The RROHCTM philosophy & method of delivering care combines patient & family-centered communication with high impact team practices to create positive health outcomes. We believe that when healthcare team members understand the results patients and families want, they operate from a common purpose to create a shared picture of success and an effective interdisciplinary care plan which clearly outlines the critical part of each member of the team.

Faculty:For the past 15 years Ruth’s national

consulting practice has worked with nursing care delivery models, critical thinking, delegation and leadership skills, and interdisciplinary team development with over 160 organizations. Ruth is the author of 5 books. She has developed a care delivery model and philosophy called Relationship and Results Oriented Healthcare (RROHC) based on her experiences with helping transform organizations. Her doctoral research focused on critical thinking and clinical judgment. She is most proud of being voted “boss of the year” by the MWBA in Spokane, WA, one of the “great head nurses” by the AJN in the 1980s, and helping raise 5 kids.

Ruth Hansten RN MBA PhD FACHE

Faculty: Kimberly McNally, RN MN, Coaching Expert

Kimberly McNally is a certified executive coach. Her expertise includes working with leaders and teams in over 50 organizations. She has significant experience in clinical, educational, leadership and governance positions both locally and nationally. She is Past-President of the Healthcare Educators Association and chairs the board of a large academic medical center.

Faculty: Linda Pullins RN MS Linda Pullins is the Vice President of

Patient Care Services at Marion General Hospital, Marion, OH, having thirty years of combined clinical and administrative experience, including critical care staff nursing and director of ancillary services. She has an MS from St. Joseph’s College in Healthcare Administration. Linda helped to lead her organization through the merger of two hospitals and has championed clinical and system improvements during her tenure. She has served as a community faculty member at Marion Technical College and Tri-Rivers School of Paramedicine. Marion General Hospital is a 160-bed community hospital.

What is a RROHC philosophy? (Relationship & Results Oriented Healthcare)?

3 Elements, 4 Ps, and 10 StepsWIIFM: What’s In It for Me (Us)?Sample Results 3 levels of educationMoving Forward: what’s next?

Outline

RROHC Program Patient/Family Results obtained through

an individualized relationships among care providers and the patient/family

Relationships among the care providers allow for the patient/family to become partners in achieving the pt/family’spreferred outcomes

Provides a common mental model for thinking and systems streamlining

Relationship & Results Oriented HC Program 3 Major Elements

Knowing the Patient Critical

Thinking/Problem Solving to get to preferred outcomes

Trans-disciplinary teamwork

3 Levels of Training & Certification

Relationship & Results Oriented Healthcare™ philosophy and method of delivering care combines patient and family-centered, outcomes-focused communication with high impact team practices to create optimal health.

When healthcare team members understand the results patients want, they operate from a common purpose tocreate a shared picture of success and an effective interdisciplinary care plan which clearly outlines the critical part (role) of each member of the team.

3 Elements of RROHC™ Philosophy

Skills/Behaviors to achieve this element:

• “Knowing” and partnering

• Introduction process and statements

• Focused listening process

• Outcomes/results focus

1. Fundamental Relationship with the Professional and the Patient and Family

3 Elements of RROHC™ Philosophy

2. Critical Thinking and Problem Solving to get to preferred outcomes

Skills/Behaviors to achieve this element:

• Logical, Analytical, Creative and Intuitive thinking

• Emotional Intelligence

• Problem solving 6 Steps

3 Elements of RROHC™ Philosophy

3. Transdisciplinary Teamwork

Skills/Behaviors to achieve this element

• 4 Ps known by all on team

• Coordination

• Communication

• Conflict Resolution

• Giving feedback

4Ps:PURPOSE - PICTURE - PLAN

- PART

What’s In It for Us? Bundle of Best Practices to teach novices and reignite

the jaded Consistency in care delivery A common language and construct to deal with

complexity: Throughput/volume Better communication w/MDs/team Better clinical outcomes and safety Improved staff and provider satisfaction RN retention improved Improved patient satisfaction

7. Interdisciplinary Rounds

3. Plan with Team &Give Initial Direction:

CT

5. Focused Interview at Eye Level: Plan

8. Checkpoints

9. Feedback & CelebrationRROHC

10. Plan assignments &Give report based On 4Ps

1. Fundamental Relationship w/ Patient/Family2. Critical Thinking & Problem-Solving

3. Trans-disciplinary Teamwork

6. Communicate Plan & Patient’s 4Ps

4. Introductory Rounds

2. Shift Report, Hand offs (4Ps)

1. Make assignmentsBased on 4Ps

Semantic Memory• Concepts

• Theories or models

• Knowledge

Episodic Memory• Personal Experiences

• Increases with number

Productive Memory:Basis ofCritical Thinking

Whiteside, 1997, DCCN

Promoting Professional Practice

Measured Improvement in Professional Skills through RROHC Education

Up to 37% Improvement

Skill Improvements

Errors, Falls, and Complaints

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1999 2000

Falls PPD

C/O PPD

Errors PPD

Increase in respect, coordination of care, communication, education

Sample small Small Community Hospital

Benefit Early with Bedside Goals

Physician Satisfaction

Patient Satisfaction, 6 years

RN Recruitment

63

5051

57

15

33

50

4035

22

1511

7

41

0

10

20

30

40

50

60

70

2001 2002 2003 2004 2005 2006

TotalNew GradsExperienced

RN Recruitment

*

* Through 09/09/06

Turnover and Throughput MultiCare Health System:

RN Turnover Decreased by 50%: (2002) 16.4% for the system-wide average to 7.3%, 13.9% in 2002 to 6.8% in 2005, 18.6% to 7.4%, and from 26.7% to 10.6%.

MGH: ER throughput: (2004) 8.7% admitted within 60 minutes to 70% or more

Harrison Case Study:Employee Engagement

Harrison Medical Center exceeded their goals for the 1st

to 2nd year improvement in employee engagement (Summer 2006)

Press Ganey: Acute Care/Pediatrics (Harrison)

Press Ganey: Progressive Care Unit (Harrison)

Press Ganey Emergency Department Harrison

In 2009, values are 97-99%!

Emergency Department

Bedside Case Presentations 85% of patients preferred to

be present when case discussed

68% found it increased understanding of their problems

85% says not breaching of confidentiality

84% would recommend 100% of students, interns,

residents believed it was valuable once experienced

Bedside discussion: Patients perceived doctors to be there 10 minutes rather than 6 minutes.

(Multiple studies: Lehmann at Johns Hopkins, Nair, Kroenke, Wang-Chenge)

Correlation Between Pt. Satisfaction and Positive Clinical Outcomes

Significant with PSat & willingness to recommend (O’Holleran)

2 strongest and absolute predictors of PSat Whether tx expectations

were met ∆ in symptoms, pain, or

“bothersomeness” (George SZ)

PSat may confer short term pain improvements (Hurwitz)

PSat predicted more compliance

(Hirsh)

Normalized BP and Stress acids (Annals of Internal Med 1992, Berkman)

Patient’s Preferred Outcome 84% of the variance of satisfaction

with treatment outcome had to do with eliciting the patient’s most important reason for undergoing treatment.

Overall clinical outcome, a priori self-selected clinical outcomes, expectations, psychological state, embodiment. (Hudak)

Pt/Family Satisfaction & Risk

Decrease in PSat scores related to rate of unsolicited c/o and risk mgt episodes

Middle tertile had 26% higher rate of malpractice suits

Bottom tertile had 110% higher rate of suits (Stelfox, Ghandi)

Failed communication most common cause (Eastaugh, Tongue)

Pt/Family Centered Communication Improved health outcomes (Halldorsdottir) Improved pt. and provider satisfaction Less risk of malpractice suits (Fortin)

Meet Nurse X-2008. She will be handling your recovery.

Any questions? Call Radio Shack.

RROHC Concepts Synergy with IHI, The Joint Commission,

NPSF recommendations for patient safety. Staff with a purpose are engaged, and

behaviors are customer-service oriented, family centered care.

Empowerment, accountability, and critical thinking training with concepts and on unit application develop staff expertise.

Sample Plan for an Organization’s Education Reading and prep Determine outcomes and measures Assessment : online surveys, shift report, conference calls Training: Foundations classes, Level 1 Specialist and Level

2 Facilitator Certification LT: Interdisciplinary Implementation LT: RROHC™ Master Coach training

The Five Rights of Delegation and Supervision are Incorporated into the 10 Steps of RROHC

The 5 Rights Right Circumstances Right Task Right Person Right Communication/Direction Right Feedback/SupervisionHansten and Washburn and NCSBN

RROHC Steps Assignments Initial Direction Checkpoints Celebration and Feedback

Checkpoint

NAs: “Every day RNs tell me I am appreciated.”

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

always sometimes rarely never morefdback

requested

Retention based on the 4 Ps: Motivation

GoalsFdback

Goals and Feedback

0102030405060

From Kouzes and Posner, 1993 from Bandura and Cervone research

PerformanceEffort

Performance effort increases nearly 60% (40% more than with feedback or goals alone)

Each individual must know the 4 Ps (purpose, picture, plan and part)

RROHC Specialist

Level 1 — Relationship & Results OrientedHealthcare Specialist:

1 day seminar + 4 months of guided self-studyThe Specialist is prepared to function as an expert team leader, charge nurse, clinical leader or allied health care leader who expertly demonstrates & role models RROHC processes.

RROHC Specialist

Level 1 —At the end of level 1, participants will gain:• An understanding of the RROHC philosophy & practicesfor immediate application on the job• Practical information on how to delegate, supervise &lead a clinical team• Experience applying critical thinking & problemsolving skills to clinical scenarios• Methods to communicate effectively & resolve conflict• Understanding about the coaching relationship

At the end of level 2, participants will:• Customize & conduct RROHC training using adulteducation principles• Apply advanced content on interdisciplinary teamwork• Increase emotional intelligence for self & others• Anticipate obstacles & facilitate team memberslearning new behaviors• Conduct basic coaching conversations with teammembers to accelerate learning RROHC• Use tools for conducting department-based auditing &focused problem solving

Level 2: RROHC Facilitator

Level 2 - RROHC Facilitator

Level 3: RROHC Master Coach

At the end of level 3, participants will know how to:• Diagnose organizational needs & orchestrate thechange process to implement RROHC• Coach in a variety of situations — for development &performance improvement• Create a coaching culture• Benchmark results & measure the rate of adoption• Communicate progress to stakeholders

We share the best practices & “lessons learned” from ourconsulting experience so your organization can align &reinforce all related variables to ensure success.

Results of the RROHC Process

From Good to Great to World Class Support of growth of RN professionalism Prepares staff for critical thinking and problem solving

in unit based councils Develops new leadership skills Better clinical outcomes Improved staff and provider satisfaction RN retention improved Improved patient satisfaction

It’s about the Patient/Familyand Partnerships to Achieve THEIR Results with all disciplines working together as a team.

Being Brilliant at the Basics:Bundling Best Bedside Practices

One must be BRILLIANT at the Basics to Become “World Class” (Roger Dow)

RROHC™ provides the templates

Never to know you are beaten is the way to victory.

It is a noble calling, the calling of Nurses but it depends on you nurses to make it noble.

I have never felt inclined to say, “resign yourself” but, overcome.

We should strive for what we can best do and what is most attractive and thereby find our duty.

Dare to stand alone.

Florence Nightingale

Celebrate Successful Teams!Questions?

www.Hansten.comwww.RROHC.com

Visit our Weblog atwww.Hansten.com/blog

Ruth Hansten at 360.437.8060Ruth@Hansten.com