During the webinar, Ruth Hansten will highlight the recent field results from implementation of the RROHC bundle of best practices, review the RROHC philosophy and steps, and open the conversation for dialogue and questions.

If you would like Ruth to address your specific healthcare delivery questions/concerns during the session, please send them in advance to Kathy Watkins via Email.

The program will be recorded and made available for all those who register.

To register for the webinar, click on the following link: https://attendee.gotowebinar.com/register/5556635249194853120

We hope you can join us!

Kathy Watkins

• Assess current unit or department practices and processes
• Use tools and worksheets to apply RROHC principles to your workplace
• Review teamwork at the bedside and within the interdisciplinary team
• Solve internal issues using your critical thinking problem solving tools
• Revitalize your connections to patients and families
• Better lead and coordinate your teams

Actual clinical results, when RNs change their orientation to the patient’s priorities and goals rather than merely what tasks might need to be done, include such improvements as:

• Patient satisfaction mean and percentiles
• Staff engagement
• Fewer falls with injury
• Fewer pressure ulcers

Would it be worth it to you to improve nurses’ reasoning and your departmental processes by using the RROHC Bundle of 10 Best Practices?

The next cohort begins July 1.

We invite you to visit our web page Improve Nursing Leadership at the Point of Care to look at how to best engage leadership at the point of care and review the results that have been achieved by organizations like yours.

To register, visit RROHC Professional Practice Specialist Registration

Kathy Watkins

1)   Caring for the costliest patients, high utilizers of services (often joint eligible Medicare and Medicaid patients, often the most vulnerable) has been raised as in issue in many journals, as we face reimbursement reductions in Medicare, Medicaid  programs.  Experiments to assist patients with care management, using population health management principles, are beginning to emerge as successful.  Relationship building and behavioral change are essential components of care management. End of life care that is managed and compassionate, attention to patient-family-centeredness and engagement, home visits, and inclusion of behavioral health and dental care, are beginning to reduce overall costs while improving quality. Nurses are key members of an interdisciplinary coordinated approach.  (see November 2012, H HNmag.com, Hospitals & Health Networks.) 

2. Nurse Care Coordinators:  Care coordination by RNs is necessary to reduce unnecessary (unpaid) hospital readmissions and losses to the hospital’s value based purchasing scores (VBP). A new Medicare rule that will pay RNs when they help with transitions will help make transitions between care settings will assist in patient outcomes but also will incentivize payors for using RNs in the care coordinator role.  (Alexandra Wilson Pecci, Nurses Uniquely Suited to be Care Coordinators, April 30, 2013).  HealthLeadersMedia.com)

3. Nurses Critical to Patient Safety: Nurses are leading the way to reduce falls: rate of injurious patient falls dropped by 5.4% from 2009 to 2011 (from the ANA National Quality Forum (NQF) Nurse Leader Insider, March 25, 2013). One patient fall w/o serious injury increases costs about $3500, whereas patients with 2 or more falls w/o serious injury cost an additional $16,500.  One or mor falls with serious injury costs an additional $27,000.  By 2020, they project that more than 4 million patients will  fall sustaining an injury, costing about $47 BILLION. (www.hcpro.com/print/NRS-290533-868/Nurses-Play-Critical-Role-in-Reducing-Patient-Falls)

4. Measuring Patient Safety Culture:  If RNs are afraid to speak up about patient safety concerns or potential issues, then the root causes cannot be repaired.  For example, at Johns Hopkins, at the unit level, only 30% said they were able to speak up.  In-depth small group discussion is essential for employees to know how, where, and when to talk about their concerns.  Tips for measuring patient safety culture include:

1) Measure the root causes, not the symptoms:  for every adverse event:  what was really occuring? Why did that patient fall? (Did the last set of rounds occur but w/o taking the patient to the commode?) There must be a just culture in which there is not blame for behaviors that are purely mistakes or unintended results of system problems, but instead a spirit of inquiry and improvement through learning should be used.

2)  Be creative and experiment. Remember that key to long term results is the ability to discuss issues openly.  Increasing awareness of patient risks and the need to speak up is a vital part of the journey to safety. (How can Healthcare Organizations Measure “Soft” Aspects of Patient Safety? Sabrina Rodak, April 15, 2013.  www.beckershospitalreview.com/quality)

 To better health everywhere!

Ruth

 In this 1-1/2 minute video, Ruth Hansten explains how the RROHC program can improve patient satisfaction, staff satisfaction and clinical outcomes; and increase employee engagement by up to 4x. 

The RROHC Professional Practice Specialist Program has been shown to improve professional practice up to 37%!

IMPROVE DELEGATION SKILLS, OUTCOMES AND SATISFACTION

Following are just a few of the real results our clients have experienced by implementing the RROHC philosophy and bundle of best bedside practices and expert delegation and supervision skills.

• Nurses at a Michigan hospital gained 30 more minutes a day by implementing the RROHC system for shift handoffs.
• Organizations enrolled in the RROHC program show 37% improvement in clinical delegation skills.
• Graduates show improved team engagement and satisfaction with improved nurse retention.
• An Emergency Department in Ohio improved the time from admission to patient transfer by an average of 54 minutes.
• A Midwest hospital’s overall rating of inpatient care grew by 20%.
• A Pediatrics Unit and ED earned a 99% in Press Ganey score and reached 80-90% mean patient satisfaction.

RESERVE YOUR SPOT NOW!

We are now accepting registrations for the RROHC Professional Practice Specialists Course that begins July 1.

This enhanced course will offer customized, online training at its best, with access to live coaching by Ruth Hansten.

Highlights of the five-month instructor-guided self-study include:

• Each student receives a portfolio, worksheets, tools and assignments. Two textbooks are required, and access to a computer and specified online sites is needed.

• Each participant will have access to video coaching and live group coaching via pre-scheduled conference calls spaced periodically to enable access to all shifts.

• Four hours of Nursing credit is granted from Olympic College (additional registration fees apply).

• Your organization’s coordinator assists with discussions or group work internally.

• Each participant completes an individual or group critical thinking project.

To register, visit RROHC Professional Practice Specialist Registration.

For more information, email Kathy Watkins.

Patient engagement and knowledge:  A study in February 2013 of Health Affairs found that patients that were more engaged, more knowledgeable, “skilled and confident” about management of their daily lives with their diagnoses, had healthcare costs 8% lower the first year and 21% lower in the next year: this was true EVEN after correcting the research groups for severity of illness.  When looking at specific populations, for example, asthma and hypertension, the differences were 21% higher costs (asthma) and 14% (hypertension).  (Healthleaders Media, April 17, 2013)

Computerization in Patient Hand0ffs: April AJN (In the News, p. 16) discussed a synopsis of an article from Staggers N, Blaz JW,   Journal of Adv Nursing 2013; 69(2): 247-62.  They attempted to review how the complex nursing handoffs at change of shift  on med-surg units could be supported by computerization.  They note that verbal, face to face handoffs are important, and believe that the opportunity for teaching and mentoring new nurses and other side benefits allow for better patient safety.  They recommend that nurses should do what they can to standardize the types or categories of information they need to share on each unit, and prioritize that.  If they can customize the current computer information to tailor the information, it will support better handovers.  

What Patients Really Want:  From NurseZone February 21, 2103. (Debra Wood, contributor).  There are no surprises here. Patients want to be heard, be a valued member of their healthcare team with attentive listening by providers. More than 80% of people surveyed expressed the desire for their provider to listen to them, but only 60% indicate that happens. Less than half of 1068 respondents stated that goals and concerns were asked about by their healthcare providers.  When RNs and MDs asked about their goals and listened to them, they were 3 to 5X more satisfied. 80% wanted to hear the full truth about diagnosis, 70% wanted to understand treatment risks.  (IOM Roundtable on Value and Science-Driven Healthcare)

1) the quality of connections between RNs and LPNs

2) degree of interchangeability between the 2 roles

3) and RN/LPN staffing ratios. 

Not surprising to me, the degree of confusion about scope of practice was an issue and LPNs find themselves in roles that require RN preparation and licensure.  Failure to differentiate between RNs and LPNs, failure to keep adequate RN staffing, and lack of team communication connections between the roles all “thwart effective implementation of nursing care.” 

We as nurse leaders,  educators,  and certainly nursing home administrators, must begin to rectify these issues in order to create better care for the burgeoning population requiring long term care.

see http://www.healthgrades.com/quality
We share the vision that all of your organizations, all of US hospitals, would follow the lead of these Healthgrade Patient Safety Excellence Award™ Recipients offering world class care and patient safety!

http://digital.hhnmag.com/DigitalAnywhere/viewer.aspx?id=47&pageId=46&refid=271079&s=share

In the April 2013 issue of HHN, Press Ganey outlines how to improve the patient experience and the key steps for leadership, including weekly executive rounding and supporting employees to connect their work with “numbers” and patient outcomes.  For staff best practices, PG discusses some RROHC practices. (I am doubtful they know some of these are also our RROHC best practices because they are becoming universal….although I did speak about RN/patient connections at their national meeting about 10 years ago!)  Essential care processes  include rounding, bedside shift reporting, and monitoring and feedback coaching to help caregivers better connect with patients.

The Mayo Clinic future model..that of “Wrap-Around Care” instead of current day “Conveyor Belt Care”, featuring a community of multidisciplinary workers with patients in the middle. Population health management, prevention, and a proactive approach to health is featured.  Florence Nightingale would be proud to see this come to fruition!

http://digital.hhnmag.com/DigitalAnywhere/viewer.aspx?id=47&pageId=46&refid=271079&s=share

Research information from our 3/25/2013 RROHC Specialist Conference call:

1) JAMA study from the Advisory Board Daily Briefing, March 21, 2013: Study by OregonHS U, John McConnell , of 600 cardiac catheterization labs compared 18 points from Lean methodology to actual performance and management practices. No surprises here but: more effective management also demonstrated better patient results and lower mortality. YES. Improving processes at the point of care as we do in RROHC’s 10 best practices does improve patient results! Management Practices and the Quality of Care in Cardiac Units. K. John McConnell, PhD; Richard C. Lindrooth, PhD; Douglas R. Wholey, PhD; Thomas M. Maddox, MD; Nick Bloom, PhD. JAMA Intern Med. 2013;():1-9. doi:10.1001/jamainternmed.2013.3577.

2) Bedside report articles we discussed in our last blog entry from February on hourly rounding and Shift Report at the Bedside, articles have been in Nursing Management in February (2 articles) and March 2013: We recommend review of the experiences from Novant Health (hourly rounding) and Kean University in NJ and we celebrate their HCAHPs results. The March 2013 article “Make it a Habit: 2 Weeks to bedside Report” by Stephen Carlson discusses the advantages of using a template for shift handovers.

3) Impact of Charge RN Education: March 2013 Nursing Management features an article by Rosemary Homer and Linda Ryan related to measurement of Charge RN education needs and results at Adventist Hinsdale Hospital in Illinois. Because I do quite a bit of charge RN education and find that in many hospitals, this crucial group has never been educated even in the basics of making assignments! I was pleased to note that qualitative analysis showed improved understanding of roles and personality impact, different methods of communication, improved conflict resolution, improved delegation skills, and more intentional creation of a healing environment.

4) Readmissions are featuring prominently in many research studies published recently due to value based purchasing incentives to keep patients healthy. A 2009 study of 2003-4 Medicare patients showed that nearly 1/5th were readmitted in 30 days, and 34% within 90 days, costing $17.4 billion. It’s not new news to us that individualized discharge instruction re: self-care and post hospital appointments must be done. Good news, though, nursing care coordinators at NYU Langone Med Ctr’s 4 hospitals showed excellent results, and at John Muir Health in CA, a patient- centered medical home with an LVN teaming with case manager RN resulted in the control group being admitted 2.42x more frequently than the patients in the medical home care management group. http://news.nurse.com/apps/pbcs.dll/article?AID=/20130225/NATIONAL01/102250031. Heather Stringer, Editor