Me to We : Our Journey to Accountability & Leadership Jaylee Hilliard, MSN, RN, NEA-BC Disclosure I have nothing to disclose. 1 Objective List two ideas that could be implemented to increase accountability in your department. 2 1
McLane Children s Hospital Part of Baylor Scott and White Health 1 of 11 NICU s in Baylor Scott & White Health System 115 bed Children s Hospital serving 30,000 square miles in Central Texas Level IV NICU with 900-1,000 discharges a year 3 Background 2008 bedside RN in NICU 2011-2016 several leadership positions including Director, Patient and Family Support Services April 2016 Director of Neonatal Services for McLane Children s Hospital Increase in staff and provider turnover Lack of unit engagement Decline in quality of care 4 Initial Assessment Unit evolved into a negative environment fostering Bullying, finger-pointing, blame Staff feared retaliation Overall lack of trust Minimal communication within silos Family experiences were less than desirable 5 2
The Blame Game 6 Initial Assessment Cont d Results Disengaged Director Severely burned out Manager Several leaders harboring resentment Provider and nurse turnover Feeling that everything was falling apart 7 Change in Culture Establishing a culture of accountability and ownership was imperative to the NICU s journey to success. This would mean CHANGE! 8 3
Establishing a Vision What would the next 6 months look like? next year look like? the next two years look like? 9 It Takes a Village Leadership Purchasing Providers Outpatient Services Nurses IT/IS Patient & Family Surgeons Admissions Support Services Radiology EVS Dietary Pharmacy 10 11 4
Row Together 12 Know Your Circle 13 Reality 14 5
People First Communication Education Empowerment Support 15 How? App Newsletter E-mail Huddle Frequency Understand the WHY Explain Connect the dots Transparency Stay connected Share Communication 16 Education Certifications and Degrees Study sessions PowerPoint Safety Safety Huddles Process variation reporting Clinical knowledge Clinical coach classes Mock codes Baseline knowledge assessment Educational sessions Multidisciplinary simulations 17 6
Empowerment Clearly outline expectations, roles, responsibilities Role playing Give permission to utilize skills Support 18 Support Coach 1:1 s Provide regular feedback Charge Nurse Retreats Peer evaluation 360 feedback Understand end goal Keep eye on the vision See the big picture Improve nurse satisfaction 19 Structure Meetings Shared Governance Staff Leadership 20 7
Meetings Meetings System Department Staff Huddles Clearly define meeting structure Ensure multidisciplinary participation How do you close the loop? 21 Shared Governance Clinical Excellence Education & Professional Development Family Experience Quality Patient Safety Retention & Recognition 22 Retention and Recognition Praise Board Birthdays/Celebrations Employee of the month Engagement/Morale Retention Quality and Patient Safety PICC/IC/EOC VAP Emergency Preparedness Lactation Midas/UPE Education and Professional Development Orientation & Competencies Certifications & Degrees CE Opportunities Clinical Excellence Skin Care Pain Policies & Procedures Developmental Care Small Baby Unit Family Centered Experience Bereavement Family Advisory Council Primary Care Nursing Discharge Planning NICU reunions 23 8
Meeting Structure Neonatal Physician Nurse Advisory Council MCMC Quality Council MCMC Family Experience Council MCMC Education & Professional Development MCMC Clinical Excellence MCMC Retention & Recognition NICU Operations NICU Quality Assurance Process Improvement (QAPI) Program NICU Family Advisory Council NICU Education & Professional Development NICU Clinical Excellence NICU Retention & recognition Discharge Planning Small Baby Unit 24 Shared Governance Charters Purpose Outcomes Expected Scope Key Responsibilities and Functions- McLane Children s Key Responsibilities and Functions-NICU Decision Making Authority Members 25 Staff Direct reports Manageable number Think creatively Clearly define roles and responsibilities Chain of command Nursing Providers Other disciplines 26 9
Leadership Leadership Roles and responsibilities Regular meetings/communication Huddle board 27 Quality & Safety Be patient. Stay the course. Quality Assurance Process Improvement (QAPI) Program Process Variations Initiatives 28 QAPI Program Monthly meeting Multidisciplinary Review Quality dashboard Process variations Current action plans 29 10
Process Variations Debriefings Immediately following event Deaths, unplanned extubation, fire drill, etc. Unplanned Events Form to guide debriefing and ensure follow-up Led by Charge Nurse 30 Initiatives Standardized Shift Report Chart Audits Nurse-Led Rounds Small Baby Unit Chronic Lung Disease Pathway 31 Family Experience Access Continuity of Care Communication Celebration 32 11
Access Visitation Increased sibling visitation Avoided closing during report Reduced minimal sibling age during RSV Season Siblings Increased visitation window Encouraged visits Engaged with Child Life Volunteer Cuddlers 33 Continuity of Care Rounding Nurse-led Rounds Multidisciplinary Primary Team Nursing Pods Logistics 34 Communication Communication Boards Addressing Pain Scripting Discuss Discharge Process Early identification Set expectations Early preparation 35 12
Celebrate Milestones Graduation certificate Discharge goody bag Hall of Hope 36 The Journey Continues Celebrate! Celebrate! Celebrate! Don t forget the why (for everything!) Rome wasn t built in a day! No one likes change. Ever. 37 The Journey Continues You will NEVER cross the finish line (or get everything checked off your To-Do List) When things don t work out as planned, remember Let it go! Be careful moving people s cheese. Work to live. Don t live to work. 38 13
Great Reads! 39 14