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Surgical Day Care at Victoria General Hospital. Using Huddles To Improve Communication in Surgical Day Care (SDC) presented at Spotlighting Surgical Improvement in BC November 15 & 16, 2012. Background. Strictly a SDC unit (no Short Stay) 20 stretcher bays - PowerPoint PPT Presentation
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Surgical Day Care at Victoria General Hospital
Using Huddles To Improve Communication in Surgical Day Care (SDC)
presented atSpotlighting Surgical Improvement in BC
November 15 & 16, 2012
Background• Strictly a SDC unit (no Short Stay)
• 20 stretcher bays
• Average of 40-45 patients per day. On busy days we can have up to 55 pts
• We are separate from the Main OR (up one floor) but we do have a SDC OR just down the hallway from us – More on this later
We were playing the “telephone game”
Purpose• We had no formal means of communication
with the whole group on a daily basis • Staff lacked clarity on some issues. Without
clarity, people create stories• Isolated areas in our unit and 2 Ors (one on
separate floor)• Manager comes and goes depending on issues
that have come up
Core Team• 9 RNs • One LPN that works in a treatment room in a
separate area of the hospital• CNL • CNE (shared with PARR)• Manager• Housekeeper• Associates: Surgeons, anaesthesia, OR and
PARR
Culture in our unit
What staff say we could improve on:• Working conditions• Safety Climate• Perceptions of Senior and Local Management
What staff say we do well:• Stress recognition• Job satisfaction
Surprises and Improvement Opportunities:• Teamwork Climate
Nurse input is well received
Disagreements are resolved appropriately
Physicians and Nurses work together as a well coordinated team
Leadership Decision:• During BCPSQC conference June 2012 the
concept of team huddles and planning sessions (start of the day for the OR teams) was discussed
• Manager and CNL made this the first priority for culture change and improvement
Data Debrief
• Survey results posted in a common gathering area for staff (Pod #4)
• Weekly staff meetings to go over results• Got clarification and feedback on questions • Voted on what we wanted to work on (staff
chose 2, Manager chose 1)
Improvement Focus
Daily Team Huddles Arrive in SDC• Easy to implement • Would be a start to improving Safety Climate,
Teamwork Climate, Perceptions of Senior and Local Management
• Enables daily input from staff (alerts, workload, changes, etc.)
Aim Statement
“SDC will do twice daily team huddles at 0735 and 1250. All staff will attend including,
Manager, CNL (will lead the huddle), RNs, Unit clerk, housekeeper, and when possible
physicians. We will achieve this 90% of the time (9 out of 10 huddles/week). We will start
huddles the last week of June”
Tests of Change• Started June 25, 2012• Everyone attended the huddles
Immediately a success with staff!
• Outline is reviewed regularly (informal PDSA cycles) with staff and leadership input
• We have adjusted times to be 0815 and 1430
• Staff only attend one huddle not two (reduce redundancy)
• We have started to include announcements for the day and reminders for the week
• Manager attends regularly. As decided by staff the minimum is 3 afternoon huddles/week
Next Steps
• Keep refining it so that the process is quick and efficient.
• Still asking improvement questions
• Is physician involvement possible – not with current times
Supports
Staff and leadership commitment!
Supports Cont’d
• On going PDSA cycles to refine the process
• Buy-in from the core team
Barriers
• Gathering staff – Will Vocera change this?
• Keeping it short – avoiding too many announcements, can become a social gathering
• Challenge to create an end statement to huddles
Lessons Learned
• Aha! Moment: BCPSQC conference • Input from staff is important • Change is continuous• This is only a small part to culture change and
there is more to come• Wasn’t as much push back from staff as we
anticipated
Contact
Nancy Reichheld, Manager PARR and SDC Victoria General [email protected]
Cheryl Larcombe, Clinical Nurse LeaderSDC Victoria General [email protected]