First on board was our new Chief Nursing Officer (CNO), who embedded himself into every unit to learn the challenges first hand. The initiatives implemented included improving professional development, initiating our Magnet journey, validating the importance of work-life balance, and fostering engagement and transparency. While the division of nursing was embarking on a new culture, the remainder of the hospital was stagnant. Our new charismatic Chief Executive Officer (CEO), who invested in learning the history of our organization’s culture, joined about a year after the CNO. Upon his arrival, he shared the organization’s history and his vision and strategic plan with frontline staff and directors; this instilled a sense of pride in a team that was otherwise disengaged. The plan included four areas of focus: patient safety and quality, patient satisfaction, team engagement, and finance. He reinforced that if we took care of the first three areas of focus, the fourth area of focus would take care of itself. Then, he empowered each team member to proceed until apprehended to take care of those first three areas of focus. Our CEO recruited our new Chief Operating Officer, who is a “hands-on leader”, as well as a new Chief Medical Officer, who is approachable and brings new strategies for addressing challenges.
The quality and safety department, who had been working on standardizing care for the last three years, was re-energized. The CEO was very clear that quality and patient safety was the number one area of focus for every employee and leader. The quality and safety department named our project “Safety Superstars”. The main objectives of our Safety Superstars were to decrease preventable patient harm to zero and become a high reliability organization. As part of our journey to zero harm, the foundation was to build trust, improve transparency, and transform from our punitive, blaming culture to a safe and accountable, process-improving culture while simultaneously implementing standard bundles of care for the prevention of hospital acquired conditions. The culmination of these initiatives peaked staff awareness of patient safety and quality, ignited team member engagement, and decreased preventable patient harm.
The nursing engagement triggered a partnership with a Values Coach who is helping to spread an organization-wide culture of ownership and engagement. Additional initiatives included identifying the organization’s values and moving from a culture of disengagement to engagement to accountability and finally to ownership. Other initiatives implemented include the CNO Advisory Council and VOICES (Values, Opportunity, Innovation, Compassion, Excellence, Service), which is our monthly, day and night, open nursing forum attended by the CNO. Both initiatives gave frontline staff the opportunity to be heard and be involved in solutions.
One prevalent nursing theme that arose from VOICES and the CNO Advisory Council centered around professional development which has been a long-standing staff need. Initiatives implemented include administrative support for continuing education and conference opportunities, on-site continuing education forums by clinical experts, membership in the Society of Pediatric Nursing, development and implementation of a Nurse Residency: Transition to Practice Program for new graduates, increasing RN certifications, implementing a certification recognition program, and developing and implementing a clinical ladder. These initiatives instilled frontline confidence and pride leading to the initiation of our Magnet journey. With the successful implementation of these initiatives frontline staff began to recognize the emergence of a “Culture of Yes” with a “Proceed until Apprehended” approach. From these successful initiatives, the nursing division, in collaboration with the Director of Patient Experience, decided to spread these concepts into the development of a hospital-wide shared governance model, with the aim to empower and engage frontline staff across the organization.
Working in a hospital is stressful, so next on the agenda was care of the caregivers. Part of our employee engagement initiatives to decrease stress included a post-code debriefing, supporting second-victims, and self-care programs to “Heal the Healer”. These initiatives combined with the cultural transformation events continue to improve team member engagement.
The third area of focus is patient experience. To improve the patient’s experience, we have implemented patient and family centered rounds and developed a patient and family advisory board. The patient and family centered rounds promote accurate communication between caregivers and has resulted in increased frontline staff confidence, as well as increased patient satisfaction and safer care. For the first time ever in our history, last month we sent a team of staff members with two family advisory board members to a national conference.
We have been on a fast-paced ride for the last 18 months, and team members know that we are just getting started. With this cultural transformation, team members feel heard and valued. Team member engagement is on the rise, and the team is vested in the strategic plan. Our Board of Directors and executive team have confidence that our facility will thrive, as evidenced by the $300 million renovation currently under way. First impressions are derived from what that the physical architecture of the building is. Lasting impressions, however, result from the invisible architecture, comprised of our core values, organizational culture, and attitudes in the work environment (Tye, Dent, & Tye, 2017). Throughout this rapid transformation, a key take-away was the interdependence of staff engagement and empowerment on quality patient outcomes and experience. Our overall employee engagement increased 36% from 2016 to 2017. With that improvement, we saw our serious safety event rate decrease by 90% from 2015 to 2017, and our patient engagement increased by 16.8% from 2016 to 2018. As a team, we are on the journey together, and we know that we are taking the right steps to innovate a healthy clinical and academic environment. We believe these tactics will result in sustained optimization of patient and staff outcomes.