RROHC™ NEWSLETTER
WINTER 2010
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"Nurses
will think critically and know how to delegate, supervise, and lead teams of
skilled assistive staff."
"Every
staff member will perceive each day or shift as their gift to bring joyfully to
those they serve."
"But
the human price tag of suboptimal care, in terms of suffering and loss of
vitality, function, or life, plus the actual financial implications for healthcare
organizations, renders the need to travel
beyond excuses and toward accountability crucial to the actual and
fiscal health of our hospitals and our
nation."
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| Greetings from Hansten Healthcare |
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As a healthcare provider, you strive for optimal, individualized,
relationship-based care, along with satisfying working conditions, and
teamwork. As a citizen, you desire superior technical care delivered
with the same compassionate focus and respect for your intended
results.
Hansten Healthcare PLLC provides practical,
exemplary service in consulting, based on decades of rich experience in
clinical practice, leadership, and administration. We focus on the
common building blocks of healthcare services and the systems that
support them.
Our mission is to promote healing and wholeness, transforming
organizations through relationship enhancement and skill development.
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LET THIS BE THE DECADE OF THE PATIENT! Because
2010 is the 100th anniversary of the death of Florence Nightingale, there is a
movement to consider this year as the International
Year of the Nurse. The RROHCTM
team hopes that the International Year of the Nurse, developed from the UN
Millennium Development Goals, will energize and educate the nations about the
integration of illness and prevention care, poverty, the environment, gender
and education, to the health of humanity.
(Visit these sites for additional ideas on celebrating the International Year of
the Nurse:
http://nursingworld.org/HomepageCategory/Announcements/IYNC.aspx
; http://www.2010iynurse.net/)
If this is the year of the nurse, let's
join together with our interdisciplinary team members to make THIS decade the
Decade of the Patient/Family. Our
vision for 2020 as the Decade of the Patient/Family concludes: - All healthcare leaders will understand that an
investment in developing RROHCTM-oriented care providers will
eliminate poor quality care, hospital acquired conditions, and never events.
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THE COSTS OF OFF-QUALITY CARE: WHAT DOES THE EVIDENCE SAY?
Each
day in the life of a healthcare worker is messy and full of surprises; creating
opportunities for errors or omissions. But
the human price tag of suboptimal care, in terms of suffering and loss of
vitality, function, or life, plus the actual financial implications for healthcare
organizations, renders the need to travel
beyond excuses and toward accountability crucial to the actual and
fiscal health of our hospitals and our
nation. For a coronary bypass patient
with a stage 3 pressure ulcer not present on admission (but without major
complications or co-morbidity), the hospital would receive about $7500 less reimbursement due to the hospital
acquired condition (HAC).
However,
the cost of care would also increase due to the need to treat these
conditions. From a national perspective
of preventable cost, pressure ulcers were estimated from $3529/case to $52,931/case; injurious falls were averaged to $15,
418 per case-adjusted 2008 dollars. The "worst case scenario" revenue at risk for
pressure ulcers nationally was estimated at $280 million, and $117 million for falls. So not only does the hospital forfeit full
reimbursement, but the costs of care skyrocket: these conditions must be
prevented not only from the patient pain and suffering perspective but also
from a fiscal perspective. (Virkstis et al. 2009). VanGilder
and colleagues associate AHRQ data with research performed by Lyder to indicate pressure ulcers
with an average LOS between 10.2 and 14.1 days, as compared with those with
similar conditions without pressure ulcers at 4.6 days, and the costs to be $500-$40,000 per case. (VanGilder
et al. 2009).
The
New England Journal of Medicine examined 2004 Medicare patients discharged
re-hospitalizations within 30 days and discovered that 1/5 (19.6%) had been readmitted within 30 days, 34% were re-hospitalized within 90 days, and
they estimated that only about 10% were planned readmissions. National costs for readmission were $17.4 billion (Jencks et al,
1418). Readmissions due to missed or
inappropriate discharge instructions, patient/family education, and/or not "knowing"
our patients, can be avoided with RROHCTM interventions.
How RROHCTM Impacts Quality
and Safety
The RROHCTM program
teaches critical thinking, a focus on outcomes, "knowing" the patient and
family, and improved communication and teamwork. These improve quality of care and reduced
"missed" or omitted care. -
The
RROHCTM patient-focused outcomes-driven
interview is similar to the surgical "time out" for patient safety.
- The
RROHCTM program features 5 steps out the
bundle of 10 best practices that help RNs communicate with, and supervise, assistive personnel on a daily basis so that care such as patient repositioning and activity,
hydration, nutrition, and care rounds are not missed. When missed, falls, pressure ulcers, DVTs, and hospital acquired pneumonia can
result.
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The
structure of the RROHCTM program provides a mental
model and framework for all healthcare staff to work together effectively.
- RROHCTM practices helps each organization use a common
language and approach to care.
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Ambulatory
care, long term care, home health: all
areas along the continuum of care benefit by focusing all interventions on
the preferred patient/family short term and long term goals, and we have the
tools to assist. The communication
along the continuum will ultimately result in fewer unplanned, unreimbursed
readmissions.
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The organizations that invest in developing
their employees in RROHCTM have improved their Press Ganey scores from
the single digits to the 90th percentiles.
For the cost of one
pressure ulcer, your staff can be educated in the RROHCTM principles. Isn't it worth the investment, if it enables you to provide optimal care to your patients?
Jencks
S., Williams M., Coleman, E. (2009,
April). Rehospitalizations among
patients in the Medicare fee-for-service program. New England Journal of Medicine, 360
(14): 1418-1428.
Virkstis, Katherine L.; Westheim, Jared;
Boston-Fleischhauer, Carol; Matsui, Paul N.; Jaggi, Tonushree Journal of Nursing Administration.
39(7/8):350-355, July/August 2009. Safeguarding
Quality: Building the Business Case to Prevent Nursing-Sensitive
Hospital-Acquired Conditions
VanGilder,
C., MacFarlane, G., Meyer, S., Lachenbruch, C. (2009). Body mass index, weight, and pressure ulcer
prevalence. Journal of Nursing Care
Quality, 24(2): 127-135.
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UPCOMING EVENTS
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We will continue to offer the RROHCTM Revisited Webinar on a periodic basis for those who need a refresher and those who are new to the RROHCTM program. If you are interested in scheduling a complimentary RROHCTM Revisited Webinar specifically for your team, contact Hansten Healthcare PLLC or Kathy Watkins.
NEW RROHCTM LEVEL 1 SPECIALIST CERTIFICATION PROGRAM BEGINS ON JANUARY 25, 2010
It's time to start identifying key staff at your facility to join the RROHCTM Level 1 Specialist Program that begins January 25, 2010. Up to 37% improvement has been evaluated as a result of participation in this program, and countless on-site problems have been avoided or solved through the six-step critical thinking problem-solving process taught in the program.
Take a look at the improvement in delegation skills pre- and post-RROHCTM Level 1 certification, as shown on the following graph:
Fees for the RROHCTM Specialist Level 1 training program,
including instructor-guided self-study, is $475/person group rate
for 3 or more from your facility (or $495/person
single registration), plus textbooks and internal copying of portfolio.
Contact Hansten Healthcare PLLC or Kathy Watkins for
more information, or to register members of your team for the RROHCTM Specialist
Level 1 Class that begins on Monday, January 25, 2010.
FACILITATOR INTENSIVE TRAINING MAY 4-6, 2010
Mark your calendars now for RROHCTM Facilitator Intensive Training in the Seattle area on May 4-6, 2010. This timing places the program in the week prior to Nurses Week and Hospital Week celebrations. Additional information will be shared as details are finalized.
RESOURCES AVAILABLE
Delegation, Supervision and Teamwork Workshop: Teams and Results-Oriented Nursing Care
We have discovered that key assistive personnel should attend this full-day on-site workshop with
their nurse leaders and staff to create an improved care delivery model
and structure. Contact Hansten Healthcare PLLC or Kathy Watkins for details on how to schedule a presentation for your
organization.
How a Good Nurse Could Go Wrong: Delegation, Supervision and Teamwork at the Point of Care
We
continue to offer this 1.5 hour webinar for organizations or
individuals. Contact Hansten Healthcare PLLC or Kathy Watkins for details on how to schedule a presentation for you or your team.
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RECENT PUBLICATIONS
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THE HEALTH CARE MANAGER
Be sure to check out the article, A Bundle of Best Bedside Practices, published in The Health Care Manager. Using examples from RROHCTM facilities and the RROHCTM Planning and Implementation Manual, which discusses the bundle of 10 best practices and nurse delegation and supervision.
NURSE LEADER
For a review of why nurses need a template and a structure for their day in order to delegate appropriately, the Nurse Leader article, Why Nurses Still Must Learn to Delegate is helpful. The need to improve leadership and supervision skills in nursing has not abated with the current economy and, in some hospitals, reduced staffing to meet the demands of a lower inpatient census. To respond to a growing number of inquiries regarding how to make a care model work with assistive personnel, we are now offering full-day conferences, as well as a short introductory webinar.
SECOND EDITION RROHCTM IMPLEMENTATION MANUAL
ON THE HORIZON
We will soon begin work on the second edition of the Relationship & Results Oriented Healthcare™ Planning and Implementation Manual! We will be contacting you for outcomes that you may want to share. We encourage you to be recognized in the new edition for your hard work and the transformation of your organization. Tell us about topics you wish had been included in the first edition so that we can include them in this next edition. We aim to help you achieve success in improving healthcare outcomes in your community.
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The RROHCTM Program
is a protected copyrighted and registered trademarked program of Hansten
Healthcare PLLC (HHC). If you wish to use our ideas and/or materials, we
would be pleased to provide licensing and/or to register your organization in
our programs in accordance with our fees and pricing schedules. You may not use
our intellectual property or materials unless you are a client of HHC and/or
have obtained express written permission from us.
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