Creating the New Culture through Relationship Based Care


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Creating the New Culture through Relationship Based Care

  1. 1. Creating the New Culture through Relationship Based Care Barbara J Cashavelly, MSN, RN, AOCN, NE-BC, Nurse Director, Lunder 9 Adele Keeley, MA, RN, Nurse Director, Phillips 21
  2. 2. Thank You (It takes a village!) • • • • • Jeanette Ives-Erickson, DNP, RN, FAAN Debbie Burke, MSN, RN, MBA Colleagues from the Institute for Patient Care Barbara Blakeney, MS, RN, FNAP The interdisciplinary teams of Lunder 9 and Phillips 21
  3. 3. Objectives • Describe how innovation based care transforms practice to create a healing environment • Understand how leadership influences culture change at the unit level
  4. 4. Unit Overview Phase One Innovation Unit • Lunder 9 • 32 Bed Medical Oncology Unit • Relationship Based Care Model • Dedicated interdisciplinary team AONE CIT Grant/Phase Two Innovation Unit • Phillips House 21 • 20 bed Gynecology/Oncology unit • Relationship Based Care Model • Dedicated interdisciplinary team
  5. 5. Innovation at the Unit level • Relationship Based Care • Influence of Leadership • Influence reflected in focus groups (videos)
  6. 6. Relationship-Based Care “We experience the essence of care in the moment when one human being connects to another. When compassion and care are conveyed through touch, a kind act, through competent clinical interventions, or through listening and seeking to understand the other’s experience, a healing relationship in created. This is the heart of Relationship-Based Care.” -”Relationship-Based Care, A Model for Transforming Practice”, Mary Koloroutis, 2004.
  7. 7. Relationship Based Care A model for transforming practice~
  8. 8. Relationship-Based Care: Enhancing Collaborative Practice From: To: • • • • • • • • • • • • • • Independence Hierarchical relationship Parallel functioning Medical plan Resisting change Competing Indirect communication Interdependence Collegial relationship Team functioning Patient’s plan Leading change Partnering Direct communication
  9. 9. Relationship-Based Care: Care Team Model • • • • • • Knowing the patient Coordination of care Consistency of teams –improved performance of teams Building plan of care around the patient Clinical support aligned around patient populations rather than transactions Learn lessons from the past Consistency = Continuity = Coordination = Efficiency/Quality
  10. 10. Adams Influence Model (AIM) • Influence is essential in optimizing practice/work environments and outcomes “Influence is the ability of an individual to sway or affect another group about a single issue based on authority, status, knowledge based competence, communication traits and or use of time or timing.”
  11. 11. Innovation Unit “Leading the way to transformational change” Inpatient units were: •Testing ground for change •Ideas were adopted, adapted or abandoned
  12. 12. Innovation Units Focus •Improves quality of care and clinical outcomes •Enhances patient and staff satisfaction •Increases safety, effectiveness, efficiency, timeliness, equitable, that is patient and family focused •Reduces costs and length of stay
  13. 13. Innovation Interventions • A few examples of many interventions… – Attending Nurse Role – Quiet Hours/Noise at Night – SharePoint Site – Admit to Chemo-in project
  14. 14. Lunder 9 • Integrating the ARN role on the unit • Chemotherapy project
  15. 15. Hold for video
  16. 16. HOLD for run chart
  17. 17. HOLD for run chart
  18. 18. Data Run Chart
  19. 19. LOS and Chemo In
  20. 20. HOLD for run chart
  21. 21. Lunder 9 Focus Group Themes • • • • • • Anticipating the Unknown Preparing for the Change Experiencing New Opportunities Establishing a new culture – before and after Leadership support Identifying more opportunities
  22. 22. Phillips 21 Clinical Innovation and Transformation (CIT) • • • • Brainstorming Quiet at Night SharePoint Site “If it’s not broken…….”
  23. 23. Hold for video
  24. 24. Hold for video
  25. 25. Hold for video
  26. 26. Quiet at night scores • Scores went from 30% to 75%; sustained 75% since May 2013 • > than the 90th percentile
  27. 27. Phillips 21 Focus Group Themes • • • • • • Teamwork Small wins led to big success Staff seek out innovation Leadership support Opportunity for making a difference “We didn’t know it was broken until we fixed it.”
  28. 28. Hold for video
  29. 29. Influence of Leadership Leaders inspire others when they have clarity of vision and purpose, confidence, and ability to influence others to share their vision, and a laser focus on what matters most: caring and healing relationships at the point of care. Koloroutis, M. Relationship Based Care
  30. 30. Leadership Reflections • Nurse Leaders have the ability to influence culture change by engaging staff. • Success depends on nurse leaders creating a safe environment for staff to risk.
  31. 31. Culture Change for Units: Before and After • Problem focused • Fear of failure • Satisfied with status quo • Resist change *Solution focused *Learn from failure *Innovative thinking * Embrace change
  32. 32. Summary Endpoint • Leadership begins at the bedside • Innovation is the forefront of healthcare • Staff are excited and embrace change
  33. 33. Hold for video
  34. 34. HOLD for run chart