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Strategies for Creating a Collaborative Patient Care Environment Jan Moellering, RN, MA Vice President, Strategic Development, ARAMARK Healthcare, Downer s Grove, IL Linda Deering, RN, MSN Executive Vice President & Chief Operating Officer, Sherman Hospital, Elgin, IL Presentation Objectives Describe action-oriented strategies and tactics to assess and implement the Guiding Principles for Relationships among Nursing and Support Services in the Clinical Setting to create a collaborative work environment Identify the behaviors and drivers that underlie support service relationships with nursing groups 1 2008 Studer Group

The Healthcare Environment Health Care cannot be separated from the setting in which it s delivered. There s no doubt that the quality of the environment can enhance or retard healing. Jain Malkin, Contributing Author Relationship-Based Care A Model for Transforming Practice The Hospital of the Future: The Patient Experience Personnel Storages Patient-Centered Culture Reimbursement Physician Relations Quality Capacity Patient Safety Patient Sat. Nurse Shortage Patient Engagement Respect Personal Touch Patient-centeredness P4P Regulatory 2 2008 Studer Group

Nurses Evaluation of Support Services High Positive Assessment RT Charge Nurses Advanced Practice Nurses Secondary Focus Non-RN Nursing Staff Physical Support Critical Concern Pharmacy Performance Low Low Special Care Teams Supply Management Nutrition/Dietary Labs/Phlebotomy Housekeeping Information Patient Sitters Systems Lift Team/Equipment Transport Importance Education Admission, Discharge, Transfer Nurses High Source: The Advisory Board, Nursing Executive Center Support Services Database, 2004 Traditional 8 Services Surveyed Food Service/Dietary Environmental Services (EVS) Clinical/Biomedical Engineering Facilities Management/Maintenance Transport Laundry/Linen Central Supply/Materials Management Security 3 2008 Studer Group

What s Really Important? Communication Teamwork/Adaptability Availability/Accessibility of Staff and Resources Timeliness Compassion/Consideration/Positive Approach/ Professionalism Knowledge Being Proactive Coordination of Care Responsibility/Accountability Guiding Principles for Relationships among Nursing and Support Services Chief Nursing Officer as the Catalyst for Change Inclusive Shared Governance Clear Scope of Practice Shared Ownership of Patient Needs Culture of Mutual Respect and Recognition Safer, Less Stressful Physical Environment Continuous, Open Communication Approved by AONE Board in January 2007 4 2008 Studer Group

Sherman Pilot Strategies Created a Steering Committee comprised of nursing, identified support service areas and ARAMARK Healthcare Project Coordinator Conducted focus groups with nursing and support services leadership and front line staff/ associates Created a Pre-Assessment tool for gap analysis Selected 3 Guiding Principles with the greatest opportunity to impact nursing satisfaction with support service areas Sherman Strategies (cont.) Brainstormed current practices, action plans, resources and tools needed to support their implementation Created implementation and communication plans Participated in use of NS 3 survey tool in February to establish richer baseline information and direction for ongoing steering committee Expanded Steering Committee that will put actions against NS 3 results 5 2008 Studer Group

Self-Assessment Tool Information to Support Decisions Gap Analysis Are all departments on the same page what are the variances between the opinions on the current state? Where is there consensus? What three Guiding Principles to start with? A few questions received a response over three categories: (rarely frequently) Support services associates are able to utilize common areas on patient care units such as break rooms / lounges Supplies and equipment are readily available and accessible to enable efficiency for both Nursing and Support Services 6 2008 Studer Group

Guiding Principle Gap Analysis (Items rated lowest) Rating 2,5,7 3,6 Nursing and SS met to discuss common patient care issues on a regular basis Nursing time is dedicated to clinical functions Nursing - Sometimes (50%) Support Services - Rarely (30%) Nursing Sometimes (50%) Support Services Sometimes (50%) 3,4,5,7 3,5,7 5,7 Nursing is involved in the orientation process of Support Services Roles have been clearly defined and understood by all members of the team The organization has a communication plan which includes key contacts and processes to address communication needs between departments Nursing - Sometimes (50%) Support Services Rarely (30%) Nursing Sometimes (50%) Support Services Rarely (30%) Nursing Sometimes (50%) Support Services - Sometimes (50%) 2,5,7 Nursing leadership attends SS staff meetings to share ideas and seek/receive feedback Nursing - Rarely (30%) Support Services Rarely (30%) What 3 to Start With: #3 - Clear Scope of Practice #5 - Culture of Mutual Respect and Recognition #7 - Continuous Open Communication 7 2008 Studer Group

#3 Clear Scope of Practice Establishing clear responsibilities, accountabilities and applicable education for all team members Focus nursing resources on clinical care functions Support Service Resource Manual Establish department processes with other departments taking all areas interests into consideration (came as a secondary gain when working on #7) Facilitate professional development and talent management across collaborative team Look for ways to promote and cross train between service lines #5 Culture of Mutual Respect and Recognition Bridge gaps and barriers created by professional, cultural, and generational differences - Translation support at staff meetings - Shared training on diversity - Shared Orientation to ensure all team members understand the roles and skill sets of each Encourage a sense of equity and facilitate shared appreciation of nursing and support services - Open House in support services area to expand nursing understanding of what it takes (Engineering, Storeroom and EVS Floor care) Reward and recognize all members of the team for their impact on the patient experience - Through rounding encourage more sharing or recognition between service lines - Celebrate wins together 8 2008 Studer Group

#7 Continuous Open Communication Develop common, patient centered language utilized by all members of the team Establish a communication plan that disseminates key messages and decisions to all levels Titles that reflect services provided: - Security / Public Safety - Housekeeping / Environmental Services - All stakeholders in the know -Hold meetings to improve awareness and communication Implement mechanism to measure and act on interdepartmental satisfaction and feedback - Managing UP that goes both ways - Everyone understands the numbers NS 3 Questions Pre- Focus Group Post Lets others know when and if there will be a delay 4.50 Inconsistency in how various departments communicate If we had the information, we could help reassure patient or know what other steps to take 5.72 Frees us up so we can do our job 4.10 We still do most transports When you don t get an answer, you go ahead and do it Easier to do it than find out who to call Not all services available on evenings or nights 5.80 Avoids unnecessary delays 4.20 Most related to staffing they try and would be good if they let us know when there is a problem 5.67 Is available (not hard to track down) when needed 4.25 When you don t get an answer, you go ahead and do it Easier to do it than find out who to call 5.82 Follows task through to completion 4.89 Not always sure who is to do what with discharges 5.77 9 2008 Studer Group

Thank You! Jan Moellering, RN, MA Vice President Operations, Strategic Development ARAMARK Healthcare, Downer s Grove, IL Linda Deering, RN, MSN Vice President and CNO, Sherman Hospital Elgin, IL 10 2008 Studer Group