Two Oregon Hospitals Take Unique Steps to Improve Communication
In the quest for improved provider communication, two Oregon hospitals used entirely different approaches and tools, and both saw success. Rogue Valley Medical Center created and launched a bedside handoff program that has improved both patient care and staff morale. Oregon Health & Science University has developed a new culture change workshop to engage their nurses and physicians in examining unit safety, improving communication, and open discussion of strategies for improvement. Both of these efforts are being driven by hospital staff and have created notable impacts.
Rogue Valley Medical Center
The Orthopedic/Neurology unit at Rogue Valley Medical Center (RVMC) is participating in Transforming Care at the Bedside (TCAB), a national program developed by the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement. This program engages front-line hospital nurses and leaders at all levels of the organization to improve quality, safety, team vitality, the patient experience, and overall team effectiveness.
RVMC used the TCAB approach to create and launch a robust bedside handoff program desired by front-line staff and developed by the nurses using the process. Nurses met weekly to discuss changes and refinements, developed a “flowing tool” to minimize redundant reporting, and developed a complementary tool for the charge nurse. To ensure a uniform process, nurses made a video of how to do a good bedside handoff and (just as importantly) how not to do a bedside handoff. All staff watched the video, took a quiz, and were certified by a TCAB team member; management was involved only to support the team. There was so much excitement about the process that every nurse on the unit was using the new tool before the official launch date. Unit manager Heather Mackey shared that communication has improved, potential near misses have been avoided, morale is up, and patient complaints are down from 4.66 per week to 3.42 per week in less than two months. When asked about their key to success, Mackey says, “I didn’t develop the tools – the team did. The decisions were truly made by the team.”
Oregon Health & Sciences University
Oregon Health & Science University’s (OHSU) Medical Intensive Care Unit (ICU) is dually enrolled in both the Oregon Patient Safety Commission’s Healthcare-Acquired Infection Prevention Collaborative and the Comprehensive Unit-based Safety Program (CUSP). CUSP, administered by the Oregon Association of Hospitals and Health Systems, is a structured framework to improve patient safety culture by engaging staff in identifying potential preventable defects, learning from defects that occur, and actively examining unit culture. OHSU’s Medical ICU used tools and ideas from the CUSP program to develop a culture change workshop series involving nearly all of their nurses and 75 percent of their physicians. Participants examined unit safety, improving communication, and openly discussing strategies for improvement. Each workshop involved 10-14 staff of different disciplines coming together for at least two hours and ultimately involved about 110 people. Using a variety of tools, surveys, and inspirational questions, participants surfaced ideas about staff satisfaction, patient safety and outcomes, and the inpatient experience. Together participants defined ideal communication as consisting of fewer physician pages, greater staff retention/satisfaction, a better patient experience, shared understanding of all plans, and better outcomes. OHSU is already seeing steps toward their goals and looking forward to a new workshop series on structured rounding using their new communication agreements and ideas from crew resource management.
