1. Surgical Day Care at Victoria General Hospital Using Huddles To Improve Communication in Surgical Day Care (SDC) presented at Spotlighting Surgical Improvement in BC November 15 & 16, 2012

2. Background Strictly a SDC unit (no Short Stay) 20 stretcher bays Average of 40-45 patients per day. On busy days we can have up to 55 pts We are separate from the Main OR (up one floor) but we do have a SDC OR just down the hallway from us – More on this later

4. We were playing the “telephone game”

5. Purpose We had no formal means of communication with the whole group on a daily basis Staff lacked clarity on some issues. Without clarity, people create stories Isolated areas in our unit and 2 Ors (one on separate floor) Manager comes and goes depending on issues that have come up

6. Core Team 9 RNs One LPN that works in a treatment room in a separate area of the hospital CNL CNE (shared with PARR) Manager Housekeeper Associates: Surgeons, anaesthesia, OR and PARR

8. Culture in our unit What staff say we could improve on: Working conditions Safety Climate Perceptions of Senior and Local Management What staff say we do well: Stress recognition Job satisfaction

9. Surprises and Improvement Opportunities: Teamwork Climate Nurse input is well received Disagreements are resolved appropriately Physicians and Nurses work together as a well coordinated team

10. Leadership Decision: During BCPSQC conference June 2012 the concept of team huddles and planning sessions (start of the day for the OR teams) was discussed Manager and CNL made this the first priority for culture change and improvement

11. Data Debrief Survey results posted in a common gathering area for staff (Pod #4) Weekly staff meetings to go over results Got clarification and feedback on questions Voted on what we wanted to work on (staff chose 2, Manager chose 1)

12. Improvement Focus Daily Team Huddles Arrive in SDC Easy to implement Would be a start to improving Safety Climate, Teamwork Climate, Perceptions of Senior and Local Management Enables daily input from staff (alerts, workload, changes, etc.)

13. Aim Statement “SDC will do twice daily team huddles at 0735 and 1250. All staff will attend including, Manager, CNL (will lead the huddle), RNs, Unit clerk, housekeeper, and when possible physicians. We will achieve this 90% of the time (9 out of 10 huddles/week). We will start huddles the last week of June”

15. Tests of Change Started June 25, 2012 Everyone attended the huddles Immediately a success with staff! Outline is reviewed regularly (informal PDSA cycles) with staff and leadership input

16. We have adjusted times to be 0815 and 1430 Staff only attend one huddle not two (reduce redundancy) We have started to include announcements for the day and reminders for the week Manager attends regularly. As decided by staff the minimum is 3 afternoon huddles/week

17. Next Steps Keep refining it so that the process is quick and efficient. Still asking improvement questions Is physician involvement possible – not with current times

18. Supports Staff and leadership commitment!

19. Supports Cont’d On going PDSA cycles to refine the process Buy-in from the core team

20. Barriers Gathering staff – Will Vocera change this? Keeping it short – avoiding too many announcements, can become a social gathering Challenge to create an end statement to huddles

21. Lessons Learned Aha! Moment: BCPSQC conference Input from staff is important Change is continuous This is only a small part to culture change and there is more to come Wasn’t as much push back from staff as we anticipated

22. Contact Nancy Reichheld, Manager PARR and SDC Victoria General Hospital nancy.reichheld@viha.ca Cheryl Larcombe, Clinical Nurse Leader SDC Victoria General Hospital cheryl.larcombe@viha.ca