How a simple staff idea board led to better safety for post acute care patients
Sarah Sjostrom, MSN, RN, ACNP-BC
Patient safety innovations routinely emerge from frontline staff, but the road from suggestion to implementation is rarely rapid. At Hebrew Rehabilitation Center’s Medical Acute Care Unit in Boston, a long-term acute-care unit, a simple blue idea board has sped things up, and led to improvements in safely transporting patients to radiology.
Moving patients to and from radiology appointments was a growing concern for staff, but managers didn’t know about the potential risk to patients because frontline caregivers had developed work-arounds. “We learned the staff was having difficulty transporting patients in a timely manner,” explained Sarah Sjostrom, MSN, RN, ACNP-BC, director of Nursing and Respiratory Care Services. “They might pull people off the floor for help, and this created a less safe environment for other patients on the unit. When the issue went up on the board, there was an overwhelming chorus of people who said, ‘Yes this is a problem.’ ”
The unit’s experience offers several lessons in how simple, low-cost steps can lead to safety gains.
First is the idea board itself, which went up in 2015. It is as basic as it gets — four long columns with headers, organized like this:
Idea board model for staff to suggest and track their ideas.
Sjostrom said the idea board began as collaboration with the Hebrew Rehabilitation Center’s process improvement department and was aimed at promoting employee engagement in problem solving and continuous improvement.
From left to right: Tatyana Arber, BSN, RN; Marie Carmell Senat, Nursing Assistant; Sarah Sjostrom, MSN, RN, ACNP-BC
“It was a way for staff to voice their concerns related to unit work flow,” she said, “but we quickly found that the suggestions were having significant impact on providing safety improvements.”
“When an idea hits, our caregivers post a suggestion about a unit concern,” she added. Ideas came from nurses, nutrition staff, occupational, physical, and speech therapists, and others, and “we now have regular huddles around the board with the medical director about the ideas, which has fostered a really great interdisciplinary atmosphere.”
Example: Moving post acute care patients safely to radiology
The problem: Staff lacked sufficient means for transporting patients safely and efficiently. Transport chairs were often difficult to locate, leading to significant wasted time for direct care staff. Patients are often transported with IVs, IV pumps, oxygen tanks, or other devices, requiring more than one staff member to support patient transport safely. This resulted in less staff to meet the needs of patients on the floor — itself a patient safety concern.
The goal: To provide easy, quick, and consistent access to appropriate transport chairs so that staff could bring patients and medical devices to radiology in a timely, safe way.
The improvements: Reliable access to two wheelchairs — standard size and bariatric size — equipped with attached IV poles and mounts for oxygen tanks, allowing one staff member to transport the patient and devices safely.
The results: New wheelchairs were purchased and placed in a central, accessible location. Productivity has risen as less time is spent searching for or maneuvering equipment. Staffers deliver more direct care to patients. Quicker transport to radiology allows for faster turn-around times for radiology reports and physician intervention and treatment.
Read More
Cost-effective solution
In discussing the wheelchair improvements, Sjostrom added: “Given the size of our department, it didn’t require a huge financial investment. In the end it was not a particularly costly solution and the cost-benefit for the staff and in time saved was clearly a big benefit.”
As for the idea board, as the Joint Commission noted in its 2012 monograph, “Improving Patient and Worker Safety,” the “informal exchange of information informs leaders of staff concerns relating to patient safety and promotes staff awareness of leadership’s commitment to patient and staff safety.”
Sjostrom concurred. “We are big proponents of this and will talk about it willingly and happily. It’s such a great staff empowerment issue in that it creates a safer patient environment, and staff have seen many positive effects from this.”
Encouraging continuous improvement by soliciting and implementing safety recommendations from frontline staff at the Hebrew Rehabilitation Center’s Medical Acute Care Unit in Boston, a long-term acute-care unit.
The Problem
Caregivers were having trouble getting patients promptly to radiology because of difficulties with wheelchairs. Work-arounds meant staffers were losing time better spent on the floor tending to patients.
The Solution
Buying and centrally locating new wheelchairs that could be handled by a single staffer, in keeping with the recommendations that staffers themselves posted on an idea board in the unit.
The Takeaway
Idea boards work as simple, low-tech ways of encouraging and putting in place safety improvements that may not otherwise come to the notice of administrators and managers.
