Jeanine Frumenti, RN, DNP, CNO, vice president of patient care services at Bronx-Lebanon (N.Y.) Hospital Center, conducted a leadership training program for patient care managers on three med/surg units to develop transformational leadership skills and improve management of operational failures, such as hospital-acquired pressure ulcers. As a result of the program, in one year each unit has saved between $70,000 and $110,000 in supplies and surfaces, such as specialty mattresses and beds.
For Frumenti, it wasn’t a question of whether the program would work. “Our managers are critical to the achievement of better patient outcomes and improved patient satisfaction,” Frumenti said. “I wanted to help them become stronger leaders, and in doing that, we improved patient care, staff satisfaction and employee relationships, and we have seen a significant cost savings.”
Teach and train
For eight weeks last fall, the PCMs received 45-minute, one-on-one weekly coaching sessions with Frumenti. Because of the training, the PCMs chose to work on the operational failure of pressure ulcer management. Each of the three PCMs identified a different specific focus to improve pressure ulcer management.
Carla Colin, RN, pulmonary patient care manager, focused on decreasing and preventing nosocomial pressure ulcers through turning and repositioning.
“After identifying the root causes, we arrived at workable solutions,” Colin said. “We created two turning teams to maintain consistency in care, and since the start of the process in January, our nosocomial pressure ulcers have decreased by 85%. Instead of having four to six a month, we have zero to one a month.”
Jacqueline Davis, RN, med/surg patient care manager, focused on identifying patients with existing pressure ulcers and those at risk for developing them upon admission using documentation from the Braden Scale.
“We started with Braden Scale documentation at a compliance rate of 33%, and after identifying the ‘whys,’ we implemented their countermeasures,” Davis said. “Our compliance level rose above 90% after the fourth week of the project.” The third unit implemented an accurate staging protocol for pressure ulcers.
Systematic approachCheryl Jerome, RN, med/surg patient care manager, left, and Jacqueline Davis, RN, med/surg and telemetry patient care manager, discuss the executive coaching and TCAB initiatives at a recent Nurse.com Nursing Spectrum roundtable.
Frumenti researched the literature and found evidence for using executive coaching to develop the manager’s leadership skills and improve knowledge. “I integrated this method to help managers develop better interpersonal skills, to think and work more strategically and create and communicate vision and mission,” Frumenti said.
During the training program, Frumenti also applied the Toyota Production System. TPS uses a scientific method to improve work systems, prevent recurrences and provide managerial support for resolving failures. When adhering to the four TPS training rules, leaders can make desired changes, monitor the progress of countermeasures and sustain changes.
Root causes at the core
“In this process, it’s critical that a group, and in this case, the manager and unit staff, identify root causes for the problem by asking ‘Why?’ ” Frumenti said. On the pulmonary unit, the team identified root causes, such as lack of staff availability to assist with turning and need for a designated team leader.
“By asking why again and again, we clearly identify the specific causes, and determine the countermeasures that help us achieve our goals,” Frumenti said.
On the unit that chose to improve Braden Scale documentation, countermeasures included placement of an alert in the electronic medical record when documentation was not completed, incorporation of Braden Scales during reports and posting documentation reminders at the nursing station.
Five more PCMs are participating in the training program with Frumenti this fall and will focus on pressure ulcers, falls and streamlining the triage process.