The RROHC philosophy & method of delivering care...
Transcript of The RROHC philosophy & method of delivering care...
The RROHCTM 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 and families want, they operate from a common purpose to create a shared picture of success and an effective interdisciplinary care plan which clearly outlines the critical part of each member of the team.
Faculty:For the past 15 years Ruth’s national
consulting practice has worked with nursing care delivery models, critical thinking, delegation and leadership skills, and interdisciplinary team development with over 160 organizations. Ruth is the author of 5 books. She has developed a care delivery model and philosophy called Relationship and Results Oriented Healthcare (RROHC) based on her experiences with helping transform organizations. Her doctoral research focused on critical thinking and clinical judgment. She is most proud of being voted “boss of the year” by the MWBA in Spokane, WA, one of the “great head nurses” by the AJN in the 1980s, and helping raise 5 kids.
Ruth Hansten RN MBA PhD FACHE
Faculty: Kimberly McNally, RN MN, Coaching Expert
Kimberly McNally is a certified executive coach. Her expertise includes working with leaders and teams in over 50 organizations. She has significant experience in clinical, educational, leadership and governance positions both locally and nationally. She is Past-President of the Healthcare Educators Association and chairs the board of a large academic medical center.
Faculty: Linda Pullins RN MS Linda Pullins is the Vice President of
Patient Care Services at Marion General Hospital, Marion, OH, having thirty years of combined clinical and administrative experience, including critical care staff nursing and director of ancillary services. She has an MS from St. Joseph’s College in Healthcare Administration. Linda helped to lead her organization through the merger of two hospitals and has championed clinical and system improvements during her tenure. She has served as a community faculty member at Marion Technical College and Tri-Rivers School of Paramedicine. Marion General Hospital is a 160-bed community hospital.
What is a RROHC philosophy? (Relationship & Results Oriented Healthcare)?
3 Elements, 4 Ps, and 10 StepsWIIFM: What’s In It for Me (Us)?Sample Results 3 levels of educationMoving Forward: what’s next?
Outline
RROHC Program Patient/Family Results obtained through
an individualized relationships among care providers and the patient/family
Relationships among the care providers allow for the patient/family to become partners in achieving the pt/family’spreferred outcomes
Provides a common mental model for thinking and systems streamlining
Relationship & Results Oriented HC Program 3 Major Elements
Knowing the Patient Critical
Thinking/Problem Solving to get to preferred outcomes
Trans-disciplinary teamwork
3 Levels of Training & Certification
Relationship & Results Oriented Healthcare™ philosophy and method of delivering care combines patient and family-centered, outcomes-focused communication with high impact team practices to create optimal health.
When healthcare team members understand the results patients want, they operate from a common purpose tocreate a shared picture of success and an effective interdisciplinary care plan which clearly outlines the critical part (role) of each member of the team.
3 Elements of RROHC™ Philosophy
Skills/Behaviors to achieve this element:
• “Knowing” and partnering
• Introduction process and statements
• Focused listening process
• Outcomes/results focus
1. Fundamental Relationship with the Professional and the Patient and Family
3 Elements of RROHC™ Philosophy
2. Critical Thinking and Problem Solving to get to preferred outcomes
Skills/Behaviors to achieve this element:
• Logical, Analytical, Creative and Intuitive thinking
• Emotional Intelligence
• Problem solving 6 Steps
3 Elements of RROHC™ Philosophy
3. Transdisciplinary Teamwork
Skills/Behaviors to achieve this element
• 4 Ps known by all on team
• Coordination
• Communication
• Conflict Resolution
• Giving feedback
What’s In It for Us? Bundle of Best Practices to teach novices and reignite
the jaded Consistency in care delivery A common language and construct to deal with
complexity: Throughput/volume Better communication w/MDs/team Better clinical outcomes and safety Improved staff and provider satisfaction RN retention improved Improved patient satisfaction
7. Interdisciplinary Rounds
3. Plan with Team &Give Initial Direction:
CT
5. Focused Interview at Eye Level: Plan
8. Checkpoints
9. Feedback & CelebrationRROHC
10. Plan assignments &Give report based On 4Ps
1. Fundamental Relationship w/ Patient/Family2. Critical Thinking & Problem-Solving
3. Trans-disciplinary Teamwork
6. Communicate Plan & Patient’s 4Ps
4. Introductory Rounds
2. Shift Report, Hand offs (4Ps)
1. Make assignmentsBased on 4Ps
Semantic Memory• Concepts
• Theories or models
• Knowledge
Episodic Memory• Personal Experiences
• Increases with number
Productive Memory:Basis ofCritical Thinking
Whiteside, 1997, DCCN
Promoting Professional Practice
Errors, Falls, and Complaints
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1999 2000
Falls PPD
C/O PPD
Errors PPD
Increase in respect, coordination of care, communication, education
Sample small Small Community Hospital
RN Recruitment
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5051
57
15
33
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4035
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1511
7
41
0
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2001 2002 2003 2004 2005 2006
TotalNew GradsExperienced
RN Recruitment
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* Through 09/09/06
Turnover and Throughput MultiCare Health System:
RN Turnover Decreased by 50%: (2002) 16.4% for the system-wide average to 7.3%, 13.9% in 2002 to 6.8% in 2005, 18.6% to 7.4%, and from 26.7% to 10.6%.
MGH: ER throughput: (2004) 8.7% admitted within 60 minutes to 70% or more
Harrison Case Study:Employee Engagement
Harrison Medical Center exceeded their goals for the 1st
to 2nd year improvement in employee engagement (Summer 2006)
Bedside Case Presentations 85% of patients preferred to
be present when case discussed
68% found it increased understanding of their problems
85% says not breaching of confidentiality
84% would recommend 100% of students, interns,
residents believed it was valuable once experienced
Bedside discussion: Patients perceived doctors to be there 10 minutes rather than 6 minutes.
(Multiple studies: Lehmann at Johns Hopkins, Nair, Kroenke, Wang-Chenge)
Correlation Between Pt. Satisfaction and Positive Clinical Outcomes
Significant with PSat & willingness to recommend (O’Holleran)
2 strongest and absolute predictors of PSat Whether tx expectations
were met ∆ in symptoms, pain, or
“bothersomeness” (George SZ)
PSat may confer short term pain improvements (Hurwitz)
PSat predicted more compliance
(Hirsh)
Normalized BP and Stress acids (Annals of Internal Med 1992, Berkman)
Patient’s Preferred Outcome 84% of the variance of satisfaction
with treatment outcome had to do with eliciting the patient’s most important reason for undergoing treatment.
Overall clinical outcome, a priori self-selected clinical outcomes, expectations, psychological state, embodiment. (Hudak)
Pt/Family Satisfaction & Risk
Decrease in PSat scores related to rate of unsolicited c/o and risk mgt episodes
Middle tertile had 26% higher rate of malpractice suits
Bottom tertile had 110% higher rate of suits (Stelfox, Ghandi)
Failed communication most common cause (Eastaugh, Tongue)
Pt/Family Centered Communication Improved health outcomes (Halldorsdottir) Improved pt. and provider satisfaction Less risk of malpractice suits (Fortin)
RROHC Concepts Synergy with IHI, The Joint Commission,
NPSF recommendations for patient safety. Staff with a purpose are engaged, and
behaviors are customer-service oriented, family centered care.
Empowerment, accountability, and critical thinking training with concepts and on unit application develop staff expertise.
Sample Plan for an Organization’s Education Reading and prep Determine outcomes and measures Assessment : online surveys, shift report, conference calls Training: Foundations classes, Level 1 Specialist and Level
2 Facilitator Certification LT: Interdisciplinary Implementation LT: RROHC™ Master Coach training
The Five Rights of Delegation and Supervision are Incorporated into the 10 Steps of RROHC
The 5 Rights Right Circumstances Right Task Right Person Right Communication/Direction Right Feedback/SupervisionHansten and Washburn and NCSBN
RROHC Steps Assignments Initial Direction Checkpoints Celebration and Feedback
Checkpoint
NAs: “Every day RNs tell me I am appreciated.”
0%
5%
10%
15%
20%
25%
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45%
always sometimes rarely never morefdback
requested
Retention based on the 4 Ps: Motivation
GoalsFdback
Goals and Feedback
0102030405060
From Kouzes and Posner, 1993 from Bandura and Cervone research
PerformanceEffort
Performance effort increases nearly 60% (40% more than with feedback or goals alone)
Each individual must know the 4 Ps (purpose, picture, plan and part)
RROHC Specialist
Level 1 — Relationship & Results OrientedHealthcare Specialist:
1 day seminar + 4 months of guided self-studyThe Specialist is prepared to function as an expert team leader, charge nurse, clinical leader or allied health care leader who expertly demonstrates & role models RROHC processes.
RROHC Specialist
Level 1 —At the end of level 1, participants will gain:• An understanding of the RROHC philosophy & practicesfor immediate application on the job• Practical information on how to delegate, supervise &lead a clinical team• Experience applying critical thinking & problemsolving skills to clinical scenarios• Methods to communicate effectively & resolve conflict• Understanding about the coaching relationship
At the end of level 2, participants will:• Customize & conduct RROHC training using adulteducation principles• Apply advanced content on interdisciplinary teamwork• Increase emotional intelligence for self & others• Anticipate obstacles & facilitate team memberslearning new behaviors• Conduct basic coaching conversations with teammembers to accelerate learning RROHC• Use tools for conducting department-based auditing &focused problem solving
Level 2: RROHC Facilitator
Level 3: RROHC Master Coach
At the end of level 3, participants will know how to:• Diagnose organizational needs & orchestrate thechange process to implement RROHC• Coach in a variety of situations — for development &performance improvement• Create a coaching culture• Benchmark results & measure the rate of adoption• Communicate progress to stakeholders
We share the best practices & “lessons learned” from ourconsulting experience so your organization can align &reinforce all related variables to ensure success.
Results of the RROHC Process
From Good to Great to World Class Support of growth of RN professionalism Prepares staff for critical thinking and problem solving
in unit based councils Develops new leadership skills Better clinical outcomes Improved staff and provider satisfaction RN retention improved Improved patient satisfaction
It’s about the Patient/Familyand Partnerships to Achieve THEIR Results with all disciplines working together as a team.
Being Brilliant at the Basics:Bundling Best Bedside Practices
One must be BRILLIANT at the Basics to Become “World Class” (Roger Dow)
RROHC™ provides the templates
Never to know you are beaten is the way to victory.
It is a noble calling, the calling of Nurses but it depends on you nurses to make it noble.
I have never felt inclined to say, “resign yourself” but, overcome.
We should strive for what we can best do and what is most attractive and thereby find our duty.
Dare to stand alone.
Florence Nightingale
Celebrate Successful Teams!Questions?
www.Hansten.comwww.RROHC.com
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Ruth Hansten at [email protected]