NHS FPX 4010 Assessment 1 Collaboration and Leadership Reflection Video JJ

NHS FPX 4010 Assessment 1 Collaboration and Leadership Reflection Video JJ

Good afternoon everyone and welcome to my Collaboration and Leadership Reflection Video for NURS4010: Leading People, Processes, and Organizations in Interprofessional Practice. My name is Julian Nkem. 

During this video I plan to: 

● Reflect on an interdisciplinary collaboration experience noting ways in which it was successful and unsuccessful in achieving desired outcomes. 

● Identify how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature. 

● Identify best-practice leadership strategies from the literature, which would improve an interdisciplinary team’s ability to achieve its goals 

● Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work more effectively together. 

● I’ll make mention of authors from literature. 

First let me provide some background 

NHS FPX 4010 Assessment 1 Collaboration and Leadership Reflection Video JJ

Effective interprofessional collaboration – also known as interdisciplinary collaboration, is an essential component in the delivery of comprehensive, safe and therapeutic patient care. In today’s healthcare marketplace, stressors such as heavy patient loads, increasing demands on nurses and other direct care providers, and system-wide financial strain can lead to a wide variety of miscommunications and tensions among members of the healthcare team. As a result, a focus on enhancing interprofessional collaboration is much needed to help

minimize undesirable events, and improve teamwork, communication, and most importantly – improve patient outcomes. 

The experience I will share tells the story of the interdisciplinary collaboration that occurred during my hospital’s monthly electronic medical record down time planning. Due to my vast experience with these types of tasks, I am always assigned this duty to help Health Care informatics Analysts and other stake holders as Nursing representative. I’ll refer to the electronic medical record as an EMR. 

As a nurse, my job is to serve as a link between the patients and hospital practitioner for day-to-day work as well as managing the EMR of patients. The IT team and the practitioners has asked me to identify a suitable time for the EMR to be taken off line in order to perform mandatory software and hardware updates. The EMR is used to enter orders, allocate medications, document patient care activities, generate lab and other diagnostic results, perform allergy and drug-drug interaction checking, monitor for fall, infection, and sepsis risks. While the EMR is “down” or off-line none of these functions are available and all nurses and other practitioners have to depend on paper-based procedures. Needless to say, we are dependent upon the EMR for all their patient care activities, and any gap in its availability causes anxiety, frustration, and has the potential to impact patient safety. Because of this, nurses want the EMR to always be available, and operating at peak performance. But on the other hand, The IT teams that manages the system are obligatory to conduct periodic software and hardware updates so that system remain reliable and its performance won’t be disturbed. 

We nurse at different department collaborated with health care informatics analysts so that they can advise the appropriate time for shutting off the EMR. Before doing the required

task, they briefed us that why it is necessary to completely shut down the entire EMR, including labs and the diagnostic imaging system known as the PACs system. They told us that if these tasks were not performed there was a great risk that the security of the EMR would be jeopardized, and the database corrupted, ultimately resulting in the inability to utilize the EMR or access any patient information. 

NHS FPX 4010 Assessment 1 Collaboration and Leadership Reflection Video JJ

The IT team would need approximately four hours to complete the updates. We were asked to help the IT team to determine a date and time for the down time, create the down time plan, identify resources to provide support pre, during, and post down time, provide down-time related education, and conduct post-down time interviews to identify opportunities for improvement. 

The objective was to identify a four-hour block of time where the least amount of patient care activities would be impacted by the lack of access to the EMR. What a great opportunity to see interprofessional collaboration in action! 

The published evidence would support my idea. Quoting from a 2015 publication the Center for Applied Research: 

● Effective interprofessional collaboration promotes the active participation of each discipline in patient care, where all disciplines are working together and fully engaging patients and those who support them, and leadership on the team adapts based on patient needs. 

NHS FPX 4010 Assessment 1 Collaboration and Leadership Reflection Video JJ

● Effective interprofessional collaboration enhances patient- and family-centered goals and values, provides mechanisms for continuous communication among caregivers,

and optimizes participation in clinical decision-making within and across disciplines. It fosters respect for the disciplinary contributions of all professionals. 

I’ll now go step by step through the Plan-Do-Study-Act process. I’ll refer to that as the PDSA. Let’s start with Plan 

PDSA as advocated by Donnelly and Kirk —- (writing in 2015) — as a foundation, I met with the physician, lab, radiology, health information management, emergency department, and IT stakeholders as well as Health Care informatics Analysts to plan the down time. During these meetings the IT team leaders explained the need and reason for the down time, underscoring the long-term benefits, despite the short-term “pain.” Other stakeholders shared critical patient care activities that occurred in their areas during a 24-hour period. Clarke (writing in 2013) would call such activities as collaborative learning, a demonstrated method for achieving shared successes. The stakeholders explored the pros/cons of a variety of days/times for the EMR down time. As expected, no one day/time was optimal, but realizing the long-term importance of the event, the stakeholders agreed that the EMR down time would occur on Wednesday from 2:00 a.m. to 6:00 a.m. 

NHS FPX 4010 Assessment 1 Collaboration and Leadership Reflection Video JJ

This selection was made for the following reasons: 

● Allow end of day billing transactions to be completed. 

● Permit the phlebotomy team to begin their morning rounds on time. ● Historically low volume of emergency department visits at the specific time. ● A radiologist was available to be on site to read imaging studies 

● Nursing unit staffing was acceptable. 

Now I’ll look at the ‘Do’ phase of the PDSA

On Wednesday at 2:00 a.m. the IT team implemented the plan and “took the EMR down.” During this time, Nurses and practitioners resorted to their down-time procedures to request, document, and monitor patient care activities manually. From 2:00 a.m. to 5:45 a.m. the IT team rebooted 57 servers, applied 17 security patches to the software, installed the new version of the operating system, and tested the updates to make sure there were no negative impact on the EMR. We could access the EMR at 5:55 a.m. 

Now let’s explore the Study phase 

At Tuesday 8:00 a.m. the organization’s stakeholders met to review (“or study”) the down time events. This activity is supported by 2018 guidance from the Institute for Healthcare Improvement support the value of PDSA cycle as a scientific method. We demonstrated this best practice when all the stakeholders identified what worked well during the down time, listed opportunities for improvement, and summarized and reflected upon lessons learned. 

Last, but not least, let’s explore the Act phase 

The stakeholders identified the following as lessons learned: 

● Wednesday from 2:00 a.m. to 6:00 a.m. was an optimal time to take the EMR offline 

● Nursing staff was not efficient in manually organizing the records documents and it delayed many patients procedures somehow. 

● Downtime procedures need to be reviewed with all nursing staff as several units did not know how to obtain down time forms. 

● Additional phlebotomy staff are needed to help with first round lab draws in order to minimize delays in lab result processing.

● The PACs administrator needs to be on site to assist radiologists with down time processes. 

● The clinical informatics staff needs to round every hour to support staff pre, during, and post down time 

● Providing an explanation of the importance of the down time was critical to the success of the event 

● There was no delay in critical test result notification or medication errors during the down time except some minor inconveniences. 

Future down time events will be communicated at least two weeks in advance; all stakeholders will meet two days before the event to review down time plan. 

When you think about it, the PDSA process is a way to lead an interdisciplinary team through effective change. This is part of being a high reliability organization 

Planning and implementing an organization-wide EMR down time provided an opportunity to demonstrate the impact of interdisciplinary collaboration. Poor collaboration and incomplete planning could have resulted in delays in communicating critical test results, medication errors, and potential patient harm. Stakeholder engagement is identified as one of the foundations to the achievement of a high reliability organization. High reliability organizations according to the Agency for Healthcare Research and Quality are those that “operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures. The concept of high reliability is attractive for health care, due to the complexity of operations and the risk of significant and even potentially catastrophic consequences when failures occur in health care” (AHRQ, 2019, para 1). Patient safety

should always be the focus of any interdisciplinary collaboration. “The Joint Commission suggests that hospitals and health care organizations work to create a strong foundation before they can begin to mature as high reliability organizations. Quoting 2019 guidance from the Agency for Healthcare Research and Quality: Such foundational work includes developing a leadership commitment to zero-harm goals, establishing a positive safety culture, and instituting a robust process improvement culture”. 

NHS FPX 4010 Assessment 1 Collaboration and Leadership Reflection Video JJ

Major factors that affect collaboration include communication, respect and trust, unequal power, understanding professional roles, and task prioritizing. Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world. 

NHS FPX 4010 Assessment 1 Collaboration and Leadership Reflection Video JJ

So, upon reflection, I am happy to say that I survived this experience. I learned a lot about myself as a result of the project. I actually thanked all the stakeholders and IT Staff for the opportunity; and told them I would be happy to do it again. Without the support and engagement of the department directors, and the cooperation and partnership of the patients, the EMR down time could have been a chaotic event, creating opportunities for medication and diagnostic errors, resulting in patient harm. Through this experience I discovered the power of collaboration, and the critical role of leadership in organization-wide project implementation.

References 

Clinical Quality & Nurse Magnet Analytics Platform | Press Ganey. (2016). Pressganey.com. https://www.pressganey.com/products/clinical-excellence 

Griggs, K., Wiechula, R., & Cusack, L. (2018). Geriatric Nursing Sensitive Indicators and quality nursing care for the older person: a scoping review protocol. JBI Evidence Synthesis, 16(1), 39-45. 

Hospital Acquired Conditions | CMS. (2014). Cms.gov. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/V alue-Based-Programs/HAC/Hospital-Acquired-Conditions 

Mangold, K., & Pearson, J. (2017). Making Sense of Nursing-Sensitive Quality Indicators. Journal for nurses in professional development, 33(3), 159-160. 

Yakusheva, O., Lindrooth, R. C., Weiner, J., Spetz, J., & Pauly, M. V. (2015). How nursing affects Medicare’s outcome-based hospital payments..

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