Numerous practice change initiatives were submitted as ARFs and routed to QPIC, a house-wide council within the Shared Leadership Council (SLC) structure. Having multiple accountabilities, QPIC could not dedicate sufficient meeting time to fully vet and investigate recommendations and ensure sound decision making on high impact, complex, organizational level changes. QPIC sought to protect time for collaborative recommendation development by direct patient care providers and clinical experts.
QPIC and Nursing Administration collaborated to form a multidisciplinary task force structure comprised of bedside clinicians and various levels of clinical experts. This format provided protected work time to develop complementary solutions for the work of QPIC and assured executive leaders of the need for related financial investments. For example, an ARF that includes an EHR enhancement recommendation was routed to the Documentation Task Force. Patient care providers contributed to design specifications and considered end user impact. Resulting recommendations were then placed on the QPIC agenda for final review. From here, they either move towards approval for organizational implementation or referred for modifications. Once a solution was approved through SLC, the task force dissolved. Model: ARF (problem identification)-> QPIC (Prioritization)-> TASK FORCE (Solution recommendation)-> QPIC (Approval of recommendation)-> COORDINATING COUNCIL (final approval).
Using the task force structure, QPIC has led impactful, complex practice changes such as development of organizational guidelines for infusion of vesicants and several EHR redesigns (Work List, ADL and pain assessment documentation). At least three traits of a high reliability organization (HRO) are demonstrated this structure – sensitivity to operations, deference to expertise, and preoccupation with failure. Benefits include early involvement of end-users in process improvement, leadership development, promotion of HRO culture, and improved adoption of practice changes. In November 2018 alone, 33 recommendations have moved forward through the recommendation/approval process. Final numbers will be provided at conference time.
By leveraging the Magnet nursing culture, QPIC has developed a successful collaborative structure within the SLC model of decision making. Shared governance councils can implement this model to promote collaborative initiatives between content experts and direct patient care providers.