Leading Quality Improvement – Essentials for Managers

Session 8: Clinical Managers Chat Log

Laura Morgan: Hello, Laura Morgan with Presbyterian Healthcare Services in NM

Faith Infante: Hi

Matt Hafen:We perform leadership rounding on each of our new patients within 24 hours of arriving on our unit. This allows us to greet them and answer any questions or solve any concerns

Laura Morgan:We are looking at holding some pt/family focus groups to help with our HCAHPS issues.

Laura Morgan:I think Patient Advisory councils are a great idea.

Anita Schambach: We are a community-based program for care management and have added peer supports to our program

Anita Schambach:They work with our patients with chronic conditions they have in common

Laura Morgan:Like Community Health Workers, Anita?

Kathy Duncan:Culture of safety?

Anita Schambach:Yes

Elizabeth Johnston:Placing patient's safety first.

Laura Morgan:Culture of Safety means that everyone is using the same processes to promote patient safety; such as evidence-based practices for things like med errors, falls.

Kathy Duncan:It is not "more work" it is the work we should be doing.

Faith Infante:Doing the right thing while doing things right

Laura Morgan:"Engagement at all levels" is not easy to obtain......

Kathy Duncan:We need to address the disrespect in our facility.

Laura Morgan:Here too; everyone needs to address it in some fashion.

Shannon Freel:We have had organization wide training on harassment and proper etiquette in the workplace, however it is not maintained following this training (which is completed only once during your career)

Faith Infante:The worst is I hear somebody saying to a colleague "We are not on the same level, so you dont talk to me"

Faith Infante:Glad one doctor defended that nurse the hostile doctor saying "you don’t talk to them like that because without them, this team will never work

Shannon Freel:We frequently have peers who say, that’s the way it’s always done so that’s how we'll do it regardless of whether it is productive or unsafe. It often risks safety and sets peers and new colleagues up for failure

Kathy Duncan:The people doing the work should be included in designing the work...

NigelLumley:There are always new policies being out in place and i find that frontline staff are not being asked to input their ideas

Kathy Duncan:WOW! great graph - great points

Nigel Lumley:With team work comes good communication skills

Faith Infante: I agree with Nigel

Kathy Duncan:Nigel - with team work comes good outcomes

Karen Rose:I totally agree with Nigel’s statement . The people doing the work should be included in designing the work .

Kathy Duncan:A great encouragement to staff - they see their work is improving care

Faith Infante:Transparency - we are trying to revise how we review competencies of the staff, before it was only the educators job, now we will try to involve the nurses themselves. One step at a time

Laura Morgan:Yes; employees tend to not report things, even when they can verbalize that we have a Just Culture. Therefore, the same issues keep happening.

Kathy Duncan:Laura - this describes what you are saying......

Laura Morgan:They don't have one

Nigel Lumley: It was a poor culture of safety

Shannon Freel:They seem to have the belief that this issue isn’t my problem so I'll only fix it at my level

Gabrielle Ouellet:Pathological

Laura Morgan:The OR manager should be the middle bridge in the culture of safety; it should start with senior leadership, and filter down via the manager to the staff. Other department managers must participate too, such as the Admissions/Registration and Radiology. This organization needs to do an RCA and/or FMEA to jump-start the resolution to this problem.

Nigel Lumley:Encouraging staff to develop a culture of safety

Anita Schambach:Shared governance allows those doing the work to problem-solve along with managers

Nigel Lumley: Not at present

Shannon Freel:The manager should review the current practices and engage the staff in where they see downfalls in the work they currently do. there the manager should help implement a plan on process improvement

Laura Morgan:Yes; Shared Governance and things like Clinical Practice Leaders helps facilitate the creation of process and dissemination of information.

Kathy Duncan:"Ikea" effect.

Nigel Lumley:No blame culture

Laura Morgan:Communication the start (in Registration), there needed to be a Time Out that went to all affected areas (radiology, OR). Do not proceed Registration until everything is corrected.

Laura Morgan:Quite a shame that nurses need to be given a "rule" to use critical thinking and do the right thing. Sigh.

Shannon Freel:He failed on the level of psychological safety

Laura Morgan:Surgeons often respond inappropriately! OR teams usually can deal with this; but everyone will feel inadequate and incompetent, and this will filter through to the patient.

Shannon Freel:It promoted an environments where it’s almost better to do the wrong thing than to correct an error for the patient's benefit. It created tension between the OR staff who normally work in a cohesive fashion

Wendy Ndhlovu:The surgeon was rather rude and added more pressure to the OR team already stressed and made them feel incompetent

Faith Infante: This is what staff feels in our OR. We need on the spot assertiveness.

Faith Infante:It's a shame that we are still at a "doctor-driven" culture instead of a team-driven one. It is however interesting to note that there are people who act their way to believing culture of safety.

Wendy Ndhlovu:Thank you very much everyone.

Shannon Freel:Thanks all

Faith Infante:Thank you for this informative session

Ronelle Peters:Thank you again for this extremely exciting session.