Ask any nurse what his or her performance indicators are and you will likely get "the deer in the headlight" response. That is exactly the response we received when we asked this question at Jacobi Medical Center in the Bronx, N.Y.
We have worked as nurse leaders in acute care facilities for many years, and have seen quality initiatives come and go. Some work and some do not. Here we describe an idea that came about because of the constant pressures that nursing leadership is faced with in providing quality care to patients, monitoring that care, and maintaining that level of quality.
The Joint Commission mandates compliance with National Patient Safety Goals, all of which are patient-focused and relate to the safe care given to patients. Numerous changes in standards and practices have been made to make hospitals safer for our patients. But how do you get staff to participate and embrace these initiatives?
Changing Lanes
[caption id="attachment_" align="alignright" width="195"] A STOP & GO PI board[/caption]
The light bulb went off when we asked these questions: Are all staff involved in data collection? Do they know what indicators or measures are being monitored? Do they understand the ramifications of poor results and do they ?buy into? the process used? Our answer to these questions was ?No.? Of course we met the requirements for reporting as all hospitals have to do, but our staff ? the front-line workers ? were not engaged. We posted the results of our data collection on the units using a dashboard, but we wondered whether staff would really remember what aspects of care their individual units were trying to improve. The answer came to light during our hospital?s recent preparation for The Joint Commission survey. In performing tracers, when staff were questioned about their units? Performance Improvements, they were hesitant and required prompting to recall.
As we discussed our concern, we thought about how professors taught us to use a mnemonic to remember the 12 cranial nerves in nursing school. A mnemonic device is a memory aid. It is often verbal, something such as a very short poem or a special word used to help a person remember something. They are simple and easy to remember. We decided to repackage our PI plan using this method.
We began to brainstorm by discussing our current PI indicators and aspects of care. We knew that the data is often portrayed in a dashboard format; we wanted to develop a mnemonic to complement this theme.
We came up with STOP & GO. STOP represents the aspects of care being monitored and GO represents the goal of good outcomes for patients. This phrase was not only simple but universally recognized. The red STOP suggests to the staff: stop, think, and focus on the aspects of the daily work. The green GO is the desired goal.
We discovered that STOP & GO was adaptable to any service. The goal was not to change our aspects of care, but rather to repackage it in a format the staff could easily recall and have fun with. After sharing our ideas with others in leadership, we were given the ?green light? to continue our PI drive on a different route. The next step was to proceed with caution when we talked to the staff, but to our surprise, they were excited and wanted to be part of the process. Each service (inpatient and outpatient) began to create its own unique and specific STOP & GO indicators, and the PI monitoring tools were redesigned into the STOP & GO format.
Next was to recreate the PI boards on each unit in the STOP & GO model. Staff participation was ?above the speed limit? in expectations and the creativity flowed.The symbol selected was a traffic light with red, yellow, and green lights. Each colored light represents the outcome of the specific indicator. For example, the green light is keep the current course. The yellow light is for caution; pay attention to dipping outcomes. The red light indicates there is a problem that requires immediate attention.
Continuing the Journey
Now when we ask staff about its unit?s Performance Improvement initiatives, the response is an automatic STOP & GO. The next step is to steer the STOP & GO concept to our sister facility, North Central Bronx Hospital, a short drive away.
