Running head: LEADERSHIP STRATEGY ANALYSIS 1

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1 Running head: LEADERSHIP STRATEGY ANALYSIS 1 Leadership Strategy Analysis Cheryl A. Nienaber Ferris State University

2 LEADERSHIP STRATEGY ANALYSIS 2 Abstract Nurses have the duty to provide a safe environment to the patients entrusted to their care. Shift change is a time for staff members to exchange information regarding those patients and pertinent information to keep them safe. Bedside reporting provides the opportunity to meet the patient, review current plan of care (POC) and clarify additional information. Multiple theories have been utilized to introduce staff members to bedside reporting. Ultimately, it is not the theory that matters; it is the end result, increased patients satisfaction and safety. Keywords: bedside report, change of shift, hand over, patient satisfaction.

3 LEADERSHIP STRATEGY ANALYSIS 3 Background and Purpose The purpose for quality and safety initiatives is to review current policy of an institution and compare those policies to current best practice evidence based guidelines. Each team member must understand the organization s mission and values, and keep an open mind during the process of change. The foundation of quality management (QM) is based on open communication and willingness to modify current trends in order to maintain high standards. They do not focus on blame, only on how to improve the current situation (Yoder-Wise, 2011). The leadership strategy of a manager is to continually seek ways to improve patient safety, satisfaction, and overall patient experience of their hospitalization. Evidence based practice (EBP) is the leading factor of change within the hospital setting. Clear roles and responsibilities are designated by the manager as leaders are identified and empowered to assist in the quality improvement (QI) process (Yoder-Wise, 2011). It is through this open communication that the QI process is successful. Clinical Need A clinical activity for review is the current transfer of care during shift-to shift reporting. This process had been completed a variety of methods over the years. Situation, background, assessment, recommendation (SBAR) is one tool, while other communication styles include verbal handoffs, and recordings. Previously, this facility has used the SBAR format and did a review of EBP to seek updated procedures. Laws & Amato (2010) stated, communication failures during shift reports as a leading cause of sentinel events in the United States (p.70). A National Patient Safety Goal was established that demanded improved communication during hand-offs. The focus included a time to ask questions and seek clarification as necessary (Revere & Eldridge, 2008).

4 LEADERSHIP STRATEGY ANALYSIS 4 Bedside reporting allows for both shifts to visualize, and identify priority patients (Laws & Amato, 2010). The benefits of this workflow indicate the highest acuity patients are evaluated first by the oncoming shift, and nurses do not rely on written reports. Environmental scans also improve patient safety as intravenous (IV) solutions, oxygen, lines, and drains are verified by both team members. A 32-bed medical-surgical unit from the University of Michigan Hospital participated in a trial of bedside reporting. The trial evaluation cited nursing staff was slow to adopt this new process, yet staff members realized the importance of this change. The rapid response team was notified of multiple condition changes that were detected during this time frame; therefore, increased better patient outcomes occurred (Evans, Grunawalt, McClish, Wood & Friese, 2012). Interdisciplinary Team Change, of any nature, is met with resistance; therefore, multiple team members must be utilized in preparation of this process. To promote teamwork, representation from each level of staff members that would be affected with this change were invited to be part of this process (Yoder-Wise, 2011). In bedside reporting, this team consisted of three main groups, the facility trainer, the unit manager, and champion nurses. The facility trainer utilized their position to provide evidence based information to show that bedside reporting is the best available option for patients. The trainer was successful in promoting teamwork, support and education to better prepare staff for changes. Educational power points were created for staff members, along with a short quiz to acknowledge the change process. The unit manager was available to share input from staff members and voice potential barriers to success of this program. She utilized role play to assist employees to feel comfortable

5 LEADERSHIP STRATEGY ANALYSIS 5 as they practiced scripts; the manager remained visible at shift change for the first three weeks to assist in complications as they arose. The final team members were champion leaders who were selected to assist with rolling out this campaign. These leaders were specially selected to assist in the promotion of bedside report due to their leadership, positive attitudes, and their continued support of evidence based practices. Data Collection A method of data collection of projects often requires the use of flowcharts, line graphs, histograms or fishbone diagrams, each with benefits and downfalls (Yoder-Wise, 2011). The multidisciplinary team worked together to promote bedside reporting, gather information on the current policy and potential barriers that would hinder the group s success. Once items were identified, a survey was created to reflect current knowledge and fears of bedside report. For this project to be successful, education was necessary to provide staff with the responsibilities of each team member. By providing staff with the necessary tools, transitioning to bed-side reporting will be a smooth process (Yoder-Wise, 2011). The pre-implementation phase involved addressing potential barriers. Nursing staff agreed that bedside reporting can increase safety, promote teamwork, hold off-going staff more accountable and promotes patient participation in their plan of care. It also provided areas of concern such as confidentiality, and length of time during report (Laws & Amato, 2010). Initial concerns were addressed through inservice education, manuals, and handouts. Patients were educated and encouraged to assist with their daily goals and ensure their needs were addressed. Their plan of care could be adjusted as necessary.

6 LEADERSHIP STRATEGY ANALYSIS 6 Outcomes A standard of care, goal for improvement, which was utilized for this project, involved nursing sensitive outcomes. These outcomes can be measured through interventions that improve the quality of nursing care for the patient (Yoder-Wise, 2011). The test facility transitioned to bedside reporting on September 4, Prior to implementation to this new system, it was decided to utilize the Press Ganey Reports to measure overall satisfaction, perceived involvement in care, team cooperation, and feeling of safety. Initial Press Ganey reports indicate that all areas have increased by at least 10% since the start of the program. The committee will evaluate the outcomes at three month intervals for the first year. After, six month intervals will be used to ensure continued growth, development, and patient safety and satisfaction. A study conducted by Laws and Amato involving bedside reporting, confidentiality rose from 59% to 100%; patient involvement increased from 29% to 78%; team cooperation rose from 29% to 49%; while accountability jumped from 39% to 59% (Laws & Amato, 2010, p. 73). This study was utilized as the basis for this facility to trial bedside reporting. If successful on this unit, then the goal would be to initiate a facility wide roll out of the policy. Implement Strategies The five step Diffusion of Innovation Theory was utilized to initiate bedside reporting. Knowledge component is the first step. The unit manager used information gained from research and employee questionnaires to gain insight of the benefits and pitfalls of bedside reporting. Next is persuasion. During this stage the manager gathered informal feedback regarding the possibility of changing current policy to reflect evidence based practice. This step is used to

7 LEADERSHIP STRATEGY ANALYSIS 7 spark interest in moving from a favorable attitude to behavior change (Yoder-Wise, 2011, p. 418). The decision to commit to this new procedure was the third step. This involved seeking staff support and team leaders to help implement this policy. The forth step of the process was the actual implementation (Yoder-Wise, 2011). Role play and scripting were utilized to prepare staff members for the change. Staff members were leery at the beginning; however, the continuous support and feedback has helped to make this project successful. The final step is the confirmation, or evaluation of the innovation (Yoder-Wise, 2011). The unit is not quite at this step yet. Prior to beginning the change process an informal survey was utilized to review staff fears, attitudes and bias on the project. The majority of staff members feared making HIPPA violations, increased time for the report, and being stuck in rooms due to issues such as patients asking for water and toileting. These concerns were valid and were addressed prior to implementation of the project. Evaluation According to Burns and Grove (2011), nurses acquire knowledge through traditions, authority, borrowing, trial and error, personal experience, role modeling, intuition, and reasoning (p.16). With these techniques, nurses can revise current situations to improve patient outcomes. The evaluation process for this change was established during the planning stages of this project. The frequency of the evaluations, at the start of the program, will allow for modifications as the team gathers additional information and feedback from staff members and Press Ganey scores. Barriers to the success of the program can be dramatically reduced due to frequent check points. Revisions can be made to the current plan and modified, if indicated.

8 LEADERSHIP STRATEGY ANALYSIS 8 Thus far, the unit has noted improved Press Ganey scores, positive verbal and written feedback from patients and increased nursing satisfaction. The formal evaluation process is slated to begin October 31, 2012, 60 days after the initial implementation. At that time, barriers will be reviewed, and recommendations will be forwarded to the manager to make adjustments to the current process. While initial change can be difficult, by working together and promoting teamwork, the best outcomes for the patients will be achieved. Patient satisfaction and safety, along with an increased sense of teamwork and cooperation will enable staff to prioritize the work flow for the shift and ensure patient safety (Laws & Amato, 2010, p. 74). Scholarship Theory and evidence based research work together to initiate change. The biggest challenges at the launch of this study were patient participation and nurse insecurity related to communication. Champion nurses were available to address these challenges and support nurses during this time of change. Laws & Amato (2010) indicated that policy was changed, and staff members were forced to comply. Although staff members were reluctant for the change, positive results were noted in a survey conducted four months after the implementation of bedside reporting. Another hospital in Phoenix, Arizona chose to utilize Lewin s change theory to incorporate bedside reporting into their facility. Lewin s model consists of three steps. The first step involves the unfreezing process. Members recognize that change in policy or procedure is needed to improve client outcomes. The second step is the moving stage. Interventions are designed to plan, initiate and revise the plan. The final step is the refreezing portion. The policy has now become part of the practice (Caruso, 2007).

9 LEADERSHIP STRATEGY ANALYSIS 9 There are several different models and theories that can be utilized to promote positive changes within the work environment. Each facility must determine the process that will work best for them. The current unit trialing bedside reporting chose to use Diffusion of Innovation Theory, as it has worked in the past for them. While early indications show that this program will be successful, team members are ready to make adjustments as needed for achievement of the project.

10 LEADERSHIP STRATEGY ANALYSIS 10 Reference Burns, N., & Grove, S. (2011). Understanding nursing research: Building an evidence-based practice (5 th Ed.), Marilyn Heights, MO: Elsevier Saunders. Caruso, E., (2007). The evolution of nurse-to-nurse bedside report on a medical-surgical cardiology unit, Medsurg Nursing, 16(1), p Evans, C., Grunawalt, J., McClish, D., Wood, W., Friese, C., (2012). Bedside shift-to-shift nursing report: Implementation and outcomes, Medsurg Nursing, 21(5), p Laws, D., & Amato, S. (2010). Incorporating bedside reporting into change-of shift report, Rehabilitation Nursing, 35(2), p Revere, A., & Eldridge, N. (2008). Joint Commission National Safety Goals for Topics in patient safety, 12 (1), p.1-4. Retrieved from Yoder-Wise, P. (2011). Leading and managing in nursing (5 th Ed.). St. Louis, MO: Elsevier Mosby.