Igniting Innovation: A Leadership toolkit

1. Igniting Innovation: A Leadership toolkit Laura Vento MSN, RN, CNL Melissa Callahan BSN, RN, CNL Jessica Mathers MSN, RN, CNL, CCRN Roxana Hazin MSN, RN, CNL

2. Who we are… • 36 bed PCU • Established in 2016 • Patient Population • Surgical Oncology • Colorectal • Gyn/Onc • Urology • Head & Neck • Abdominal Transplant

3. Jacobs 4th floor Quality Improvement structures • Purposeful Rounding, Recognition and Improving System Efficiencies (PRRAISE) • Ideas Team Collaborative • Reflection-in-Action Process (RAP) • Charge and Resource Development Tool

4. Purposeful Rounding Recognition And Improving System Efficiencies (PRRAISE) • Weekly leadership rounds • 2 hours night and day shift • Standardized Questions: • What is working well? • Is there an individual, group, or department that I can recognize for doing exceptional work? • Are there are any systems that need improvement? • Do you have the tools and resources needed to do your job? • Documented in Color Coded Spreadsheet • Green= Done • Yellow= In progress • Red= Cannot be completed at this time • Emailed weekly • Progress updates

6. Outcomes • Effective Communication • Closing the loop • Decreased needs identified • Empowerment of bedside team members • Innovation brought forth by the staff • Increased visibility and accessibility • Time efficiency • Manager and staff time • Lessened burden of requests • Requests bundled • Accountability • Employee Satisfaction Survey • Tier 1

7. Any Idea by anyone • “The ideas team had to commit to listening to any idea that anyone brought to them, to explain clearly why they rejected the ideas they rejected, and help people implement ideas that the ideas team deemed worthwhile” Excerpt from Kim Scott’s Radical Candor • Platform for all idea and project development under the oversight of UBPC • Collaborative will serve as the decision making body to say: • “YES” (green), “NO” (red), or “MODIFY” (yellow) to all performance improvement projects on J4 • If “NO”, then why? • Does the idea need modifications before consideration (yellow): Action plan? • Or is the idea green: Can next steps be identified?

8. Creating A culture OF LISTENING • GOALS: • Create a simple system for our team to use to: • Generate and/or discuss ideas • Provide feedback • Provide structured process and oversight for project development and implementation • Accountability for project implementation timeline • Avoid missed opportunity to innovate!!

9. Process & Structure ….Let’s Build this together Email submission of new idea to leadership team (Laura, Melissa & Jessica) • Email back with the following: • Scheduled presentation date • Provide project template • Support for presentation development provided during office hours every Wednesday All new idea project proposal presentations to occur in the first ~ 30-60 minutes of meeting (2 hour meeting) • Critically discuss feasibility and applicability of project at this time • The idea team will confirm the type of project…i.e. Quality Improvement vs. EBP vs. Research and give green light if applicable • Discuss barriers at length (presenters can request consultation/feedback for challenges) • Collaborate and outline implementation plan Once approved, templated implementation plan is uploaded into ishare • Individual or team to present updates/progress, monthly to Ideas team on ongoing basis in the last hour of meeting. • Spreadsheet to track all ongoing projects • Quick review of all ongoing projects every meeting to discuss progress on projects not reported out by team lead

10. Get ideas implemented

11. Outcomes • Expedited 3 CNIII’s • Nursing able to practice and hone quality improvement skills • Project development • Elevating each other’s practice • Public speaking skills • Managers: Time efficiency

12. Reflection in Action Process (RAP): Disrupting the traditional auditing process • Traditional auditing process • Resource or equivalent • Time inefficiencies data mining • Challenges with peer to peer feedback • Eliminates bedside nurse from quality review processes • Limited collaboration • Nursing knowledge of quality processes and prevention bundles

13. Nurse Knowledge 17% of nurses surveyed knew which NSIs J4 is outperforming for Magnet

14. Literature Review • Audit and feedback: effects on professional practice and healthcare outcomes • Cochrane Systematic Review: 140 articles • Auditing and feedback generally leads to small but potentially important improvements in professional practice, effectiveness depends on baseline (lower is better) and how feedback is provided • Healthcare Utilizing Deliberate Discussion Linking Events (HUDDLE): A Systematic Review, published: 2015 • Implementation of huddles led to improved patient outcomes, reduction in non-routine events, and improved teamwork • Reflection-on-action vs. Reflection-in-action • Reflection in the moment to guide decision making in real time

15. Reflection-in-Action Process • Showtime: 2x a day 11:00am/pm on weekdays

16. The Line-up

17. The RAP Sheet: • MC notes identified actions, opportunities and wins • Tool for RAP stars to close the loop during the shift • Tool to promote teamwork among the pod • Turn in RAP sheet at the end of shift to management

18. Outcomes • Zero CLABSIs! • Decrease in CAUTI, HAPIs • Culture change • Support for complex issues • Increased collaboration and teamwork • New grads

19. Charge and resource development Tool • Leadership roles designated based upon experience and seniority • Lack of standardization in evaluation process of: • Role performance • Harder-to-define characteristics • Developed structure for feedback and constructive conversation • Promote professional development • Individual Action Plan development • Maintain nurse in current role • Identify steps necessary to advance to desired role • Identify reasons for removing an individual from the current role

21. Outcomes • 7 nurses were kept in current roles • 6 nurses advanced into leadership role • 4 nurses currently bridging to role • Preceptorship to IMU level of care • Committee involvement • Succession planning

22. Thank you!What Questions do you have?