The Value of Communicating With Our Colleagues
from Caring For Our Future, Summer 2004
By Darla van Essen, MS, RN, Administrative Director, Nursing and Patient Care Services
The Communicating with Colleagues Committee (C3) was developed after the results from the 2002 Employee Opinion Survey showed that TCH had scores lower than the national average in two areas.
According to the survey, different work units don’t work as well together as they could, and communication between work units isn’t as effective as it could be. Both these items were ranked high in importance. Nursing at TCH scored lower than the rest of the hospital. Press Ganey comments from parents indicated issues related to communication such as rude, abrupt staff. Communication also is cited as the root cause in patient safety issues.
One of the “values” of The Children’s Hospital is teamwork. Communication is highlighted in the CARE Standards, which are Communication, Accountability, Respect and Education. Therefore, one of the goals of the Division of Nursing is to improve communication and relationships between and among nursing units.
TCH participated in a NACHRI (National Association of Children’s Hospitals and Related Institutions) Implementation focus group in 2003. This was a vehicle to jump-start the C3 initiative.
The primary goal of C3 is to improve communication and working relationships between inpatient nursing units. When communication improves between the different nursing units, the intent is to use what is learned and apply it to improving all communication among every department in the hospital. Press Ganey results and Employee Opinion Survey scores will measure our improvement.
The facilitators for C3 are Linda Powers, MS, MBA, RN; Darla Van Essen, MS, RN; and Norine Hemphill, MS , RN. The participating units include 5N, 5A, 4N, 3N, GCRC, CICU, NBC, PICU, float team, emergency department and perioperative services including main OR, day surgery, kids surgery and PACU (Post Anesthesia Care Unit) and nursing administration.
The approach was based on John Kotter’s article, “Leading Change: Why Transformation Efforts Fail” (1995). The first several sessions included team-building exercises. This not only helped get us acquainted with one another, but also clearly pointed out difficulties that occur with group communication and suggested strategies to enhance communication.
In one activity, we had to navigate an electronic maze made up of squares, which beeped if a member stepped on the wrong one. We were given a list of rules. We could not talk and we had to proceed through the maze in order of our birthdays. We started out with a sum of money, and every time we broke a rule, we lost money. The catch to the game was that everyone had to make it through the maze and if anyone stepped on the wrong square and got beeped we had to start over from the beginning.
We learned to help each other through the maze using hand signals and other alternative forms of communication. It took us a while to figure out the correct way through the maze and then even longer to get everyone through the right way. The path through the maze changed once, requiring us to go backward before we could go forward, and threw us all for a loop. But we rallied, got over the injustice of it all and made it through with some dignity and cash left to spare. We learned a lot about helping each other, despite some difficult communication obstacles, and had fun as well!
In the brainstorming/prioritization phase, the whole C3 group came up with general ideas pertaining to communication. All these ideas were written down and then prioritized by the group during discussion. One of the tools used to help prioritize was a grid that divided actions based on ease of action and impact of action. The ideas were grouped into behaviors, tools, processes, programs or activities. The program developed was a Sibling City program to work on specific unit-to-unit communication issues.
A C3 retreat was held in November 2003, and one activity was to map the patient flow from surgery to PACU to arrival on the nursing unit. Potential problems or barriers that cause time delays were identified. This process allowed the units to identify areas where communication is essential. One example of this was the need for information in a transfer report that allows the receiving unit to be ready to accept the postop patient. This led to a guide for the essential information to be included in report. This guide was then posted in the PACU for nurses to serve as a reminder when giving a report. The nurses receiving the report felt well-prepared to accept the patient, and communication was enhanced between the nurses from both units. This allowed for opportunities to discuss ideas that could enhance a successful transfer; for example, getting the child’s pain under control prior to transfer, resulting in successful patient outcomes.
The process of transferring patients was controlled and improved by understanding the process better, which led to a change in behaviors of staff. Staff are now more willing to work to improve communication in all areas. Other outcomes include having fun, celebrating improvements, updating an orientation manual, and educating each other about our departments.
Some of the lessons we have learned on the C3 committee revolve around the idea that improved communication between units makes everyone feel better about his or her work environments. In addition, increasing communication has a direct effect on improving morale between units. It also has aided patient flow. And finally, it has provided a venue for people to voice concerns.
What’s ahead for C3? Once the work is done for the initial teams, the C3 committee will rotate nursing units so they have a chance to experience and work with new areas. By continuing this process, the C3 Committee will truly make an impact on communication at TCH and will be positioned to continue educating the remainder of staff.
References
Kotter, John. (1995, March-April). Leading change: Why transformation efforts fail. Harvard Business Review, 101-109.
