What do you want to accomplish?
1. Review established roadmap. Review objectives and agree on agenda for session # 4. 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. Review and revise experiments. Experts in Lean base their change management theory in the scientific model, Plan-Do-Study-Act cycle and describe improvement as process perfection over time, not necessarily on the first attempt. In keeping with this model for change, review the trial sessions that team conducted using the new reporting process and identify lessons learned. Normalize the initial failed attempts as a way to learn and adjust accordingly. Provide appropriate team leadership and executive support, and continue with problem-solving through the identified issues. Revise the bedside reporting process and reporting tools as appropriate and plan for testing the revisions accordingly. You should also review the methods used in conducting the experiments and revise as needed to achieve optimal improvements. Consider how you will apply the audit tool to the bedside report trials to assist with evaluating quality and effectiveness. The data collected will serve as a visual demonstration of progress and will further identify improvement opportunities.
Hint: Document lessons learned and audit results on post-it posters as a visual progress report, demonstration of improvement opportunities, motivation and method of communication.
Hint: To reinforce positive behaviour and solidify progress, engage other team members (for example, educator, clinical nurse specialist, manager, experts from pilot unit) to work alongside the individuals during trial sessions to provide feedback, guidance and support.
4. Revise standard work and reporting tools. Review and revise the previously established standard work and reporting tools as needed to reflect the lessons learned during the initial experiments.
5. Develop implementation and coaching plan. The group should develop a planned approach for implementation of the new bedside reporting process. This should include developing educational sessions for coaches and staff, as well as planning for ongoing audits or progress checks to promote continuous evaluation and revision. Review the staff that have been identified as coaches and verify appropriateness and availability. Review and revise the coaching roster to ensure unit staff and shift schedules have been appropriately considered.
6. Develop educational session. Engage the working group in developing an appropriate educational presentation to coaches and staff. Consider what information will be appropriate for the coaches to support them as they educate unit staff regarding the new process. This should include brief overview of sessions 1-4 highlighting evidence based rationale for bedside reporting, lessons learned, benefits to patients, impact on staff and standard work, as well as support tools and techniques to assist with the coaching process. The coaches may also benefit from performing a Gemba. A similar presentation to unit staff may be an effective way to augment the coaching process. An example of a coaching package is located in resource section of this blog.
Hint: Assemble an information package for unit staff including appropriate highlights and steps for implementation.
7. Develop a celebration plan. Discuss and plan a method to celebrate milestones. Consider what will be meaningful and significant for staff and strategize next steps.
8. 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.
9. 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 session. Review outstanding items listed on the “parking lot” and develop an action plan to address these issues.
10. Prepare for next session. Review objectives for next session and determine steps for preparation as needed. This will include scheduling of coaches and staff for educational presentation and Gemba according to established plan.
A critical review of the experimental sessions was quite beneficial. Areas for improvement and adjustment were noted. The group also identified areas requiring changes to infrastructure, as well as purchase of additional tools such as white boards, and executive support was necessary to guide and direct these changes.
The group prepared a learning package for coaches and staff, and an information sheet to distribute to patients and families. The coaches were strategically assigned to work along specific staff, attempting to match skills, learning styles and personalities. The group used their experience with the working group sessions to create an appropriate agenda for the coaching sessions.
