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

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

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

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

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)

Relationship & Results Oriented Healthcare Program & Care Model

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

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.

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 www.rrohc.com

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 www.rrohc.com

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! www.rrohc.com

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 www.rrohc.com

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 www.rrohc.com

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 www.rrohc.com

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.

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!

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

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)

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

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

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

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

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

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

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 http://rrohc.com

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

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 0.88 0.98 0.10 Give Initial Direction to Members 0.94 0.98 0.04 Give Routine Feedback 0.78 0.87 0.09 Shift Report Contains 4Ps 0.58 0.87 0.29 Confident in Assigning Tasks 0.79 0.91 0.12 Comfortable Delegating Post Report 0.79 0.96 0.17 Use Planned Checkpoints 0.31 0.59 0.28 Ask for Team Feedback 0.59 0.87 0.28 Plans Based on Critical Thinking 0.65 0.90 0.25 Accountability Awareness 0.96 0.98 0.02 Evaluate Delegated Care 0.82 0.93 0.11 Clear about Roles 0.79 0.92 0.13

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

Pre and Post RROHC Professional Practice Improvements

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

Number of Employees Engaged Per Each Employee Disengaged Employee Engagement 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 Oakwood Health System Gallup Data on Employee Engagement 2007 2008 2009

Percentile Ranking "Excellent" MD Perceptions of Nursing Care Overall 90 80 82 70 60 50 40 37 30 20 10 12 15 17 8 0 2001 2002 2003 2004 2005 2006 www.hansten.com

120 100 At 4 Years: Press Ganey Marion General Hospital Inpatient Overall (Percentile Ranking) * Implementation RROHC 80 60 Overall Inpt Nursing 40 20 0 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 www.hansten.com Q2 '05 Q3 '05 Q4 '05 Q1 '06 Q2 '06 Q3 '06 Q4 '06

RN Recruitment 70 63 * 60 57 50 51 50 Total 50 40 33 40 35 41 New Grads 30 22 Experienced 20 15 15 10 7 11 * Through 09/09/06 0 0 0 2001 2002 2003 2004 2005 2006

Pressure Ulcer Hospital Rates 20% 15% 10% 5% 0% 1st Qtr 2008 2nd Qtr 2008 3rd Qtr 2008 4th Qtr 2008 1st Qtr 2009 2nd Qtr 2009 3rd Qtr 2009 4th Qtr 2009 1st Qtr 2010 2nd 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.

Patient Falls: 4 South 4 South 6.00 5.00 4.00 3.00 2.00 1.00 0.00 1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09 4Q09 1Q10 2Q10 Falls per 1,000 pt days 5.06 4.52 3.62 4.34 1.77 1.50 2.71 4.06 2.23 2.20 # of falls 15 13 10 12 5 4 7 10 6 6 Falls with injury per 1,000 pt days 1.01 2.09 1.09 1.08 0.35 0.00 0.39 1.22 0.37 0.36 # Injury falls 3 6 3 3 1 0 1 3 1 1

Patient Satisfaction -Nursing Overall :4 South

Situations on Unit Last Shift: 4 South The higher the score the more positive the rating. % Yes Had enough time with patients 100 80 60 40 20 0 2006 2007 2008 2009 Hospital All 65 72 79 82 4 South 50 88 72 91 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.

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 www.rrohc.com

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 www.hansten.com/blog Facebook: Hansten Healthcare PLLC Linked In: Ruth Hansten Twitter: @Rhansten Newsletters with videos/news/research New online education delegation product www.rrohc.com

Progress Measures OUTCOMES MEASURES Ongoing unit progress skill & process measurement Ongoing individual staff skill & process measurement integrated into evaluations www.hanstenrrohc.com

Questions?

For more information about our Relationship & Results Oriented Healthcare Certification Program See www.hansten.com, www.rrohc.com Ruth@Hansten.com or Kathy.Watkins@Hansten.com T: 360 437 8060