Our Unit Has Changed - A Culture Shift Towards Better Patient Care


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This presentation was delivered in session F2 of Quality Forum 2014 by:

Audra Leopold
Vancouver Coastal Health

Jacquie Miller
Staff Nurse, Squamish General Hospital
Vancouver Coastal Health

Published in: Health & Medicine
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  • Jacquie: My name is Jacquie and I’m a ED nurse and the ward lead at Squamish General Hospital. I’ve been working at SGH for 7 years and have been part of the RT2C initiative since the project began 2 years ago.
    Audra: My name is Audra and I am a LPN and I am one of the ward leads at Richmond Hospital. I’ve worked at RH for 20 years and have been part of this project since it began 2 years ago.
  • Audra: Releasing Time to Care (RT2C) is a methodology that originated from the UK that focuses on front-line nurse initiated problem solving. RT2C borrows several lean principles and tools to enable nurses to identify gaps and make practice and environmental changes which leads to more time to care for the patients.
  • Audra: Prior to RT2C, any changes were brought about and implemented by management. There was no input from frontline staff, even though the changes were needed, not all of the changes made sense to the staff they affected – it was a top down approach. Now with RT2C, it provides frontline staff a way to identify, analyze, and implement changes that affect both the patients and staff – decisions are made from the bottom up. By solving some of our everyday work-around problems we effectively made more time to spend with the patients.
  • Audra: Using the tools provided in the program we were able to measure our baseline data and be able to see the results as the data stays on the unit for everyone to see. Staff has taken ownership of what needs to improve. Daily team meets/huddles bring the staff together to focus on the improvements through solutions generated by staff.
    This is a picture of a safety cross which is one of the tools that we use in RT2C to collect our own data so staff are aware of what’s going on on their unit everyday.
  • Audra: As we found our voice, and knew it was supported by management, a change started to happen in our work culture. We changed from not bothering to voice our concerns because what we said didn’t matter, to solvers of problems and advocates for improved safety and care. Since RT2C was introduced we have tackled many different issues from basic care, to infection rates, to reducing wasted time gathering supplies and equipment. Overall, we have found that the RT2C initiative has really helped to improve our teamwork, communication, engagement, morale, and problem-solving at the front-line level.
  • Audra: This is a video of one of our ‘team meets’ and they happen daily at 2 o’clock. The team meet last 10 minutes and they happen around the Knowing How We’re Doing Board. They start off with a check-in so staff can voice if they need help, then we discuss ways to improve different initiatives we’re working on at the time, and we ask for suggestions right in the moment. It’s also a place where staff can bring forth their ideas. All staff are invited to join the team meets.
  • Jacquie: We’ve been doing RT2C at SGH for two years now. Since we’ve started, we’ve seen a significant shift in the culture of the hospital, particularly around teamwork. Here’s a before and after picture of the clean utility room. Unfortunately, I don’t have any action shots, but to get the room to go from pre-wow to wow, it required the combined efforts of the nursing staff as well as the support staff. Making a change that would benefit all staff and patients increased involvement across all disciplines. Unit clerk, nurses, stores and maintenance staff worked collaboratively to reach a common goal.
  • Jacquie:
  • Jacquie:
  • Audra: At RH, Morale has improved and staff has explained how they had previously turned shifts down to avoid our units now express their desire to come to our units. Staff are engaged as they participate in the daily team meets/huddles and make their suggestions known or by dot voting for their choice on changes or when they participate in a WOW on their unit.
  • Jacquie: Using a dot vote, the nursing staff determined that they wanted to look at inpatient falls rates as this is an issue that effects both the nurses as well as the patients.
  • Audra: For Richmond our most dramatic shift in culture has occurred with falls and hand hygiene. Falls-Prior to RT2C there was a lack of urgency when responding to call bells and bed alarms. Once RT2C was implemented and staff understood the difference they made to the safety of our patients, through data collection and use of their improvement suggestions, the culture shifted so much that when a bed alarm goes off now staff come running from every direction.
    Hand hygiene - Two medical units have focused on hand hygiene and have fought over the hand hygiene trophy with each winning the trophy for 5/12 months. In Dec the hand hygiene rates were 93% and 95%. These are amazing culture shifts which would not happened without RT2C.
  • Jacquie: Communication has improved tremendously through the PSAG board which is used by the multidisciplinary team. Physicians, nurses, and allied health professionals are presented with current patient information using a simple visual tool. Management is aware of all current interventions through weekly email updates. The RT2C KHWD board located by the nursing station displays up to date ward information.
  • Audra: Communication is important at all levels including management. This allows those on the front-line to voice their concerns to the senior leaders. The bottom picture is a visit pyramid which is signed every time a supervisor or manager visits the unit. This highlights to nursing staff that management is interested in issues that are pertinent to staff.
    Once our team meets are complete, it’s a great place for education to happen as well. The top photo is a picture of Langara nursing students who were introducing their care plan project to staff.
  • Audra: As our practice improves in many areas, others have noted the changes. We have been mentioned in an article in the Vancouver Sun, the President of Accreditation Canada acknowledged our receipt of the Quality award and of course the Quality award we received for Getting Better. We have also had many visitors come for site visits to hear what the buzz is about.
  • Our Unit Has Changed - A Culture Shift Towards Better Patient Care

    1. 1. Our Culture Has Changed A Culture Shift towards Better Patient Care Quality Forum 2014 Presented by: Audra Leopold, LPN Richmond Hospital Jacquie Miller, RN Squamish General Hospital 1
    2. 2. Introduction • Releasing Time to Care (RT2C) • Enables nurses to identify gaps • Provides tools to make practice and environmental changes • Release time to care for patients 2
    3. 3. Background Before RT2C 3
    4. 4. Implementation 4
    5. 5. Culture Change Teamwork Staff Engagement Communication Morale Problem-solving 5
    6. 6. RH - Teamwork 6
    7. 7. SGH - Teamwork Pre-WOW … WOW! “It’s amazing. You can find things so much easier. It’s much less frustrating because everything’s in colour-coded bins – and we save money ordering less supplies because of it.” -Staff Nurse 7
    8. 8. SGH - Teamwork 8
    9. 9. SGH – Engagement and Morale 9
    10. 10. RH - Engagement & Morale Dot Voting Daily Huddles Vision Statement 10
    11. 11. SGH - Problem-Solving 11
    12. 12. RH - Problem-Solving In December 2013 hand hygiene rates were 93% and 95% on the floors with RT2C. 12
    13. 13. SGH - Communication 13
    14. 14. RH - Communication 14
    15. 15. Where are we heading? “It’s creating change from the bottom up instead of the top down from management” “They’re able to make changes in their own work environment.” “It’s improved a lot of processes and the way we did things, but it’s more about culture change“ “the staff have an opportunity to voice their suggestions and concerns during the daily RT2C meetings, creating a true team environment.” 15
    16. 16. Thank you Questions 16