With all the initiatives in health care today, who can keep up with the number of new processes and protocols that need to be established? Imagine, then, our delight when we recognized that we were on the precipice of a solution that would address multiple initiatives.
Last fall, CHRISTUS Health nurse executives recognized that we needed to speed the rate of improvement on our patient experience scores and continue working toward our goal of zero harm across the organization.
We recently had rolled out two improvement initiatives that many organizations are using. Through a program called Nurse Leader Rounding, we seek to make sure that patients and their families have the best possible experience by giving them an opportunity to provide feedback and ask questions. And through our Bedside Shift Report initiative, we involve the patient and family to ensure a safe handoff between nurses at every shift change.
However, our progress on harm elimination and patient experience performance was simply not meeting our expectations, and we were getting impatient to see the anticipated results. Our nurse executives believed that we needed to add hourly rounding, an evidence-based intervention that improves patient care by letting nurses proactively anticipate and address patient needs.
We were concerned about adding another intervention before the previous two had been hardwired into our hospitals. That’s when it occurred to us that Nurse Leader Rounding, Bedside Shift Report, and Hourly Rounding are not distinct interventions; they are three parts of a single concept of care. This multifaceted approach—the Safety Experience Triad—forms a new way to organize the care we provide to those who trust us to serve their healthcare needs.
Once the Nurse Executive Council endorsed the concept, it was time to plan the rollout. We knew from experience that to carry out our mission every day, we needed input from frontline staff. To that end, we brought a group of direct care nurses, educators, patient experience leaders, and nurse leaders from each of our U.S. markets to our headquarters in Irving, Texas, to plan the launch and make recommendations about education, collateral pieces, and timelines.
A day of flying sticky notes, flip charts, and PowerPoint revisions generated a lot of enthusiasm. These nurses returned to their markets excited about this three-pronged strategy and became our champions for its rollout.
Tracking Performance
Defining success for these efforts is easy: We watch the data. For example, published studies document that hourly rounding is highly effective at reducing falls, so tracking our fall rates is a simple way to measure the effectiveness of our hourly rounding without adding metrics. Similarly, the scores patients give us for nurse communication and responsiveness are especially sensitive to these new activities, so they help us evaluate the effectiveness of the Safety Experience Triad.
The pilot trials for the Hourly Rounding component of the initiative have exceeded our expectations, with fall rates decreasing dramatically on the pilot units. In fact, CHRISTUS hospitals that were not in the pilot were so eager to get started that they launched their efforts with the pilots still in progress.
Most importantly, our overall harm scores hit a historical low in March. We are incredibly proud of our associates and caregivers.
Widespread Support
The secret to our success was simple: Involve those closest to the point of care. Our direct care nurses readily identified potential barriers to the new protocols and helped design realistic ways to overcome those barriers.
Beyond that, we had the leadership support needed to make this initiative a success. Our system director for patient experience helped design and implement the Safety Experience Triad and is coaching performance for success around the three components. Our human resource coaches supported the effort, as have others from many system-level departments. And the importance of this initiative reverberated throughout the organization when Ernie Sadau, our president and CEO, opened a leadership-level planning session with an impassioned plea regarding the imperative of standardizing best practices around these interventions.
Bottom-up and top-down support—it doesn’t get any better than that.
Debi Pasley, MS, RN, NEA-BC, FACHE, is system senior vice president and chief nursing officer, CHRISTUS Health, Irving, Texas.
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