What do you want to accomplish?
1. Review established roadmap. Review objectives and agree on agenda for session # 3. Facilitate a brief recap and review of accomplishments from last session.
2. Review action plan. Discuss progress on related aspects of the action plan and determine next steps as necessary.
3. Discuss templates and tools. Distribute the templates and examples for standard work and reporting tools. Encourage the team to use the examples to assist them in creating their unit-specific standard work and reporting tools.
4. Create standard work. Verify scope for the reporting process and clinicians involved. This will likely include group shift huddle, charge nurse-to-charge nurse, nurse-to-nurse, health care aide-to-health care aide, nurse-to-health care aide. The team should break into smaller working groups and using the standard work examples and template, describe steps for a specific portion of the new bedside report process.
5. Create reporting tools. To ensure a consistent report format is used, the group should create a template of information to be used for each shift handover. Once the reporting tools are finalized, the template can be laminated as a pocket guide, posted at the patients’ bedside to allow for easy access during report, or used as a way for staff to document information received during report. Depending on the unit needs and structure, the tool can be used as a means of verifying transfer of accountability. Examples of reporting tools are located in the resource section of this blog.
6. Write clinical scenarios. Consider your clinical setting and ask the group to write several scenarios that would be representative of actual situations expected during shift handovers. The team may find it helpful to review the previously identified list of barriers and develop scenarios including these barriers. These scenarios should include various levels of complexity, providing opportunity to role-play typical uncomplicated as well as complicated or difficult situations. The group should then spend time discussing and documenting the appropriate responses and approaches. This will benefit the implementation of the change process and assist with coaching of staff. The clinical scenarios and approaches may need to be revised once the experiments for the new bedside reporting process have been completed. Examples of clinical scenarios are listed in the reference section of this blog.
7. Role-play scenarios. Work with the group to decide best approach for role-playing the clinical scenarios and applying the new reporting process in each situation. Depending on the group dynamics and team decisions, the scenarios can be demonstrated through either small group work or through the larger working group. This exercise will assist with problem-solving potential situations, enhance comprehension of the process change and prepare the group for testing the process in the clinical setting. As the group works through these tasks, providing appropriate feedback, guidance and encouragement is vital to acquiring knowledge and developing confidence.
Hint: Schedule specific days and times to conduct the experimental sessions and consider how to involve unit staff in the trial process, encouraging participation and feedback. Several trial sessions, at varying times and with various teams, should take place before the next group session.
8. Plan for experiments. To further solidify and develop the new reporting process, the group should trial the steps of the new process and the reporting tools on the unit. Strategize on how to proceed with the trials with consideration to the group, unit staff and stakeholders, and overall operational needs of the unit. Testing the new report process will further validate effectiveness, identify barriers and assist with problem-solving. Demonstrating the new process will also be an effective strategy to provide education and motivation to individuals in various stages of readiness to change. Develop a communication strategy to ensure all stakeholders are aware and informed of the scheduled trials and the rationale for these experiments.
9. 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.
10. 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.
11. Prepare for next session. Review objectives for next session and determine steps for preparation as needed.
Prior to writing standard work, the group found it beneficial to work in smaller groups and use the information previously collected regarding potential barriers, the process map, lessons learned from the Gemba and the safety criteria as a guide to formulate the new process. Each group chose a specific section of the process map, itemized all the steps for the new bedside reporting process, and created a reporting or communication tool for the specific report process. This exercise required substantial amount of time to complete as the team became engaged and creative in their efforts.
The group began creating several clinical scenarios based on actual situations, being attentive to de-identifying to maintain confidentiality. The scenarios allowed the team to review potential situations in a safe, non-clinical setting and to problem-solve an appropriate approach. Various scenarios were created and included situations related to staff bullying and non-compliance. Once the scenarios were delineated, the group reviewed the steps they created for the new process and applied them to the specific scenarios and adjusted the work accordingly. These scenarios were later included in the coaching package to assist with the implementation process.
Once the group agreed on the steps for the new process, a detailed action plan was created for testing the process on the unit. Although the team communicated the plan and intent for the trial, the unit staff felt unprepared for the trials and initially were quite confused and anxious. Several different attempts and approaches were needed to re-establish trust. Feedback from patients and families, however, was quite positive and affirmed progress
