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To Jump Start Change, Look to Early Adopters

 |  By Alexandra Wilson Pecci  
   August 05, 2014

Forward-thinking nurse leaders who are at the forefront of unit-level changes can help lead change throughout the organization.

The idea of making huge, institution-wide changes can seem daunting, even to the most seasoned nurse leader. That's why when Linda Talley, MS, BSN, RN, NE-BC, Vice President and CNO at Children's National Health System in Washington, DC, wanted to pilot LEAN initiatives, she started with units that she already knew were helped by people whom she calls "change agents."

"You want to look for your early adopters so they can pilot," Talley told me. "We knew we needed to have a unit that was already successful."

Doing so not only ensures that the most forward-thinking nurse leaders are at the forefront of such changes, but also means that once the pilot is successfully completed, those forward-thinkers can help make institutional changes and "lead on behalf of the organization."

In the case of Children's National, some of those change agents are the nurses on its 7 East Medical Care Unit, which just received the Beacon Award for Excellence from the American Association of Critical-Care Nurses.

The more than 100 RNs on 7 East, a 50-bed acute care unit with a staff of 160, have been working on LEAN initiatives for the past nine months, says Debbie Freiburg, MS, RN, director for Medical Nursing and Patient and Family Education Program at Children's National. 

Among the ways that Freiburg and her team got staff engaged and involved in making changes and keeping up with them is through the use of what they call a "huddle board," a white board where unit metrics are posted for everyone to see in the conference room.

The metrics include real-time outcomes directly related to care, and features personal notes, such as who's gotten married, had a baby, or achieved a new professional certification.

"You want to get the staff more involved," Freiburg said, and the huddle board provides that in black-and-white, actually showing staff how their actions have made a difference, "letting them know how they have increased the patient satisfaction."

For instance, their LEAN work has helped them improve their patient discharge scores, as well as see a reduction in pressure ulcers and falls, and increased accuracy and compliance with Pediatric Early Warning Scores (PEWS). In fact, Freiburg says they've achieved 100% compliance with everyone using the PEWS.

Another interesting element of the huddle boards is what Freiburg calls "Just Do Its." These address little problems or annoyances that could have easy fixes. Instead of simply complaining about such problems, and wishing that someone else would fix them, the staff puts the problems on a grid in the middle of the huddle board. That way, they can "just do it" and solve them. The grid includes four sections:

  • High impact of change, low complexity; do it now
  • High impact high complexity; needs help, is a challenge, and will do soon
  • Low impact, high complexity, might be a "not do it" for now
  • Low impact, low complexity; we will work on it when we can

The action items are voted on by the staff, who decide where they belong in the grid. Among recent "just do it" items were fixing a broken chair and getting a printer hooked in a more convenient location, so staff could get discharge summaries to patients more quickly.

The printer, for example, had a high impact: Using its Press Ganey patient satisfaction scores as a guide, the unit knew it had room for improvement when it came to elements such as providing clear discharge instructions and getting patients discharged in a timely manner.

In the case of fixing chairs, the impact was felt by both patients and staff. Freiburg said one of the nurses on the unit had pointed out the broken chair, and finally feels like he's being listened to now that it's been fixed.

"He's able to have more time with the patients… we have fixed those little things," she said. "He felt empowered because we listened to him, but more importantly we had it fixed within two weeks."

Now that the 7 East Unit has had such success with its LEAN initiatives, its leaders can help spread that change to the rest of the organization. They know what they're doing because they've already done it.

"We have experts now," Talley said. "You really need to people who are at the sharp edge of the knife, driving the change."

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Alexandra Wilson Pecci is an editor for HealthLeaders.

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