Creating the New Culture through Relationship Based Care

Barbara J Cashavelly, MSN, RN, AOCN, NE-BC, Nurse Director, Lunder 9

Adele Keeley, MA, RN, Nurse Director, Phillips 21

Thank You(It takes a village!)

• Jeanette Ives-Erickson, DNP, RN, FAAN• Debbie Burke, MSN, RN, MBA• Colleagues from the Institute for Patient Care• Barbara Blakeney, MS, RN, FNAP• The interdisciplinary teams of Lunder 9 and

Phillips 21

Objectives

• Describe how innovation based care transforms practice to create a healing environment

• Understand how leadership influences culture change at the unit level

Unit Overview

Phase One Innovation Unit• Lunder 9• 32 Bed

Medical Oncology Unit• Relationship Based Care

Model• Dedicated interdisciplinary

team

AONE CIT Grant/Phase Two Innovation Unit

• Phillips House 21• 20 bed

Gynecology/Oncology unit• Relationship Based Care

Model• Dedicated interdisciplinary

team

Innovation at the Unit level

• Relationship Based Care • Influence of Leadership• Influence reflected in focus groups (videos)

Relationship-Based Care

“We experience the essence of care in the moment when one human being connects to another. When compassion and care are conveyed through touch, a kind act, through competent clinical interventions, or through listening and seeking to understand the other’s experience, a healing relationship in created. This is the heart of Relationship-Based Care.”

-”Relationship-Based Care, A Model for Transforming Practice”, Mary Koloroutis, 2004.

Relationship Based CareA model for transforming practice~

Relationship-Based Care: Enhancing Collaborative Practice

From:• Independence• Hierarchical relationship• Parallel functioning• Medical plan• Resisting change• Competing• Indirect communication

To:• Interdependence• Collegial relationship• Team functioning• Patient’s plan• Leading change• Partnering• Direct communication

Relationship-Based Care: Care Team Model

• Knowing the patient • Coordination of care • Consistency of teams –improved performance of teams• Building plan of care around the patient• Clinical support aligned around patient populations rather than

transactions• Learn lessons from the past

Consistency = Continuity = Coordination = Efficiency/Quality

Adams Influence Model (AIM)

• Influence is essential in optimizing practice/work environments and outcomes

“Influence is the ability of an individual to sway or affect another group about a single issue based on authority, status, knowledge based competence, communication traits and or use of time or timing.”

Innovation Unit

“Leading the way to transformational change”

Inpatient units were:•Testing ground for change•Ideas were adopted, adapted or abandoned

Innovation Units Focus•Improves quality of care and clinical outcomes•Enhances patient and staff satisfaction•Increases safety, effectiveness, efficiency, timeliness, equitable, that is patient and family focused •Reduces costs and length of stay

Innovation Interventions

• A few examples of many interventions…– Attending Nurse Role– Quiet Hours/Noise at Night– SharePoint Site– Admit to Chemo-in project

Lunder 9

• Integrating the ARN role on the unit

• Chemotherapy project

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Data Run Chart

LOS and Chemo In

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Lunder 9Focus Group Themes

• Anticipating the Unknown • Preparing for the Change• Experiencing New Opportunities• Establishing a new culture – before and after• Leadership support• Identifying more opportunities

Phillips 21 Clinical Innovation and Transformation

(CIT)

• Brainstorming• Quiet at Night• SharePoint Site• “If it’s not broken…….”

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Quiet at night scores

• Scores went from 30% to 75%; sustained 75% since May 2013

• > than the 90th percentile

Phillips 21 Focus Group Themes

• Teamwork• Small wins led to big success• Staff seek out innovation• Leadership support • Opportunity for making a difference• “We didn’t know it was broken until we fixed it.”

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Influence of Leadership

Leaders inspire others when they have clarity of vision and purpose, confidence, and ability to influence others to share their vision, and a laser focus on what matters most: caring and healing relationships at the point of care.

Koloroutis, M. Relationship Based Care

Leadership Reflections

• Nurse Leaders have the ability to influence culture change by engaging staff.

• Success depends on nurse leaders creating a safe environment for staff to risk.

Culture Change for Units: Before and After

• Problem focused *Solution focused• Fear of failure *Learn from failure• Satisfied with *Innovative thinking

status quo • Resist change * Embrace change

Summary Endpoint

• Leadership begins at the bedside

• Innovation is the forefront of healthcare

• Staff are excited and embrace change

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