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, DNP
Director of the
Norman Knight Nursing Center & Clinical
and Professional Development

The New Triple A



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 Foundation – Plan, Do, Study, Act

The Three Questions
1. 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

Lean – One Approach



The relentless pursuit of the perfect process through
elimination of waste & through respect for the worker
Value/Waste in Process

Before

After

VALUE
WASTE
Lean Targets Waste In a Process

Key: The Focus Is On the Process Not the People

Source: GE Healthcare


Lean Thinking – The Fundamentals

It’s About The Patient
• 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


Tips for Testing Changes


• 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 Abandon

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 Training
Target Audience: All members of the
Interdisciplinary Team
Goal: 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 Care
Goal: 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 Engagement
Target Audience: Leadership
Goal: To provide the necessary skills to
effectively engage with conflict and
produce a positive and healthy
outcome and environment



Topic: Presentation Skills
Target Audience: Attending RN
Goal: To provide an opportunity for the
Attending RN to develop skill and
confidence with their new and
emerging role



Topic: Diversity
Goal: To understand how the needs of
our patients, families and ourselves
impact on our relationships



Topic: HCAHPS
Goal: 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 Coaching
Target 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

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