145 its tough on the facilitator and then on top of

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145 It's tough on the facilitator. And then on top of it we had a green facilitator the person who was a process champion who was facilitating…. So [the nurse manager] was coaching her as a facilitator at the same time we're having this really very complex discussion.” Senior executive Department Where Implemented: Long-Term Care and Acute Care Unit This project was implemented in both the long-term care and acute care (hospital) units. Project Selection According to senior executives and nurse managers, UTIs have been a longstanding issue at Suntown, with a peak of infections in 2009 at about 9 10 percent, as reported by two nurse managers. Most of the nursing staff interviewed viewed UTIs as an important clinical issue. Before the RCE, as part of activities for a larger collaborative they were working on with other hospitals, Suntown staff began administering cranberry capsules and vaginal estrogen cream as UTI prevention measures. The CEO proposed the project as well as five others to the quality team. The UTI prevention project was selected by the quality team based on the existing collaborative and the importance of the issue as deemed by nurse managers. Project Staffing The CEO selected the team members for the UTI project (Exhibit 4.12). The process owner a nurse manager also provided input on team staff selection. Because the issue of UTIs was believed to cut across multiple departments that include clinical and nonclinical support staff, the process owner suggested including staff from environmental services (i.e., housekeeping) and the dietary department. Other team members included nursing staff from long-term care (LTC) and acute care services and the chief nursing officer (CNO). The facilitator for the event was a nurse manager who had not previously facilitated an RCE on her own but had co-facilitated and participated in numerous RCEs. An executive who is also an experienced facilitator was present during the event but describes his involvement as a “casual observer.” Planning and Implementation The facilitator reported that she prepared to implement the 10-step process, but other staff said there was little to no planning before the Lean event. However, baseline data for the event were available because Suntown routinely collects infection rates as a required patient safety indicator, including UTI rates that are reported at monthly quality team meetings. After beginning the RCE and mapping the process, the team realized that there were several sub-processes requiring attention. An executive and nursing manager described the project and process as being the most complex project they had attempted at Suntown. After the first day, interviewees said that the team regrouped and divided into two separate teams to, in a more targeted way, review and walk through the processes believed to affect UTI rates.
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