Terry Capuano

The effects of mindfulness-based stress reduction on nurse stress and burnout: a qualitative and quantitative study, part III.

Part III of the study on mindfulness-based stress reduction (MBSR) describes qualitative data and discusses the implications of the findings. Study analysis revealed that nurses found MBSR helpful. Greater relaxation and self-care and improvement in work and family relationships were among reported benefits. Challenges included restlessness, physical pain, and dealing with difficult emotions.

Work Flow Analysis: Eliminating Non-Value-Added Work

Objective: To evaluate the impact of implemented work environment changes on nursing and support staff roles. Background: In 1999, the authors identified key drivers of unnecessary work associated with the day-to-day delivery of patient care in their institution and implemented changes based on their results. Methods: Both quantitative and qualitative methods were used. Work sampling and focus groups were used to evaluate work flow. Activity categories were identified and clearly defined by advanced practice nurses. All compiled data were subsequently synthesized and cross-checked with the information acquired through independent, multidisciplinary validation studies. Results: There were significant changes (P <.0001) noted in overall distribution of observed activities for nurses and all support staff. Conclusions: The significant changes noted in overall distribution of observed activities reflect the important adjustments made in both job descriptions and the environment to eliminate key drivers of unnecessary work in the delivery of patient care.

Nonpunitive medication error reporting: 3-year findings from one hospital's Primum Non Nocere initiative.

Objective: To identify underlying practices and attitudes on medication error occurrences and reporting practices. Background: In response to a hospital-wide quality improvement initiative, a task force was formed to facilitate a nonpunitive culture toward reporting medication errors. To identify underlying practices and attitudes on medication errors and medication error reporting, a baseline survey was conducted. Based on findings, an initiative that included modifications to clinical and administrative processes was developed and implemented. Methods: A pre/post initiative questionnaire to measure staff practices and attitudes on medication error reporting was developed and administered. Findings from the presurvey were used to craft the Nonpunitive Patient Safety Policy and its implementation plan. Pre-post comparative analysis was performed following a baseline-postimplementation design. Results: Conceptually, a medication error is qualified by its outcome severity. Medication errors with more serious outcomes are more likely to be reported than those with less serious ones. Staff perception that medication error reporting carries the risks of disciplinary action was identified as a primary barrier to the likelihood of reporting. Conclusion: Evaluation of the initiative suggests that a multicomponent approach facilitates positive movement in the direction of a nonpunitive culture toward reporting medication errors.

Use of a Validated Model to Evaluate the Impact of the Work Environment on Outcomes at a Magnet Hospital

Abstract: Using a structural model, we evaluated the impact of leadership, staff stability, resources, workload, work environment, and staff expertise on nurse-sensitive patient outcomes to determine elements that can be modified.

Becoming a Leader in Patient Satisfaction: Changing the Culture of Care in an Academic Community Hospital

Abstract In the context of the current health care payer system, quality of care standards, financial incentives and consumer choice are not well aligned, yet competition for increased admissions has become a matter of survival. Satisfaction and loyalty are two constructs that are the most meaningful measures in the context of sustaining and increas—ing admissions. Lehigh Valley Hospital and Health Network (LVHHN) launched an ambitious patient satisfaction improvement initiative in 2001. LVHHN augmented existing patient service excellence programs with an ethnographic study of a representative unit. Interview and obser—vational data were analyzed using NVivo software. These results (four distilled domains of patient experience) can then be used to identify key components of the care environment that made meaningful differences in the perceptions of patients and their satisfaction. A designated interde—partmental task force can then develop interventions from those learnings, track outcomes through the Press Ganey scores, and ultimately yield in—creased admissions through unit-specific process change across the hos—pital. Admissions for fiscal year 2001 to fiscal year 2003 increased from 5,817 to 7,795 patients. The clear value and return on this initiative for our organization included a 34% increase in patient admissions over a four-year period. Improvements in both patient satisfaction and loyalty were demonstrated by a 24% increase for the question, “Likelihood of your recommending this hospital to others” as measured by the Press Ganey Inpatient survey. This initiative demonstrates the successful application of qualitative methods in a clinical microsystem to better un—derstand patient perceptions that determine their satisfaction with medical care.

Peer case review sharpens event analysis.

This manuscript describes a scholarly approach to peer case review that identifies and analyzes quality-of-care issues in response to a question about nursing care of a specific patient. The comprehensive method provides a structured format that critically examines untoward patient events, generates an awareness of gaps in care from a systems perspective, ensures action planning focused on legitimate root causes, stimulates performance improvement initiatives, and provides a forum to share learning throughout the organization.

Achieving succession planning and implementation: One healthcare network's story

Frequent transitions in leadership can cause inefficiency, inconsistency, and lack of alignment with priorities and strategy. Retaining management talent and collaboratively planning their succession can help ensure organizational survival. Succession planning, in healthcare and other industries, addresses some of these concerns; however, there is a dearth of descriptive articles emphasizing “how to.” This article demonstrates one healthcare networks comprehensive system for succession planning and implementation. Leaders looking to plan their human resource processes for organizational sustainability would be able to emulate and adapt practices for their networks.

Lehigh Valley Hospital: Engaging Patients and Families

BACKGROUND Lehigh Valley Hospital (LVH), a 623-bed tertiary care referral center, is one of two hospitals of the Lehigh Valley Hospital and Health Network. PATIENT AND FAMILY INVOLVEMENT Improving patient safety requires active engagement. Many units have collaborative rounds, which family members may join. Family meetings often include multimedia sources to review patient conditions, results, and plans of care. LVHs advanced intensive care unit program allows virtual meetings with an off-site intensivist. USE OF INFORMATION TO SET AND EVALUATE QUALITY GOALS AND PRIORITIZE INITIATIVES The Institute of Medicine (IOM) aims of care are addressed in terms of Donabedians clinical outcomes (safety, effectiveness, and timeliness), financial outcomes (efficiency), and service outcomes (patient-centeredness and equity). APPROACH TO ADDRESSING THE SIX IOM AIMS Two strategies to address the IOMs six aims have been employed--patient engagement and an emphasis on technology. More than

Development of a Reliable and Valid Organization-Specific Professional Practice Assessment Tool

30 million has been invested, thereby creating a digital hospital, which, in combination with evidence-based practice, uses advanced computerized and wireless systems to improve patient care and safety. CHALLENGES AND LESSONS LEARNED New problems evident once process improvements are made are quickly addressed. Technology cannot fix bad processes; rather, process improvements should come first, with technology then added to enhance those improvements.

The Professional Excellence Council: Implications for All Forces of Magnetism

PurposeThis article describes a study to devise an organization-specific professional practice model (PPM) assessment that reflects actual unit involvement. A secondary study goal is the development of a unit-based index that can be used to conduct comparative analyses in an efficient way. DesignEach of the 5 elements of the organizations PPM was represented by 1 or more items on an author-developed instrument. The tool was structured so that item scores could be summed to achieve a single subscale for each PPM element and further aggregated into a total score. MethodsThe instrument was administered to a 40% random sample of all regularly scheduled, full- and part-time registered nurses in an academic, community Magnet hospital in 2003 and 2005. Descriptive statistics were calculated for items, subscales, and summary scores for each patient care unit and overall. A weighted, unit-based index was developed to reflect each units score on a scale of 100. FindingsThe 2003 assessment response rate was 51% (n = 200); the 2005 response rate was 48% (n = 193). Subscale scores and a total PPM score were calculated by summing the values of each individual item. Submissions enabled calculations of total scores by unit, mean scores by item, and the development of a unit-specific PPM index of performance. ConclusionsBeyond shared principles of empowerment, the specifics of each organizations PPM may differ in those key components of care delivery nurses are empowered to effect. Thus, fidelity to the organization-specific PPM is not well tested with generic decisional-involvement instruments. An organization-specific assessment such as this one can provide evidence of not only organizational PPM fidelity but a quantitative method to ensure that staff nurse decisional involvement is continuously evolving to an ever higher state.