3.4 Describe mechanisms or processes that create a practice environment that fosters horizontal and vertical communication between nurses at all levels throughout the organization. Since Jeanette Ives Erickson, RN, MS, Senior Vice President for Patient Care/Chief Nurse articulated her original four-point plan (Force 3.1) to the leadership and staff throughout Patient Care Services in 1996, the first point, Communicate, communicate, communicate has been hardwired into operations through the implementation of numerous communications strategies to promote dialogue and information sharing between nurses at all levels throughout the organization. Below is a sampling of vertical (top-down; bottom-up) and horizontal (across the unit, department and hospital) communication strategies. Communication via Committee Structures Collaborative Governance: Promotes Vertical & Horizontal Communication The most formal communication structure in Patient Care Services and, more specifically, Nursing, is the Collaborative Governance communication and decision-making structure. Reporting into the Patient Care Services Executive Committee, the seven committees focus on addressing key issues that impact care delivery and quality of work-life. Collaborative Governance Senior Vice President for Patient Care and Chief Nurse PCSEC Committee Leaders Diversity Steering Ethics in Clinical Practice Nursing Practice Patient Eudcation Quality Nursing Research Staff Nurse Advisory Professional Development (disbanded) The Staff Nurse Advisory Committee, comprised of staff nurse representatives from every patient care unit, is specifically charged with promoting two-way communication between staff and leadership. It is not unusual for a meeting to begin with the Chief Nurse (who chairs this group) asking, What keeps you awake at night? or What rumors are you hearing. The environment which 166
has been created in this forum is one in which the Staff Nurses feel safe and comfortable to bring up issues controversial including practice concerns and staff safety. Additional Committees and meetings: In addition to these Collaborative Governance committees, numerous role-group meetings are held to foster communication. These include: Joint PCSEC/Nursing: Monthly meeting of Patient Care Services Executive Team with Nursing Directors. Chaired by Senior Vice President for Patient Care/Chief Nurse, agendas are comprised of updates and presentations that are targeted to the line leadership of Patient Care Services. (Vertical communication). Nursing Director: Weekly meeting of Nursing Directors chaired by Senior Vice President for Patient Care/Chief Nurse. Additional invitees to this meeting are: Associate Chief Nurses, Staff Specialists and Human Resource Generalists. Agendas are focused on pertinent updates regarding hospital, department and unit-related reports, programs and initiatives. In addition, Human Resource-related topics including MGH s compensation program and recruitment/retention efforts discussed. The timing of this meeting is strategically slated to follow the weekly General Executive Committee and Chiefs Council meeting (these two groups meet every other week and alternate in the same time slot) which the Senior Vice President/Chief Nurse attends so the relay of time-sensitive information is expedited. (Vertical communication). In addition, the Nursing Directors meet monthly with the four Associate Chief Nurses to focus more fully on the communication of key information and initiatives regarding patient care delivery and key initiatives. (Horizontal communication). Clinical Nurse Specialists: Monthly meeting of Clinical Nurse Specialists led by two CNS cochairs. Jackie Somerville, RN, PhDc, Associate Chief is the nursing executive liaison to this group. Agendas focus on practice, education, and research initiatives. (Vertical & horizontal communication). Operations Coordinators (OCs): Biweekly meeting of Operations Coordinators co-chaired by two OCs with PCS executive liaisons, Theresa Gallivan, RN, Associate Chief Nurse and George Reardon, Director of PCS Systems Improvement. Agendas focus on the communication of key 167
information and initiatives related to the operations of the patient care unit including: environment of care issues, non-salary and supply budgets, capital budgets, maintenance and repair of new technology/equipment, and pertinent information that needs to be communicated to unit support staff. (Vertical & horizontal communication). Combined Leadership: Biweekly meeting of the clinical triad comprised of Nursing Directors, Clinical Nurse Specialists, Operations Coordinators and co-chaired by two Nursing Directors. Other attendees include: Associate Chief Nurses, Program Directors, and Staff Specialists. It is a forum for the leadership triad to hear key information and discuss implications for their respective practice areas. (Vertical & horizontal communication). Unit-based Staff Meetings: Chaired by the respective Nursing Director of each clinical unit, agendas are comprised of providing key information to unit staff and identifying issues to be brought back for discussion in other Patient Care Services and Nursing forums. Frequency and times of meeting vary across clinical units. (Vertical & horizontal communication). Communication via Print Publications: Annual Reports: Formal communication of accomplishments, milestones, new programs, strategic initiatives, financial data and outcomes are published annually by the MGH and Patient Care Services in their respective annual reports (OOD 12). Hotline: Weekly newsletter published by MGH Public Affairs to communicate timely information to the employees and staff of the MGH. Hotline is available on-line, in display cases throughout the first floor, and at the information desks. Caring Headlines: Biweekly newsletter for Patient Care Services designed to inform, enlighten and support leadership and staff through the news coverage of key events and programs. The Senior Vice President for Patient Care/Chief Nurse writes a column in every issue and other ongoing columns or sections include: fielding the issues (questions and answers about important topics), clinical narratives (clinical narrative written by Patient Care Services clinicians about the care they provide to patients and families), professional achievements, and educational offerings. Caring Headlines is available on-line and in display cases throughout the first floor. 168
Fruit Street Physician: Monthly newsletter published by the Massachusetts General Physicians Organization (MGPO) intended to promote communication of key information to MGH physicians. Communication via Email and Electronic Updates: From the Desktop of Peter L Slavin, MD: Monthly e-mail communication from the President of MGH sent to leadership throughout the MGH on the last working day of each month. Topics include: quality and safety updates, events, information on new initiatives and programs, professional achievements and financial updates. PCS News You Can Use: Biweekly e-mail communication from the Senior Vice President for Patient Care/Chief Nurse sent to leadership and staff throughout Patient Care Services. Topics include: quality and safety best practices, time-sensitive information on new programs and initiatives, professional achievements and new appointments. All-user messages: Daily (Monday through Friday) e-mail communication coordinated by MGH Human Resources sent to all leadership and staff throughout the MGH regarding timely updates and reminders about key programs and events. Additional Communication Strategies: Staff Perceptions of the Professional Practice Environment Survey: Research-based survey tool designed to measure clinician s satisfaction with the professional practice environment. Administered by Senior Vice President for Patient Care/Chief Nurse every 12-18 months, the survey asks clinicians throughout Patient Care Services for their input about what s working and what s not working regarding the delivery of patient care. Results of the survey are analyzed and shared in a timely fashion with leadership and staff by the Senior Vice President for Patient Care/Chief Nurse in meetings and staff forums. Clinician Forums: Open forums led by the Senior Vice President for Patient Care Services/Chief Nurse with clinicians throughout Patient Care Services designed for clinicians to raise issues/concerns or talk about timely information. In addition to clinician forums, the Senior Vice 169
President for Patient Care/Chief Nurse meets with support staff throughout Patient Care Services to promote a similar dialogue with that role group. Grand Rounds: Weekly presentations by leadership and staff throughout Nursing designed to communicate the outcomes and evaluation of key initiatives, share information gained from continuing education programs, and research study outcomes. Nurse Recognition Week: The Senior Vice President for Patient Care/Chief Nurse hosts an annual week-long celebration of Nursing Recognition Week. The week is full of activities, including educational sessions and opportunities for leadership and staff to network through breakfasts, receptions and the annual party at the Museum of Science. Creating and maintaining a practice environment in which communication is timely, efficient and pertinent requires evaluation and reflection. An example of a tool employed to assess the effectiveness of current communication strategies in Patient Care Services in August 2006 is the PCS Communication Survey (attachment 3.4.a). Feedback from respondents included the following key points: We live in a world of information overload: too much, difficult to wade through and a challenge to prioritize. It takes different strokes for different folks: print/newsletters, e-mail, letters to home, web site. Letters to home are effective for delivering key pieces of information making this a very costeffective method of communicating. E-mail is the clear favorite, along with direct, face-to-face messages, BUT, need to: cut down on the volume, keep the content short and sweet (sound bites when possible) and link to more detailed information (e.g. websites, policies, etc.). Print media and newsletters are popular, particularly Hotline, Caring Headlines and PCS News You Can Use. In Caring Headlines, staff would like to see more articles re: educational offerings, best practice, new products and services, what s happening in Departments outside of Patient Care Services, humanitarian/community outreach, parking and transportation. 170
Action steps driven from the results included: Retooling the content and messages delivered via each communication medium: Caring Headlines lends itself to longer, more detailed pieces. Pay keen attention to including more stories about best practices. PCS News You Can Use lends itself to shorter, more operationally focused and timesensitive news items and updates. Coordinate publication of same theme articles in Caring Headlines, Hotline and Fruit Street Physician to reinforce key information (e.g. handwashing, smoking cessation, etc.). 171
Attachment Force 3.4.a PCS COMMUNICATIONS SURVEY Dear Colleague, You know better than anyone that MGH is a busy and exciting place! And there s a lot going on that impacts our work within Patient Care Services (PCS). We want to be sure we re keeping you as up-to-date as possible in a way that is easy for you to get the news you need and want. Your opinions and ideas are important, so please take a few minutes to answer the following questions about PCS communications. You can submit the attached survey anonymously, and the results will help us shape communications moving forward. As always, thank you for weighing-in! Jeanette Ives Erickson, RN, MS Senior Vice President for Patient Care Services Chief Nurse P.S. Please return this survey by September 15. Once completed, simply fold the form so the return address appears on the outside, staple or seal it closed with a piece of tape, and drop it into in-house mail. Or, you may hand-deliver the completed survey to Bulfinch 230. 172
Attachment 3.4.a continued I. How you get information: Please RANK (1 thru 5) IN ORDER OF IMPORTANCE all items in the following 3 lists: (1= most important or most used, 2= second most, 3= third most, etc.) 1) My primary source(s) of PCS-related 2) My preferred source(s) of PCS-related news and information are: news and information are: Printed materials/newsletters E-mail Web site Unit-based meetings/announcements Word of mouth Other Printed materials/newsletters E-mail Web site Unit-based meetings/announcements Word of mouth Other 3) My primary print sources of news of special interest to PCS employees and staff are: Hotline Caring Headlines PCS NEWS you can use Letters mailed to your home The Boston Globe The Boston Herald Nursing Spectrum ADVANCE On Call Metro Other Main internal communications vehicles: For each of the following questions, mark the SINGLE most appropriate answer: I read Hotline: I read Caring Headlines: I read PCS NEWS you can use: I read letters mailed to home: a. Always a. Always a. Always a. Always b. Most issues b. Most issues b. Most issues b. Most issues c. Seldom c. Seldom c. Seldom c. Seldom d. Never d. Never d. Never d. Never II. Rating methods of communication: (Circle the number that represents your level of agreement or disagreement.) 1= Strongly Disagree 2=Disagree 3=Unsure/Do Not Know 4= Agree 5=Strongly agree Caring Headlines is a good way to get PCS news/information 1 2 3 4 5 PCS NEWS you can use is a good way to get PCS news/information 1 2 3 4 5 E-mail is a good way to get PCS news/information 1 2 3 4 5 The Web is a good way to get PCS news/information 1 2 3 4 5 Letters to home are a good way to get PCS news/information 1 2 3 4 5 173
Attachment 3.4.a continued Caring Headlines features matters I care about 1 2 3 4 5 PCS NEWS you can use e-mail transmissions feature matters I care about 1 2 3 4 5 I read the PCS NEWS you can use posters at Coffee Central 1 2 3 4 5 III. What you want to know about: (Please rate the following in terms of importance to you.) 1=Very Disinterested 2=Somewhat Disinterested 3=Not Sure or Undecided 4=Somewhat Interested 5=Very Interested Research 1 2 3 4 5 Community Outreach 1 2 3 4 5 Achievements/honors 1 2 3 4 5 Reporting back from conferences 1 2 3 4 5 Parking/transportation 1 2 3 4 5 Construction updates 1 2 3 4 5 Clinical Narratives 1 2 3 4 5 Quality & Safety Updates 1 2 3 4 5 Updates on the work of collaborative governance committees 1 2 3 4 5 Humanitarian-aid stories 1 2 3 4 5 Features about people in PCS 1 2 3 4 5 Legislative issues affecting PCS/MGH 1 2 3 4 5 Diversity issues 1 2 3 4 5 Finances (budget and funding) 1 2 3 4 5 New Programs/New Products 1 2 3 4 5 Sharing best practices 1 2 3 4 5 Updates from departments outside of Patient Care Services 1 2 3 4 5 (Food & Nutrition, Materials Management, Police & Security, etc.) Educational Offerings 1 2 3 4 5 IV. Who you are: I am: Leadership Direct care Support Other Shift(s) generally worked: Days Evenings Nights I have been at MGH: 0 to 3 years 4 to 7 years 8 to 15 years 16 to 25 years more than 25 years You may submit your survey anonymously, but if you are available to discuss your thoughts and ideas, please provide your contact information: 174
Attachment 3.4.a continued Name: Best contact number: E-mail: V. Your thoughts and/or suggestions How can we improve communications: (Please attach another sheet of paper if extra space is needed.) Thank you for sharing your thoughts and ideas about communicating important information throughout PCS. 175