The Power of One: Creating an Environment for Change

Transcription

1 The Power of One: Creating an Environment for Change Kathleen M Vollman MSN, RN, CCNS, FCCM, FAAN Clinical Nurse Specialist/Consultant ADVANCING NURSING Northville Michigan USA kvollman@comcast.net Vollman

2 S A F E T Y Self Advocacy Fundamentals /Foundation Evidence Team Yes I Will Self 2

3 Number 1 Respected Profession Nursing Gallup Poll: 82% Honesty & Ethical Rating So Why Don t We Feel Respected? Reclaiming Professional Respect Work Environment Quality of Care You Provide to Patient & Families What Behaviors or Communications Make You Feel the Recipient of Respect? 3

4 Feeling of Respect or Not being Respected Bournes DA, et al. Nursing Science Quarterly, 2009;22(1):47-56 Respected Feeling listened to Feeling revered for their knowledge Feeling trusted Feel part of the group Being acknowledged Sense of belonging/contributing Persons look out for each other and their support Fairness Free to speak Opportunities to excel Not Being Respected Disregarded Not revered Not trusted Not supported Not recognized Closed conversation Speaking in a tone that is demeaning Ideas and opinions not considered a value priority Unsafe, guarded, pressured, put down The Nature and Causes of Disrespectful Behavior Barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect Disruptive behavior Inappropriate conduct, outburst, verbal threats, bullying Humiliation, demeaning treatment Passive aggressive behavior Pattern of negativistic attitudes & passive resistance to adequate performance Passive disrespect suppressed anger Dismissive treatment of patients System disrespect Patient waiting, hostile working conditions, fail to ensure the physical safety of staff. Leape LL, et al. Academic Medicine, 2012;87(7):

5 The Nature and Causes of Disrespectful Behavior Disrespect does the following; Immediate aftermath; experience fear, anger, confusion, self-doubt, that can lead to error in decision-making Long-term effects; Avoid the person inflicting hurtful behavior Inhibits collegiality and cooperation key to teamwork Cuts off communication Undermines morale Inhibits compliance and implementation of new practices Diminishes joy and fulfillment in work and increases turnover Leape LL, et al. Academic Medicine, 2012;87(7): Endogenous factors Causes of Disrespect Characteristics of the individual, including insecurity or aggressiveness, threats to self-esteem, depression, narcissism, aggressiveness, prior, victimization Exogenous Factors It can be learned, tolerated and reinforced Culture can reinforce, top-down hierarchy Worsens in a stressful healthcare environment Leape LL, et al. Academic Medicine, 2012;87(7):

6 Facts About Respect How we live our lives depends on whether we respect ourselves. The value of self-respect may be something we take for granted We may discover how very important it is when our selfrespect is threatened, or we lose it and have to work to regain it, or we have to struggle to develop or maintain it in a hostile environment. Respect is a foundational element of professionalism It is part of everyday wisdom that respect and selfrespect are deeply connected 02/17/2009 Leape LL, et al. Academic Medicine, 2012;87(7): Self Respect Internal Dialogue External Dialogue 6

7 Culture of Respect Develop effective methods for responding to episodes of disrespectful behavior Initiating cultural changes needed to prevent the episodes Disrespectful behavior must be addressed consistently and transparently Organization set up a code of conduct and it must be enforced Culture of respect requires building a shared vision Leape LL, et al. Academic Medicine, 2012;87(7): The Road to Respect I spoke. You listened. I felt valued and honored. You shared your opinion. I trusted your wisdom. The circle of respect was complete. We saw in each other s eyes are common humanity. Now, moving to a zone of mutual affirmation, we felt safe to trust and learn and nurture in the give-andtake of life. Yasmin Morais

8 A Advocacy Advocacy Advocacy can be seen as a deliberate process of speaking out on issues of concern in order to exert some influence on behalf of ideas or persons. accessed 03/05/2009 8

9 Broaden the Definition of Advocacy It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. Florence Nightingale Notes on Hospitals: 1859 Advocacy = Safety Patient Advocacy/Safety Related to Clinical Practice Nurses knowledge of the Evidence based care Ability to deliver the care to the right patient at the right time, every time it is needed The ability to communicate patient concerns in a concise, data driven manner and take appropriate action Understanding that I am the voice of the patient 9

10 Why Effective Communication May Be Challenging for Nursing Self Respect Safety Environment Communication Advocacy Teamwork The Silent Treatment: April % of workers reported a safety tool warned them of a problem that may have been otherwise missed & could harm a patient Safety tools include: handoff protocols, checklists, COPE, automated medication dispensing machines. 58% said they got the warning, but failed to effectively speak up & solve the problem 3 undiscussbale issues: dangerous short cuts, incompetence & disrespect (4/5 nurses) 1/2 say shortcuts lead to near misses 1/3 say incompetence leads to near misses 1/2 say disrespect prevented them from getting others to listen or respect their opinion Only 16% confronted the disrespectful behavior 10

11 What Happens When You Speak Up!! 16% of healthcare workers who raise these crucial concerns observe better patient outcomes, work harder, are were more satisfied and are more committed to staying in their jobs. cy/silencekills.pdf Our lives begin to end the day we become silent about things that matter Martin Luther King Jr. 11

12 Understanding Your Culture & Communication Strategies Tweeners Negatoids Positrons If you Permit it you Promote it 12

13 Non-Verbal Communication Speaking Up: Does a Plan Education Program Improve Advocacy Quasi-experimental design Intervention design to increase speaking up behaviors among nurses in situations were patient safety is in jeopardy 2 hospital, same health system 51 RN s control group, 53 in intervention group Intervention; remove any sanctions, viewed video from CNO & CMO expressing commitment to back speaking up, discussion of organization obstacles, then individual obstacles, generate a personal action plan, planned peer support Results: Significant increase in speaking up behaviors vs. control (p<.0001) Sayre MM, et al. J Nurs Care Qual. 2012;27(2):

14 Courage Courage is what it takes to stand up and speak. Courage is also what it takes to sit down and listen Winston Churchill What to Do Individually? Prevent from occurring through training on effective communication Deal in real time to prevent staff or patient harm Initiate post event reviews, action and follow-up Make it as transparent as possible Zero-tolerance policy and procedure Intervention strategy: code white 14

15 Communication Training Communication Strategies Tools to help structure communication SBAR for communication with Doctors: Situation, Background, Assessment and Recommendation CUS Words: I am Concerned, I am Uncomfortable, This is not Safe Use CUS words when assertion of your communication fails things go wrong concern expressed but mutual decision not reached or proposed action doesn t happen in time frame agreed upon 15

16 What to Do Individually? Prevent from occurring through training on effective communication Deal in real time to prevent staff or patient harm Initiate post event reviews, action and follow-up Make it as transparent as possible Zero-tolerance policy and procedure Intervention strategy: code white F Fundamentals/Foundation 16

17 Missed Nursing Care Any aspect of required patient care that is omitted (either in part or whole) or significantly delayed. A predictor of patient outcomes Measures the process of nursing care Kalish, R. et al. (2012) Am Jour Med Quality, 26(4), Hospital Variation in Missed Nursing Care Kalish, R. et al. (2012) Am Jour Med Quality, 26(4),

18 Patient Perceptions of Missed Nursing Care Kalisch, B et al. (2012). TJC Jour Qual Patient Safety,38(4), Missed Nursing Care* Elevated HOB Mobility Oral Care IS/C&DB 0% 20% 40% 60% 80% 100% Missed Achieved Impacted by poor teamwork between RN and aids Low HPPD correlated to higher missed nursing care Impacts LOS, pneumonia, falls, pressure ulcers, etc. Kalisch, B. (2013). Am Journ Med Qual. Piscotty R & Kalisch B. Nursing Management, 2014;144 18

19 Protect The Patient From Bad Things Happening on Your Watch Interventional Patient Hygiene Hygiene the science and practice of the establishment and maintenance of health Interventional Patient Hygiene.nursing action plan directly focused on fortifying the patients host defense through proactive use of evidence based hygiene care strategies Incontinence Associated Dermatitis Prevention Program 19

20 INTERVENTIONAL PATIENT HYGIENE(IPH) VAP/HAP Oral Care/ Mobility HAND Patient HYGIENE Catheter Care Skin Care/ Bathing/Mobility CA-UTI CA-BSI Vollman KM. Australian Crit Care, 2009;22(4): Vollman KM. Intensive & Critical Care Nursing, 2013 Oct; 29(5): SSI HASI Achieving the Use of the Evidence Factors Impacting the ability to Achieve Quality Nursing Outcomes at the Point of Care Value Attitude & Accountability CNO s Vollman KM. Intensive & Critical Care Nursing, 2013 Oct; 29(5):

21 Preventing Infection Through Source Control: Evidence Based Bathing The Bath: The First Line Of Defense Nurse!!! Health/Social Well Being 21

22 Optimal Hygiene ph balanced (4-6.8) Stable ph discourages colonization of bacteria & risk of infection Bar soaps may harbor pathogenic bacteria Skin ph requires 45 minutes to return to normal following a ordinary washing Excessive washing/use of soap compromises the water holding capacity of the skin Non-drying, lotion applied Multiple steps can lead to large process variation Voegeli D. J WOCN, 2008;35(1):84-90 Byers P, et al. WOCN. 1995; 22: Hill M. Skin Disorders. St Louis: Mosby; Fiers SA. Ostomy Wound Managment.1996; 42: Kabara JJ. et. al. J Environ Pathol Toxicol Oncol. 1984;5:1-14 Doughty D, et al. JWOCN. 2012;39(3): Bath Basins: Potential Source of Infection Multicenter sampling study (3 ICU s) of 92 bath basins Identify & quantify bacteria in patients basins Sampling done on basins used > 2x in patients hospitalized > 48 hours & pre-formed 2 hours post bath Cultures sent to outside laboratory Qualitative vs. quantitative measures used to exclude growth that may have occurred in transport Bathing practices not controlled & no antiseptic soaps used to bathe Johnson D, et al. Am J of Crit Care, 2009;18:

23 Bath Basins Potential Source of Infection Large multi-center study evaluates presence of multi-drug resistant organisms Total hospitals: 88 Total basins: % 45% Contaminated 686 basins/88 Hospital 35% Gram negative bacilli 495 basins/86 hospitals 3% Colonized w/ VRE 385 basins/80 hospitals MRSA 36 basins/28 hospitals Marchaim D, et al. Am J of Infect Control. 2012;40(6): Used with Permission Advancing Nursing LLC Copyright 2013 AACN and Advancing Nursing LLC Waterborne Infection Hospital Tap Water Bacterial biofilm Most overlooked source for pathogens 29 studies demonstrate an association with HAIs and outbreaks Transmission: -Drinking -Bathing -Rinsing items -Contaminated environmental surfaces Immunocompromised patients at greatest risk Anaissie EJ, et al. Arch Intern Med. 2002;162(13): Cervia JS, et al. Arch Intern Med, 2007;167:92-93 Trautmann M, et al. Am J of Infect Control, 2005;33(5):S41-S49, Used with Permission Advancing Nursing LLC Copyright 2013 AACN and Advancing Nursing LLC 23

24 Impact on UTI with Basin Bathing UTI Rate- Removal of Prepackaged Bath Product QTR 3 FY Rate/1000 Device Days th percentile 0 QTR 1 FY05 QTR 2 FY05 QTR 3 FY05 QTR 4 FY05 QTR 1 FY06 QTR 2 FY06 QTR 3 FY06 McGuckin M, Torress-Cook A, et al APWCA Annual Meeting, Philadelphia, April 2007 The Effect of Bathing with Basin and Water and UTI Rate, LOS and Costs Unit Census: 14 Phases Product Cost/ No. of UTI Median 4 LOS 17 Days Median 4 Cost ( ) I- Pre-Packaged Bathing Washcloths (9 months) $10,530 1 ($3.00) $117,175 II- Basin/Water (9 months) III- Additional Product Cost, UTI, LOS, COSTS $3, $224,916 ($1.00) $7, $107,741 1 Based on 3 packages of 8 towels each 2 Based on product cost of towels, soap, and basin 3 Difference between phase I pre-package/phase II basin water 4 Chen Yin-Yin, et al. Infect Control Hosp Epidemiol 2005;26:

25 Traditional Bathing Why are nurwse! there so many bugs in here? Soap and water basin bath was an independent predictor for the development of a CLABSI Bleasdale SC, e tal. Arch Intern Med. 2007;167(19):

26 2% CHG Cloth Bathing: SCRUB Trial Critically Ill Children Cluster-randomized 2-period cross over trail >2 months of age 6 month 4947 admissions SOC: basin less bathing or soap & H 2 O CHG: 2% CHG cloth Demographics similar Outcomes: Primary bacteremia-36% reduction 12 pts withdrew because of skin irritations (1%) CHG-associated skin reactions-1-2 per 1000 pt days Bacteremia per 1000 days % Reduction Milstone AM, et al. 2013; 381(9872): The Evidence: Impact of 2% CHG Cloth Baths Evaluate effect of daily bathing with CHG on acquisition of MDRO s and incidence of CLABSI 9ICU s & Bone Marrow Transplant unit Randomly assigned 7727 patient: a.no-rinse, 2% CHG impregnated washcloths b.non-antimicrobial, no-rinse bath cloths Results of 2% CHG bathing 23% reduction 28% reduction 50% reduction 90% reduction Climo, M et al, N Engl J Med, 2013;368:

27 Impact of 2% CHG Cloth Baths: Study to determine the best method for reducing spread of MRSA & MDROs 3 protocols tested: a)swab for MRSA on admission to ICU - Isolate if positive b)swab for MRSA on admission to ICU - Isolate if positive - Nasal mucopiricin x 5 days - 2% CHG cloth bathing for entire ICU stay c)no swab - Nasal mucopiricin x 5 days - 2% CHG bath for entire ICU stay Results: No Swab Group Universal Decolonization Demonstrated 37% reduction 44% reduction Huang SS, et al. New Engl J of Med, 2013;368(24): % CHG Body Decolonization 2% CHG cloths (off label) have 3 large RCTs showing significant in CLABSI, MRSA/MDRO infections, plus multiple before and after studies Liquid CHG diluted and rinsed off has 1 small RCT showing small difference and multiple before and after showing in CLABSI Milstone AM, et al. 2013; 381(9872): Climo, M et al, N Engl J Med, 2013;368: Huang SS, et al. New Engl J of Med, 2013;368(24): O Horo JC, et al. Infect control Hosp Epidemiol, 2012;33(3):

28 For Successful Banning of Basins for Patient Care We need to provide alternatives for the other functions: Current Emesis New Emebags being installed in every adult and ped pt. room, ACU, PACU Storage of patient items Clear plastic baggies Trial of Concierge List to decrease waste of unused/unneeded products Foot soaks Shampoo caps, prepackaged Shampoo patient s hair Shampoo caps par d on all units 24 hour urine, ice Store some basins in lab to be dispensed with each 24 hour jug. Bath cloths with no insulation, cold halfway through bath. Bath cloths with insulation to stay warm longer Quinn B. Presented at NACNS March 2014 General Implementation Strategies Monitor for potential resistance Tools for successful implementation available at AHRQ Educate patients and families about new bathing technologies Improves condition of the skin Reduces the spread of microorganisms Should not be rinsed off Monitor compliance Assess estimated number of baths given Compare to use of bathing products used. niversal_icu_decolonization/universalicu.pdf Used with Permission Advancing Nursing LLC Copyright 2013 AACN and Advancing Nursing LLC 28

29 It is not enough to do your best; you must know what to do, and THEN do your best. ~ W. Edwards Deming F Foundation 29

30 Healthy Work Culture Standards Skilled communication True collaboration Effective shared decision making Appropriate staffing Meaningful Recognition Authentic Leadership AACN Standards for Establishing & Sustaining Healthy Work Environments, 2005 Organizational & Unit Structures that Supported the Empowerment Shared Governance Model Professional Practice Model/Clinical Ladder Unit Based Leadership Model Educational Support Continuous Quality Improvement Model 30

31 Keys to Success PARTNERSHIPS Relationships between stakeholders are essential to success ACCOUNTABILITY Participants are responsible for: Results Actions Consequences of own behavior EQUITY No role is more important than another Common goals are achieved through collaboration OWNERSHIP Every role must be meaningful and affect the outcome Clearly defined responsibilities help guide actions Commitment to team and mission are essential Foundational Principles to Maximize Staff Empowerment Share Governance = Shared Leadership of Practice/Ownership Shared governance is a structural model that frames the professional practice within health care settings (Porter-O'Grady, 2012). Shared governance empowers nurses to participate in decision making, nursing practice, and development of nursing policies (Bednarski, 2009). The Unit is the center of a shared governance model..the locus of control is at the point of service 31

32 Foundational Principles to Maximize Staff Empowerment Staff need mentoring and leadership coaching Shared leadership means the clinical and administrative lead of the unit are part of the unit based governance council Defined accountability of all members Sufficient time in meetings to formulate ideas and plan work (unit meeting 4hrs) One of the reasons people don t achieve their dreams is that they desire to change their results without changing their thinking John C. Maxwell 32

33 Identification of System Barriers for Success Is there high variability in application Use of current shared governance model that result in inadequate representation of the staff nurse in practice decision making Are Work arounds used to address problems instead of tackling the system or process barriers within the governance system Identification of System Barriers for Success How many task forces or meeting occur outside the shared governance structure to solve problems that are related to practice issues Fragmented systems where to many roles doing the same function (quality/safety officers) Are people held accountability for their job roles What communication structures are supported formally & informally 33

34 Shared Governance Model Requires a proactive approach by the unit manager to create the culture Support Facilitation Integration Coordination Dunbar, Park, Berger, Cameron, Lorenz, Mayes, Ashby (2007) A leader is best when people barely know he exists, when his work is done, his aim fulfilled, they will say: we did it ourselves. Lao Tzu 34

35 Leadership: Critical Behaviors Help teams to complete a task getting the job done making decisions adapting to changes achieving goals Keep team members maintained and functioning developing a positive climate maintaining cohesion encouragement/providing feedback Kunzle B, et al Safety Science, 2010;48:1-17 Schmalenberg C, et al. Critical Care Nurse, 2009;29:61-69 Value of Staff Nurse Involvement in Shared Decision Making Cluster random sampling Staff nurses & CNO s from 10 hospitals in CO Focus groups & individual interviews Results: 7 Themes Collaboration only theme where groups differed Staff nurses viewed involvement as shared ideas, giving suggestions Administration: soliciting input but making decisions unilaterally Dickerson PG, et al. JONA, 2013;43(5):

36 Before you are a leader, success is all about growing yourself. When you become a leader, success is all about growing others. Jack Welch How to Actualize These Principles 36

37 Components That Strengthen a Share Governance System Ownership of practice needs to start at the unit level Consider unit governance council ELECTS a practice, development, resource and research representative etc. and had meeting ground rules At the unit level each rep leads a task force (practice task force, development task force etc) for greater staff involvement, to help carry out the work of the UGC and improve communication Will provides opportunities for advancement Allows more staff to participate in an organized fashion and they can be held accountable Ideas for Structure Components Use elections Standardize meeting agenda format and minutes and provide to groups Initial meeting used to set up group norms Consider 2 year terms Assess unit culture for values of importance of fundamental nursing care, safety and teamwork using the tools presented. Develop 2 year strategic plan based on department goals and unit needs. 37

38 System Role Unit Medical Director Empowered Work Environment Inpatient Unit Unit Governance Council Unit Medical Director Education Specialist Unit Educator Patient/ & Family Bedside Nurse Clinical Nurse Specialist Nurse Manager CNS System Role Nurse Manager System Role E Evidence 38

39 Evidence-Based Practice Patients who receive care based on the best and latest evidence from well-designed studies experience 28% better outcomes. (Heater, et.al Nursing interventions and patient outcomes: A meta-analysis of studies. Nursing Research, 37, ) It takes as long as 17 years to translate research findings into practice (Balas & Boren, 2000, Managing clinical knowledge for healthcare improvements pp Germany: Schattauer Publishing Co.) Without current best evidence, practice is rapidly outdated, often to the detriment of patients. Melnyk, B. (2005). Evidence-based practice in nursing & healthcare, pp. 4-6, Philadelphia, Lippincott, Williams & Wilkins. Quality Patient Care Strategies to Implement EBP Organizational Infrastructure Evidence-Based Decision Making Evidence-Based Practice Program overview: Cullen, L. & Titler, M.G. (2004). Promoting evidence-based practice: An internship for staff nurses. Worldviews on Evidence-Based Nursing,1(4), Cullen, L. (2004). Evidence-based practice staff nurse Internship: Program training manual. Iowa City, IA: University of Iowa Hospitals and Clinics. 39

40 What is Good About EBP!!! Firm foundation to do the right thing Improved patient outcomes Basis for interventions Basis for evaluation Ability to talk in a similar language with other disciplines Methods allow correct and more expedient movement of evidence into practice 40

41 Challenges Incorporating EBP into Practice Misconceptions that EBN is cookbook nursing Lack of training and critical appraisal of research evidence Lack of clinically relevant nursing research on a particular clinical topic Gap between available nursing research in the form of systematic reviews and use by nurses for direct patient care Lack of health care agencies organizational infrastructure to promote EBN practice We are not connecting quality patient outcomes to EBN We Make a Difference in Quality & Safety Increase nurse staffing was associated with; lower hospital related mortality, lower cardiac arrest, lower hospital acquired pneumonia in the surgical population, lower episodes of failure to rescue, lower UTIs, lower G.I. bleed/shock, lower falls & rates in hospital acquired pressure ulcers The risk of hospital deaths would increase by 31% or roughly 20,000 avoidable deaths each year if all hospitals at eight patients per nurse instead of four (JAMA 2002) When nurses case managed children with asthma there were fewer absences from school 11% improvement in failure to rescue (HealthGrades 2009 Report) 41

42 We Make a Difference in Quality & Safety Home care/discharge planning/aprn s; lower length of stay, lower healthcare costs, fewer hysterectomies Patient satisfaction directly correlated to registered nurse satisfaction (HCAHPS) 10% in the # of RNs lung collapsed by 1.5%, pressure ulcers 2%, Falls 3%, UTI < 1% (Urich Med Care 2003, 41(1): Nurses effect explained 7.9% of variance in patients clinical condition during their hospital stay (Yakusheva O, et al, HSR, 2014) Patient Safety Strategies Strongly Encouraged for Adoption with Moderate to High Evidence Preoperative and anesthesia checklists to prevent perioperative events Bundles with a checklist to prevent CLA-BSI Interventions to reduce use of urinary catheters; stop orders, reminders or removal protocols Bundle to prevent ventilator associated pneumonia Hand hygiene Multiple component initiative to prevent pressure ulcers Prophylaxis intervention for venous thromboembolism Using real-time ultrasonography for placement of central catheters Alspach JG. Crit Care Nurse, 2013;33(3):

43 Patient Safety Strategies Encouraged for Adoption with Moderate to High Evidence Interventions to reduce patient falls Using clinical pharmacist to reduce adverse drug events Documenting patient preference for life-sustaining treatment Obtaining informed consent prior to medical procedures Team training Medication reconciliation Using surgical outcome report cards Rapid response systems Computerized provider order entry Using simulation training and patient safety efforts Alspach JG. Crit Care Nurse, 2013;33(3):9-12 T Team 43

44 There is no I in TEAM but there is a ME Team Leadership Path to High Performing Teams Mutual performance monitoring Backup behavior Adaptability Team orientation Shared Mental Model Closed Looped Communication The leader directs & coordinates team activities Team members monitor each other performance Team members anticipate & respond to one another's needs Team adjust strategies based on new information Prioritize team goals over individual goals Mutual Trust O Leary KL, et al. J Of Hosp Med, 2012;7(1):

45 Communication is Key for Effective Teams Effective communication amongst caregivers is essential for a functioning team The Joint Commission reports that ineffective communication is the most commonly cited cause for a sentinel event (70%) Observations of ICU teams have shown errors in the ICU to be concentrated after communication events (shift change, handoffs, ect) 30% of errors are associated with communication between nurses and physicians Reader, CCM 2009 Vol 37 No 5; Donchin CCM 1995 Vol 23 Tools and Strategies to Improve Communication and Teamwork Structured Handoff Huddles Daily rounds/goals Pre-procedure briefing Checklists 45

46 Structured Handoffs/Clinical Handover Information Processing: Making sure the essential data are transferred for patient safety Structured face to face, structured tool, electronic sign outs Substandard or variable handoffs has contributed to errors, care omissions, treatment delays, inefficiencies from repeated work, inappropriate treatment, adverse events, increase length of stay, voidable readmissions, an increase cost ACHS NSQHS Standards measure to implement a standardized approach to communication during handoffs Halm MA.Am J of Crit Care, 2013;22(2): ACHS NSQHE Standards hure_pdf_28_09_12_-_final.pdf Huddles Enable teams to have frequent but short briefings so that they can stay informed, review work, make plans, and move ahead rapidly. Allow fuller participation of front-line staff and bedside caregivers, who often find it impossible to get away for the conventional hour-long improvement team meetings. They keep momentum going, as teams are able to meet more frequently. 46

47 Hospitals With High Teamwork Ratings Higher patient satisfaction Higher nurse retention rates Lower hospital costs O Leary KL, et al. J Of Hosp Med, 2012;7(1):48-54 Tools Don t Create Safety People Do!!! The Silent Treatment, April

48 The Most Powerful Force of Human Behavior is Social Influence Setting an Example is Not the Main Means of Influencing Others.It is the Only Means Albert Einstein 48

49 T E A M Together Everyone Achieves More Y Yes I Will 49

50 Yes I Will Focus on Achieving Nurse Sensitive Outcomes & Commit to a Culture of Safety & Accountability Yes I Will I am only one, but still I am one. I cannot do everything, but still I can do something. I will not refuse to do the something I can do. Helen Keller 50

51 Yes I Will You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You must do the thing which you think you cannot do. Be Accountable & Do the Things I Think I Can t Do Eleanor Roosevelt S Self Advocacy Change A and F Fundamentals growth take place when a person has risked himself & dares to become /Foundation involved with experimenting Evidence with his own life E T Y Team Herbert Otto Yes I Will 51

52 Yes I Will Art Work By Diane English Questions? kvollman@comcast.net 52