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Documenting the Pattern to Defend the Issue at Hand

Written by: James Farrell, RN, MBA on Tuesday, March 10, 2015 Posted in: Inpatient Rehab

Rehab nurse priorities: Part 2

In part 1 of this 3 part series, we examined the 4 big challenges nursing leaders need to take into account when looking at data on productivity, quality measures, census data and trends, fall rates, turnover rates, patient satisfaction scores and more. Once the nursing leader has the numbers, considered the rates and benchmarks, established a pattern rather than making generalizations on short term data, and determined causation, what next? How should a nurse leader prioritize? Looking at the data, there may be one piece of information that is so far off the benchmark that it creates cause for alarm that cannot be ignored. When those events happen, they force nurse leaders to pay attention to that issue and make it the highest priority. Although that is usually not the case, it does occur and there is no way the nurse leader can make anything else a priority but that. Typically we think in terms of patient safety, compliance, and revenue. Should any issue arise among those three areas that is significantly off the benchmark, then immediate action must be taken.

Documenting the pattern is the first task required when this occurs. Without a pattern of abnormal behavior that deviates from the benchmark, the nurse leader is placed in a difficult position of defending why an issue deserves immediate attention. The second step is to begin a root cause analysis. Typically, the Six Sigma strategy is to use the five “whys”. By asking the question “why” up to five times, you can get past the initial human factor to find the system factor and ultimate cause. Once the root cause has been determined, a team should help formulate a set of solutions using brainstorming techniques. During a brainstorming session, no solution or idea should be criticized. Brainstorming is an opportunity to get ideas out and begin to mold them into shape for implementation. An idea that initially may appear impractical, can launch or be the conception of an idea that may address and help solve the problem. Finally, the team should come to a consensus on the solution(s). Consensus is not absolute agreement or even majority opinion. It is agreeing to a solution by the group without significant reservations. Should the team find a member who has significant reservations about the solution, the mediator, or leader of the group, should help the team address those reservations. Perhaps a slight adjustment in the solution is all that is needed. By refining the solution, the team can create a solution that everyone can support.

In part 3, we’ll look at the next steps of where to go with the data, and how to prioritize.

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