Adopt, Adapt, or Abandon: An education plan built on process improvement

INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Adopt, Adapt, Abandon:An Educational Plan Built on

Process Improvement

R. Gino Chisari, RN, DNPDirector of the

Norman Knight Nursing Center & Clinical and Professional Development



Guiding Principles

• This was more than the “usual” process improvement strategy of the moment

• We would incorporate a known set of concepts and tools and apply them in a structured but flexible approach to designing a new reality

• All employees are included and encouraged to be part of the process

• Leadership support is mandatory

• New ideas to improve the work and for the team to learn together

The New Triple A



The Three Questions1. What are we trying to accomplish?2. What change might we try that could result in an

improvement?3. How will we know that a change is an improvement?

PDSA Cycle

Source: Langley et. al., The Improvement Guide

The Foundation – Plan, Do, Study, Act



After

Before

WASTE

Lean Targets Waste In a Process

Key: The Focus Is On the Process Not the People

VALUE

Value/Waste in Process

Source: GE Healthcare

The relentless pursuit of the perfect process through

elimination of waste & through respect for the worker

Lean – One Approach



• Define value from the patient’s perspective

• Identify the value stream – i.e. the patient’s experience from beginning to end

• Standardize work processes in order to identify & reduce unnecessary variation

• Establish and optimize flow

• Stop and correct defects, do not pass them along

• Continuously improve the process to perfection

Source: GE Healthcare

Lean Thinking – The Fundamentals

It’s About The Patient



• Test with willing volunteers

• Avoid the need for total consensus for testing

• Pick relatively easy, non-controversial changes first

• Collect useful data during the test and reflect on the results

• Be prepared to end the small test of change

• When the test is completed, select one of the following:

Adopt, Adapt or AbandonAdopt, Adapt or Abandon

Tips for Testing Changes

Adapted from IHI



The primary goals of the educational plan was to provide each participant with a:

• Strong base of support from which to successfully build upon, and actively engage on the Innovation Units

• Consistent understanding and application of the principles, concepts and other transportable components of the project’s aim across each of the innovation units



Approach• Self-study assignments and Proficiency

Evaluation of Acquired Skills (PEAS) • Facilitated/Interprofessional Workshops • Unit-based modules• Attending Registered Nurse Weekly

Meetings



Tracks• General – foundational, introductory

for all members of the community• Role – domain specific, including a

leadership track • Unit – team building/training



Content Areas• Quality & Safety• Satisfaction: patients, families and staff• Clinical Outcomes• Best Practices• Diversity• Care Continuity• Financial Outcomes• Compliance Outcomes



Ongoing and Continuous Development• Support the paradigm shift • Each member of the team is entitled to

professional development that raises the bar on excellence in patient and family centered care

• Designed on adult learner theory that actively engages the learner, resulting in a demonstrable change in behavior and performance



The Challenge and Opportunity• The need to continue providing

educational support to Phase I units, while simultaneously on-boarding Phase II and thinking about Phase III and beyond



Topic: Resiliency TrainingTarget Audience: All members of the

Interdisciplinary TeamGoal: To provide the opportunity for all

members within the interdisciplinary team to develop skills necessary to successfully adapt to the quick pace of change



Topic: Relationship Based CareTarget Audience: All members of the

Interdisciplinary TeamGoal: To provide a consistent and

uniform understanding of how each member of the interdisciplinary team has a unique opportunity to provide excellence through their personal contributions



Topic: Conflict EngagementTarget Audience: Leadership Goal: To provide the necessary skills to

effectively engage with conflict and produce a positive and healthy outcome and environment



Topic: Presentation SkillsTarget Audience: Attending RNGoal: To provide an opportunity for the

Attending RN to develop skill and confidence with their new and emerging role



Topic: DiversityTarget Audience: All members of the

Interdisciplinary TeamGoal: To understand how the needs of

our patients, families and ourselves impact on our relationships



Topic: HCAHPSTarget Audience: All members of the

Interdisciplinary TeamGoal: To provide a understanding and

meaning of patient satisfaction data and how every member of the team has a responsibility to “get the red out ”.



Topic: Leadership CoachingTarget Audience: Innovation Unit

Leadership (nursing directors & CNSs)Goal: To provide a dedicated support to

the unit-based leadership in managing the complex nature of change at the local level



Evaluation • Restate the goal• Assess for communication & marketing• Assess for availability and scheduling• Assess the adequacy of the content • Assess for personal goal attainment• Assess for an example of how the

information has been used• Comment section



Design• Electronic survey focusing on

communication and marketing strategies, availability and scheduling of educational activities, content and attainment of the desired outcomes of each activity

• Likert-type scale and free text responses that will be used to establish themes. The themes will drive further professional development and on-going educational interventions



“People grow through experience if they meet life honestly and courageously.

This is how character is built.”

Eleanor Roosevelt

Adopt, Adapt, or Abandon: An education plan built on process improvement

Health & Medicine

process leadership support

perfect process

educational support

interdisciplinary team

small test of change

continuous development

educational plan

improvement guide