Ten Best Practices for Results-Oriented Teamwork
at the Point of Care
Building on a RROHC   

"True healing of healthcare must be based on one foundation: knowing the patient/family's preferred outcomes and priorities. If the person seeking care does not achieve those results, if their priority needs are not met--at a minimum to gain knowledge about potential care alternatives--then, why bother?"

~ Ruth Hansten, RN, PhD, FACHE

Ruth Hansten at Machu Picchu Photo courtesy of P. Hansten

The Relationship & Results Oriented Healthcare® (RROHC) Program's 3 elements and 10 best practices provide a shared mental model (SMM) or framework for thinking. The skills and processes that we teach are expert practices that assist healthcare providers to achieve patient safety through better teamwork and communication, develop RN leadership and coordination of the team, delegation and supervision of assistive personnel, and promote critical thinking/clinical reasoning efficacy.

We owe it to our patients and our communities to better steward reimbursement and resources by more effective use of our teams and their work processes. At Hansten Healthcare, we have been assessing organizations nationally and have identified the emergence of skill deficits in the following areas.

• TEAMWORK AND PATIENT SAFETY: Healthcare team synergy, so essential for safety and quality, must be based on knowing patient/family 4Ps (purpose, picture, plan and part), and the team 4 Ps for each shift or episode of care. Team communication suffers when a shared mental model for teamwork is lacking. If assistive personnel work without leadership, in parallel practice, staff and patient satisfaction plummets. The most recent report at www.SilentTreatmentstudy.com would support our field findings. Team members do not always speak up when issues arise that could compromise patients.

• RN PROFESSIONAL LEADERSHIP: RN leadership and patient care coordination, so necessary to sustain budgets, must be based on the patient and family's 4Ps.  We have discovered that some RNs are not aware of their accountability for the total nursing care of the patient by statute and state rules. More often, they state they did not understand they have the responsibility to supervise the care processes and use an outcomes-focused rather than a task-oriented role.   Taking on the mantle of authority and licensure, our program participants help the patient/family navigate through the system, resulting in fewer readmissions and better health maintenance. RROHC students, now believing in themselves and their ability to lead necessary change, use critical thinking and problem solving to correct issues that impede best care quality in their clinical areas. 

• RN DELEGATION/SUPERVISION OF ASSISTIVE PERSONNEL: With budgets tight nationally, we must be able to safely leverage the brainwork of expert RNs by using competent assistants to gather data and provide observation.   All the decisions of delegation rest on knowledge of the patient's 4 Ps and the care providers' skills and competencies, but this is a highly complex critical thinking/reasoning skill and process that is frequently taught without ongoing experiential application and coaching. After teaching delegation in various ways for 20 years, we've tried quick inservices, and we know that "hit and run" instructions just don't work to improve practice expertise. We teach RNs how to apply the NCSBN's 5 Rights of Delegation to their clinical practice. Managers and facilitators use the RROHC delegation/supervision steps in their own settings, with tools for assessment, coaching, and evaluation. Our methods work to instill competency and confidence.  

The RROHC philosophy is the overarching umbrella under which the diverse requirements of each organization, each group of learners, are met. In the complexity and chaos of clinical practice, isn't it comforting to refocus on the basic needs of patients and families?   Our commitment, track record, and experience will encourage worn or tired practitioners and leaders as we revitalize your organization's culture with the energy of renewed purpose.   

"My goals were lofty when beginning my RROHC journey. I was just out of my orientation as a graduate nurse when my manager approached me with the opportunity. Being very involved in the unit from the start I was already a preceptor and chair of one of the unit councils so it seemed like another notch to put in my belt. But the experience ended up surpassing my expectations as I revisited the RROHC program throughout my experiences as a nurse the last two years. I have been able to apply it to both a general floor and the ICU setting and it has certainly surpassed my initial goal and become a tool I have turned to in times of need."
~Former RROHC Level 1 Specialist Student  

To learn more about our 20-week program, as well as our webinars and full-day delegation on-site workshops, please follow these links:

Improve Delegation Skills, Outcomes and Satisfaction 

 Charge Nurse Development 

Delegation Skills Enhancement 

If you have questions or want additional information, email Ruth Hansten or Kathy Watkins.