developing a person- centred safety and quality framework
TRANSCRIPT
Developing a Person-Centred Safety and Quality Framework Kay MaddisonHand Clinical Nurse Consultant Sydney Hospital and Sydney Eye Hospital [email protected]
How have you agreed to work together to achieve you departments
vision for Quality and Safety?
What will quality & safety look like in your department?
A shared vision by the entire team !
A collaborative team approach placing the patient at the centre of all activities
Mindful of priorities of all team members
Collaboratively as a team
With a shared vision and all to model acceptable behaviours and practices
Supportively challenge the processes in order to improve patient safety and
outcomes
Engage with consumers and reflect upon information received to gain greater clarity
and act to make change
What Framework have your team chosen?
Engage staff
How Will you engage staff in your Frame work and
Improvement?
Discussions at monthly ward meetings & daily during the shift
to shift safety brief
What's the role of the
NUM – lead discussions with staff in ward meetings and safety briefs
CNC – engage in conversations with staff
CNE – promote activities
Staff – actively contribute to discussions
Multidisciplinary team members - consultative role as required
Base-line Data Collection
What process will you use to collect patients feedback?
Patient stories Feedback via the consumer
feedback boxes Complaints and compliments
What process will you use to collect Quantitative Data
Safety crosses IIMS
TopCat/Audits
What process will you use for staff to give feedback
Ward meetings and directly to NUM
What's the role of the
NUM – lead ward meetings and assign projects
CNC – lead and minute take for Hand Nursing leadership team huddle (HNLTH )& facilitates assigned projects
CNE – facilitates assigned projects
Staff – participate in PDSAcycles and projects
Multidisciplinary team members - consultative role as required
How will staff be involved in Critical analysis of data?
Initial review in HNLTH Via ward meetings
How will Best practice be considered?
Review literature Compare to other units
What's the role of the
NUM – Engage/support staff. Lead processes
CNC – Obtain data and present to the team for analysis. Support staff in this process
CNE – provide tools and knowledge to enable analysis
Staff – participate in discussions, ownership of issues identified
Multidisciplinary team members – consultative role as required
Action Planning
How will decisions be made to include all stakeholders?
Via ward meetings and Safety briefs
How will the team prioritise projects
According to IIMs & safety crosses
How will ownership of projects be determined
Assigned to most appropriate member in the HNLTH with that
experience
How will you lead the implementation
All attend weekly HNLTH
What's the role of the
NUM – Determine clinical risks to the patients, ward, staff. Attend weekly HNLTH
CNC – part of daily role
CNE – part of daily role
Staff - part of daily role
Multidisciplinary team members – as appropriate
How will you evaluate & report your changes
Via ward meetings & during HNLTH. Report to Reflective
Leadership meeting
What's the role of the
NUM – lead ward meetings and assign projects
CNC – lead and minute take for Hand Nursing leadership team huddle (HNLTH )& facilitates assigned projects
CNE – facilitates assigned projects
Staff – participate in PDSAcycles and projects
Multidisciplinary team members – act as a advisory and consultative team. Reports to be include with quarterly M&M
How will you use this frame work to;
How will you lead Safety Crosses and Team
Huddles in your clinical department?
• HNLTH meet weekly to review project
progression and identify new
issues/projects
• Involve entire nursing team to complete
safety crosses each day
Person-Centred Practice Framework
• Incorporating - Plan, Do, Study, Act (PDSA) cycles to implement change
Person-Centred Practice Framework
• The Framework comprises of four domains:
• Prerequisites focus on the attributes of the Nurses
• The care environment focuses on the context in which care is delivered
• Person-centred processes focus on delivering care through a range of activities
• Person-centred outcomes, the central component of the Framework, are the results of effective, person-centred practice and include: satisfaction with care, involvement in care, feeling of well being, and the existence of a healthful culture.
2 West/Hand Clinic Prerequisites
Professionally
competent
All nursing staff working on 2 West/Hand Clinic are registered with AHPRA and as
part of their employment at SSEH undertake regular competencies in clinical
procedures such as administration of intravenous medications; CPR & aseptic
technique.
Developed
interpersonal
skills
Communication is integral to a nurses role and the development of effective
communication is supported in the area through modelling and reflection.
Knowing selfSelf reflection is a component of the Nurses registration and all staff working in
2West/Hand Clinic are encouraged to reflect and develop through identifying what
went well and what could have been done differently.
Clarity of beliefs
and values
Just like our patients and their carers, our staff are individuals and we as a team
embrace diversity and respect all individuals’ beliefs and values.
Commitment to
the job
The nurses in 2West/Hand Clinic are passionate about surgical nursing, in
particular Hand and ENT. Care is planned and guided through evidence base
knowledge and current research practices.
2 West/Hand Clinic Care EnvironmentAppropriate skill
mix
2 West/Hand Clinic employs both Registered and Enrolled Nurses with a range
of experience (from 20years+ to newly qualified). Rosters are developed
considering staff experience and the needs of the patients/Unit.
Shared decision-
making systems
The Nursing staff are dedicated to working effectively as a team and making
decisions following collaborative discussions.
Effective staff
relationships
The nursing staff have effective processes in place to facilitate the provision of
holistic person-centred care from admission to discharge.
Power sharing
The shared values for 2 West/Hand Clinic are: “We strive to be a unit of
excellence in surgical care, continuously aiming to improve our knowledge
and practice. We are here to be an advocate for all patients during their
stay. We will respect and support patients by providing high quality care in
a timely, efficient and confidential manner”.
The physical
environment
The 2 West/Hand Clinic has recently undergone renovations to the environment
as a means to improve the experience and privacy for consumers and
employees.
Supportive
organisational
systems
The SESLHD CORE values of Collaboration, Openness, Respect,
Empowerment underpin actions at SSEH.
Potential for
innovation and
risk taking
Evidence based practice with clinical judgement, partnered with patient
preferences underpin care delivery for 2 West/Hand Clinic Nurses.
2 West/Hand Clinic Person-centred Processes
Working with
patient’s beliefs
and values
Patient values and beliefs are important to the Nursing staff and care is planned
and provided with these in mind.
Sharing decision
making
The Nursing staff are dedicated to working effectively with patients and their
carers to form collaborative decisions upon treatment plans.
Engaging
authentically
The Nursing team embarks to connect with patients and their carers through
individualised care planning for the duration of the admission and during hospital
follow ups.
Being
sympathetically
present
The Nursing team endeavours to connect with patients and their carers through
individualised care planning.
Providing holistic
care The Nursing team plans and provides care/treatment that is developed through
the individualised assessments and identification of patient needs.
How will the department:• Contribute to conversations around Safety & Quality within SSEH?
•
• Support the facilitators to do the work? ( or staff leading improvements)
•
• Support the facilitators development?
• How would the department like to be supported by;
Locally attend monthly ward meetings; HNLTH, Hand Unit Operational MDT meeting;
Participate in in-charge safety huddles; patient safety programme
Provide updates at facility level the various leadership and quality meetings
HNLTH – to cover ward staff if necessary
Provide framework, resources and support when/where necessary
Attend relevant professional training days
Initiate clinical supervision model for all staff to participate in (voluntary)
SSEH Nursing Executive
SSEH Hand Unit MDT As required
How it works in practice !!!
IIMs -
Clinical IIMs - Complaints
Patient stories
TopCat
Audits
Safety
Crosses
Routine Audits
Ward Meetings
Pt. feedback/complaints Direct from staff
Audits / Monitoring tools Nursing Team Consumers (patients)
Safety Huddles
What happens with the information?
Data is reviewed – trends are identified
Issues are discussed during the monthly ward meetings and at the weekly HNLTH(HNLTH - NUM, CNC, CNE, CNS2 30min meetings)
Need for PDSA project identified
PDSA cylces
Action plans developed and project lead identified
Plan – Do – Study – Act
Enter into MAPS database (quality & safety project database)
How do we identify issues/quality activities
Observations
Example
IIMs -
Clinical IIMs - Complaints
Patient stories
TopCat
Audits
Safety
Crosses
Routine Audits
Ward Meetings
Pt. feedback/complaints Direct from staff
Audits / Monitoring tools Nursing Team Consumers (patients)
Safety Huddles
What happens with the information?
Data is reviewed – trends are identified
Issues are discussed during the monthly ward meetings and at the weekly HNLTH
Need for PDSA project identified
PDSA cylces
Action plans developed and project lead identified
Plan – Do – Study – Act
Enter into MAPS database (quality & safety project database)
How do we identify issues/quality activities
Observations
IIMs – Jake
18yo MVA Hand injury
required 10hr surgery
IDC in situ – no FBC during
surgery, Abdo pain post op,
IDC needed reciting.
Development of safe patient collection
resource card for nurses receiving clinical
handover. Act as a prompt and facilitates
the ward RN receiving all relevant
information
Currently implemented and positively
evaluated at the 6 week & 3 month reviews
MAPS √
Examples of PDSA cycles completed
New patient
prior
preparation
Post
operative
HT/dressing
management
Specialised hand wound
management resource availability
for non hand in-patient areas
Identifying patients
own medications
on admission
Review of patient
information for
attending HC
appointments
Safety crosses
Ward Nurses complete the crosses on a daily basis
– E-N shift handover
Provision of specialist hand treatment.
• Specialised Nursing, Medical & Allied
Health treatment was acknowledged by
all participants
• Communication: text message reminder
for Hand Clinic appointments and follow
up phone calls (day 1 post op)
SSEH 2016 Hand Unit Patient stories:
What we learnt …
Areas for improvement
• Length of waiting time for surgery on
day of surgery (non-elective cases) &
communication regarding same
• Information provided by referring
facilities
• Customer service skills
“Overall my experience has been positive throughout my
surgical journey, the service at the hospital was excellent
and very efficient, and the care from my surgeon and his
team has been great”. (Lewis’s story)
“I had to wait a long time for surgery, it was much longer
than I expected, I wasn’t sure if I was going to be done. I
was watching the screen and tracking the patients, I think
I had to wait because they were doing all the cataract
eye surgeries first and then doing the hands at the end of
the day” (Emmanuel’s story)
“I found it tough waiting all day for
the surgery and found it hard that I
couldn’t get a specific time for
surgery when I asked the nurses” (Christopher’s story)
“I was very impressed with the
doctors wonderfully old fashioned
style, covering everything in a
holistic approach. I always felt as
though I was involved”. (Ann’s story)
“We arrived at the hand hospital clinic on the Tuesday, only to
be told I had missed the appointment the initial hospital made
for me on the Monday (the Dr in the ED had not made my wife
or I aware of this appointment and had given us little instruction
of how to get to the hand hospital”. (Lewis’s story)
“when I arrived at the clinic it took a
while to be acknowledged by the
clerical staff, I was feeling really
nervous and agitated” (Anthony’s
story)
“I found the Hand clinic check in very disjointed, it
didn’t seem like there was a clear process of how
to check in just a massive line with a long wait. It
seemed there was a lack of communication
between admin staff” (Christopher’s story)What are we doing to get it right?
• Reviewing operating list planning to better inform
patients of ‘to come in’ & ‘fasting’ times
• Collaborating with referring facilities to provide patients
with accurate information on the Hand Clinic/services
• Developing ways of working for clerical staff
• Continue to capture 8-10 patient stories annually
MDT development ~Hand Clinic Clerical Staff Engagement
An example
Hand Clinic What matters to me
Smile
Attitude:
positive attitude
A welcome
Make eye contact
Courtesy
“how can/could I help you”
Polite and pleasant
Helpful
Give full attention
Be true and honest
Talk with a smile:
a smile can be heard in
conversation
Talk clearly and calmly
Volume of voice
Tone of voice
Active listening:
listen and respond with
understanding
Smile
Attitude:
positive attitude
A welcome
Make eye contact
Courtesy
“How can/could I help you?”
Polite and pleasant
Helpful
Give full attention
Hand Clinic Ways of working
Be approachable
open arms (not folded)
Come to work with a positive attitude:
Smile
Greet everyone with a smile
Greet everyone with a salutation –“Good morning, how can I help you?”
Organise yourself:
organised area
organised self
Be tolerant and non-judgemental
Be aware that not all people will
be pleasant to us
Warm smiling expression
Communication with colleagues/
clerical team:
Be supportive
Be helpful
Work as a team
Be honest with each other
Thank you
Questions ?
Acknowledgements:
The Nursing staff of 2West/Hand Clinic for their continued engagement and enthusiasm
Karen Tuqiri, SSEH A/DON&SS 2016
Michelle Gibbons, SES Nursing/Midwifery Practice Development Essentials of Care
Jennie Barry, SSEH DON&SS
Brendan McCormack for sharing and approving the use of the Person-centred Practice Framework