RROHC Level 2 Implementation Questions – Reflection and Reevaluation

My question to the group (esp to Sharon Lacrosse and/or Linda Pullins) centers around length of time doing RROHC, compliance with the principles, engagement of staff, monitoring of the process, etc.  We are now at the 6 month mark since implementation (hard to believe!) and I would like to do some reflection and re-evaluation. How did you measure your success and celebrate it?  How did you monitor engagement of staff and key stakeholders?   How are your organizations currently performing reflection and re-evaluation?

Diane Difiore Oakwood

One Response to “RROHC Level 2 Implementation Questions – Reflection and Reevaluation”

  1. Ruth Says:

    Diane… We are now at year 5 of incorporating RROHC principles into everything we do. In a simple way of answering your questions… we are using the same tools and metholodolgies that we initially started with, as they have proven to be timeless.

    As we have turnover of staff we have recognized that we are continuously “starting RROHC” with new staff and revitalizing the efforts around the principles. So here is what we do on a continuous basis, which gives us feedback, and provides for celebration and measurements, and key stakeholder engagement:

    We use the tool from Level I certification that asks a series of questions to staff (with particular emphasis on RNs) about their impression of care pre and post exposure to utilization of RROHC principles in their practice.
    For new grads, we do not ask them to complete the follow-up until about 9 months post hire.

    We interview each new staff with a “this is how we work at Marion General”
    discussion, and provide a brief overview of RROHC and how behaviors are incorporated into the day in the life of an RN I meet with all new patient care staff during their first week in orientation.. to reinforce RROHC, give them examples and our expectations, and WHY we have chosen to do this.

    Managers continue to monitor shift report and gives them a sense of the use of critical thinking.. which in Med/Surg we have gone to walking rounds Managers, Directors and myself continue to make patient rounds, at which time we are very focused in our questions, asking patients/families about sitting at the bedside, establishment of #1 need , etc.

    Our Press Ganey Satisfaction tool for patients includes 3 questions dealing with RROHC principles
    1) Introduction of staff
    2) Planning care with you at the bedside
    3) Establish the #1 need you identified as a priority

    The staff evaluation tools also address expected behaviors, and a unit/team score for patient satisfaction results We have a nursing service council that addresses RROHC principles… first for patients, and we have modified this for physicians satisfaction also.

    Each individual is to bring a patient story that RROHC directly
    impacted, and examples of staff working to meet the expectation of #1
    needs. We also discuss ( constantly) how are we doing? What isn’t hardwired with new staff? Sharing successes across the various units, and feedback from patient rounds.

    We share our success stories at physician meetings. I meet with new physicians and ask about their impressions of patient care.. and get them to tell me what is different here from their previous experiences. They haven’t connected easily with using the “RROHC” wording.. so I focus on the behaviors, and what resulting outcomes we expect, that will assist them in patient care.

    So… with this said… we didn’t do all of this at once.. we started with basic monitoring of shift report, sitting at the beside, establishment of
    #1 need and team meetings throughout the shift. We did this through a
    special meeting held weekly, which I attended to keep this on the front burner… and it took us about 10-12 months before we started to see the slightest sense of consistency. Everyone in attendance had a defined responsibility and brought their own log of activities for the week, along with their challenges and any breakthroughs. We absolutely found that without tracking our efforts it floundered!!

    I also provided regular updates to the Admin team, and often brought team members with me to speak to real examples of good catches, feedback from staff, physicians, etc. This can be pretty “fluffy” to the execs that want “hard facts and numbers”. We scheduled ourselves regularly and made sure that we were prepared., citing information from our logging activities…even down to prevention of medication errors, sending home a patient with a more comprehensive discharge plan… and connecting this to the “business” of preventing readmissions, lowering infection costs, etc.

    Over time… and as we gained more experience, we looked at every opportunity to use existing structures where RROHC could be incorporated…even with a bit of a stretch sometimes. These are what I have outlined in my list above. In this way, it wasn’t seen as something separate.. but something that just fit.

    Just stick with a basic list of what you want to work on.. and stick with it for weeks or months, until it becomes habit, then add.

    But as you can see, we have attempted to eat, live and breathe RROHC across all facets of our culture. Please let me know if I’ve helped— sounds like this could have been the answer to “world piece” as I look back. HA… it has been a journey!

    Linda Pullins, RN, MS : Vice President Patient Care
    Marion General Hospital : 740-383-8670

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