The Best Care Begins With the Best Staff
When the Barnes-Jewish Hospital neurosurgical innovation unit was in the works, the plan was to trial and then implement a variety of best practices directed at better patient care. Those practices deemed successful would be rolled out hospital-wide.
One year after opening, the unit is embracing the concept that better patient care starts with having leaders and caregivers who best align with the unit’s objectives.
One of the most innovative concepts was a program that created behavioral-based interview guides to select and develop staff for the unit.
“Nursing leaders and staff were hired based on the same competencies, but modified to their role. Everyone had to be willing and enthusiastic to try new things, speak up and escalate any concern for the sake of improvement,” says Liz Pratt, DNP, RN, ACNS-BC, research scientist and clinical nurse specialist.
The focus on hiring the right team was right on target. The unit is ranked in the 83rd percentile in overall quality of care when compared to like units by Professional Research Consultants, Inc. (PRC). This means it is performing higher than 83 percent of the neurological units across the country who are in the PRC database.
Another part of the unit’s success is the Marbella care management rounding tool. The assistant nurse managers round on (visit without being called for) patients daily just like other floors, but unlike other units, the questions are geared toward clinical care and patient expectations.
Clinical milestones such as achieving pain control and removing urinary catheters are monitored within specific timeframes. The milestones for patient expectations ensure that staff help patients understand expectations of their care, confirm whether our goals match up with their goals, and whether patients know their discharge date.
“Patients are tracked for the entire length of their stay; it’s not a one and done,” says Pat Potter, RN, PhD, FAAN, director of research for patient care services. “A report is available on each patient to see if they are having success and, if they’re not, we can adjust to make improvements.”
Another success Potter refers to is each patient’s journey through the mobility program. Patients are placed on a mobility protocol once they reach 11300. There are four levels of mobility:
- Turning and moving in bed
- Sitting up on the side of the bed
- Sitting in the chair
- Walking actively
Developed by the unit’s nurses, a sign displaying the mobility levels is kept within patients’ view as a reminder of their goals. The current average time all patients reach level four is 14.9 hours after surgery. According to Potter, at discharge, 93.8 percent are at level four. A few are in wheelchairs because they are not able to walk.
Christina Ward, BSN, BS, CMSRN, clinical nurse manager for the unit, reiterates the importance of the mobility program. “It helps prevent complications for patients down the road and has enhanced the relationships between caregivers and patients with more dialogue contributing to the success of the reduction in falls. The nurses have been diligent about interventions and safety measures.”
Ward sees a huge level of engagement with her staff. “We have an amazing team of nurses, patient care technicians, therapists and unit secretaries, and they have really owned the culture of safety. They share ideas on the board in the break room and many of our nurses participate in the UPC,” says Ward. Evidently, the feeling is mutual. The unit is using the Leadership Empowering Behavior Scale, which asks staff to evaluate the leader in the categories of:
- Enhances meaningfulness of work
- Facilitates goal accomplishment
- Fosters participation in decision making
In the first survey, Ward received an above average score for all three categories.
Potter, Pratt and Ward believe the success of the unit has a common denominator – the staff, specifically the hiring of the right staff, which leads back to the interview guides that were created for 11300. On Sept. 1, we began using the guides for the hiring of all nursing positions. Says Pratt, “A few hiring managers had been using behavioral-based interviewing. Now all nursing leaders have transformational competencies combined with behavioral-based interviewing, improving the consistency at Barnes-Jewish. This best practice can only result in more engaged units and leadership, and improved patient care.”