1. Innovation in Care Delivery:
The Patient Journey
Jeanette Ives Erickson, RN, DNP, FAAN
Senior Vice President for Patient Care and Chief Nurse
Massachusetts General Hospital
Boston, MA

2. Objectives
At the completion of this workshop participants will:
1. Illustrate the impact that innovation units have in
making care delivery safe, effective, efficient, timely,
equitable and patient- and family-centered.
2. Describe the role of the attending nurse in promoting
continuity of care.
3. Identify strategies to promote patient and family
involvement in the plan of care.
-2-

3. Waste in the US Healthcare System: A Story Emerges
JAMA 2012;307:1513-6
-3-

4. Rising health care costs are a problem
• Per capita health care costs
have grown steadily for 40
years
2500
2000
Per Capita Growth In Health
Expenditures Has Increased at 2%
Above Inflation For 40 Years
1500
1000
500
0
(adjusted for inflation)
1966
1968
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
• Expanding health insurance
coverage magnifies cost
pressures
3000
Per Capita NHE in $
• Unmet need is perpetual
3500
• The US employer-based health
insurance system is a handicap
in a global economy
Source: 2009 presentation by Stuart Altman, PhD titled
Growing Healthcare Spending: Can or Should It Be
Controlled to Prevent a Health System “Meltdown” ?
-4-

5. Here’s What Is Happening in Health Care in the US
Michael Porter, Harvard Business School 2011
-5-

6. Here’s Where We Need to Go
A need to
innovate new
ways of being
Michael Porter, Harvard Business School, 2011

7. Positioning MGH for The Future
Care
Redesign:
Population
Management:
Reducing the
Trend of
Healthcare
Costs, Long-term
Outpatient Care
Multidisciplinary
Services, Large
Patient
Population, Big $
$$
The
Patient
Journey
Patient
Affordability
For MGH &
Payers:
Direct
Patient Care:
ED, Periop,
Inpatient
(Innovation
Units)
Overhead (NonLabor costs)
Incentives: Intrinsic and Extrinsic
Technology Application: Partners E-Care, Outcomes Registries
-7-

8. -8-

9. Innovating Care at MGH
We are attempting transformational change.
Innovation Units are tests of change that will help us quickly identify what works
and what does not work to improve the quality of care delivered to our
patients.

High performing interdisciplinary teams that deliver safe, effective, efficient,
timely, equitable care, that is patient- and family-centered

Standardization of processes and care reduces variation and introduces a
systematic approach to improving quality and safety in the inpatient setting

Identify and prioritize hazards and opportunities for standardization, then
implement evidence based methods to rectify the problem
-9-

10. Guiding Principles

Care delivery should always be: patient and family-focused, evidence-based,
accountable and autonomous, coordinated and continuous.

It’s important to know the patient.

Inpatient and family care is provided by a designated nurse and physician
who are accountable and responsible for continuity of care.

Continuity of the team is a basic precept.

Every novice team member deserves mentoring from an experienced clinician.

Every patient deserves the opportunity to participate in the planning of his/her
care.

Advancements in technology create opportunity for improved provider
communication and efficiency.

Revised 2013
10 Care should be delivered in the most -cost-effective manner.

11. “Patient Journey” Framework
Before
Preadmission
Care
During
Admission
Process: ED,
Direct Admits,
Transfers
Patient Stay;
Direct Patient Care, Tests,
Treatments, Procedures,
Clinical Support,
Operational Support
Post
Discharge
Process
Support Functions: Finance, Information Systems, HR
Goal: High-performing interdisciplinary teams that deliver safe, effective, timely,
efficient and equitable care that is patient and family centered.
Where Are There Opportunities to Reduce Costs Across These Processes of Care?
Copyright Partners HealthCare 2011
- 11 -
Post
Discharge
Care

12. Innovations in Care Delivery “Patient Journey” Framework –
Initial 15 Interventions
Patient stay; direct patient care;
tests; treatments; procedures;
clinical support;
operational support
Discharg
e process
Intervention
Admission
process: ED,
direct admits,
transfers
After
Intervention
Intervention
Preadmission
care
During
Intervention
Before
Postdischarge
care
Goal: High-performing, inter-disciplinary teams that deliver safe, effective,
timely, efficient, and equitable care that is patient- and family-centered
Discharge Planning:
-Est. discharge date
-Discharge disposition
Domains of Practice
Daily Interdisciplinary Team Rounds
Electronic Unit Whiteboards
In-Room Whiteboards
Smart Phones
Wireless laptop computers/tablets
Business cards
Hourly rounding
Quiet hours
Welcome Packet (notebook
and discharge envelope)
Relationship-based care
♦
The Attending Nurse role
Copyright MGH 2012
- 12 -
♦
Discharge
-Follow-up Call Program
Hand-Over Rounding Checklist

13. Three Key Areas of Focus and Four Desired Outcomes
Focus
1. New Culture through Relationship-Based Care
2. New Role of Attending Nurse; Domains of Practice
3. Standardized Processes
 Throughput and LOS Reduction
 Technology
 Controlling Variation
 Implementing Evidence-Based Practice
Outcomes
1.
2.
3.
4.
Patient Satisfaction: care is equitable and patient- and family-focused
Clinical Quality: to improve quality and to make care safer
Unit Cost Reductions: to make care more cost effective
Staff Satisfaction: to remain a great place to practice
- 13 -

14. Roll-Out of Innovation Units
•
Wave I: 12 Units launched March 10, 2012
Unit Types: General Surgery; Vascular Surgery; General
Medicine; Orthopaedics; Oncology; Newborn/Family;
Pediatrics; Psychiatry; Neonatal ICU; Cardiac ICU; Surgical
ICU
•
Wave II: 27 Units launched April 1, 2013
Unit Types: General Medicine; Medical ICU; Cardiac Surgery
(ICU and Intermediate); Cardiac Telemetry and Intervention;
Orthopaedics; General Surgery; Thoracic Surgery;
Gynecology; Oncology; Newborn/Family; Pediatrics;
Burns/Plastics; Transplant; Neuroscience (ICU and General);
Respiratory Acute Care
•
Wave III: 4 Units launched September 24, 2013
Unit Types: General Medicine; Surgical ICU; Short-Stay Unit;
Observation Unit
- 14 -

15. Intervention: Relationship-Based Care
Relationship-Based Care
Relationship-based care is a transformation
model and intervention that improves key care improves outcomes:
provider relationships within an organization:
 Relationships with Patients and Families
 Relationship with Self
 Relationships with Colleagues
- 15 -
 Enhanced Quality
 Improved Clinical Safety
 Increased Patient and
Family Satisfaction
 Increased Physician and
Staff Satisfaction
 Greater Efficiency
 Improved Resource
Management

16. Relationship-Based Care – Three Key Care Provider Relationships
Patients & Families
Self
Colleagues
The relationship between
patients and their families
and members of the clinical
team belongs at the heart
of care delivery.
 Patient and family as
the central focus
 Respect and personal
concern
 Protection of dignity
and well-being
 Active engagement
 Intention to connect
The relationship with self is
essential to maintaining
each individual’s optimum
health, for having empathy
for the experience of others,
and for being a productive
member of an organization.
 Skills and knowledge to
manage stress
 Ability to recognize
personal needs and
values
 Willingness to balance
work demands with
one’s own physical and
emotional health and
well-being
The delivery of
compassionate care
requires a commitment
by all members of the
health care team to
accept responsibly for
establishing and
maintaining healthy
interpersonal
relationships.
 Open and honest
communication
 Respect
 Trust
 Consistent and
visible support
- 16 -

17. Intervention: Attending Nurse Role
Responsible Nurse/Attending Nurse
Expand staff nurse role.
 Accountable for patient/family continuity and progression along the
developed overall plan of care from admission to discharge
 Ensures, along with the Attending MD, that patient care meets the
unit’s clinical standards and vision of patient- and family-centered
care
 Develops and revises the patient care goals with the clinical care
team daily
 Coordinates meetings with clinicians for timely decision making and
connects nurses to optimize handoffs across the continuum
 Is the primary bedside communicator with the patient and family,
discussing plan of the day, care progress, potential discharge, and
answers questions/teaches/coaches
- 17 -

18. Intervention: Hand-Over Communication
 Passing patient-specific
information:
 From one caregiver to
another
 From caregiver to patient
and family
 Transfer of information
from one type of
organization to another or
to the patient’s home
SBAR: Hand-Over Communication Tool
This format should be used whenever a “hand-over” of
patient responsibility occurs, i.e. shift to shift report, etc.
S-Situation: Identify yourself and position,
patient’s name and the current situation.
Describe what is going on with the patient.
B-Background: State the relevant history and
physical (H&P), physical assessment pertinent
to the problem, treatment/clinical course
summary and any pertinent changes.
A-Assessment: Offer your conclusion about the
present situation.
R-Recommendations: Explain what you think
needs to be done, what the patient needs and when.
Verify any critical information received, review the history, seek
clarification, ask questions, and read back critical test results.
Goal: To ensure patient care continuity and safety
- 18 -

19. Intervention: Clinical data collection pre-admit
 Pre-admission clinical data collection, along with screening and
patient education, are key components of “knowing our patients”
 Current data collection standards and tools vary for different
populations (e.g. ED, Same-Day Surgery, Transfers)
 At minimum, estimated discharge date and discharge disposition
should be documented upon admission.
- 19 -

20. Intervention: Welcome Packet
Discharge Information
Envelope Checklist
Patient and Family Notebook



Informs patients and families of goals
Designed to invite feedback
Includes patient and clinician compact
- 20 -

21. Intervention: Domains of Practice
Each clinical discipline articulated Domains of Practice - A sphere of activity or knowledge,
the perspective and territory, which includes subject matter, the main agreed-on values and
beliefs, the central concepts, the phenomena of interest and the methods used to provide
answers in the discipline
Disciplines: Nursing, Chaplaincy, Child-Life, Dieticians, Medical Interpretation, Occupational Therapy, Pharmacy, Physical Therapy,
Respiratory Care, Social Work, Speech-Language Pathology, Volunteers
Example 1 – Nursing: Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and
injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals,
families, communities, and populations (ANA).
 Creation of a caring, individualized therapeutic relationship with patients and families that promotes health and healing

 Assessment, diagnosis, plan, implementation and evaluation of interventions to promote the best possible outcome; this

process is done in partnership with patients, families and the health care team
 Health teaching and promotion

 Delivery of safe, quality and evidence-based practice

 Collaboration and communication with all members of the health care team

 Clinical inquiry and ongoing professional development

Example 2 – Respiratory Care: Respiratory therapists focus on improving and maintaining the cardiopulmonary health of
patients.
 Set-up management and discontinuation of mechanical ventilation (both via artificial airway and face mask)

 Administration and evaluation of the efficacy of aerosolized pharmacological agents

 Set-up management and discontinuation of extracorporeal life-support to patients in the ICUs

 Obtaining and analysis of arterial blood for gas exchange, pH and electrolytes

 Assessment, maintenance, replacement, reposition and discontinuation of artificial airways

 Education of patients and families on all aspects of respiratory care

- 21 -

22. Intervention: Interdisciplinary Team Rounds
“Interdisciplinary rounds keeps everyone on the same page. We all
hear the same information at the same time so we can craft our plan of
care in a way that’s best for the patient. It has had a noticeable impact
on communication on our Unit.”
Team member, White 6 - Orthopaedics
 Create formal mechanism for daily communication between all
members of the care team
 Facilitate concise and timely communication
 Communicate clear picture of patient’s planned course among all
members of the care team
- 22 -

23. Communication: In-Room White Boards








A “communication basic”
Supports knowledge of care team
Builds relationships
Articulates patient’s goal
Keeps an eye on discharge
Can be integrated with notebook
and other teaching tools
Keeping the board current is
critical
It’s only as good a resource as it
is used…
- 23 -

24. Enabling Technology: Smartphones
 iPhone and web application for sending/receiving instant messages to specific
individuals or groups. Users can write their own message or use the Quick
Messages available in the system.
 Voalté iPhones send/receive phone calls over MGH secure wifi (no cell plan
used).
 Sender selects staff they are trying to reach via a list with their name/role and
picture so no need to memorize who is carrying which phone
- 24 -

25. Intervention: Quiet Times
 Designated hours on inpatient
units where activity and
conversation is minimized to
allow patients to rest
 Most effective model is to have
a period in the afternoon and
during the night when quiet
hours are observed
- 25 -

26. Intervention: Discharge Follow-up Calls
 100% of patients in the inpatient setting being discharged to home
will be asked to consent to receiving a discharge follow-up call.
 Calls are made within 24-48 hours
 We estimate 3-5 calls per day per nurse or attending nurse
 Average call time is 3-5 minutes
 Standard is two attempts to reach patient
 Scripts are utilized
- 26 -

27. Intervention: Discharge Planning/Discharge Readiness Tool
 Guides proactive discharge planning and is comprised of:






General Information
Work-up
Functional Requirements
Educational material
Post-Discharge instructions
Discharge Information
 Discharge Checklist
 Tools and workflow procedures, including checklists incorporating
LEAN principles from Toyota
 Other relevant information
- 27 -

28. Intervention: Hourly Rounds – The Four Ps
Evidence-based research indicates that hourly rounding increases
patient satisfaction, decreases fall rates, decreases skin
breakdown rates, and increases staff satisfaction.
The Four Ps
Presence: Establish personal connection at the beginning
and end of each shift and with each hourly round
Pain: Assess and address patient’s pain
Positioning: Patient’s physical position and comfort;
Positioning of needed items within reach
Personal Hygiene: Help with toileting
- 28 -

29. Intervention: Business cards
- 29 -

30. – Evaluation
Innovation Cluster
Focus Areas *
Interventions **
Evaluation
(Pre, During, Post)
Throughout Admission
Relationship-Based Care
Attending Nurse
Handover Rounding Checklist
Patient Engagement
Quantitative
•HCAHPS
Pre-Admission
•Leadership Influence
over Professional
Practice Environments
(LIPPES)
Pre-Admit Data Collection
Welcome Packet
During Admission
Roles & Structures
Education
Communication
Domains of Practice
Interdisciplinary Rounds
Business Cards
Quiet Hours
Hourly Rounding
Electronic White Boards
In Room White Boards
Smart Phones
Hand Held/ Tablets
Post-Discharge
Discharge Follow-up Phone Calls
Others as identified
•LOS
•Quality Indicators
•Patients Perceptions
of Feeling Known
(PPFKN)
•Readmissions
Qualitative
•Focus Groups
(Staff, Patients,
Families, etc)
•Observations
•Survey of the
Innovation Unit
Expectations
(SIUE-pre)
•Survey of the
Innovation Unit
Experiences
(SIUE-post)
•Revised Perceptions
of Practice
Environment Scale
(RPPE)
•Cost per Case Mix
* The clusters are a lens
with which we gain
perspective on any
particular intervention.
•Staff Retention
Other measures as identified
** May apply to any or all 3 of the cluster focus areas
June 2013

31. Innovation Unit Metrics
Throughput and Efficiency
 LOS
 Average Cost per Case Mix
Adjusted Discharge (CMAD)
 TSI bud/flex
 Wait time for bed to be ready
 Admits
Patient & Staff Satisfaction
 MD & RN Communication
 Responsiveness
 Cleanliness
 Noise reduction
 Staff satisfaction
Quality and Safety
 Readmission Rate
 Restraint Free Rate
 Falls/Pressure Ulcer Reduction
 Foley Catheter Days
Massachusetts General Hospital - PCS Innovation Units Dashboard
Measures
Ortho
White 6
Pediatrics
Oncology Medicine
NICU
Lunder 9 Ellison 16 Blake 10 Ellison 17 Ellison 18
Surgery
White 7
CICU
ICU Obstetrics Psych
Vascular
Ellison 9 Blake 12 Blake 13 Blake 11 Bigelow 14
QUALITY AND SAFETY
Patient-Centered Outcome Measures
Falls per 1,000 Patient Days
Total Fall Rate
Observed (N)
Falls with Injury per 1,000 Patient Days
Falls with Injury Rate
Observed (N)
4.50
11
1.46
3
4.95
13
0.77
1
1.92
2
1.32
2
2.16
5
1.79
2
TBD
0.65
2
4.85
10
0.45
1
0.41
1
0.49
1
1.52
4
0.00
0
0.96
1
0.00
0
0.00
0
0.89
1
TBD
0.00
0
1.45
3
0.45
1
0.0%
0
6.9%
2
0.0%
0
0.0%
0
0.0%
0
0.0%
0
7.7%
1
TBD
NA
4.8%
1
4.2%
1
0.0%
0
0.0%
0
0.0%
0
0.0%
0
0.0%
0
0.0%
0
7.7%
1
TBD
NA
4.8%
1
4.2%
1
0.0%
0
0.0%
0
0.0%
0
0.0%
0
0.0%
0
0.0%
0
7.7%
1
TBD
NA
0.0%
0
0.0%
0
NA
NA
0.0%
0
0.0%
0
0.0%
0
NA
NA
NA
NA
NA
NA
2.90
1
4.76
1
0.00
0
1.10
1
1.70
2
TBD
NA
0.00
0
0.00
0
Hospital Acquired (HA) Pressure Ulcers
Total HA Pressure Ulcer Prevalence Rate
0.0%
Observed (N)
0
Hospital Acquired (HA) Pressure Ulcers Type II or Greater
Total HA Pressure Ulcer Type II or Greater Prevalence Rate
0.0%
Observed (N)
0
Restraints
Total Restraint Prevalence Rate
Observed (N)
0.0%
0
Peripheral Intravenous (PIV) Infiltrations - Pediatric/Neonatal
Total PIV Infiltration Prevalence
NA
Observed (N)
Central Line-associated Bloodstream Infections per 1,000 Line Days (CLABSI)
Total CLABSI Rate
6.54
NA
1.36
Observed (N)
1
1
Note: metrics to be reported beginning FY 2012
Catheter-associated Urinary Tract Infections per 1,000 Device Days
Ventilator-associated Pneumonia per 1,000 Vent Days
Color Shading relative to Benchmark:
Rate is worse (higher) than benchmark.
Rate is better (lower) than benchmark.
Innovation Unit Dashboard sample
- 31 -

32. Outcomes - Phase I
ALOS April 2012-September 2013; Readmits April 2012– June 2013
Average Length of Stay (ALOS) in Days
Baseline
Innovation
Period
Change
Phase I Innovation Units
5.5
5.2
-5%
TOTAL MGH
5.9
5.9
0%
30-Day All Cause Readmission Rates
Baseline
Phase I Innovation Units
TOTAL MGH
Innovation
Period
Change
9.9%
8.9%
-1.0
11.3%
11.0%
-0.3
Data Sources: PATCOM, EPSI
Time Periods: Baseline FY11; Innovation Period begins March 2012. Average length of stay data include patient discharges through September 2013. Readmission data expressed as a percent of
patient discharges beginning April 2012 through June 2013 with readmissions through July 2013.
- 32 -

33. ALOS - Phase II Early Results Overall
Discharge ALOS, April-September 2013
Average Length of Stay (ALOS) in Days
Baseline
Total Phase II Units
TOTAL MGH
Innovation
Period
6.1
5.9
6.0
5.9
Change
-2%
0%
Data Sources: PATCOM, TSI
Time Periods: Baseline -Year ending March 2013; Innovation Period begins April 2013. Average length of stay data include patient discharges through October 2013.
- 33 -

34. Cost Impact – Phase I
Inpatient Direct Cost per Case Mix Adjusted Discharge (CMAD)
$8,000
$7,219
$7,000
$6,000
$5,469
$5,848
$5,351
$5,595
$5,394
$5,000
$4,000
$3,000
$2,000
$1,000
$0
Phase I Innovation UnitsGeneral Care
Phase I Innovation UnitsICUs
Pre
Total Phase I Innovation Units
Post
 Average Direct Cost per Case Mix Adjusted Discharge (CMAD) decreased 3.6% for
Innovation units between October 2011-March 2012 (Pre) and April 2012-June 2013 (Post).
Source: Direct Cost per CMAD data from PHS Finance (EPSI). Case mix adjusted using AP21 NY DRG weights.
- 34 -

35. Quality & Safety Outcomes - Phase I
Falls, Pressure ulcers, CY13Q2
Falls with Injury per 1,000 Patient Days
1.00

0.90
0.80
0.70
0.60
Fall rate decreased 23% over
baseline FY11 on Phase I
Innovation units.
0.50
0.40
0.30
0.20
0.10
0.00
CY10
Q4
CY11
Q1
CY11
Q2
CY11
Q3
CY11
Q4
CY12
Q1
CY12
Q2
CY12
Q3
CY12
Q4
CY13
Q1
CY13
Q2
Pressure Ulcer Prevalence (Stage II or Greater)
4.0%

Pressure ulcer prevalence
decreased from 1.75% to 1.41%
of patients on Phase I units.
3.5%
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
CY10
Q4
CY11
Q1
CY11
Q2
CY11
Q3
CY11
Q4
Data Source: NDNQI
Time Periods: Baseline FY11; Innovation Period April 2012 through June 2013.
Notes: Data displayed are Falls with Injury and Pressure Ulcer Stage II or greater. ICUs excluded.
- 35 -
CY12
Q1
CY12
Q2
CY12
Q3
CY12
Q4
CY13
Q1
CY13
Q2

36. HCAHPS Results – 2011 vs. 2012
MGH-wide vs. Phase 1 Innovation Units
Survey Measure
Nurse Communication Composite
Doctor Communication Composite
Room Clean
Quiet at Night
Cleanliness/Quiet Composite
Staff Responsiveness Composite
Pain Management Composite
Communication About Meds Composite
Discharge Information Composite
Overall Rating
Likelihood to Recommend
•
•
MGH
2012
81.0
81.6
72.9
48.5
60.7
64.9
71.9
64.0
91.2
80.1
90.5
HCAHPS Data for Innovation Units includes 6
units for which data is available – Bigelow 14,
Blake 13, Ellison 16, Lunder 9, White 6 and
White. Data not available for ICU’s and Psych.
Date pull: 3.04.13
Change
(2011 - 2012)
+1.6
-0.3
+3.1
+3.3
+3.2
+1.3
+0.4
+1.3
+1.4
+1.0
+1.1
Innovation
Change
Units 2012 (2011 - 2012)
80.8
82.0
70.6
49.8
60.2
64.0
73.3
65.7
92.3
78.5
90.3
+4.5
+0.5
+4.2
+6.2
+5.2
+1.7
+3.7
+6.8
+2.7
+2.4
+2.4
KEY
2012 Score exceeds that of entire hospital
Rate of Improvement Exceeds that of the entire hospital
- 36 -

37. HCAHPS Results – 2012 vs. 2013 YTD
MGH-wide vs. Phase 2 Innovation Units
Survey Measure
Nurse Communication Composite
Doctor Communication Composite
Room Clean
Quiet at Night
Cleanliness/Quiet Composite
Staff Responsiveness Composite
Pain Management Composite
Communication About Meds Composite
Discharge Information Composite
Overall Rating
Likelihood to Recommend
•
•
Phase 2 Units
Change
Change
2013
MGH 2013 YTD
(2012 – April
(2012-2013)
April YTD
2013 YTD)
Score
81.5
82.2
74.3
50.3
62.3
64.3
71.9
64.6
91.3
80.7
90.3
* HCAHPS Data for Innovation Units includes 21 units for
which data is available – Blake 6, Bigelow 9,11, Ellison
6,7,8,10,11,13, 14,19, Lunder 7,8,10, Philips House
20,21,22, White 8,9,10,11
Date pull: 10.18.13
+0.5
+0.6
+1.4
+1.8
+1.6
-0.6
No Change
+0.6
+0.1
+0.6
-0.2
82.0
81.8
75.0
51.4
63.2
64.5
73.4
65.5
91.6
80.3
90.5
+1.2
+0.4
+1.6
+3.5
+2.5
-0.3
+2.3
+2.2
+0.7
-0.2
-0.1
KEY
Rate of Improvement Exceeds that of the entire
hospital
- 37 -

38. Intervention: Discharge Follow-up Calls
Goal: 100% of patients in the inpatient setting being discharged to home will be
asked to consent to receiving a discharge follow-up call.
Patient Call Manager Results
(Discharges 4/5/13-10/18/13 from units live with PCM)
Number of units live (as of 10/18)
38
Calls made (since first go-live)
16,157
(23,000+ calls since
program inception)
Call attempt rate
96%
Call completion rate
65%
Average call length
~5 minutes
Peak calling times
11:00 AM – 3:00 PM
Percent of calls with clinical advice or care coordination
provided
22%
Percent of patients with questions about their discharge
instructions
11%
Themes for Reward/Recognition
Nursing Care (44%)
Doctors (10%)
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39. Innovation Units
 Are attempting transformational change
 Will help us quickly identify what works and what doesn’t
without ever losing sight of our patients goals
 Innovation and care redesign moving us closer to efficient,
cost-effective, high quality care that is patient- and familycentered and responsive.
 Create the opportunity for evaluation and research inquiry that
can to link patient-sensitive interventions specific to
populations, enhancing care and potentially sustaining
behavior over time.
“We experience the essence of care in the moment when one human being
connects to another. When compassion and care are conveyed through touch, a
kind act, through competent clinical interventions, or through listening and seeking
to understand the other’s experience, a healing relationship in created.
This is the heart of Relationship-Based Care.”
”Relationship-Based Care, A Model for Transforming Practice”
Mary Koloroutis, 2004
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40. The Voice of the Attending Nurse
 Michelle Anderson, RN
White 7 General Surgery Unit
 Sarah Ballard Molway, RN
Ellison 19 Thoracic Surgery Unit
 Kelly Brown, RN
White 6 Orthopaedics Unit
 Betty Ann Burns-Britton, RN
Lunder 9 Hematology/Oncology Unit
 Claire Paras, RN
Phillips House 22 Medical/Surgical Unit
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