What do you want to accomplish?
1. Establish framework and roadmap. Having a standard problem-solving process is essential to promote effective discussion, brainstorming, and productivity. The initial meeting will set the foundation and framework for the working group. Begin with general introductions and facilitate development of ground rules to support and enhance the group’s participation. Review the overall plan and goal for the working group and their role in developing the bedside reporting process for their unit. Collaborate with the team on creating a roadmap for the completion of the objectives within the allotted time frame. Review and agree on agenda for session # 1. Promote dialogue, address concerns, build trust, and validate their commitment to participate. Discuss how you will use a “parking lot” to list topics or issues that may arise during group dialogue that are important but outside of the scope of the group's purpose.
Hint: use poster post-it paper to record ground rules, objectives, roadmap, parking lot ideas, etc. Post sheets around the room. Encourage unit staff to review ongoing work.
2. Identify individual learning styles. Ask participants to describe their learning style to the group. This will benefit the individuals’ understanding of themselves and others and will be valuable in directing the group sessions. Review the different learning styles and discuss practical application in clinical setting.Consider obtaining permission to use a VARK questionnaire. A link to VARK is located in resource section of this blog.
3. Review rationale for bedside reporting. Review articles previously distributed and encourage dialogue. Distribute and review the established safety criteria for safe shift handover. Allow each participant opportunity to share current view or experience with bedside reporting process. Consider a presentation from a pilot unit to share their experience with bedside reporting and implementing process change. Links to videos demonstrating bedside reporting are available in the resource section of this blog.
4. Map out current process. Shift handovers occur at specific times and with various groups of clinicians, depending on the particular program or unit. Transfer of information at shift change will likely involve team shift huddle, charge nurse-to-charge nurse, nurse-to-nurse, health care aide-to-health care aide, nurse-to-health care aide, ward clerk-to-ward clerk. Identify specifics for your particular unit and agree on the scope for the bedside reporting process, identifying when the first step of the shift report starts and when the report process ends. Using the agreed upon scope of report process, involve team members in identifying all steps involved in the current shift handover process, document these steps longitudinally to form a detailed, process-flow diagram. The team may benefit from observing the shift handover process and documenting their observations to assist with this process-flow diagram. Timing various parts of the shift handover may be part of the observational experience as this may be used for measuring improvements.
Hint: When mapping the process, remember to include all shift handovers to capture all aspects in the current process. To create a graphic representation of the process, use post-it notes to write each step and affix the notes to sheets of paper posted on the wall.
5. Critically review current process. To assist the team in evaluating the current shift-to-shift reporting process in relation to the established safety criteria, collaborate with the team to organize an audit of the current process. Distribute the audit tool and agree on a specific plan and approach. The audit should be conducted before the next session. Once completed, these findings can be added to the process map and used as the metrics for evaluating the efficiency of the revised patient hand-over process. The team should also establish a method to engage unit staff to obtain their feedback and input regarding the current reporting process and allow staff to identify gaps, concerns and benefits. The team can discuss this information at the next session and incorporate the findings into the implementation plan. Consider how you will obtain a patient and family perspective regarding the current shift handover process and prepare to share this information at the next session.
6. Develop an action plan. Review overall session and verify objectives achieved. Develop and agree on an action plan. Determine effective method and manner for providing communication and feedback to staff and agree on how this will be implemented and sustained. Determine and document next steps and person(s) responsible for the completion.
Hint: Having a written, systematically developed action plan allows for better implementation, focused attention and accountability.
7. Evaluate session. Encourage participants to provide feedback on effectiveness of the working session, noting what went well and what could have been done differently. Utilize this information to optimize upcoming sessions.
8. Prepare for next session. Review objectives for next session and determine steps for preparation as needed. This will include arranging for the group to visit a pilot unit(s) to observe the bedside reporting process. Experts in Lean theory refer to this as Gemba or going to observe where the work is done.
As part of the initial group work, a nurse champion from a pilot unit presented a brief overview of their experience with bedside reporting, including highlights as well as challenges and lessons learned. The group appreciated this presentation and found the open dialogue answered questions and was overall supportive and effective.
The group also found identifying learning styles was both interesting and informative. Once each member completed a VARK questionnaire, the group was given opportunity to discuss specific examples on how learning styles affect interactions with staff and patients in the clinical setting.
Prior to creating a process diagram of the current shift report structure, the group required additional information and instruction regarding the mapping process. Opportunity to visualize and time specific steps helped overall understanding of the graphic representation. The team used different colored post-it notes to assist with visual identification of key or complex problem areas. The process map remained posted in a common staff area and staff were encouraged to use post-it notes to contribute comments or ideas.
