Evaluation & Implementation of New Employee Orientation Program

Transcription

1 Evaluation & Implementation of New Employee Orientation Program Kansas Healthcare Education Council Spring Conference April 11-12, 2017 Goals for Today Attendees will recognize that change is difficult, but GOOD! Attendees will understand how a Kaizen Event was used to evaluate and change the classroom orientation program at St. Jude Children s Research Hospital Attendees will be able to use Kaizen Event tools to evaluate and recommend changes to a process 1

2 St. Jude Children s Research Hospital Tina Dieckhaus, MSN, RN-BC, NE-BC, CPHIMS, FHIMSS 2

3 Activity - Activity - Change Change and stress are interchangeable Result in concrete thinking Result in isolated thinking 3

4 Why Change? What does strategic planning and change have to do with each other? What is more important? Strategy or Execution? Issues with executing a plan The whirlwind Wildly Important Goal (WIG) Lead measures vs lag measures Scoreboard Creating a cadence of accountability 4

5 Our WIGs We will increase nursing team confidence/trust in the orientees readiness to practice from XX to XX by XX. We will increase the orientees satisfaction with nursing orientation from XX to XX by XX. KAIZEN 5

6 Kaizen Lean thinking Improve quality Improve customer service/perception Decrease non-value added cost Start Identify Waste The Standard Work elements of a Kaizen are: Document Reality Do It Again Celebrate Make this the Standard Results: A new way of work Measure Results Plan Countermeasures Reality Check Make Changes Verify Change 6

7 When to use Kaizen Event When the scope and boundaries of a problem are clearly defined When results are needed immediately In the early stages of a project to gain momentum and build credibility As a change agent when there is resistance to stimulate change As a project launching tool leading to multiple follow-up projects As a continuous improvement tool (not Kaizen Event) Typical steps Gemba walk Current state map Value stream map Spaghetti diagram Future state map 7

8 Current State Patient Flow Current State Map 8

9 The set of all activities (value and waste) required to provide product or service for the customer. Value Stream Mapping Steps in identifying a Value Stream: 1. Identify the Customer 2. Define the Value 3. Observe the work yourself 4. Include your partners Value Streams know no Departmental boundaries! Solutions know no Departmental boundaries! Value Stream Mapping 9

10 Kaizen Tools for preparation Create event charter Review planning checklist Schedule meetings Find Rooms! Order supplies 10

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12 Activity A process that needs to be fixed Current process is inefficient Customer is dissatisfied Who are the team members? 12

13 Activity A process that needs to be fixed Buying Tickets to a Concert Current process is inefficient Customer is dissatisfied Who are the team members? 13

14 Pre-work Our Kaizen Event Surveys Surveyed participants in orientation (n=54) Rate the following Surveyed participants, preceptors, educators, peers, leadership (n=149) Rate on these three questions: Was the information important or necessary? Was the information interesting or helpful? Was it presented in an enjoyable format? WIG questions. When staff have completed their orientation, I have confidence in them and trust their readiness to practice Rate your satisfaction as an orientee with the nursing orientation process Facilitators Project Managers Quality Management Department Participants (27) Co-Facilitators Nursing Excellence Team Nursing Educators Unit Educators/Orientation Educators Unit Managers Preceptors Recent Orientees Technology training team (Nursing and Clinical Informatics) 14

15 Orientation Orientation Topics ALL/AML Overview Angiogenesis Video Barcoding specimen collection/blood administration Basic Physical Assessment of infant/pediatric patient BMT Overview Capillary Puncture Competency/Overview Care Map/Case Study CBC Hematopoiesis Overview Clinical Immersion on Unit Clinical Trials CNS G-Tubes CNS Tumors/shunts overview Computer access Critical Thinking/Effective Communication End of Life/Palliative Care Epidural Pain Management Competency/Overview Line Care Overview/Competency Line Nurse Shadowing Day Long Term Survivor Lunch Lymphoma Overview Medication Calculation Test Milli Basics Milli EMAR Mission Possible Nursing Education Critical Information Icon Check Oncologic Emergencies Oral Care Overview Orientation Disease Presentations Orientation Process Overview/Expectations Pain Team PCSI Computer Basics PCSI Milli Recap Professional Practice Model/SDM Overview Protective Intervention (Child Abuse and Neglect) Protocol Development Pyxis Access/PPE/Chemo Spills QI 101 Rapid Response Team Resource Videos Respiratory Therapy overview Restraints application Demonstration Solid Tumor Overview Pancytopenia Standard of Care Spiritual Conversations TPN/CADD Pump Overview Tracheostomy Competency Check off Unit Scavenger Hunt Pathways Milli Tutorials Pathways Web Based Training Modules Grief & Bereavement Article Pediatric Cancer Overview Pathways Hem/Onc Bundle Harvey Team Overview/Competency Pertinent Policy Sign off Welcome by CNS Harvey Team Crash Cart Hunt Pharmacy Overview/Tour Welcome by Nursing Orientation Educator Hematology Overview Post Op Care Welcome by Nursing Unit Director HR Nursing Orientation Study Packet HIV Overview Independent Study Time PreAnesthesia/Sedation/PostOp Surgery Overview Pressure Ulcer Prevention Welcome by Nursing Education Director 15

16 Reviewed the Plan for the week Reviewed all of our data 16

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19 Orientation Word Cloud Our WIGs We will increase nursing team confidence/trust in the orientees readiness to practice from 63.36% to 80% by 12/31/17. We will increase the orientees satisfaction with nursing orientation from 61.05% to 80% by 12/31/17. 19

20 Activity What kind of pre-data would we need to collect prior to our Kaizen Event? Can we do a Gemba walk? Or is our process dispersed over time and space, and would require survey results? Both? 20

21 Mapped out the problem statements 21

22 Activity Create your problem statement 22

23 Mapped out current state Orientation Process 23

24 Content Development Process Activity What is your current state? 24

25 Developed goal statements 25

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27 Activity What is your goal? Mapped out future state 27

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29 Activity What does your future state look like? 29

30 What happened next? 30

31 First step Define goals of orientation Introduce new staff to the culture and expectations of St. Jude Children s Research Hospital Provide staff with the basic safety information required to work within patient care services. Introduce staff to basic concepts about the St. Jude patient population and care models. Next Steps T-Shirt Committee! Content Review Committee Technology Committee HR Packet Committee Milli Review Committee SharePoint Committee Program Review Committee Speaker Development Committee 31

32 T-shirt! (celebrate) Week 1 Day 2 Culture/Safety Day 3-5 AM Clinical Overviews PM Skills and Simulations Content Focus Week 2 WBT Computer Classes Weeks 3-12 (+) (quarterly) Skills and Simulation events weekly Trach Care/Line Care/G-tubes/Harvey Team (2) Pressure Ulcer Prevention/Skin Assessment/Wound Care (2) Line Care/Dressing Changes (3) SIMULATION (6) 32

33 Orientation Topics ALL/AML Overview Angiogenesis Video Barcoding specimen collection/blood administration Basic Physical Assessment of infant/pediatric patient BMT Overview Capillary Puncture Competency/Overview Care Map/Case Study CBC Hematopoiesis Overview Clinical Immersion on Unit Clinical Trials CNS G-Tubes CNS Tumors/shunts overview Computer access Critical Thinking/Effective Communication End of Life/Palliative Care Epidural Pain Management Competency/Overview Line Care Overview/Competency Line Nurse Shadowing Day Long Term Survivor Lunch Lymphoma Overview Medication Calculation Test Milli Basics Milli EMAR Mission Possible Nursing Education Critical Information Icon Check Oncologic Emergencies Oral Care Overview Orientation Disease Presentations Orientation Process Overview/Expectations Pain Team PCSI Computer Basics PCSI Milli Recap Professional Practice Model/SDM Overview Protective Intervention (Child Abuse and Neglect) Protocol Development Pyxis Access/PPE/Chemo Spills QI 101 Rapid Response Team Resource Videos Respiratory Therapy overview Restraints application Demonstration Solid Tumor Overview Pancytopenia Standard of Care Spiritual Conversations TPN/CADD Pump Overview Tracheostomy Competency Check off Unit Scavenger Hunt Pathways Milli Tutorials Pathways Web Based Training Modules Grief & Bereavement Article Pediatric Cancer Overview Pathways Hem/Onc Bundle Harvey Team Overview/Competency Pertinent Policy Sign off Welcome by CNS Harvey Team Crash Cart Hunt Pharmacy Overview/Tour Welcome by Nursing Orientation Educator Hematology Overview Post Op Care Welcome by Nursing Unit Director HR Nursing Orientation Study Packet HIV Overview Independent Study Time PreAnesthesia/Sedation/PostOp Surgery Overview Pressure Ulcer Prevention Welcome by Nursing Education Director Content Review Committee Orientation Expectations Welcome by Nursing Leadership Effective Communication Lunch/Professional Development Teamwork/Professionalism/Accountability Palliative Care/End of Life Spiritual Conversations Long Term Survivors Infection Prevention and Control Patient Rights/Ethics Pediatric Cancer Overview Transplant Overview Personal Protection Patient Education/Family Centered Care Pyxis Access Leukemia Lymphoma Overview Solid Tumor/NeuroOncology Overview Skills Day (chest tubes, trachs, g-tubes, etc) Nursing Surgical Services Overview HIV Overview Oncologic Emergencies Respiratory Overview Compassion Fatigue/Professional Boundaries Pressure Ulcer Prevention RRT/Harvey Team Overview Physical Assessment Simulation Line Care Overview/Skills Demonstration EMR (Milli) Class-Bar-code Scanning Critical Thinking/Effective Communication SIM Milli Simulation/Basic Computer Skills CITI Training Radiation Therapy Overview Populations Served/Age Specific Care Review 33

34 Technology Committee Millennial and Gen-X staff Communication of changes HR Packet Committee 34

35 HR Packet Committee Program Review, Speaker Development teams Committee formed to review speaker content Speaker development committee and curriculum developed 35

36 To date, only one orientation class has gone through the new process. This has gone very smoothly Outcomes We cut our computer class from 3 days to 1, and were still done early! We cut our scanning class from 4 hours to 1 hour, but they completed their WBT prior to class, finished with time to spare and asked well thought out questions. I think this is better! Student comments were specific how interesting the content was. No comments mirroring the original themes (disorganization, poor communication, poor class/hands on balance) 36

37 Questions? Tina Dieckhaus, MSN, RN-BC, NE-BC, CPHIMS, FHIMSS References Martin, K., Osterling, M., (2007). The Kaizen Event Planner. Boca Raton FL; CRC Press. Huling, J., McChesney, C., Covey, S., (2012) The 4 Disciplines of Execution. New York, NY: Free Press. Gorman, K., (2015). Architectural design for orientation. Finding a common ground for success. Journal for Nurses in Professional Development, 31(4), Rizzo, L. H., (2016). Navigations. The road to a better orientation. Journal for Nurses in Professional Development, 32 (2), Rivera, E.K., Shedenhelp, H. J., Gibbs, A. L., (2015). Improving orientation outcomes. Implementation of phased orientation process in an intermediate special care nursery. Journal for Nurses in Professional Development, 31 (5), Ryan, C., Tatum, K., (2013). Customizing orientation to improve the critical thinking ability of newly hired pediatric nurse. The Journal of Nursing Administration - 43(4), Trossman, S,. (2016). Stepping into a culture of safety. Onboarding programs help retain nurses, strengthen patient care. The American Nurse November/December, 1-2. Walton, S. A., (2017) Bringing nursing orientation back to life. How our Magnet journey helped us achieve excellence. American Nurse Today. 12 (3) Schuelke, S., Ba4rnason, S., (2017). Interventions used by nurse preceptors to develop critical thinking of new graduates. Journal for Nurses in Professional Development. 33(1)., E1-E7. \\ TJC Staff Competency Checklist TJC Standard Orientation & Ongoing Education, Required Personnel 37