patient Satisfaction Physician Satisfaction Problem Solving Processes

28 Pre and Post RROHC Delegation Skills Pre and Post RROHC Delegation Skills Education Pre RROHC 473 Responses Post RROHC 264 Responses Change Clear Team Plan Give Initial Direction to Members Give Routine Feedback Shift Report Contains 4Ps Confident in Assigning Tasks Comfortable Delegating Post Report Use Planned Checkpoints Ask for Team Feedback Plans Based on Critical Thinking Accountability Awareness Evaluate Delegated Care Clear about Roles

29 Measured Improvement in Professional Skills through RROHC Education Up to 37% Improvement

30 Pre and Post RROHC Professional Practice Improvements

31 Pre and Post RROHC Professional Practice 1-5 Years - Delegation Skills Improvement

32 Number of Employees Engaged Per Each Employee Disengaged Employee Engagement Oakwood Health System Gallup Data on Employee Engagement

33 Percentile Ranking "Excellent" MD Perceptions of Nursing Care Overall

34 At 4 Years: Press Ganey Marion General Hospital Inpatient Overall (Percentile Ranking) * Implementation RROHC Overall Inpt Nursing 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 Amazing Consistency! Q2 '04 Q3 '04 Q4 '04 Q1 '05 Q2 '05 Q3 '05 Q4 '05 Q1 '06 Q2 '06 Q3 '06 Q4 '06

35 RN Recruitment * Total New Grads Experienced * Through 09/09/

36 Pressure Ulcer Hospital Rates 20% 15% 10% 5% 0% 1st Qtr nd Qtr rd Qtr th Qtr st Qtr nd Qtr rd Qtr th Qtr st Qtr nd Qtr 2010 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% 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 2 nd Quarter 2008.

37 Patient Falls: 4 South 4 South Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09 4Q09 1Q10 2Q10 Falls per 1,000 pt days # of falls Falls with injury per 1,000 pt days # Injury falls

38 Patient Satisfaction -Nursing Overall :4 South

39 Situations on Unit Last Shift: 4 South The higher the score the more positive the rating. % Yes Had enough time with patients Hospital All South 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 90 th percentile for adult step-down units in Magnet facilities that participated in the 2009 NDNQI RN survey.

40 Implementation 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

41 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 Facebook: Hansten Healthcare PLLC Linked In: Ruth Hansten Newsletters with videos/news/research New online education delegation product

42 Progress Measures OUTCOMES MEASURES Ongoing unit progress skill & process measurement Ongoing individual staff skill & process measurement integrated into evaluations

43 Questions?

44

45 For more information about our Relationship & Results Oriented Healthcare Certification Program See or T:

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