Final_Project_Christine_Vaz_2_19_19.docx

A larger evaluation of the hospital system would

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A larger evaluation of the hospital system would collect data in regards to communication protocols, job satisfaction, and staffing ratios. Based on the survey results, these are areas that are lagging and have a critical impact on the patient safety culture at the organization and need to be investigated deeper. During this evaluation, I would focus on if there were units in the hospital where hand-offs and communication between staff was exceeding expectations, a survey of staff job satisfaction, and a comparison of staffing levels in areas where adverse patient outcomes were high and low. This in depth analysis would allow the leaders of the organization to identify
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ROOT CAUSE ANALYSIS & RECOMMENDATIONS 11 the root cause of the deficiencies and implement changes that would improve patient safety. Communication: Strategy A communication strategy for a healthcare system needs to be inclusive of many protocols and methodologies as each scenario can call for a different type of communication. At Union Hospital hand-offs and transitions seem to be deficient. The Joint Commission (2017, September 12), noted that in thirty percent of all malpractice cases, failures in communication were partially of fully responsible for the claim. Additionally, they stated that in a typical teaching hospital can have upwards of four thousand hand-offs each day. This process should be structured in way that all healthcare parties understand the care that needs to be provided for the patient. In order to ensure proper communication, I would recommend implementing the SBAR method of communication. The SBAR platform stands for situation (a concise statement of the problem), background (brief info on the situations), assessment (what you know, found, think), and recommendation (actions needed/recommendations) (IHI, 2019). As part of this implementation, training will incorporate mock scenario and basic team building exercise for the staff to gain confidence in their communication skills and build better relationships. Another recommendation, would be ensure that the hospital is following the Joint Commission’s (2017, September 11) eight tips for high quality hand-offs. There suggestions include face to face meetings for the hand-off if possible, sign-offs for all parties and usage of electronic health records to document the hand-off . Communication: Safer Patient Care When providers use a structure method of communication it fosters a culture of safety, provides essential information on patients and builds teamwork. Staff members can ensure the continuity of care, expectations are outlined not only for the providers but the patient
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ROOT CAUSE ANALYSIS & RECOMMENDATIONS 12 understands their care better. Implementation of one structured hand-off program was noted to reduce adverse events by thirty percent and reduce medical errors by twenty three percent during the course of almost 11,000 patient admissions (JC, 2017, September 12). This is proof that mandating coordinated communication meetings will improve continuity of care which ultimately leads to fewer adverse outcomes due to lack of proper handoff (IHI, 2019).
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  • Summer '18
  • Health care provider, attending physician, Quality and Patient Safety

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