Managing Theatre Culture From Within: Practice Development Applications
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Managing Theatre Culture From Within: Practice Development Applications

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Jodie Hulm, Clinical Nurse Specialist, Operating Theatre, Princess Margaret Hospital for Children, WA and ...

Jodie Hulm, Clinical Nurse Specialist, Operating Theatre, Princess Margaret Hospital for Children, WA and
Kirstie Johnson, Clinical Development Nurse, Operating Theatre, Princess Margaret Hospital for Children, WA delivered this presentation at the 2013 Operating Theatre Management conference in Sydney/Australia. The event offers attendees insights into the latest programs and practices being implemented across the country & key strategies and methods to help improve your skills and knowledge as a Theatre Manager. For more information, please visit www.healthcareconferences.com.au.

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Managing Theatre Culture From Within: Practice Development Applications Managing Theatre Culture From Within: Practice Development Applications Presentation Transcript

  • Managing Theatre Culture from Within: Practice Development Applications Jodie Hulm – Clinical Nurse Specialist Kirstie Johnson – Clinical Development Nurse Operating Theatres Princess Margaret Hospital for Children, Perth
  •  Theatre workplace culture and morale  Triggers for change  Development of a person centered environment  Action plan  Theatre Culture Survey (CAI) & Results  Leadership development  Limitations  Transitioning to the New Children’s Hospital Presentation Overview
  • Theatre workplace culture and morale  What is already known View slide
  • Theatre workplace culture and morale A little bit about us... View slide
  • Triggers for Change  Increased Clinical Incidents:  Adverse events & near misses  Low staff morale, hostility, bullying and conflicts  Change in performance management process:  Behavioural issues  Difficulty retaining and recruiting staff  Informal reporting of declining clinical standards…
  •  As a result: Patient safety, outcomes and quality of peri-operative patient care were being impacted!
  • Introduction to Practice Development Practice Development is:  Collaborative, inclusive and participatory approaches  Person centred  Values based  Enabling facilitation  High challenge and supportive environment  Critical reflection to critique, evaluate and support ongoing development
  • Person centred environment  Respecting and valuing individuals  Engaging in a way that promotes dignity, sense of worth and independence
  • Leadership Development
  •  Meetings held between Theatre nursing leaders and Human Resource department  Problems and issues register implemented  Review of Performance Development and Management processes.  Social events  Theatre Context Assessment Index (CAI)  Workshops / Group Work Action Plan
  • Theatre Culture Survey – Context Assessment  Context Assessment Index (CAI) tool used  Survey consisted of 37 Questions  Leadership, Culture & Evaluation elements  Survey was sent out to all theatre nursing staff:  Scrub, circulating and PACU nurses of all levels  CN’s, RN’s and EN’s (SRN’s excluded)  44 surveys were completed - 63% of overall staff  Overall context score calculated to determine a strong or weak context
  • Theatre Context Results
  • 0 10 20 30 40 50 60 70 80 90 100 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 ContextPercentage Participants Individual participant results Culture Evaluation Leadership
  • Leadership Results Documentat ionofcare Family participation Equal authorityin MDT MGT Structure Planned discussions Evidence based knowledge Specialist consultation 0 10 20 30 40 50 60 70 80 90 100 2 6 10 17 22 27 29 Percentage Questions
  • Leadership Analysis Weak results - Question 10: Health Care Professionals (HCP’s) in the multi-disciplinary team have equal authority in decision making. (66%) - Question 17: The management structure is democratic and inclusive. (61%) Strong results - Question 22: Discussions are planned between HCP’s and patients/families (89%) - Question 29: HCP’s have the opportunity to consult with specialists (91%)
  • EBPractice CNLeadersrole models Workingrelations Developing practice Ownattitudes Family participation Teamwork Assessments Autonomy Culturaldiversity Empowered Guidelines/policy Structure Education Evaluation 0 10 20 30 40 50 60 70 80 90 100 4 5 8 11 13 14 19 20 25 26 30 32 35 37 Percentage Questions
  • Weak results - Question 25: Organisational management has high regard for staff autonomy (61%) - Question 35: The organisation is non-hierarchical (47%) Strong results - Question 14: Patients/families are encouraged to be active participants in their own care (90%) - Question 19: HCP’s and patients work as partners providing individual care (90%) - Question 20: Care is based on comprehensive assessment by the MDT (93%) Evaluation Analysis
  • Culture Results Professional boundaries Proactivecare Education Feedback Performance mngt Ptprivacy Understanding roles Accessible information Supported Skill development Reflective practice Patient involvement Ideasharing environment Patients/parent sfeedback Available resources Ptfocused objectives 0 10 20 30 40 50 60 70 80 90 100 1 3 7 9 12 15 16 18 21 23 24 28 31 33 34 36 Percentage Questions
  • Culture Analysis Weak results  Question 9: Staff receive feedback on the outcomes of complaints (62%)  Question 21: Challenges to practice are supported and encouraged by nurse leaders and nurse managers (68%)  Question 31: Clinical nurse leaders (CNM, NM, CNS) create an environment conducive to the development and sharing of ideas (68%) Strong results  Question 3: A proactive approach is taken (86%)  Question 15: There is a high regard for patient privacy and dignity (93%)  Question 34: Resources are available to provide evidence- based care (87%)
  • Overall Theatre Context Results 66.37 67.34 66.02 66.58 0 10 20 30 40 50 60 70 80 90 100 Culture Leadership Evaluation Overall
  •  What we are doing well:  Care of patients is a priority  Family partnerships, active participation in care  Proactive MDT consultation and approach to care  Evidence based care resources available  Areas for improvement:  Care and support of each other is perceived as low  Hierarchical organisation, staff autonomy not supported by managers  Feedback on complaint outcomes Conclusions - What this tells us?
  • Beginning to change Introduced:  Problems register (traffic light report)  Ongoing feedback & evaluation  CN meetings  Improved performance development & management processes  Leadership development  New roles for nursing staff
  • Plans for the future  Feedback Inservice/Education  Focus groups:  Each group focused on specific question  Verify if statements are true  Above/Below the Line  Practice Development Workshops  WCCAT observations  Repeat CAI
  • Limitations  First real introduction into practice development  Lack of concrete management structure  Ongoing staffing issues  Unprecedented demand for change  Time and resources  Skill mix
  • Attitudes towards change - Transitioning to the New Children’s Hospital  Relocation – Late 2015  Increase in theatre capacity  Workforce implications  Foundations for change
  • References and Acknowledgements  Thanks to Jo Siffleet and Tessie Zappia, NMOC Team (External facilitators), Princess Margaret Hospital for Children for their input, guidance and support.  Professor Brendan McCormack, Institute of Nursing Research/School of Nursing, University of Ulster, Ireland.  Manley K, McCormack B (2004). Practice development: Purpose, methodology, facilitation and evaluation. In McCormack B et al (eds) Practice Development in Nursing. Oxford: Blackwell Publishing.  McCormack B, Henderson E, Wilson, V & Wright J. Practice Development in Health Care. Pract. Dev. Health. Care 8(1) 28-43, 2009.  Dewling J. Implications for nursing managers from a systematic review of practice development. Journal of Nursing Management 16, 134-140, 2008.  Wilson V, McCormack B, Ives G. Understanding the workplace culture of a special care nursery. Journal of Advanced Nursing, 50(1), 27-38, 2005.
  • Thank you for your time! Any Questions?