Improvements in patient safety, quality of care, and organizational processes are fostered by work environments that empower and engage frontline nursing staff, nursing leaders say.
Creating an organizational culture that emphasizes quality, safety, and continuous process improvement is a must in order to provide value-based care.
More than two dozen nurse executives discussed nursing's in role providing high-quality patient care along with strategies to reduce errors, promote best practices, and support process improvement during nursing quality roundtable sessions at HealthLeaders Media's invitation-only 2016 CNO Exchange at the Bacara Resort in Santa Barbara, CA in November.
According to the group discussions, high-quality nursing care hinges on three components:
- Frontline engagement
- Empowerment
- Accountability
1. Engagement
When she began her role at Montefiore Health System's Wakefield campus in Bronx, New York, Joan O'Brien, MSN, RN, NE-BC, director of nursing, intentionally focused on ways to boost staff engagement as a means to improve the facility's HCAHPS scores.
"We created a list of 'nine elements' of how staff could [positively] connect with and engage patients and colleagues—namely by showing courtesy and respect," she says.
Knocking on the door before entering a patient's room, introducing oneself to patients and families, and asking for permission before assessing a patient are visible ways to communicate respect.
"Can I take your blood pressure? Which arm would you like for me to use? By asking, you're connecting with the patient," O'Brien says.
These interventions may sound simple, but they are effective. Over a four-year timeframe, the Wakefield campus' patient satisfaction scores rose and it received a patient satisfaction award from Press Ganey.
2. Empowerment
To sustain and continue quality improvements, it's crucial to tap into the wisdom of the frontline staff, O'Brien says.
"Now, whenever we have a problem, we go to the frontline staff and say, 'This is the issue. How can we make a difference?' When people take [on] ownership and accountability, things begin to change."
An empowered staff is critical to ensuring patient safety. When staff members have the confidence, authority, and support to raise concerns about safety and patient care, nurses can stop harm before it occurs.
At Anne Arundel Medical Center in Annapolis, Maryland, some clinicians were hesitant to escalate a concerns, says Barbara Jacobs, MSN, NEA-BC, RN-BC, CCRN-K, vice president of nursing and CNO.
To address this, she has provided a "resource nurse," an RN with critical care training, dedicated to responding to staff concerns. In addition, Jacobs trains staff on the steps to take and language to use to ask for help and resolve issues before defaulting to the route of rapid response.
"A nurse needs to be able to articulate her concerns," she says. "It's OK if you're not exactly sure what the problem is [and] you need someone more experienced to [assess the situation]."
3. Accountability
Accountability and team work are instrumental in driving consensus on best practices, nurse leaders say.
Baptist Medical Center Jacksonville in Florida holds hospital-acquired incident meetings, led by a chief medical officer and chief quality officer, who are both physicians, and a nurse from the quality team to discuss compliance, says Tammy Daniel, DNP, MA, RN, NEA-BC, vice president of patient services.
At the meeting, a nurse manager, nurse director, nurse navigator, and several staff members bring up a recent incident and discuss how it could have been prevented. The directors from nursing and other departments are in attendance so information can be disseminated throughout the organization.
"The CMO has the difficult conversations with the physicians. "You've got to have that physician partner with your nursing team to drive those metrics."
Full analysis of the in-depth discussions from the quality roundtable sessions can be found in the HealthLeaders Media CNO Exchange 2016 Insights Report: Seizing the Reins on Quality Control.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.