Amal's Profile

In a highly complex organization with more than 1200 bed capacity and several tertiary care specialties, care coordination is considered a big challenge, especially with the fact of the low literacy level in the patient’s community and their caregivers’. Our institution created some strategies to cope with this and try to reach the best outcomes in patient coordination and patient/ patient partnership in the below levels of patient referrals:
1. Within the specialty care ( Combined services such as Medical oncology, Radiation oncology and Oncology Surgery)
2. Cross specialty consultation
3. Outside the organization consultation (long term care facility)
4. Home Health Care referrals and follow ups

Firstly,
Creating combined clinics for each complicated specialty such as Organ transplant or Cancer Care, where the different specialties discuss the cases in both clinic setting and post clinic conference, this happen in a form of a multidisciplinary approach with the presence of MDs from several specialties, health education, nursing, social workers, and psychologist in some diseases.

Secondly,
The hospital policy mandate all primary physicians to provide phone handover and verbal approval before referring any new follow up to different specialty, this will take the shape of calling the consultant on call that week and explain the reasons for the referral and the urgency, then the accepting MD will advise the right date and name of the clinic to fit the patient or will visit the patient in the inpatient room if was admitted to the hospital, otherwise case will be rejected and Adverse Occurrence report will be initiated from the receiving service

Thirdly,
The hospital recruited a crew of care coordinators ( Nursing and Clerical) to facilitate patient discharge and referral to outside facility , they take care of the communication, transportation, and financial agreements

For the in-house care coordination, a leadership team from clinical nursing care coordinators are assigned to each specialty to ensure continuity of care in regard to follow up appointments for MD, treatment , or investigations. This team is granted a direct phone access and can be reached at any time during the day by patients and care givers and by other health care providers, they are also equipped with electronic access to Health Records on tablets and laptops to facilitate the care, and they are expected to reconcile patient’s records ( orders and requests) at the end of each clinic.

For Home Health Care referrals,
The MD will evaluate the patient condition and the need to be treated at home for several indications and treatments such as Enzyme replacement, or Home TPN or even end of life care, then will initiate a referral to HHC by both filling the referral criteria form and calling the HHC coordinator to assess patient within set time frame.
HHC coordinator will then assess the eligibility and fitness and will schedule the patient with proper HHC team according to the geographical location and case acuity.

In addition to all of that, the hospital created a call center ( Toll Free Number) to contact by patients/ caregivers and to answer any question related to their appointments, travel and logistics.

Finally, with all the efforts put into place, we are still facing some patients who failed to confirm their appointments or lost the follow up after several no shows to their clinic appointments, and for those we rely on the providers reporting those incidences to try to prevent them from happening in the future due to the seriousness of the consequences that may impact patient health or prognosis.

Hi Ivo
It was proven that the relationship with the immediate manager is a key factor if not the most important factor in staff satisfaction on their workplace and in reducing burnout, apparently the previous manager is greatly talented and skillful in aspects rather than people management, that made your organization keen to retain her even with her negative influence on her peer and subordinates.
In cases like this which we encountered in our organization, we sat the below steps to manage talents and potentials as wisely as possible:
• Create a succession planning for each department head up to executive managers and leaders
• Equip succession planning candidates with the tools to help them in the new leadership era through a one year leadership program that include both written and practicum aspects with coaching methodology of education.
• Allocate the staff to an area of the best of their capabilities such as: writing Policies and procedures, running equipment and processing inventories, Units rounds and accreditation readiness, Computer and software engineering, etc…
• The leader of that area usually set a performance management plan, that will be discussed with the staff member and agreed upon with her on the objectives and the area of influence ( this conversation may not sound easy, however emphasizing on the strong points of AB will support the discussion which should end with mutual agreement that AB will not be back to the area and will focus her energy somewhere else)

The golden rule here, is that each staff member is talented somehow, and the key is to dig deeper and find where they could shine more and provide them with the best tools and support to give the best of themselves for the benefit of the patients and the organization at the end.
Wish this could help you.

Communication was classified as the third leading cause of sentinel events as per the latest JCI report, in addition to that, handover in both hand off and transition was always a challenging area, where you may encounter legitimate reasons for the non-compliance of the Health care providers (HCP), however those reasons need to be eradicated to ensure proper patient care in both quality and continuity.
From the last patient safety culture survey which was conducted for in our organization, one area was highlighted and need improve is handoff and transition. Depending on that survey results, the hospital’s Safety committee recommended to the CEO a proposal for a hospital wide project that aim to enhance professional’s handover of patient care and fill in the gaps in the last JCI visit’s recommendations as well of having the documentation of hand over and communication of staff nurses upon shift exchange, the proposal was approved and the PI was supported by the hospital executives and board of directors as a strategic project. My organization using ICIS since 2001. In 2016, we implemented handover and communication tool in Integrated Clinical Information System (ICIS) for nursing and Physician.

Speaking about workplace experience with shared governance at my Organization,where the nursing department took the team involvement gradually into several steps or milestones, as the value of shared governance was not clear by that time to frontline nurses as well as many middle managers and educators.
In my origination we adapted the SG since 2011, at that time the first nursing council started as the fllowing:
• Select the highly motivated and influential staff to set in the councils, by that time no elections or even bylaws were present, nevertheless there were no council evaluation criteria as the main goal was to get the councils the initiation spark
• Involving the education staff in EBP appraisal for new ideas introduced to the council, and mandate staff to consult the assigned faculty to their unit or division before the idea submission
• Shaped by drawing the fine lines for the manager’s involvement in the unit council as well as the quality and education facilitators by setting the bylaws and forms linked to each council according to ranking of decision making and influence
• Education department involvement with the councils is remarkable and defined in the bylaws at different levels in nursing

In Nursing, each staff role in shared governance is in staff performance appraisal as technical competency which should be understood by each staff member according to the document of SG bylaws.

Currently, our shared governance system is well formed and structured where everyone knows his/her roles and responsibilities and adheres to those as they will be reflected in staff annual appraisal with supporting evidences
There are strong support of the nursing executive leaders to the whole process of shared governance as it requires staff dedication and enthusiasm to keep it going which was understood and appreciated by the top executives and rolled down to leaders and mangers to sustain enculturation of the Magnet Concept as SG is the soul of the Magnet Journey.

Update
We have 95% improve in reduction in 2017.

Amal

At our organization ,In May 2012, the adult Bone Marrow Transplant Unit (BMT) grieved after a sentinel event were we lost a patient as a consequences of fall related injury, the hospital decided to act seriously on creating a robust falls prevention program, that can cover all age groups and prevent harm resulted from fall.
The collaborative team was led by nursing staff from the adult BMT unit, and included a multidisciplinary team from several departments such as, Medical, Pharmacy, Physical Therapy, Nutrition, patient and family Education, and Quality and patient safety staff. This step was the consolidation in the program were all relevant parties put their hand on the gap that required the improvement and the latest EBP on how to fix it.
The below are some examples of the actions done in each of the PDCA cycle:
Planning:
• Set a goal oriented project charter and approve it from all team players
• Define a time frame for each suggested action and approve it in a time schemed gantt chart
• Design a structural gap analysis survey and perform safety pulse check on the essentials for fall prevention in patient care environment
• Monitor the Nursing Quality Indicator falls indicators on quarterly basis
• Analyze all Adverse occurrences and perform Root Cause Analysis that indicates the potential fall reasons and risk factors
Do:
• Perform the Environment of care survey by qualified and trained staff on all the piloted units in the adult medical and oncology/ hematology units
• Data was shared with the team members and presented to hospital safety committee
• Recommendations of the survey were communicated from the chief Operating Officer to the project management department for implementations of structure change
• Policy and procedure changed to include : EBP fall assessment tool ( Morse for adult patient and Humpty Dumpty for children) , post fall care algorithm, role of pharmacy, PT and Dietician in the fall prevention,
• Develop a patient education booklet in both languages to educate patients and family on fall prevention within hospitals
• Develop posters for fall prevention in the toilet and post them in each patient toilet
• Introduce and implement fall assessment care planning to manage high risk to fall patients
• Educate staff on reporting Adverse occurrences of falls.
• Include the fall project in all the units’ based council agendas in all piloted units and the divisional and hospital wide nursing quality councils
• Introduce none-slippery footwear to be used by all at risk patients.
• Educate staff nurses on the cultural aspect of fall prevention and the required modification in the care schedule and plans to overcome patient cultural and religious practices and exhibit the respect to those by Check:
• Continuous monitoring falls indicators ( Falls and falls with Injury quarterly
• Continuous RCA evaluation of all adverse occurrences of falls
• Audit the compliance with falls assessment, care planning and education quarterly
Act:
• Apply policy and procedure in all hospital units
• The hospital is currently consistently below the 25% in falls with injury in all hospital units.

Amal