P O P U L A T I O N
H E A L T H
Hot Fun in the Summertime… Summer Wellness
Q U A L I T Y
S A F E T Y
Rethinking the Way We Work: The Eastern Health Model of Acute Clinical Nursing Practice
A C C E S S
Keeping Promises Resident Assessment Instrument - Home Care: Streamlining the Client Evaluation Process
S U S T A I N A B I L I T Y
17 M Y
Solving the Discharge Riddle Predicting Success with Real Time Demand Capacity
S T O R Y
Sharron Power, MLA
Thank you to all those who submitted
photos for the Summer Wellness Photo Contest. Congratulations to the winner Susan Hutchings! DRAWN BY: CAMILLA TUBRETT
Questions • Comments • Ideas
email email@example.com telephone 709•777•1412 mail Connect Magazine c/o Eastern Health Administrative Oﬃce, Waterford Bridge Road St. John's, NL A1E 4J8
visit www.issuu.com/easternhealth Connect is an Eastern Health publication created by Corporate Communications. All rights reserved. Reproduction in whole or in part is prohibited without prior written permission from Eastern Health© 2013
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Melisa Valverde Deborah Collins Robyn Lush Phil Simms Susan Bonnell Zelda Burt Angela Lawrence
Cover Photography by Phil Simms On the Cover: Judy Oâ€™Keefe, Director Long Term Care, and family enjoying a beautiful summer day in Placentia.
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by DEBORAH COLLINS The sky is blue, the air is warm and the days are long…in a good way! It must be summer, those days and months when our minds turn to vacations, the great outdoors and relaxing in our own backyards. It’s a feel-good time of year, but there are things we can do to make sure it’s also a safe and healthy time of year that makes us feel as well as possible - physically and mentally.
Move more and sit less. That’s the message in a nutshell. Being physically active not only makes you feel good - it also makes you feel good about yourself, according to Natalie Moody, Regional Director Health Promotion. “Incorporating physical activity into your daily routine is not always easy but it is so important,” says Natalie. “After a long day or night at work it is often diﬃcult to convince yourself that participating in some physical activity is even possible but it is – and the beneﬁts to your health both physically and mentally are immediate.” Physical activity is essential for your health, well-being and quality of life. It reduces stress, strengthens the heart and lungs, increases energy levels, helps you have a healthy body weight, and improves your outlook on life. Children need regular physical activity to grow and develop. Being active allows adults to perform daily tasks with greater ease and
comfort and with less fatigue. For seniors, weight-bearing physical activity reduces the rate of bone loss associated with osteoporosis. Regular physical activity also maintains strength, ﬂexibility, balance, and coordination, and can help reduce the risk of falls. Physical activity across the lifespan is vital to our health. And it doesn’t involve only sports – it can include everyday activities such as: walking the dog; riding a bike; planting a garden or mowing the lawn; playing tag; or household chores like raking the leaves, sweeping the garage or hanging clothes on the line!
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One of the great advantages of summer is the availability of fruits and vegetables – important all year round – but especially delicious when eaten fresh from the ground or tree! Crisp salads, crunchy raw vegetables, a variety of grilled vegetables and fresh fruit add great taste and variety to all summer snacks. And they’re good for you! “Summer is an ideal time to explore the pleasures of healthy eating,” says Natalie. “Whether you’re growing some vegetables, starting an herb garden, checking out the local farmers market, bringing home a basket of fresh peaches from the supermarket or picking blueberries there are many opportunities to savour the great taste of healthy choices.” However, there are some things to looks out for. As temperatures rise, so does the risk of foodborne illness as people cook outdoors more often. Harmful bacteria grow quickly in warm, moist conditions, so measures should be taken to guard against it. Keep the following food safety tips in mind to keep you and your family safe from foodborne illness.
Chill. Keep raw foods cold. Use a cooler to store your food. Keep the cooler out of direct sunlight, and avoid opening it too often. Use plenty of ice packs to avoid the temperature ‘danger zone’ of 4°C to 60°C (40°F to 140°F). On hot days, don't keep food unrefrigerated for more than two hours. Remember: when in doubt, throw it out!
Separate. Make sure to keep raw meat, poultry and seafood away from other foods so you don't spread foodborne bacteria between foods. You can avoid crosscontamination by packing or wrapping meat, poultry and seafood separately or by using separate containers to prevent leaks. If you pack vegetables in the same cooler,
always put meat, poultry and seafood at the bottom of the cooler to keep juices from dripping onto other foods. Never put ready-to-eat or cooked food on a plate that held raw meat, poultry or seafood. When cooking outdoors, take several sets of utensils, cutting boards, or plates to help prevent cross-contamination.
Clean. Clean hands, plates and utensils help reduce the risk of foodborne illness. Follow the same washing instructions outdoors as you do at home. Wash your hands with soap and warm clean water for at least 20 seconds. Cook. Bacteria such as E. coli, Salmonella and Listeria can be killed by heat. Raw meat, poultry and seafood must be cooked properly to a safe internal temperature to eliminate these bacteria. But you can't tell by looking use a digital food thermometer to be sure! Hydrate! When the weather heats up and you’re more active, it’s important to stay hydrated. While a general rule of thumb is to drink eight glasses of water per day - the amount of water you need to hydrate your body varies - depending on factors like gender, physical size and level of activity, as well as environmental factors like heat and humidity. To help stay hydrated, drink plain water (tap or bottled) plus other beverages like milk, coﬀee or tea throughout the day.
Summer is an ideal time to explore the pleasures of healthy eating. Summer 2013
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Closely connected with physical health is mental health. The summer months are a perfect time to take a deep breath of fragrant air – and take stock of how you’re doing mentally. With the spring and summer seasons come longer days with more hours of sunlight. While winter can leave you feeling shut in and insular the summer sun encourages openness and the desire to get outside and take advantage of this ﬂeeting season. Here are a few simple suggestions for encouraging positive mental health during our warmer months:
A walk is good exercise, but it’s also a way to reacquaint yourself with the natural beauty of the region we live in. This helps you feel connected to something greater than ourselves. Any form of basic exercise helps promote mental wellness so ﬁnd something you enjoy - and do it.
This involves eating a balanced diet with a variety of diverse whole foods (non-processed). The emphasis here should be on fruits and vegetables they can help you stay hydrated in warmer weather.
Maintain your relationships.
Relationships of all kinds are important sources of social support - and summer is a good time to connect with people who are important to you. Having adequate social supports can help you get through trying times. Like anything in life, they require work and maintenance but in the end you reap the beneﬁts.
Be gentle with yourself.
If you need a day for yourself, take it. It’s impossible to feel good all the time, so if you ﬁnd yourself struggling with depression or anxiety realize that it’s okay to take what you need for yourself. It’s also okay to reach out to others. If needed, enlist the help of a professional - your physician, psychologist or spiritual guide; whoever is in a position to listen to you, assist in your wellness, and encourage healthy relationships and life styles.
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A warm, sunny day is a wonderful thing – especially in Newfoundland and Labrador. But sometimes, in our enthusiasm after a long winter we can overdo it when it comes to sun exposure. That can result in sunburn, skin cancer, eye damage and premature aging. An ounce of prevention now can spare you a ton of grief down the road.
Stay in the shade and out of the hot sun between 11 a.m. and 4
p.m. Otherwise, wear long pants, long sleeves and a hat with a wide brim to protect your skin from sunburn. Wear sunglasses that provide UVA and UVB protection. Use a sunscreen lotion or cream that is SPF 15 or more. SPF means Sun Protection Factor. Use a sunscreen that says "broad-spectrum" on the label. It will screen out most of the UVA and UVB rays. Put sunscreen on your skin 20 minutes before you go out and reapply 20 minutes after being out in the sun to ensure even application of the product and better protection. Reapply sunscreen after swimming or if you are sweating. Don't forget your lips, ears and nose. These parts of your body burn easily.
Too much sun and humidity can also cause something known as heat stress. It includes a variety of conditions where the body is under stress from overheating such as heat rash, sunburn, heat cramps, fainting, heat exhaustion and heat stroke. Heat stress can also be fatal. To make sure this doesn’t happen to you or members of your family...
Make sure cool drinking water is readily accessible and take rest breaks in cool areas.
Check with your doctor before working if you
are taking medications that cause ﬂuid loss such as diuretics. Use fans, ventilators, exhaust systems and air conditioning systems to control the temperature. Wear clothing that is loose ﬁtting, tightly woven and light colored in order to reﬂect heat rather than absorb it - and avoid strenuous activity during the hottest part of the day. Turn oﬀ lights and unnecessary thermal generating equipment (kettle, microwave, fridge). Prepare foods that generate less heat. Take protective measures against hazards of UV radiation.
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S A F E T Y
Rethinking the Way We Work by ZELDA BURT Photography by Phil Simms astern Health has been taking steps to reshape how nursing care delivery is organized in its acute care facilities. In November of 2010, Eastern Health accepted the Ottawa Hospital Model of Nursing Clinical Practice for implementation. The nursing model was adopted and named the Eastern Health Model of Acute Clinical Nursing Practice, and was designed on the premise that nurses’ autonomy and accountability require supportive practice environments, and that strong interprofessional teamwork lead to better patient outcomes and improved nurses’ satisfaction.
Researchers have demonstrated that this model of nursing practice is an effective and efficient clinical approach to organize nursing care delivery. Furthermore, implementation of the model’s guiding principles, combined with nurses’ knowledge, skills and expertise, has enabled nurses to enhance the quality care they currently provide. Eastern Health’s Professional Practice Nursing Department and Katherine Chubbs, Vice President and Chief Nursing Officer, are leading the implementation throughout the eastern region.
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Full scope of practice Autonomy Accountability Continuity of care
Role Clarity Increased patient / family involvement in decision-making
“The Eastern Health Model of Acute Clinical Nursing Practice reinforces the importance of recognizing our nurses’ unique skills and abilities, and the need for strong leadership and more involvement with the people we care for,” says Katherine. “The people we serve depend on the success of efficient nursing practice. I am so proud to be part of a team that is dedicated to delivering the highest quality and most efficient care possible.” Guiding Principles, which underpin the model, have been established and are used to help organize the delivery of nursing care among different categories of nursing personnel, including Registered Nurses (RNs), Licensed Practical Nurse (LPNs) and Personal Care Attendants (PCAs). The Guiding Principles are followed while taking in account competencies of the nurse and the values of the organization. The Guiding Principles include sets of description questions and are organized around themes, which focus on: Direct Care: the patient, family and the provider of clinical care; Clinical Day-to-Day: support for the novice nurse and valuing the clinical expertise of each staff member; Organizational Day-to-Day: clerical and departmental support such as material resources and housekeeping services; Educational Support: individual learning needs as well as the unit needs for orientation, policies and procedures and professional development; Management Support: immediate management support required by the direct care providers; and The Culture and Structure of Eastern Health Support: organizational support required for managers to fulfill their role. One tool that has been incorporated as part of Eastern Health Model of Acute Clinical Nursing Practice is using white boards at each
patient’s bedside, which aims to enhance communication and orientation for patients and their families. The white board is used to document information such as the date, names of serving physicians and nurses, reminders for fasting and mobility, or an area for families to write general messages. Further, daily “bullet rounds” with interprofessional team members are formed to review discharge care plans for patients, and “unit councils” are used as a forum for nurses to participate in nursing practice and patient care issues. “As nurses, we want our patients to know that they can count on us to treat them with dignity and respect at all times, ” says Ina MacLean, Division Manager for a Medicine and Rheumatology unit at St. Clare’s Mercy Hospital. “By working in more cohesive team setting, I have found that we spend more quality time
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The people we serve depend on the success of eﬃcient nursing practice.
with our patients, which allows us to be more focused on the end goal – successful discharge planning, which meets our patients’ individual needs. This lets our patients know that we are there for them and that our team has a vested interest in their health and in the care that we provide.” Eastern Health’s Model of Acute Clinical Nursing Practice was initiated at the St. Clare’s Mercy Hospital in St. John’s in November 2010. The model is being launched at Eastern Health acute care facilities in a phased-approach, where the Regional Site Committee oversees the model implementation.
Goals The overall goal of the model is to improve the quality of care provided to patients and their families.
Nurses are able to work to their full scope of practice and to be accountable and have autonomy to make decisions about direct nursing care and the organization of care.
The continuity of patient care is improved by reducing the number of care providers that interact with the patient.
Nurses communicate openly and often with patients, ensuring they have access to the information they need and also the opportunity to take part in the decisions that are made in developing their individual plan of care
There will be Improved communication and collaborative practice among the interprofessional team members.
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Project Lead from Professional Practice Nursing Joan Downey RN, MN
Facility (Site Leads):
Status of Implementation:
St. Clareâ€™s Mercy Hospital Jackie Brockerville BN, RN Site Facilitator
Initiated in November 2010, the model has been 95% implemented, with full implementation scheduled by September 2013.
Burin Peninsula Healthcare Centre Kim Green RN, BN Site Facilitator
Initiated in November 2011, the model will be 90% implemented by June 2013, with full implementation scheduled for October 2013.
Carbonear General Hospital Debbie Mercer RN Site Facilitator
Initiated in March 2012, with implementation completed by June 2013.
General Hospital (Health Sciences Centre) Jackie Brockerville BN, RN Model Facilitator Gloria Earle BN, RN Site Facilitator
Initiated in January 2013, the model is scheduled to be implemented by April 2014.
Janeway Childrenâ€™s Health and Rehabilitation Jackie Brockerville BN, RN Model Facilitator Michelle Cooper RN, M.Ed Site Facilitator
Initiated in February 2013, the model is scheduled to be implemented by April 2014.
Dr. G. B. Cross Memorial Hospital Marilyn MacKeigan RN Clinical Site Lead
Initiated in April 2013, the full implementation is anticipated over the next 12-18 months.
A C C E S S
LAURA FLYNN, JACKIE MACKENZIE, KIM LEAR, AND KAREN DROVER
Resident Assessment Instrument - Home Care: Streamlining the Client Evaluation Process by ROBYN LUSH Photography by Phil Simms
id you know that Eastern Healthâ€™s Long-Term Care Placement Services received 1,266 applications for placement in nursing homes, personal care homes or respite in long-term care in the last fiscal year? Of the 1,266 applications, 45 per cent, or almost half of the requests come from acute care. Community Services is a close second at 39 per cent is a close second, and even more seniors require home supports to remain in the community. To some, those numbers may be surprising. But the fact is Newfoundland and Labrador has an aging population and demand for these services will likely increase.
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Having the ability to complete documentation via an electronic tool while you’re with the client is a real game-changer.
Eastern Health has identified access as one of its four strategic priorities. Simply put, we need to provide timely access to our services, which includes a promise to our clients that we will improve access to long-term care beds or community supports. The key to this is client assessment to determine the most appropriate placement.
Managing the Process RAI-HC: A Global Standard RAI-HC was developed by an international group of health care professionals known as interRAI. They are a collaborative network of researchers in over thirty countries committed to improving care for persons who are disabled or medically complex. InterRAI’s goal is to promote evidenced-informed clinical practice and policy decision making. In Canada the RAI-HC system is being used in Ontario, B.C., N.S., Manitoba, Alberta and Yukon.
Other RAI Tools in Use at Eastern Health Resident Assessment Instrument – Minimum Data Set, Version 2.0 (RAI - MDS 2.0) Similar in function to RAI-HC, RAI-MDS 2.0 evaluates and provides information to support eﬀective care planning for residents who already reside in long-term care, while RAI-HC evaluates clients for placement in LTC or for home support services.
Currently, the health care worker completes a paperbased Adult Needs Assessment form, which, depending on the complexity of the client, can take up to two hours. However, the assessment doesn’t end there, as Kim Lear, Manager of Home and Community Care for Rural Avalon explains. “After the assessment, the care provider must pull together all the information and transcribe notes to help formulate thoughts and recommendations – which takes even more time.” However, good news is on the way, in the form of a faster, more concise assessment tool scheduled for the fall of 2013. The new Resident Assessment Instrument – Home Care tool (RAI-HC) sharply contrasts with the current paper-based procedure. Easily accessible via a laptop, RAI- HC is an international, research-based assessment process that is completed at point-of-care, either from the bedside, or in a home setting. The RAI-HC provides the assessor with a series of questions that use a common language designed to collect information on a broad range of physical, mental and social abilities. The coding is standardized, reducing variations between users. RAI-HC will be used to assess the following individuals:
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clients over 65 for placement in long-term care, personal care homes, or for respite; clients over 65 for home support; and clients under 65 (adults) with physical disabilities for placement only. It evaluates the person’s level of function and quality of life by assessing needs, strengths and preferences that guide the decision either for long-term home support services or long-term care placement. The tool measures strengths as well as problems or potential problems. Once staff have been trained and are familiar with the tool, a typical assessment can be completed in just one hour! “While this is a much more objective, comprehensive tool than currently exists,” says Kim, “the professional judgment of the health care provider is still key to the assessment. And having the ability to complete documentation via an electronic tool while you’re with the client is a real game-changer.” RAI-HC will be implemented provincially, first this summer at Western Health with the remaining provincial health authorities, including Eastern Health, to follow this fall.
You’re Not Alone! Guiding Eastern Health staff through this change will be RAI-HC Coordinators Karen Drover and Jackie MacDonald. As the ‘goto’ professionals, their mandate will cross all program areas and encompass acute care, long-term care, community support services, placement services, personal care homes and nursing homes. Their focus will be on training, ongoing monitoring and data integrity. They will also be involved in reading data and identifying the trends. Karen says that because the tool is objective and asks specific questions for a specific window of time, it requires a new way of thinking for assessors. “RAI-HC has a three-day look back for most assessment areas which means only the behaviour and functioning for the client during that time period will be used in the coding of the assessment,” she explains. “This is different from the current assessment process where the assessor looks at the general functioning of the client over the last year.”
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Jackie feels strongly that the client is the most important aspect of the whole process. “Once completed, the RAI-HC assessment will support the assessor’s service recommendations so the client gets the services he or she needs, where they need them and when they need them,” says Jackie. “Over time, these assessments can be compared to determine whether the client is responding to the interventions put in place.” RAI- HC will show areas of improvement, and more importantly, areas where the client might be at risk for functional decline. Laura Flynn, Regional Manager with Eastern Health’s Long-Term Care Program, believes that the RAI-HC system will improve Eastern Health’s assessment process and overall service to clients. “This is a standardized evidence-based assessment and care planning system that will help us keep our promise of quality care to our clients,” she added. “Not only is it a great tool to assist with individual care planning, it also provides information that can be used for decision support at the regional, provincial or national level. For the first time, we will be able to benchmark our client results nationally and compare our findings on a regional, provincial or national basis.”
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PREDICTING SUCCESS WITH REAL TIME DEMAND CAPACITY by SUSAN BONNELL Photography by Phil Simms
rom the moment a patient enters one of our hospitals, everyone on the team is focused on getting that patient home, safe and well. Whether that patient is in an emergency, requiring a diagnosis, admitted for a procedure, or in need of a some other type of care, our goal is to provide that care in the most effective and efficient way possible. No one wants a patient to have to stay in hospital one hour longer than they absolutely have to. So, why is it we struggle so much with discharges? Over the years, our hospitals have tried many different approaches to discharge planning, from forms and protocols to slogans and catch phrases (who in St. John’s remembers Mr. Levon Time?!), all with varying success. Today, the organization is banking on an internationally-recognized, best-practice initiative that is all about timely access to beds and improved quality of care. Real Time Demand Capacity (RTDC) is being introduced at the Health Sciences Centre; first on 4NA, a Medicine unit that primarily offers hematology and oncology services.
So, what makes RTDC any different from all the other strategies? A simple, yet powerful approach that offers frontline staff the opportunity to predict their demand, take ownership of their capacity and manage patient flow collaboratively across the entire facility.
Changing the System, One Discharge at a Time In 2012 a team of representatives from Eastern Health travelled to Washington to see RTDC in action. Dr. Stephen Raab, Clinical Chief of Laboratory Medicine and an expert in the Lean management philosophy, worked in Pittsburg and Colorado and was part of a team implementing RTDC. Stephen knows first hand how effective this initiative can be. “In Colorado,” Stephen says, “we noticed immediately that the number of patients ready to go home on their expected date of discharge kept increasing. “But the biggest change was in the way the nurses began to work,” he says. “They really began to take ownership for their patient care in a way we hadn’t seen before.”
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DR. STEPHEN RAAB AND SHARON LEHR
Our goal is to develop teams of problem solvers here at Eastern Health who feel empowered and are supported to eﬀect change.
Implementing RTDC at Eastern Health means more than just trying the latest fad in discharge planning; RTDC means a real shift in the way we do things. “This whole process is really about transforming our system and changing the way we manage patients,” says Sharon Lehr, Chief Performance Officer. “The key requirement for success through RTDC is frontline engagement.” In hospitals where RTDC has been successful, individuals work collaboratively and with autonomy to identify, address and solve problems. “Our goal,” says Sharon, “is to
develop teams of problem solvers here at Eastern Health who feel empowered and are supported to effect change.” So, how does RTDC work? The immediate steps that lead to a patient discharge are in fact very simple. In most cases, all a patient needs is a physician-signed order to go, sometimes with instructions and a prescription for medications or supportive equipment. The actual discharge itself may take only minutes to complete, but planning for that moment of discharge begins long before the patient walks out the door. “For many patients, discharge planning involves an entire team of
health care professionals, including the nurses and responsible physician,” says Elizabeth Kennedy, Director of Clinical Efficiency. According to Liz, the patient care coordinators and discharge planning liaison nurse, consulting physicians, diagnostic imaging and laboratory teams, allied health professionals including PT, OT, Social Workers and Assistants, porters and family members all need to coordinate their efforts to make sure that a patient can leave or be transferred in a timely manner. “Coordinating all these individuals and services is what discharge planning is all about,” she says. “That truly is at the core of operating a health care facility that puts patients first.” A firm believer in RTDC, President and CEO Vickie Kaminski agrees: “By starting the discharge planning process on admission, our staff are not only putting that patient at the heart of their efforts, they are also putting all others in need of their care and service first, too. “When units manage their demand and capacity for beds effectively and efficiently,” says Vickie, “they are managing the complete patient experience and they will get patients in and out so that others can access their services when they need them.”
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Continuous Quality Improvement, the Lean Way If you work at the Health Sciences Centre it’s not hard to notice a change on 4NA. Aside from all the talk and excitement around identifying issues and solving problems, the most noticeable change is the number of people on the unit. Throughout April and May, the unit has been under observation from managers and directors who are coaching and mentoring the staff and physicians on their continuous quality improvement journey. At first, the nurses, PTs, OTs and Social Workers couldn’t help but feel a little intimidated by the Lean facilitators, who come armed with stopwatches and multiple questions. “We can be overwhelming, sometimes,” says Karen Butler, one of the team’s facilitators, “but the staff have been just excellent about it.” Laboratory Medicine has been experiencing Lean improvements over the past year, so the 4NA team enjoyed a visit from Sharron Power, a Laboratory Technologist who herself is now taking a quality improvement role within the program. But Sharron’s opinion of Lean wasn’t always so positive, as she explained to the 4NA team. “Listen, I was really not happy to be followed around by these guys. It’s intimidating at first and I felt like saying, ‘look go away – you’re slowing me down!’” she says with a smile. Today, Sharron encourages others who are new to the process to give it time and not to give up on it right away. “You are going to make changes for the better, believe me,” she says. (Read Sharron’s personal story on page 26.) The idea behind RTDC is to be able to predict demand and better manage capacity – something that, at first, the 4NA team were challenged to believe was possible. However, after only a couple of weeks already the team is able to, as Patient Care Coordinator Tony Moores says, “see the possibilities.” On April 9, a segment of the 4NA team participated in a rapid improvement event. The group zeroed in on the reasons why discharges can be uncoordinated and working in teams, they hypothesized that a quick and simple checklist, attached to the front of the patient chart, may be an easy visual cue to every member of the team to get their pieces of the discharge plan in place. On April 25, 2013 a second rapid improvement event focused on chemo drugs and pre-meds for patients not arriving at the same time.
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A staff nurse and a Lean facilitator got up, walked down to the pharmacy and came back, only moments later with not only a better understanding of the pressures on Pharmacy and the way medication requisitions are processed, but also with a potential solution, thanks to cooperation and a shared commitment between the unit and the Pharmacy to provide the best and most efficient care possible to the patient. “Lean is an exciting and engaging tool for managing change,” says Elizabeth Kennedy. “But it’s really just a way of analyzing problems and testing
solutions. What’s really exciting is seeing our staff take that ownership. Great things can happen when people have the freedom to test things out and try new ways of solving old problems.”
From McDonald’s to Management. A Lean Journey Kim Adams worked as a medicine nurse for six years before moving to critical care for another seven years and then into a management role, but that’s not what really prepared Kim for her current assignment leading the implementation of RTDC for the Medicine Program. “My first real job was at McDonalds,” she explains, “where they taught us to measure waste and we used visual cues for stocking products and assembling products. I didn’t know that was a Lean philosophy then – but I do now!” Kim was introduced to Lean through a project she was working on with management engineering.
“I became interested,” she says, “and when a chance came up I attended the three-day Lean session. After that I started involving myself in some projects I knew were happening and jumped at the chance to rookie-facilitate the three-day Lean session in September, and it’s grown from there!” Originally from Gander, Kim now lives in Mount Pearl and has a large circle of family and friends. “I have two teenage boys,” she says. “…Nothing further needs to be said there!” She believes her children help her to balance work and life, along with her love of reading, the outdoors and cooking new things. Kim’s personal motto is “Just take the leap and build your wings on the way down!” This certainly can also apply to her role with the implementation RTDC, and as the Quality lead for her program. “It is so fabulous to see staff engage in problem solving to make their work life and work place better, “she says. “I learn something new every day.”
What is Lean? Lean is an improvement philosophy and a systematic approach to eliminating waste in health care. It's not about reducing positions, working with less, or working faster; it is about removing barriers, solving problems and adding value to the patient, client and resident experience.
Here are the ﬁve guiding principles of Lean: 1. Think about problems from the client's perspective 2. Identify the process and remove unnecessary steps 3. Create "ﬂow" in your process, or reduce variability 4. Only do what is needed 5. Seek perfection through continuous quality improvement
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