![[ Visit Client Website ]](images/banner.gif)
Tuesday, November 3, 2009: 1:55 PM
Learning Objective 1: define and identify tools available to measure high reliability among interdisciplinary teams.
Learning Objective 2: identify products and processes that have influenced the measureable success of an interdisciplinary team within a multi-hospital system.
Within a multi-hospital system, products and processes aimed at evidence-based pressure ulcer prevention have emerged from individual facility teams and included the following: evidence-based pressure ulcer assessment scale and skin and wound protocols, staff competencies centered on staging, and equipment standardization. A number of successes resulted from this collaborative effort. For example, the development and implementation of an evidence-based protocol guiding management of skin breakdown including stageable pressure ulcers, incontinence dermatitis, fungal infections and skin tears. The protocol empowers nurses to put preventive measures in place early and also to implement management measures as soon as they occur. The protocol also identifies who the in-house resources are for the staff for consultation including but not limited to WOCN Nurses and CNSs. What emerged was the identification of pockets of excellence and the opportunity for an interdisciplinary, system-wide approach to prevention aimed at highly reliable, consistent high performance across the system. Historically, facility-based teams had focused on standardization, personal checklists, working harder, and training all of which are marginally effective in a high reliability organization. Elements of team evolution included interdisciplinary team formation led by a PhD nurse with particular expertise in wound management. Team membership is intentional and includes nursing representation from all levels including but not limited to shared governance staff leadership. A complex adaptive systems (Plsek, 2008) approach was the framework guiding team design and implementation of structures, processes, and patterns influencing development and sustainability of products and processes. Team assessment of high reliability (Vogus, 2006) incorporated the 5 principles of high reliability and is evaluated quarterly. Failure modes effects analysis exercises are conducted on the front end of implementation to identify and mitigate potential failures. Knowledge transfer was designed by the team and intended to cascade all levels of the organization.