Small Troubles, Adaptive Responses (STAR): Fostering a Quality Culture in Nursing*: A Mechanism to Increase Awareness of First Order Operational Failures in Med-Surg Units

2.50
Hdl Handle:
http://hdl.handle.net/10755/203203
Type:
Presentation
Title:
Small Troubles, Adaptive Responses (STAR): Fostering a Quality Culture in Nursing*: A Mechanism to Increase Awareness of First Order Operational Failures in Med-Surg Units
Abstract:
(Summer Institute) Problem: In frontline nursing, workarounds are a response to first order operational failures1 exposing patients to errors and creating inefficiencies in care. Endemic shortages of nursing staff and difficult working conditions present substantial barriers on the path to improvement.2 Evidence: Detection of first order operational failures provides opportunities to fix underlying system failures and contributes to organizational learning.2 Failures occur about one per hour per nurse on hospital units and 95% of problems are managed through workarounds.2 Strategy: As part of a larger project on frontline improvement, index-sized pocket cards were used to self-report problems occurring during work shifts. This approach was developed in the funded project, “Small Troubles, Adaptive Response (STAR): Fostering a Quality Culture in Nursing” to capture small problems encountered in daily practice. Practice Change: Practice change consisted of using pocket cards to detect problems. Staff devoted time to using the tool to detect first order operational failures. This increased awareness of small troubles encountered during routine care. A summary of small problems was presented to the group. Evaluation: The strategy was evaluated through cross validation of the tool’s ability to capture self-report of first order operational failures, identify problems and create awareness of common workarounds among nurses working in the units/ hospital microsystems. Results were compared to Tucker’s findings 2 and confirmed by key informant interviews. Results: Preliminary findings show staff reported about six workarounds per twelve hour shift. Frequency was half of that expected, yet type of workarounds detected with pocket cards were comparable to those directly observed 2, with highest failures in equipment/supplies, facilities, and communication. Recommendations: Nurses can effectively identify first order operational failures, thus the pocket card approach can be used for problem identification in designing improvement interventions. Lessons Learned: Careful planning is needed to encourage pocket card use. Success depends on championing by mid managers/microsystem leaders. A clinical-academic partnership can open new avenues for detecting targets for frontline improvements. Bibliography: 1. Hassmiller SB, Cozine M. Addressing the nursing shortage to improve the quality of patient care. Health Affairs 2006;25:268-74. 2. Tucker AL, Edmondson AC. Why hospitals don't learn from failure: organizational and psychological dynamics that inhibit system change. California Management Review 2003;45:55-72. *This study was supported by a generous grant from the Robert Wood Johnson Foundation as part of their Interdisciplinary Nursing Quality Research Initiative. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]
Keywords:
Awareness; Operational Failures
Repository Posting Date:
16-Jan-2012
Date of Publication:
3-Jan-2012
Sponsors:
UTHSCSA Summer Institute

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleSmall Troubles, Adaptive Responses (STAR): Fostering a Quality Culture in Nursing*: A Mechanism to Increase Awareness of First Order Operational Failures in Med-Surg Unitsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/203203-
dc.description.abstract(Summer Institute) Problem: In frontline nursing, workarounds are a response to first order operational failures1 exposing patients to errors and creating inefficiencies in care. Endemic shortages of nursing staff and difficult working conditions present substantial barriers on the path to improvement.2 Evidence: Detection of first order operational failures provides opportunities to fix underlying system failures and contributes to organizational learning.2 Failures occur about one per hour per nurse on hospital units and 95% of problems are managed through workarounds.2 Strategy: As part of a larger project on frontline improvement, index-sized pocket cards were used to self-report problems occurring during work shifts. This approach was developed in the funded project, “Small Troubles, Adaptive Response (STAR): Fostering a Quality Culture in Nursing” to capture small problems encountered in daily practice. Practice Change: Practice change consisted of using pocket cards to detect problems. Staff devoted time to using the tool to detect first order operational failures. This increased awareness of small troubles encountered during routine care. A summary of small problems was presented to the group. Evaluation: The strategy was evaluated through cross validation of the tool’s ability to capture self-report of first order operational failures, identify problems and create awareness of common workarounds among nurses working in the units/ hospital microsystems. Results were compared to Tucker’s findings 2 and confirmed by key informant interviews. Results: Preliminary findings show staff reported about six workarounds per twelve hour shift. Frequency was half of that expected, yet type of workarounds detected with pocket cards were comparable to those directly observed 2, with highest failures in equipment/supplies, facilities, and communication. Recommendations: Nurses can effectively identify first order operational failures, thus the pocket card approach can be used for problem identification in designing improvement interventions. Lessons Learned: Careful planning is needed to encourage pocket card use. Success depends on championing by mid managers/microsystem leaders. A clinical-academic partnership can open new avenues for detecting targets for frontline improvements. Bibliography: 1. Hassmiller SB, Cozine M. Addressing the nursing shortage to improve the quality of patient care. Health Affairs 2006;25:268-74. 2. Tucker AL, Edmondson AC. Why hospitals don't learn from failure: organizational and psychological dynamics that inhibit system change. California Management Review 2003;45:55-72. *This study was supported by a generous grant from the Robert Wood Johnson Foundation as part of their Interdisciplinary Nursing Quality Research Initiative. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]en_GB
dc.subjectAwarenessen_GB
dc.subjectOperational Failuresen_GB
dc.date.available2012-01-16T11:03:10Z-
dc.date.issued2012-01-03en_GB
dc.date.accessioned2012-01-16T11:03:10Z-
dc.description.sponsorshipUTHSCSA Summer Instituteen_GB
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