NurseWeek News

Innovations at an Austin hospital to improve patient care and job satisfaction nationwide come just in time to help a dwindling number of nurses treat a growing number of patients.

Seton Northwest was among three hospitals chosen for Phase 1 of a two-year, $1.4 million study funded by the Robert Wood Johnson Foundation and conducted by the Institute for Healthcare Improvement.

The study, “Nursing: Transforming Care at the Bedside,” is designed to improve patient care by making changes in systems of care delivery for hospital medical/surgical units. Seton Northwest also is participating in the second phase, which began in June.

“It’s been pretty incredible to watch,” said Joyce Batcheller, RN, MSN, CNAA, senior vice president and network chief nursing officer for Seton Healthcare Network.

Pat Rutherford, RN, MSN, vice president of the Institute for Healthcare Improvement, said Seton Northwest was chosen because it’s part of Ascension Health, which has a reputation for being a health care innovator. Seton Northwest, in turn, is seen by Ascension officials as an innovator within its system, Rutherford said.

Seton Northwest is one of four Seton Healthcare Network hospitals to achieve the Magnet award designation, the highest national honor awarded for nursing care. Seton Northwest is a nonprofit, acute and subacute care, 113-bed hospital with more than 5,500 inpatient visits per year. The hospital has 10 operating rooms. More than 7,000 inpatient and outpatient surgeries were performed last year.

Seton Northwest and the two other hospitals were asked to come up with and test innovations and ideas for change that contributed to a “detailed conceptual framework” and a package of ideas that would redesign patient care at the bedside.

The project comes three years after a 2001 report by the Institute of Medicine. Its authors, representing every major stakeholder in the health care industry, recommended a fundamental system redesign. They advised changes be made to improve safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.

Batcheller, a 29-year nursing veteran, said the nursing staff began with a brainstorming session to come up with ideas for improvements without regard to cost. She said that within three to four hours the staff had come up with more than 300 ideas, which were then grouped based on how easy they would be to implement.

“The majority of the ideas were fairly easy to do and cost minimal dollars,” she said. “What the staff did was come up with a series of tests they wanted to do in terms of new ideas.”

They then tested them using the Institute for Healthcare Improvement’s “rapid cycle,” in which ideas are tested on a small group of patients and/or with a small number of staff members. The results are reported back to the main group and a decision is made about whether the idea should be abandoned, adopted, or adjusted.

Mary Viney, RN, MSN, director of patient care services for Seton Northwest, said some ideas worked so well they were immediately implemented and spread to other departments. Others still are being studied and several ideas were abandoned.

One idea that worked is a nurse status board where nurses declare their level of work using green, yellow, and red magnetic dots. They place the dots next to their names on a white board every two hours. Green means all is well, yellow indicates that they’re a little behind in their work, and red denotes that they’re swamped with work, Viney said.

Nurses who placed red dots next to their names often received help from others to help them catch up, Viney said, and nurses who placed red dots next to their names were motivated to work harder and improve efficiency in order to upgrade their status.

Batcheller said another idea that worked was the implementation of quiet zones in areas where medications were being put together. Reducing noise led to fewer mistakes and better care for patients. Yet another change has been the practice of nurses making rounds with physicians (an old practice that is being reborn). She said the physician, nurse, and patient discuss five key issues.

Issues covered are results from the previous day, updates on previous problems, patient issues and questions, plans for the day, and progress toward discharge. The result has been better progress, better communication, fewer calls to physicians, and better patient satisfaction, Batcheller said.

Patient-centered care is one of the project’s overall missions. The care should honor the whole person and family members and respect individual values and choices, according to a project mission statement. Other major components of the mission are to ensure that care is safe, reliable, effective, and equitable and that it be administered in a joyful and supportive environment that nurtures professional development.

Another major component of the overall mission is to ensure that all care is free of waste and promotes a continuous flow. More measurable goals are to increase the amount of time nurses spend with patients from 35% to 70% and to reduce time spent on paperwork by half.

Rutherford said nurses spent too much time “hunting and gathering” for supplies, which takes them away from patients. She said helping nurses increase the amount of time doing things that motivated them to go to nursing school in the first place will improve morale and, ultimately, patient care.

Phase 1 of the project took place between August 2003 and March. The second phase, which began in June and will continue through March 2006, is being conducted at 13 hospitals across the country, including Seton Northwest. Staff at these hospitals will continue to innovate and implement comprehensive changes on a designated medical or surgical unit as well as at the organizational level. The changes must result in improved levels of care for patients and families and an improved work environment for staff.

Viney said Phase 2 will seek to measure the improvements being made in regard to patient outcomes, satisfaction levels, staff retention, and the ability to recruit nurses.

“If it worked on one shift, we stopped there and now our job is to go back and think about those things that worked well and [that] we need to implement on all shifts or with all doctors,” she said.

Seton Northwest will work with experts from the Institute for Healthcare Improvement to report on findings weekly and monthly. And they will continue to work with support departments internally to reduce test cycle time, decrease patient waiting, and increase efficiency.

Batcheller said nurses felt valued because it was their ideas that were being researched.

“They have the answers,” she said, referring to the frontline health care providers. “I just don’t think we necessarily ask and listen to what they’re telling us. Staff can see that the changes they’re making are making a difference and the resistance to making changes is less because they can see the results.”

Phase 3 of the project will disseminate successful changes on a widespread basis. Batcheller said the project has proved so successful at Seton Northwest that three other Seton hospitals are considering starting similar teams.