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Background

Description of problem or issue

Communication is a crucial tool within the field of healthcare. Effective communication among nursing staff members is imperative in the provision of high quality patient care. A wide body of literature has identified lack of effective communication as a significant factor affecting nursing staff relationships and the delivery of patient centered care (Cohen, 2013). Previous studies have shown that poor communication can result to medical errors, delays in treatment, misunderstanding and even severe patient outcomes. Moreover, poor communication can lead to lack of satisfaction among the staff, high turnover rates and low morale among the staff members (Yoder-Wise, 2019). Additionally, there have been discoveries of an increase in the number of patients who have developed delirium in the course of the hospital stay. There are high chances that the problem can be resolved by improving communication.

Impact on patient safety and quality of care

Poor communication among the nursing staff members has adverse effects. When there is a communication breakdown, conveying important communication can be daunting which in turn leads to misunderstandings, medical errors and even delay in treatment. As a result of these adversities, patient safety becomes questionable and the quality of care is significantly reduced (Cohen, 2013). A good example is administration of wrong medication as a result of poor communication during administration. Furthermore, poor communication can also affect the quality of care due to delayed diagnoses and treatment.

Justification for intervention

Poor communication can have detrimental effects not only to the working conditions but also to the outcome of patient care. As evident, poor communication jeopardizes patient safety and the quality of care offered by a healthcare organization (McCulloch et al. 2011). Due to this findings, there is dire need for coming up with effective intervention that will minimize if not elevate the problem of communication among nursing staff members. Improving nursing staff communication is essential to enhance patient safety, quality of care, and organizational performance (Yoder-Wise, 2019).

Organizing

Proposed change or intervention

The proposed change for the underlying problem is implementation of a communication training program for all the nursing staff members. The purpose of this training will be enhancing communication skills and improve the general communication practices among the nursing staff members. The objectives of the training will be to explain to the staff the importance of communication, gather evidence that will help in supporting staff communication with the use of plan-do-study-act (PDSA). The training will also highlight on the barriers of effective communication among the staff members and describe how the PDSA methods will be integral in the process.

How change is related to mission

The proposed change is related with the mission since improving communication among the staff will enhance quality patient care and prioritize patient safety.

How change impacts health of organization

Improving communication among the nursing staff will result in improvement in regard to patient outcomes, reduced medical errors and heightened patient satisfaction. Eventually, the intervention in place will improve the health and performance of the organization.

Planning

What is being done

A communication training program is being implemented for all the nursing staff members on how to improve communication skills and deliver better services. Also, a delirium assessment tool is being implemented. A nursing practitioner (NP) and a clinical nurse specialist (CNS) are being hired. Additionally, an interdisciplinary team is being developed.

Members of the interprofessional team and their responsibilities

The members of the interprofessional team will comprise of Medical Director, NP or CNS, Charge RN, social work, case manager, pharmacist, and physical therapist (PT) and an occupational therapist (OT). The medical director will provide support and the resources needed for the success of the underlying intervention. Also, the medical director will oversee the implementation of the communication plan and ascertain that the intervention aligns with the mission, goals and objectives of the organization. He or she will also examine the effectiveness of the program. The NP and CNS will play a crucial role in educating the nursing staff on the effective communication techniques. They will also provide training on the use of communication tools and technologies. Also, they will follow the patients and write reports on their progress. The charge nurse will be responsible for implementing the communication plan and ascertaining that the rest of the nursing staff members are abiding by the communication protocols. The social worker will work together with the nursing staff members to offer psychosocial support to the patients and their families. They will work in collaboration to identify the needs of the patients and address them. The case manager will coordinate care across the healthcare continuum and ascertaining that there is effective communication among the team. The pharmacist will be responsible in matters pertaining to medication. The PT and OT will work together to develop a plan to provide treatment for the delirium patients.

Where intervention will occur

The training and intervention will take place on site at the healthcare facility.

How it will be accomplished

The training and intervention will be conducted through interactive activities, discussions and even role playing.

How long it will take

The intervention program will be carried out in eight weeks; two training sessions per week.

Evidence base for planning

The training program will be grounded on evidence based communication practices that have been established as effective in enhancing communication among healthcare professionals. 

Connection to objectives

The intervention aligns with the organizational objectives since they aim at improving quality patient care, prioritizing patient safety and enhancing communication among the nursing staff and even the patients.

Impact on scheduling, staffing, staff development, satisfaction

The training program will have a positive impact on staffing and staff development as it will provide the staff with the necessary knowledge on building a positive working relationship among the current and even future employees at the facility. In the long term the program will help the staff understand the significance of effective communication and find mechanisms of practicing it which is critical in improving staff retention.

Communication plan: Include who, what, how

The communication plan will include all the staff members and even the management team at the hospital. The training program will be shared through the staff meetings that will be organized, flyers and emails. The hired communication specialist will communicate directly with the staff members who will be in attendance during the training sessions. Pamphlets and online reading materials will also be provided to the members.

Timeline

The program will be conducted in 8 weeks. The first two weeks will be used for planning and development of the communication training program. Week 3-6 will be employed in the implementation of the communication training program while the remaining two weeks will be used in evaluation and follow up of the program.

Budgeting

Variable costs

Hiring NP/CNS will cost an average of around $100,000- $130,000. Hiring of 2 part time aids will cost $40,000.

Fixed costs

$1000 will be set aside to hire an IT team that will be responsible of updating the emergency medical records (EMR) system. Walkers will cost $1,400 and the clocks will cost $400.

Direct costs

Completion of education for the registered nurses will cost $25,000 while completion of education for the aids will be $2,000.

Indirect costs

The Education and Implementation Bundle which encompasses consultation services and training program will cost $5,000.

Evaluation of budget

The budge will be evaluated by conducting a cost benefit analysis which will aid in ascertaining the financial feasibility of the proposal. Also, it will be compared with the industry standards and a return on investment will be calculated to examine the benefits of the intervention in relation to the costs.

Directing

List of strategies to implement

The communication training program will be implemented using several strategies. One of the strategies will be through the use of one on one training whereby a specialist will teach the staff members on how to practice effective communication during patient care. Communication technologies such as the use of Electronic medical record (EMR) system will be installed. The staff members will be used on effective use of these systems to improve communication. Clear communication guidelines and policies will also be put in place.

Coalition member responsible for each step

The management team will be responsible for provision of resources and overseeing the entire process inclusive of evaluating the outcome of the intervention. Certified Nursing Assistants (CNA’s) and Patient Care Assistants (PCA’s) will be responsible for reporting patient observations, needs and changes in vital signs to the Registered Nurses (RN’s), Licensed Practical Nurses (LPN’s) and other nursing staff members. The RN’s will be responsible for patient care and coordination of patient care plans. They will also communicating effectively patient information and delegate tasks to their subordinates. LPN’s will help the RN’s with patient assessments and reporting the changes to other nursing staff members. Physician Assistants (PA’s) will be responsible for providing contribution of patient care plans and coordinating the care plans among the different departments within the facility. PT/OT and Respiratory Therapists (RT’s) will be responsible for timely communication on matters pertaining to the state of the delirium patients.

Controlling

Evaluating indicators

There are several indicators that can be employed in the evaluation process. One of the indicators is improved patient outcomes. In the occasion whereby there will be improved patient outcomes due to reduced medical errors and high patient satisfaction can be used to signify the success of the program. Increased staff satisfaction is also another indicator that can be used to show that the proposal was a success. Reduced incidences of patients acquiring delirium can also be used to indicate the success level of the program. Moreover, compliance with communication policies and increased efficiency are also vital indicators of the progress.

Implementation of communication plan

Who implements

The implementation of the communication plan will be done by the medical director since he or she is the leader of the nursing team. The medical director will work in collaboration with the nursing staff members to come up with the comprehensive communication plan that aligns with the needs of the healthcare facility and its patients.

How implemented

The implementation will be done in several steps. The first phase will involve an assessment of the current communication practices. The assessment will be carried out through surveys, holding focus groups and conducting an observation of the interactions between the staff members to identify the critical areas that need improvement. The next phase will be development of the communication plan. The communication plan will involve coming up with effective guidelines and policies for communication. Identification of communication tools and technologies will also be established at this stage. The training program will also be developed at this stage. The next phase will be to train the staff members on the policies, guidelines and effective communication techniques. The staff will also be trained on how to effectively use the different communication technologies.  The next phase will be monitoring and evaluating the plan while the last stage will be making adjustments.

How change will be sustained

Change will be sustained by conducting weekly huddles and having text and videos sent to the staff members to help rely information on the new communication plan. Also, there will be ongoing training to reinforce the significance of effective communication. Performance metrics will also be developed to monitor and examine the effectiveness of the communication plan over time.

Benefits to organization from change

There are several benefits that the organization will realize from the change. One of the benefits will be increased staff satisfaction. Effective communication in place will help in improving transparency and collaboration among the staff. As a result, a positive working environment will be developed which will lead to heighted staff satisfaction. Efficiency and enhanced quality care will also be attained. Moreover, there will be improved patient outcomes which will positively impact the organization.Blog

Summary

Summing up, improving communication among nursing staff members is critical to improving the quality of care provided by any healthcare facility. Through the implementation of a comprehensive communication plan, nursing staff members can work in a healthier environment which in turn promotes performance, improved patient outcomes, better patient experience and increased satisfaction among the staff and patients. Sustaining the change in place calls for ongoing training and support from the leadership team and involvement from the nursing staff members.

References

Cohen, Shelley MSN, RN, CEN. Talk it and walk it: Staff communication. Nursing Management (Springhouse) 44(6):p 16-18, June 2013. | DOI: 10.1097/01.NUMA.0000430411.73206.bc

McCulloch P, Rathbone J, Catchpole K. Interventions to improve teamwork and communications among healthcare staff. Br J Surg. 2011 Apr;98(4):469-79. doi: 10.1002/bjs.7434. Epub 2011 Feb 8. PMID: 21305537.

Yoder-Wise, P.A. (2019). Leading and managing in nursing (7th Ed.). Elsevier. ISBN:978-0- 323-44913-7. (The 8th edition is being published, but we are still using the 7th edition).

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