Are you struggling to find ways to improve quality of care, the patient experience, throughput, LOS and more?
By Page M. Etzler RN, PhD, MBA, MS, FACHE
What if I told you there are three things you can address in your huddles and hand-offs that can get you these results? Throughout my years in many roles including running a trauma center, I have witnessed dramatic turnaround in these measures by implementing these three key concepts: Challenging the Norm, Having a Questioning Attitude and Asking What is Best for the Patient. Let’s look at each individually in depth.
Challenging the Norm
Imagine you have a patient that comes into the ER, you probably have protocols and SOPs for how to do things when that patient is seen. You get his vitals, provide a diagnosis, determine treatment and prepare for a transfer to another department. How could you creatively think outside of your immediate environment to make sure this patient’s needs could be better addressed?
As an example, let’s say this patient has a broken hand and arm. You probably will follow the standard care plan, but what if you did things differently? What if you asked the patient what is most important to him about his care and his goals for recovery? You may come to find that he is a professional violinist with the symphony and his goal isn’t to be treated quickly, but to make sure the care he gets will ensure he can return to the symphony and play as well as he did before his accident.
By thinking outside of the box and understanding what is important to the patient instead of what is important to you, you’ve elevated his care, improved his experience and can better help him progress towards his ultimate goals for recovery.
Having a Questioning Attitude
Have you ever worked in an environment where you’ve feared retribution for speaking your mind? This is a very common fear in the workplace. If you want to truly improve the care you give your patients, you must remove this fear from your organization.
For example, let’s say there is a hand-off for a shift change for the violinist patient I mentioned above. You find out that the prior nurse has been following the standard care plan, but after reviewing notes in his record you think there is a better option for care. However, you are afraid to tell your colleague out of fear that they may think you are questioning their clinical judgement and not simply pointing out new information that will improve that patient’s care. If you can build a level of trust within your employees and they feel that they can openly ask questions and state their opinion, this will only help your patients and bring their needs to the forefront.
Asking What is Best for the Patient
Think about the last time you were completing a hand-off and had to decide the next steps for your patient’s care. What kind of discussion was had? Was it something like “I want to move the patient to this unit”, and then a response of “well I can’t take this patient now because…?” In this exchange, each individual provider is thinking about their own departmental goals. This causes them to lose sight of the actual patient’s goals. Just think what could happen if we put the patient’s needs first during this hand-off.
Let’s look at this another way as well. I know from experience how busy nurses are. Sometimes everyone looks for ways to lighten their load, but this can come at the expense of the patient. A patient might be ready to step down to a med-surg unit because the level of care in the ICU no longer matches their current needs. A nurse might not want to expedite the movement of the patient to the next unit because they just received the last admission and want to avoid increasing their own workload with another new admission. If the nurse asks themselves “what is best for the patient?”, they are improving not only that patient’s care, but also the experience of the next patient who needs the bed.
As you can see, asking this simple question can have a trickle down effect for every department and impact the care of multiple patients every day while also improving patient flow through the entire hospital.
It may be easy after reading these key concepts to understand how making these small changes could greatly affect patient experience, but by putting the focus back on the patient and removing the department-centered thinking, you will also be able to improve other measures like LOS, throughput and patient progression as well. As the focus is shifted back to the patient, every aspect of their care is optimized, and you can see dramatic results in your organization with a small shift in thinking.