Nursing teams contributing to breakthroughs
WHEN the Philippine Heart Center (PHC) started to adopt the Performance Governance System (PGS), it asked the various units and teams in the hospital to look at very carefully, and to understand deeply, the different strategic objectives the entire hospital had committed to attain in pursuit of its “vision” for PHC. It then asked a simple, straightforward question to each unit and team: How can you contribute to the attainment of at least one or two of the PHC strategic objectives?
The nursing teams immediately got to work to come up with an answer. In the words of Dr. Buhat: “We conducted a 2-day strategic planning exercise. All nurse managers were asked to attend and participate so they would align their nursing programs to the PHC breakthrough goals. In the process, they were asked to review programs, methodology, approaches, policies, and procedures.” The exercise proved to be intense, but at the end, the different nursing teams agreed “to work on two nursing breakthrough outcomes. The first of these was to decrease medication error from 12 cases per month to only 9; and the second, to increase patient satisfaction from 89% to 97%. Both breakthrough outcomes should be delivered by the end of 2016.”
As experience with a governance and transformation program abundantly attests, it is easy to set breakthrough goals; but it requires system and effort to achieve them.
Dr. Buhat writes concerning the first breakthrough goal: “It was mandated across the board, but particularly in all the medical surgical floors. For every shift, added to the core nurse function was a medication review of properly measured performance by each nurse. We introduced template forms for standardized reports, to facilitate understanding and compliance assessment. We organized cascading and training sessions, from top to bottom, so as to spread understanding on the what, when, where, when, and why of the practices and activities associated with this specific breakthrough outcome. Monthly over-all performance reports were tracked. Corrective actions were immediately taken. And after six months, we found that medication error decreased by 50%,” or well ahead of target.
For the breakthrough outcome associated with patient satisfaction, the nursing teams adopted various approaches, which inevitably brought in more acronyms to PHC. Again, Dr. Buhat has this to say: “In pediatric cases, nurses at every shift were encouraged to talk with the patient and to add a simple caring touch. The nurses adopted the “Pediatouch” (touch of a caring heart), adapted and benchmarked against international best practice. In wards attending to adult critical cases, the nurses adopted “patch” (pain activities of daily living treatment, comfort level, and hygiene). In the emergency room, nurses had the “Hope” program (health teaching and orientation coupled with patient update and enlightenment). At bottom of all these acronyms was the insistence on “timely patient service assistance.”
Dr. Buhat concludes: “Such team efforts to personalize patient service and assistance through increased patient interaction” contributed significantly “to increasing patient satisfaction of 89% in 2013 to a high 97% in 2015.”
Certainly, not yet a perfect score, but with the target already achieved, the nursing teams at PHC were certainly getting ever-nearer to perfection. While they may never attain a perfect score, still the team efforts continue to get as close to perfection as possible!