EXECUTIVE SUMMARY
Nurses can lead and help change a surgery center’s culture to one that focuses around patients and their families.
- One simple way to embody this culture change is to introduce the OR team to the patient when the patient enters the room.
- Another technique is to include families in the recovery room and to ask them what they observe as the patient is recovering from the procedure.
- It also is important for nurses to take a few minutes to sit, look patients in the eyes, and listen to their concerns and questions.
Nurses can lead efforts to change surgery center culture to focus more on patient-centered operations.
For instance, in a patient-centered culture, surgery center staff thinks of the patient and family as part of the team, says Deanna Collins, RN, MSN, CCRN, charge nurse, ICU, at St. Charles Health System in Bend, OR. “In a changing culture, families are not visitors anymore,” she says. “We can change our concept of how important the whole team is and how important the family is as part of that team.”
Collins offers a few examples of how nurses and organizations can shift to patient-centered operations:
• Introduce the entire team. “Do you introduce the entire team when someone enters the OR?” Collins asks. “Sometimes, if you go into the OR with the patient, nurses could have their backs to the table, and they might not turn around to meet the patient.”
A patient-centered approach calls for a nurse to make an introduction to the patient and introduce the patient to the entire team. “She could say, ‘I’m Deanna, and I’m going to be taking care of you today. Josh, over here, is going to take care of you, too,’” Collins says. “‘Do you have any concerns or questions before we start?’”
The simple courtesy of an introduction can make a big difference in patient satisfaction scores, she adds.
• Include families in the recovery room. “Something we’ve always done in pediatric operations is allow the family in, but we don’t necessarily do that with the elderly population,” Collins says.
The family’s presence could be helpful to patients and the surgery team. For example, if a patient is delirious coming out of surgery, the team might not know if this is a new symptom or the patient’s baseline because of the onset of Alzheimer’s disease, she explains. The family can provide answers. Some hospitals and surgery centers might direct a nurse liaison to provide information to families as they wait. Other facilities maintain an electronic board that provides families updates vs. displays with the patient’s code, Collins says. “You can look at the board and see that the patient is in preop, the OR, or the recovery room phase,” she says. “It will say when visitors are allowed.”
Families appreciate transparency, and they like feeling they are part of the team. Their feedback should be sought, as it is useful. “We could have a stoic gentleman as a patient, and only his wife or child would know that he’s really hurting,” Collins notes. It is critical to change the culture from one of doing something for patients to a culture of doing this with patients and their families, Collins adds.
• Promote dignity and collaboration with patients. “This starts with leadership,” Collins says. “Any system has to assess what barriers they have.” For instance, does workflow design allow for more patient-centered care? Are nurses’ and other employees’ greetings and instructions to patients designed to allow for a conversation? Do you discuss the patient’s stress about surgery and their concerns regarding potential risks?
• Set workflow patterns to allow time with patients. “It shouldn’t be a cattle call,” Collins says. “Spend time with patients, and it doesn’t have to be long,” she notes. “It could be less than five minutes.”
The point is to take time to sit and listen to patients, making eye contact. “Make that bond to try to get more information,” Collins suggests. “I’ve seen families go from being super angry and super scared to being fine within four minutes. Just open a chart, sit with them, and look them in the eyes. It takes a lot of stress out of it.”
• Educate staff. Organizations should know their own barriers through process improvement groups and practice committees. Most employees, including nurses, hate change. Educating employees about ways to be more patient- and family-focused requires some small steps with follow-up, Collins says. “It’s just having a set of principles, defining them, and putting them into our practice.”
• Demonstrate patient-centered actions. It also helps if leaders are demonstrating how the culture change can work. For example, some nurses simply do not want to engage with the family when they are busy with their recovery room work. This is where a leader can handle that simple task for the nurse, she says.
“I just come in the room, greet the family and patient, and say, ‘Hi, is there anything I can do for you?’” Collins explains. “It takes me two minutes, and it eliminates the nurse’s stress. The family goes back to their phone or magazine, and the nurse is a lot happier.”
Leaders can link organizational strategies directly to daily work, she says. “The organizational strategy should be reflected in what bedside staff do. It would be nice to talk to staff the way you want them to talk with patients and families.”
At weekly staff meetings, leaders can touch on the patient-centered strategy and align priorities. “We try to make progress and develop goals that reach down to staff so they’re tangible,” Collins adds.
• Emphasize cultural sensitivity. “Make sure staff has competency in handling cultural differences,” Collins says. For instance, some patients might want sage in the room.
“See what we can do for them in the operating room; learn what’s important to them,” she suggests. Once, a family wanted the patient to hold a medallion. Since the patient’s hand was not part of the procedure, the staff allowed it.
• Start a patient and family advisory committee. This group can help the organization with changes and standards. For instance, the committee members could provide input on patient lounges and waiting areas, expressing what kind of environment they would like to experience while they are waiting.
“Ask members of the community to be on the committee,” Collins suggests. “We had two long-term patients who agreed to help us, and we had volunteers.”
A few examples of how nurses and their organizations can shift to patient-centered operations.
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