What do you need to do to begin?
1. Establish a core leadership or management team. Effective leadership is a key factor in laying the foundation and supportive infrastructure. The team will help you develop an action plan that is appropriate for your department and organization and serve as a source of support and encouragement as you implement the process change.
To ensure that the process improvement aligns with the organization’s own strategic initiatives, involvement of senior executives is vital to success. Including an executive sponsor on this core team will provide appropriate global oversight and support, ensure continued alignment to organizational goals, provide visual endorsement of the project, and facilitate any necessary infrastructure changes or problem-solve roadblocks. The other members of this core team will be dependent on the particular organization and the extent and number of programs involved in the process change. Consideration should be given to include change management champions, program directors, managers, physicians, patient safety officers, clinical team leaders or specialists as well as collaboration with sites who have successfully implemented the initiative and early involvement of staff from pilot units.
The following is a checklist to assist you in establishing this core leadership or management team:
- Who has the authority in your organization to formalize such a team?
- Who will assist in establishing this team?
- Who will be appropriate individuals for this team?
- Who will chair this team?
- When will this team meet?
- What will be the terms of reference for this team?
2. Establish a baseline. Once the core team is established, each member should review this blog and as a team adopt, adapt or modify the format to meet the organization’s culture and your team’s consensus. The team must also understand and value the process improvement initiative, define the scope, expected goals and timelines, and identify the target population for the initiative.
Patient-centered bedside reporting is well supported in literature as an essential element of patient safety and quality. The team should complete a literature search to form the basis of their support for this initiative. The articles listed in the resource section of this blog may be used to assist with this review. Collaborate with Patient Quality and Safety consultants to determine specific safety criteria requirements for safe shift handover. An example of safety criteria is listed in the resource section of this blog.
Clearly defining the scope and details of the project with measurable and achievable goals is essential. Understanding the current state and articulating the rationale for implementation of bedside reporting will raise awareness, establish a sense of urgency, and provide a baseline for evaluating and measuring results. Key metrics should be established and an effective audit tool developed to monitor progress and check effectiveness of the process change. An example of an audit tool is included in the resource section of this blog. Consider how you will celebrate progress and gains associated with the process change.
The following is a checklist to assist you with establishing a baseline:
- What is the evidence for best practice related to safe shift-to-shift handovers?
- What is the reason for the process change?
- What is the current process for shift handover?
- What does the current data reveal regarding quality or safety incidents during or shift change? For example, what are the numbers of incidents of falls, medication or communication errors occurring during periods of shift handover?
- What patient and family feedback do you have related to existing communication processes, patient and family involvement, and current shift handover process?
- What do staff satisfaction or communication surveys reveal?
- What is the intended goal for the process change?
- What programs or departments will be involved?
- What objectives will be achieved during this process change?
- How will results be measured and evaluated?
- What are the intended dates for development and implementation of this process change?
- How will you celebrate gains?
- What will be your strategy for communication?
Case Example
Review of the current method of communication for patient hand-offs on a medical unit showed evidence of an existing gap between the present practice of taped report and the gold standard of patient-centered bedside reporting; current communication model did not meet standards. Clinical examples of safety concerns, including medication and treatment errors, had occurred at shift change, and attributed to gaps in communication and lack of accountability during the hand-off process. The lack of coordination between nursing and health care aides activity during shift changes left patients unattended for extended periods of time, further contributing to safety risk. The handover information was inconsistent, redundant, inadequate, and demonstrated ineffective use of time during shift reports. Patients and families were not part of the hand-off process and the goals of care were not incorporated into the report. Formal concerns to the Patient Representative Office had been submitted by patients and families relating their personal experiences of miscommunication regarding their care plans and had recommended a patient-involved approach for shift-to-shift reporting. Individual and group discussions with staff indicated staff were at varying levels of knowledge, understanding and acceptance of bedside reporting. Although some staff were supportive, most were ambivalent, uncertain, disinterested or opposed.
The evidence indicated that the current shift-to-shift reporting process on this unit needed to be restructured and staff would require information and education to effectively implement this change.
The goal was to create a patient-centered bedside reporting process on this medical unit that would meet the hospital standards for bedside reporting.
A unit-specific working group was established, consisting of 8-10 key stakeholders. The core team supported the working group as they constructed a patient-centered bedside reporting process. Specific objectives were developed and a target go-live date was established. The members of the working group met for 5 sessions to complete the objectives and accomplish the goal of creating a bedside reporting process. A strategic communication plan was developed for centre-wide, as well as detailed unit-specific dissemination of information. The core team worked with Quality and Decision Support to gather baseline date and to develop an effective audit tool.
