Open Space Exercise Topic Area 1 - Medical Staff Engagement

1. Open Space Exercise Topic Area 1 - Medical Staff Engagement • Involve medical staff in team meetings with RCA for near misses/ adverse events/ sentinel events & share action plans with them. • CEO visibility & availability - Open to discussion • Clinical Documentation Coordinator – Acts as a liaison between hospital & MDs • New Chief Medical Officer • Physician Liaisons • How to get MDs to commit time? • CEU’s for medical staff – • E Learning • Information Provided - Credentialing • We have Physician Leadership Group (PLG) & Nurse Leadership Group (NLG) that meet monthly – Nurse should attend PLG & MD should attend NLG – discussions of needs & solutions

2. Open Space Exercise Topic Area 2 - Readmissions • Call for patients to help their family – i.e., patient with PN & expectations of the family • Discharge Care Plan • User friendly • How to get them to read it • Nurse engagement prior to discharge • Need the transport staff involved with care timelines • How to address compliance ( or non compliance) with patients & families • Can we “fire” our patients? • How to ID frequent admission patients • Coaches are not always welcomed – what to do?

3. Open Space Exercise Topic Area 3 - Communication • TEAM STEPPs Training • Respect for each other’s expertise • Daily Safety Huddles – each shift • Psychological Safety – Deal with unprofessional behavior • Newsletters during the month – have updates for staff in between regularly scheduled meetings • Beside rapport with SBAR • Keeping positive attitudes in negative situations • Once isn’t enough! • Quarterly employee forum • Better use of technology to communicate (Email , text, phone, etc)

4. Open Space Exercise Topic Area 4 - Data • Too much “bean counting.” Need better ways to capture needed data • Nurses work with IT to get needed reports • Tip – Transparency of data display • Use of dashboard and flow of information to let people know • Shared drives for data reporting • Display to make meaningful & useful • Timely and accurate data • Display simplicity (to read/ understand) • Staff responsible for data on dashboard • Offer (MCCG): Crosswalk of data requirements: OP, IP VBP

5. Open Space Exercise Topic Area 5 - Multidisciplinary • 1 form to document on & a daily C930 – Have a meeting where all come together to discuss each patient • Change name to INTER disciplinary & work together as such • Help get daily department head huddle information to front line staff • Resources allocated for the workload • Leaders insist that teams are multidisciplinary • Daily huddles – Multidisciplinary • Collaborative Care – All disciplines responsible for patient care – e.g. Out of Bed, walking, call lights, etc. Weekly team meetings including staff, patient, and family. • Driven by nursing • Unit-based meetings – hospital-wide meetings often too vague.

6. Open Space Exercise Topic Area 6 – Culture of Safety • Department & unit-based quality councils/ teams that work on various measures • Implement CUSP • Reward those that come up with an idea that promotes safety • Engage senior leadership – Hear it from the top • Implement patient safety corps – Engaging front line staff consistently • Encourage event reporting & involve staff in process improvement plan/ action plan to change or improve the process • Daily 15 minute safety huddle with all leaders/ stand up • Multidisciplinary team meetings • Make it easier to report incidents & safety concerns • Accountability tool & visual tracking board (CHOA)

7. Open Space Exercise Topic Area 7 – Nurse Engagement • Nurse Liaisons • Teamwork • Developed work groups – front line staff run • “Shared” unit governance • Unit based champions • Visit units to get input from nurses that may not volunteer for teams/ groups • Huddles for input • Incentive to participate • Unit based subject matter experts • Blogs • Career ladder - recognition for engagement • Visual tracking boards (CHOA)

8. Open Space Exercise Topic Area 8 – Budget Restrictions • Automation – doesn’t always decrease work time. How to manage unintended consequences from electronic medication reconciliation, etc? • Reduced revenue > Cannot justify a program for reduction & measure cost avoidance – Difficult to explain or finance the cost of a project • Grant writing assistance needed • Quality care vs. limited budget • Staffing based on productivity – census vs. acuity of patient - affects quality of care provided/ safety of patient . Not all patients are created equal • Ability to perform concurrent review of core measures with limited resources

9. Open Space Exercise Topic Area 9 – Time Commitment • Too many hat to do well • Business case to remove work & then work on new topics • Determine what you are NOT going to do • Map processes to remove duplication - free up for other priorities

10. Open Space Exercise Topic Area 10 – Discharge Calls • Integration of Meditech use • Connecting the “why” to front line • Saves lives! • Admin./ Discharge Nurses • Medications? • Dosage? • Questions? • Follow-up • Have a callback form on the discharge sheet • Scripted questions that relate to hospital teaching • Patients/ families need phone number of someone to call with questions • Visual Tracking Boards (CHOA) • Calls needs to be done in first 24-48 hours post-discharge