Transforming a unit’s culture to improve clinical outcomes.

Abstract

243 Background: Leadership identified an unhealthy work environment existed in our Oncology Hematology Special Care Unit (OHSCU). This was evidenced by increased turnover, low National Database of Nursing Quality Indicators (NDNQI), and nurse sensitive quality indicator scores. In the fall of 2014 changes were made to the unit with a goal of creating within the unit a culture of clinical excellence, engagement, professionalism, accountability, and improve staff satisfaction. Methods: Leadership met to define the future state of the unit and develop a vision statement. The Quality Manager met with our Unit based Council (UBC) to review data, discuss shared accountability between leadership, and staff and the impact each individual can have on culture and clinical outcomes. Organizational Development facilitated staff focus groups without unit leadership present. Questions asked included: What behaviors would you like to see more or less of? What is your role in supporting change? Focus group results were shared with staff, and guided the development of an OHSCU Guidelines for Professional Behavior. Leadership met with lead staff nurses to discuss their willingness to embrace cultural change and unit vision. Leads completed the Crucial Conversations Class to help them provide immediate, direct, and specific feedback to staff. Leadership met with each staff member to review the guidelines and discuss their commitment to support change. The unit vision was incorporated in all written and verbal communication with staff. Changes in leadership behaviors included increased leadership presence on nights and weekends, daily rounding with patients and staff, and increased amount of positive feedback. Results: Fall injury scores were decreased from 1.55 to 0.25 per 1,000 patient days, target of 0.72. OHSCU has had no catheter associated urinary tract infections (CAUTI) or pressure ulcers in the last 17 months. Patient satisfaction scores have consistently improved over the last nine months. Response of hospital staff scores have increased from 53.6 to 70.9 and currently 90% of patients rate the hospital as a 9 or 10. Conclusions: Through focused efforts and thoughtful actions, it is possible to change the culture of a unit and have a positive impact on quality metrics.