Surgical Day Care at Victoria General Hospital

Using Huddles To Improve Communication in Surgical Day Care (SDC)

presented atSpotlighting Surgical Improvement in BC

November 15 & 16, 2012

Background• Strictly a SDC unit (no Short Stay)

• 20 stretcher bays

• Average of 40-45 patients per day. On busy days we can have up to 55 pts

• We are separate from the Main OR (up one floor) but we do have a SDC OR just down the hallway from us – More on this later

We were playing the “telephone game”

Purpose• We had no formal means of communication

with the whole group on a daily basis • Staff lacked clarity on some issues. Without

clarity, people create stories• Isolated areas in our unit and 2 Ors (one on

separate floor)• Manager comes and goes depending on issues

that have come up

Core Team• 9 RNs • One LPN that works in a treatment room in a

separate area of the hospital• CNL • CNE (shared with PARR)• Manager• Housekeeper• Associates: Surgeons, anaesthesia, OR and

PARR

Culture in our unit

What staff say we could improve on:• Working conditions• Safety Climate• Perceptions of Senior and Local Management

What staff say we do well:• Stress recognition• Job satisfaction

Surprises and Improvement Opportunities:• Teamwork Climate

Nurse input is well received

Disagreements are resolved appropriately

Physicians and Nurses work together as a well coordinated team

Leadership Decision:• During BCPSQC conference June 2012 the

concept of team huddles and planning sessions (start of the day for the OR teams) was discussed

• Manager and CNL made this the first priority for culture change and improvement

Data Debrief

• Survey results posted in a common gathering area for staff (Pod #4)

• Weekly staff meetings to go over results• Got clarification and feedback on questions • Voted on what we wanted to work on (staff

chose 2, Manager chose 1)

Improvement Focus

Daily Team Huddles Arrive in SDC• Easy to implement • Would be a start to improving Safety Climate,

Teamwork Climate, Perceptions of Senior and Local Management

• Enables daily input from staff (alerts, workload, changes, etc.)

Aim Statement

“SDC will do twice daily team huddles at 0735 and 1250. All staff will attend including,

Manager, CNL (will lead the huddle), RNs, Unit clerk, housekeeper, and when possible

physicians. We will achieve this 90% of the time (9 out of 10 huddles/week). We will start

huddles the last week of June”

Tests of Change• Started June 25, 2012• Everyone attended the huddles

Immediately a success with staff!

• Outline is reviewed regularly (informal PDSA cycles) with staff and leadership input

• We have adjusted times to be 0815 and 1430

• Staff only attend one huddle not two (reduce redundancy)

• We have started to include announcements for the day and reminders for the week

• Manager attends regularly. As decided by staff the minimum is 3 afternoon huddles/week

Next Steps

• Keep refining it so that the process is quick and efficient.

• Still asking improvement questions

• Is physician involvement possible – not with current times

Supports

Staff and leadership commitment!

Supports Cont’d

• On going PDSA cycles to refine the process

• Buy-in from the core team

Barriers

• Gathering staff – Will Vocera change this?

• Keeping it short – avoiding too many announcements, can become a social gathering

• Challenge to create an end statement to huddles

Lessons Learned

• Aha! Moment: BCPSQC conference • Input from staff is important • Change is continuous• This is only a small part to culture change and

there is more to come• Wasn’t as much push back from staff as we

anticipated

Contact

Nancy Reichheld, Manager PARR and SDC Victoria General Hospitalnancy.reichheld@viha.ca

Cheryl Larcombe, Clinical Nurse LeaderSDC Victoria General Hospitalcheryl.larcombe@viha.ca