Relationship & Results Oriented Healthcare’s® 10 Best Practices at the

Point of Care

Today’s Agenda

Our team

Review : what is RROHC?

Why RROHC?

More indepth about RROHC

Field Results

RROHC Implementation

Q & A

www.RROHC.com

Hansten Healthcare PLLC Team

www.RROHC.com

We share your passion for patient/family

centered care delivered through expert

professional practice.

Faculty: Ruth Hansten, RN PhD FACHE

Consultant with > 175 organizations

Author of 6 books

Delegation & supervision , teamwork at bedside

Doctoral research focused on critical thinking and clinical judgment

Care delivery model and philosophy called Relationship and Results Oriented Healthcare® (RROHC)

Relationship & Results Oriented Healthcare™ Program & Care Model

Faculty: Kimberly McNally, RN MN BCC

Certified executive coach

The Nurse Executive’s Coaching Manual

(McNally & Cunningham, Sigma Theta Tau, 2010)

Worked with leaders & teams in 75 organizations

Previously held clinical, education, & leadership roles

Past-President - Healthcare Educators Association

Past-chair, Board of Trustees - large AMC

Chair, AHA Committee on Governance

RROHC development

Formerly the Vice President of Patient Care Services at Marion General Hospital, Marion, OH

30 + years combined clinical and administrative experience, including critical care staff nursing and director of ancillary services

Community faculty member at Marion Technical College and Tri-Rivers School of Paramedicine

RROHC Master Coach and began working with Hansten Healthcare as faculty in 2009.

Faculty: Linda Pullins, RN MS

What is RROHC?

Acronym for Relationship & Results-Oriented Health Care

Pronounced like “ROCK”…our symbol to visually describe the concepts

Way of working…set of principles & bundle of best practices to make your job easier

Organizational approach to improving patient outcomes

www.RROHC.com

RROHC

Method to clarify & teach a shared structure of care for all disciplines

Simplifies & makes sense of complex work

Embeds caring as a daily routine

Implement bundle of 10 best practices

Basics MUST be done accurately, consistently & expertly to achieve improvements with quality and safety initiatives

“We must

become

brilliant at

the basics

to become

world class.” Roger Dow and

Susan Cook

www.RROHC.com

Why was RROHC developed?

175 organizations (then >100)

Teamwork processes ? at the point of care

Omissions, clinical results, and/or poor pt/staff satisfaction

10 practices most often missed

Delegation/supervision gaps

RN/pt. relationship suffering from not knowing pt or team

Shared mental model or map helps for improved results!

www.RROHC.com

Gaps

Step 1: Assignment

Step 2-4: Shift report with SMM shorthand of 4 Ps,

planning w/team including checkpoints, and introduction, and rounds

Assignments do not reflect pt needs, staff needs, and lines of authority

Shift handover at the bedside can accomplish all of these, plus set up delegation for shift

www.RROHC.com

Gaps

Step 5: Focused interview at bedside

Step 6: Communicate plan and update w/team

Step 7: IDT Rounds

Nurses are often unclear about healing presence and listening skills, focusing on patient results

Nurses and UAPs parallel practice w/o teamwork

Nurses and other disciplines not in sync w/pt/family

www.RROHC.com

Gaps

Step 8: Checkpoints

Step 9: Feedback, celebration and debrief

Step 10: Plan assignments and give report based on pt/fam 4 Ps

Nurses and UAPs uncertain re: tasks and roles and don’t update or evaluate

Best teams recognize results and offer +/- feedback

Critical thinking from debrief used to inform next shift’s plans

www.RROHC.com

The RROHC® philosophy & method of delivering care combines patient & family-centered communication with high impact team practices to create positive health outcomes.

We believe that when healthcare team members understand the results patients & families want, they operate from a common purpose to create a shared picture of success & an effective interdisciplinary care plan which clearly outlines the critical part of each member of the team.

RROHC integrates…

Practical & realistic…grounded in real world

Intentional decision to care/healing presence

Critical Thinking & Clinical Judgment

Delegation & Teamwork competencies

Neurobiology

Adult Education Principles

Change Theory & Culture development

Patient/family Outcomes – 100% of the time!

Three Major Elements

1. Knowing the Patient

2. Critical Thinking/Problem Solving to get to preferred outcomes

3. Transdisciplinary teamwork

Bundle of 10 Best Practices to address the 3 elements

Implemented via 3 Levels of Training & Certification

Why an OUTCOMES Orientation?

Outcomes or Results = vision of preferred future Encourages Critical Thinking

Seeing Big Picture (purpose/picture)

Ability to Prioritize

Engagement of all to move more quickly toward that result

Includes patient engagement in healing

84% of the variance of satisfaction with treatment outcome had to do with eliciting the patient’s most important reason for undergoing treatment. (Hudak)

Why are Shared Mental Models Necessary?

Shared mental models help teams focus on common goals…

“filter and fuse an overwhelming amount of information and make

critical decisions under time constraints”

Purpose for nursing

Guides education, research

3 Elements of RROHC™ Philosophy

1. Fundamental Relationship between the Professional & the Patient/Family

Skills/Behaviors to achieve this element:

• “Knowing” & partnering

• Introduction process & language

• Focused listening process

• Outcomes/results focus

3 Elements of RROHC™ Philosophy

2. Critical Thinking & Problem Solving to get to preferred outcomes

Skills/Behaviors to achieve this element:

Logical, Analytical, Creative &Intuitive thinking

Emotional Intelligence

Problem solving 6 Steps

3 Elements of RROHC™ Philosophy

3. Transdisciplinary Teamwork

Skills/Behaviors to achieve this element

4 Ps (purpose, picture, plan, part) known by all team members

Coordination

Communication

Conflict Resolution

Giving feedback

5 Rights of Assignment & Supervision are Incorporated into the 10 Steps of RROHC

RROHC Steps

Assignments

Initial Direction

Checkpoints

Celebration and Feedback Checkpoint

7. Interdisciplinary

Rounds

3. Plan with Team &

Give Initial Direction: CT

5. Focused Interview

at Eye Level: Plan

8. Checkpoints

9. Feedback

& Celebration

Debrief

RROHC 10. Plan assignments &

Give report based on 4Ps

1. Fundamental Relationship w/ Patient/Family

2. Critical Thinking & Problem-Solving

3. Transdisciplinary Teamwork

6. Communicate Plan

& Patient’s 4Ps

4. Introductory

Rounds

2. Shift Report,

Hand offs (4Ps)

1. Make assignments

Based on 4Ps

Bundle of Best Practices

http://RROHC.com

Cost Effective Care

& Resource Mgt

7. Interdisciplinary

Rounds

3. Plan with Team &

Give Initial Direction: CT

5. Focused Interview

at Eye Level: Plan

8. Checkpoints

9. Feedback

& Celebration

Debrief

6. Communicate Plan

& Patient’s 4Ps

4. Introductory

Rounds

2. Shift Report,

Hand offs (4Ps)

1. Make assignments

Based on 4Ps

Staff

Engagement

Quality Safety

Patient

Satisfaction Team

Satisfaction

And Joy

Teamwork

Across the

Continuum

10. Plan assignments &

Give report based On 4Ps

Results

Clinical Outcomes

Staff Engagement

Nurse Satisfaction

Patient Satisfaction

Physician Satisfaction

Problem Solving Processes

Pre and Post RROHC Delegation Skills

Pre RROHC

473 Responses

Post RROHC 264 Responses Change

Clear Team Plan 0.88 0.98 0.10

Give Initial Direction to Members 0.94 0.98 0.04

Give Routine Feedback 0.78 0.87 0.09

Shift Report Contains 4Ps 0.58 0.87 0.29

Confident in Assigning Tasks 0.79 0.91 0.12

Comfortable Delegating Post Report 0.79 0.96 0.17

Use Planned Checkpoints 0.31 0.59 0.28

Ask for Team Feedback 0.59 0.87 0.28

Plans Based on Critical Thinking 0.65 0.90 0.25

Accountability Awareness 0.96 0.98 0.02

Evaluate Delegated Care 0.82 0.93 0.11

Clear about Roles 0.79 0.92 0.13

Pre and Post RROHC® Delegation Skills Education

Measured Improvement in Professional Skills through RROHC Education

Up to 37% Improvement

Pre and Post RROHC Professional Practice Improvements

Pre and Post RROHC Professional Practice 1-5 Years - Delegation Skills Improvement

Employee Engagement

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Nu

mb

er

of

Emp

loye

es

Enga

ged

P

er

Each

Em

plo

yee

Dis

en

gage

d

Oakwood Health System Gallup Data on Employee Engagement

2007

2008

2009

www.Hansten.com

MD Perceptions of Nursing Care Overall

0

10

20

30

40

50

60

70

80

90

2001 2002 2003 2004 2005 2006

12 15

17

8

37

82

Perc

entile

Rankin

g "

Exce

llent"

www.Hansten.com

At 4 Years: Press Ganey

Marion General Hospital

Inpatient Overall

(Percentile Ranking)

0

20

40

60

80

100

120

Q1'01

Q2'01

Q3'01

Q4'01

Q1'02

Q2'02

Q3'02

Q4'02

Q1'03

Q2'03

Q3'03

Q4'03

Q1'04

Q2'04

Q3'04

Q4'04

Q1'05

Q2'05

Q3'05

Q4'05

Q1'06

Q2'06

Q3'06

Q4'06

Overall

Inpt Nursing

*

* Implementation – RROHC

Amazing Consistency!

RN Recruitment

15

33

57

51 50

63

0 0

50

40

35

22

0

7

11

15

41

0

10

20

30

40

50

60

70

2001 2002 2003 2004 2005 2006

Total

New Grads

Experienced

*

* Through 09/09/06

Pressure Ulcer Hospital Rates

0%

5%

10%

15%

20%

Pressure Ulcer 8.1% 17.7% 10.3% 7.8% 9.9% 4.5% 6.5% 4.9% 3.3% 3.9%

Hospital Acquired 3.4% 9.5% 6.4% 1.7% 4.2% 0.5% 4.0% 1.8% 1.8% 2.7%

Unit Acquired 2.1% 7.9% 6.2% 1.2% 2.6% 0.2% 3.2% 1.2% 1.1% 2.7%

1st Qtr

2008

2nd Qtr

2008

3rd Qtr

2008

4th Qtr

2008

1st Qtr

2009

2nd Qtr

2009

3rd Qtr

2009

4th Qtr

2009

1st Qtr

2010

2nd Qtr

2010

Data Summary: Data above is from the quarterly pressure ulcer studies which are performed on all adult inpatient units by the

Wound Care representatives. Quarterly data is submitted to the National Database of Nursing Quality Indicators (NDNQI).

Both hospital acquired and unit acquired pressure ulcers rates have been decreasing since 2nd Quarter 2008.

Patient Falls: 4 South

4 South

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Falls per 1,000 pt days 5.06 4.52 3.62 4.34 1.77 1.50 2.71 4.06 2.23 2.20

# of falls 15 13 10 12 5 4 7 10 6 6

Falls with injury per 1,000 pt days 1.01 2.09 1.09 1.08 0.35 0.00 0.39 1.22 0.37 0.36

# Injury falls 3 6 3 3 1 0 1 3 1 1

1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09 4Q09 1Q10 2Q10

Patient Satisfaction -Nursing Overall :4 South

Situations on Unit Last Shift: 4 South

Had enough time with patients

0

20

40

60

80

100

Hospital All 65 72 79 82

4 South 50 88 72 91

2006 2007 2008 2009

The higher the score the more positive the rating.

% Yes

Think about the last shift that you worked.

Did any of the following situations occur?:

3. I had enough time to spend with each patient.

Response options: yes, no, not applicable.

4 South’s score for “Had enough time with

patients” is above the 90th percentile for adult

step-down units in Magnet facilities that

participated in the 2009 NDNQI RN survey.

Implementation

www.RROHC.com

Assessments (online & onsite)

Workshops

On-unit practicums

Expectations for follow-up with assessment & measurement

RROHC Specialist Course

RROHC 2 Day Facilitator Course with on-unit practicum

On-going Support to Sustain Results

Organizational Coaching - phone & on-site sessions Online education (learning.Hansten.com) (Level 1 Professional Practice Specialist self-study) January and June www.Hansten.com/blog Facebook: Hansten Healthcare PLLC Linked In: Ruth Hansten Twitter: @Rhansten Newsletters with videos/news/research New online education delegation product

www.RROHC.com

www.HanstenRROHC.com

OUTCOMES MEASURES

Ongoing unit progress skill & process measurement

Progress Measures

Ongoing individual staff skill & process measurement integrated into evaluations

Questions?

For more information about our

Relationship & Results Oriented Healthcare® Certification Program

See www.Hansten.com, www.RROHC.com

Ruth@Hansten.com or Kathy.Watkins@Hansten.com

T: 360 437 8060