we presentation

7/24/2019 We Presentation

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AACNs Healthy WorkEnvironments Initiative


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The mistakes are all there,waiting to be made.

Chess master Savielly Tartakower (1887-1956)


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Organizations learn and evolvethrough conscious, deliberate

action. Deliberate action is ethical.

When the time to act has come,it is unethical not to do something.

David Thomas

Ethicist !"thor o#Ethics of Choice


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Assertion #1

There is a direct li$k %etwee$work e$viro$me$t a$d &atie$tsa#ety

There#ore if we are notaddressing our workenvironment, we are not

addressing patient safety


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Assertion #2

'ealthy work e$viro$me$ts do$ot "st ha&&e$

There#ore if we do not havea formal program in placeaddressing work environmentissues, little will change


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Assertion #3

Creati$ healthy worke$viro$me$ts re*"ires cha$i$lo$-sta$di$ c"lt"res traditio$sa$d hierarchies

There#ore tho"h everyo$em"st %e i$volved i$ the creatio$

o# healthy work e$viro$me$ts,the onus is on organizational,departmental and unit leadersto ensure that it happens


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The Assertions

'+Es are directly li$ked to&atie$t sa#ety

'+Es re*"ire a #ormal &roram

,eaders m"st drive '+Es


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Skilled comm"$icatio$

Tr"e colla%oratio$

E##ective decisio$ maki$!&&ro&riate sta##i$

ea$i$#"l reco$itio$

!"the$tic leadershi&

Healthy WorkEnvironments Require


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AAC !tandards for Establishing and!ustaining "ealth# Work Environments

Skilled Communication

."rses m"st %e as &ro#icie$t

i$ comm"$icatio$ skills asthey are i$ cli$ical skills


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True Collaboration

."rses m"st %e rele$tless

i$ &"rs"i$ a$d #osteri$colla%oratio$



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Effective Decision Making

."rses m"st %e val"ed a$d

committed &art$ers i$ maki$&olicy directi$ a$d

eval"ati$ cli$ical care a$d

leadi$ ora$i/atio$alo&eratio$s


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ppropriate Staffing

Sta##i$ m"st e$s"re the

e##ective match %etwee$&atie$t $eeds a$d $"rse

com&ete$cies


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Meaningful !ecognition

."rses m"st %e reco$i/ed

a$d m"st reco$i/e others #orthe val"e each %ri$s to the

work o# the ora$i/atio$


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uthentic "eadership

."rse leaders m"st #"lly

em%race the im&erative o# ahealthy work e$viro$me$t

a"the$tically live it a$d

e$ae others i$ itsachieveme$t


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Creating the $case% for a health# work environment&

+hat do we k$ow0

are &rese$t i$

!"o# !,,

se$ti$el eve$ts

re&orted to

C!'2

Communi$ation Issues


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!re &rese$t i$ more tha$ 753 o# wro$ site s"reries

a$d delays i$ treatme$t

!re &rese$t i$ more tha$ 643 o# medicatio$ errors a$dve$tilator eve$ts

Communi$ation Issues

+hat do we k$ow0


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653 o# $"rses re&ort &erso$ally e&erie$ci$ ver%al

a%"se i$ the last year #rom other $"rses &hysicia$s

&atie$ts a$d &atie$ts #amily mem%ers1

5:3 o# $"rses re&ort that a%"se or disres&ect#"l

%ehavior is o#te$ or #re*"e$tly tolerated1

773 o# hos&ital careivers work with collea"es who

are co$desce$di$ r"de or ver%ally a%"sive:

1Ulrich B, Lavandero R, Hart K, Woods D, Leggett J, Taylor D. Critical Care Nrses! Wor" #nviron$ent%

& Baseline 'tats Re(ort. Critical Care Nurse, )**+ )+-/% 0+2

)3a45ield D, 6renny J, 3c3illan R, 7atterson K, '8it9ler &. Silence Kills, &ccessi:le at 888.silence"ills.co$

Colla%oration Issues

+hat do we k$ow0


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!ome docs can make incorrect orders.

We let it slide ' es(eciall# if it is a )erk&

*or e+am(le, one (h#sician (rescribed adrug that #ou should give times a da#,

but he said to give it twice a da#. - let it go,

because it was )ust a (ain (ill. -t wasnt

going to make the child an# sicker.;"ote #rom a &harmacist i$

!ilence /ills 0 !even CrucialConversations for "ealthcare


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&ta''in( an) *ut$omes

+hat do we k$ow0

! Sam&li$ o# the ,iterat"re Creati$ 'ealthy +ork E$viro$me$ts= !&&ro&riate Sta##i$

(C"E!T 1h#sician !&ril :447)

>m&act o# the ."rse Shortae o$ 'os&ital ?atie$t Care= Com&arative

?ers&ectives ("ealth Affairs arch :447)

."rse Sta##i$ i$ 'os&itals= >s There a @"si$ess Case #or ;"ality0

("ealth Affairs a$"ary :446)

The +orki$ 'o"rs o# 'os&ital Sta## ."rses a$d ?atie$t Sa#ety

("ealth Affairs "ly :44A)

."rsi$ @"r$o"t a$d ?atie$t Sa#ety

(2ournal of the American 3edical Association Be%r"ary :44) 'os&ital Sta##i$ 2ra$i/atio$ a$d ;"ality o# Care= Cross-.atio$al

Bi$di$s (American 2ournal of 1ublic "ealth "ly :44:)

."rse-Sta##i$ ,evels a$d the ;"ality o# Care i$ 'os&itals

(ew England 2ournal of 3edicine ay :44:)


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!$ emere$cy de&artme$t task #orce develo&s a

&atie$t re&ort #orm that ca$ %e #aed to i$&atie$t "$its

to #acilitate &atie$t tra$s#ers a$d ease overcrowdi$

The $ew #orm is #irst "sed #or a$ "$sta%le &atie$t+he$ #aed to the >C $o o$e sees the #orm

+he$ the &atie$t arrives $o o$e is availa%le to admit

the &atie$t Te$sio$s r"$ hih #amily is a$ry

everyo$e &itches i$ to coverF

AAC !tandards for Establishing and

!ustaining "ealth# Work Environments

:445

+e$ision ,akin(

+hat do we k$ow0


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One of the most decisive functions of

leadershi( is the creation, management,

and when necessar#, the destructionand rebuilding of culture.

Edar Schei$

+hat do we k$ow0

-ea)ershi.


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,i$k to &atie$t sa#ety $ot "$iversally reco$i/ed

Gelatio$shi& iss"es see$ as so#t'ierarchy a$d &ower str"ct"res

Di##ic"lt to meas"re im&roveme$ts

Traditio$

.ot a sey iss"e

Challen(es to the Case 'orHealthy Work Environments

!re There Challe$es0


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"os(itals, like an# other business, need to be

accountable for (roviding services that dont

harm the (eo(le the# serve. G Hi%so$ I Si$h :44

Wall of !ilence

We s(end 456,777 for (ills, (rocedures and

bed(ans for ever# one dollar on (atient

safet#. G +achter I J Shoa$ia :44A

-nternal8leeding


In the /10" trillion 0&0 Health$are &ystem

!re There Challe$es0


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The &"%lic

?olicy makers

Ge"lators'ealthcare &ro#essio$als

Commo$ se$se a$d doi$ the riht thi$

Healthy Work Environments AreEssential'or ,akin( atients &a'e

This is %ei$ dema$ded %y=


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$1ainting a (icture% of a health# work environment&

Commo$ Threads

2ra$i/atio$al res&o$si%ilities

>$divid"al res&o$si%ilities

S"&&ort #or a$d access to ed"catio$al

&rorams related to each

,eadershi&Kadmi$istratio$ s"&&ort


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!killed Communication

Boc"s o$ #i$di$ sol"tio$s

?rotect a$d adva$ce relatio$shi&s

>$vite a$d hear all &ers&ectives

Hoodwill a$d m"t"al res&ect

Co$r"e$ce %etwee$ actio$ a$d words

Lero-tolera$ce &olicies

Bormal str"ct"res #or comm"$icatio$

!ccess to tech$oloy

Eval"atio$ com&o$e$t

?art o# &er#orma$ce a&&raisal


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True Collaboration

!cco"$ta%ility de#i$ed

Decisio$-maki$ a"thority

!ccess to reso"rces #or dis&"te resol"tio$

!ll em%race c"lt"re o# colla%oratio$

Ges&ect each voice

?erso$al i$terity

Skilled comm"$icatio$

Com&ete$ce o# all team mem%ers

."rse ma$aers a$d Ds e*"al &art$ers


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Effective Decision 3aking

2ra$i/atio$al val"es clear a$d &art o# decisio$maki$

Str"ct"res e$s"re &atie$ts a$d #amilies are heard

Shared acco"$ta%ility #or decisio$ maki$

Ges&ect #or rihts o# all !ll key &ers&ectives i$cor&orated

?rocesses i$ &lace to eval"ate res"lts o# decisio$s


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A((ro(riate !taffing

Sta##i$ &olicies solidly ro"$ded

."rses at all levels &artici&ate i$ e$tire sta##i$ &rocess

Sta##i$ decisio$s are eval"ated

System i$ &lace to #acilitate access to sta##i$ data

S"&&ort services availa%le to e$s"re $"rses #oc"s o$$"rsi$ work

Tech$oloies ado&ted that e$ha$ce e##ective$ess o# $"rsi$ care delivery


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3eaningful 9ecognition

Com&rehe$sive reco$itio$ &roram i$ &lace #or all

Systematic &rocess #or k$owi$ how to &artici&ate

@edside to %oardroom

>$cl"des &rocess to determi$e that reco$itio$ is mea$i$#"l

Geco$itio$ system is re"larly eval"ated

Everyo$e is res&o$si%le


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Authentic :eadershi(

$dersta$d re*"ireme$tsKdy$amics at &oi$t o# care

He$erate visi%le e$th"siasm

Gole model comm"$icatio$ colla%oratio$ etc

Eval"ate leaders im&act a$d &roress toward '+E E$s"re leaders are well &ositio$ed a$d s"&&orted

?rovide time #i$a$cial a$d h"ma$ reso"rces

?rovide co-me$tori$

>$cl"de leaders role i$ '+E i$ &er#orma$cea&&raisal


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."rses a$d all health &ro#essio$alsEmbrace, develo(, follow through

'ealthcare ora$i/atio$s

Ado(t, im(lement, evaluate, role model

!!C. a$d the comm"$ity o# $"rsi$1romote, develo(, (ublicize

Call to A$tion


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Our lives begin to end

the da# we become silent

about things that matter. arti$ ,"ther Ji$ r


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AACN &tan)ar)s 'orEsta%lishin( an) &ustainin(

Healthy Work Environments #ourney to E$cellence

www.aacn.org;hwe

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