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The Roots of Peer Review

The following is an excerpt from Nursing Peer Review, Second Edition

Medical staffs have been peer reviewing their cases for decades, and as fellow professionals, we must hold ourselves to the same high standards. Nurses are professionals who must hold each other accountable and evaluate patient care so we can eliminate system and human errors. Nurses are no different than physicians in this way.

 

An early crusader for quality improvement, E. A. Codman helped develop the concept of outcomes management in patient care. He was a proponent of peer review and quality programs for healthcare delivered at the hospital level.

 

Practicing in the early 20th century, Codman was a founder of the American College of Surgeons and its Hospital Standardization Program. Eventually, that program would morph into what we know today as The Joint Commission. His statement from 1916 calling for review and transparency are as relevant today as they were a hundred years ago:
I am called eccentric for saying in public that hospitals, if they wish to be sure of improvement, must find out what their results are, must analyze their results to find their strong and weak points, must compare their results with those of other hospitals, must care for cases that they can care for well and avoid attempting to care for cases which they are not qualified to care for well, must welcome publicity, not only for their successes, but for their errors. Such opinions will not be eccentric a few years hence.

—E. A. Codman, A Study in Hospital Efficiency, 1916

 

Codman would likely be happy to see today that the practice of physicians reviewing the work of other physicians—peer review—is a common practice and is considered to be a crucial element of ensuring that quality medical care is provided to patients.

 

That element is just as crucial in the nursing profession. The major reason for implementing a peer review process is to improve patient care. If nothing else, peer review is the right thing to do to protect the patient from potential harm. It is just a matter of time before external accreditation agencies, the government, and your hospital will require a formal peer review process of nurses.

 

More and more, healthcare organizations are required to be transparent about quality performance metrics. While the information that is publically reported is aggregate data, it is important for the healthcare organization to know person-specific performance data so that they can drive improved patient outcomes.

 

Typically, the outliers or underperformers are a small number of nurses who may not know they are not performing to the standard of care. It is important to give them specific and periodic performance feedback so that they can adjust their care model. Additionally, providing performance data to nurses helps them understand where they rank among their peers. When doing so, it is important to report the data in an anonymous way so that each nurse is uniquely identified using a coding system. This can be useful when metrics are performance based and specific in nature. Transparency is the way of the future, and moving in that direction will help the nursing infrastructure catch up with performance models used by physicians.

 

The goals and benefits of peer review include:

  • Improving the quality of care provided by individual nurses
  • Monitoring the performance of nurses
  • Identifying opportunities for performance improvement
  • Identifying system-wide issues
  • Identifying educational needs of nurses

If the process of peer review is to be effective, then a formal structure must be created to allow for the tracking and trending of information and the identification of potential system or human failures. Case review is useful for this, as it presents opportunities to identify failures through investigation so nurses and other team members can correct them before injury occurs in another patient or patients.

Strategies for implementing evidence-based practices: Journal clubs

If you’re looking for ways to get your staff engaged and current on the latest evidence-based practices, then you should consider starting a journal club, a regular meeting of staff members to discuss articles from nursing journals. It’s a great way to improve your staff’s reading habits and critical thinking while promoting cooperation and teamwork.

To start your club, you need to choose someone to select readings. A master’s-prepared nurse specialist or educator would be an ideal candidate to lead the group, but anyone with the proper knowledge or enthusiasm would make a fine choice. They should endeavor to select readings that are informative, relevant, and accessible to encourage nurses of all levels to participate. They should start by selecting a guide to critical reading, so everyone has the tools to discuss the articles. Once they’ve selected the article, make sure the reading is easily obtainable and give plenty of advanced notice to ensure everyone has time to read it.

The biggest hurdle for starting a journal club in a healthcare environment is finding time in your staff’s busy schedule. Ideally, you want to find a time that works for everyone, perhaps during a shared break or change of shift. If this proves too daunting, you can always create a virtual journal club. You could use a hospital intranet, email list, or even a chat forum to discuss the readings.

Once you get everyone together, encourage them to think about the article critically and ask them to evaluate it. Here’s a great list of questions to start discussions and get the group thinking about the reading.

If you find that your group has lost momentum or attendance is waning over time, try providing incentives for attendees. Small perks or competitions can be a great way to encourage attendance and let your group have some fun!

Here are some helpful links to get you started!

Running an effective journal club

From the desk of Adrianne Avillion, DEd, RN

Who should facilitate journal clubs?

Help nurses critique journal articles

Do you have a journal group at your facility? We’d love to hear about your experiences in the comments below!

What to get your nurses this year

The holidays are well and truly upon us, which means across the world people are panicking as they realize they haven’t bought any presents yet.

The holidays are a busy time of year for healthcare professionals, with nurses trying to balance an increased workload with holiday obligations. A few simple gifts can do wonders for morale and show nurses that they are appreciated for their work.

And if you miss the holiday deadline? Hand out presents on New Year’s. It’s a federally recognized holiday and gives you more time to buy.

  1. Keep Calm I’m a Nurse T-shirt

So nurses can go off the clock and still let the world know who’s boss. You can buy them on an individual basis or buy them in bulk for your staff.

  1. Coffee

Give the gift of caffeine. Either gift cards to Starbucks or (if you have $100 to spare) a Keurig brewing system for the nurses’ lounge.

  1. Scrubs Season One

Good for some laughs and to remind everyone that you work in a much less dysfunctional hospital. Or that you do, but at least your janitors aren’t actively conspiring against you.

  1. Chicken Soup for the Nurses Soul by Jack Canfield

Stories from the frontlines of nursing. Some are funny, some are uplifting, and some are moving. A good read for both new and veteran nurses.

  1. “Do not disturb: Nurse sleeping” sign

Need I say more?

  1. Things that they would like

This is your chance to show your nurses that you really know them. A running joke in the hospital, fixing something that’s been broken a long time, or something particular to your area. Be creative! And always leave the receipt in the wrapper.

Free tool from Ending Nurse-to-Nurse Hostility

As promised last week, we’ve added a free download downloadicon3from Kathleen Bartholomew’s Ending Nurse-to-Nurse Hostility, Second Edition, in honor of being the only book chosen by the American Nurses Association as a recommended bullying and horizontal hostility prevention tool.

To access the download site for a tool you can use to evaluate the health of your workplace as regards bullying, lateral violence, and other undesirable behaviors, click here.

To read last week’s story the ANA position statement on workplace violence and the nursing profession, click here.

New ANA Hostility Prevention Guide Recommends Bartholomew Book

On August 31, the American Nurses Association issued a press NTNH2 coverrelease announcing its updated position statement on workplace bullying and violence, stating that the “nursing profession will no longer tolerate violence of any kind from any source.”

Among the interventions recommended as “primary prevention” is the HCPro classic work by Kathleen Bartholomew,
Ending Nurse-to-Nurse Hostility, Second Edition. In fact, Ending Nurse-to-Nurse Hostility has the distinction of being the only book recommended to RNs and their employers in the statement as a front line tool for preventing incivility and bullying.

We are so honored to have published Kathleen’s work, and congratulate her for this wonderful recognition of a lifetime commitment to making the nursing workplace a healthier, more collegial place. If you would like to add your best wishes, feel free to comment below!

Free tool: Build nursing team self-esteem

As promised in last week’s post, Try This: Build nursing team self-esteem, downloadicon2the exercise that Kathleen Bartholomew uses to encourage nurses’ self-esteem has been posted to our Tools Library.

To download the Hierarchy of Voice tool, click here.

 


Excerpted from Ending Nurse-to-Nurse Hostility, Second Edition, by Kathleen Bartholomew

Try This: Build nursing team self-esteem

Hierarchy of Voice

Excerpted from Ending Nurse-to-Nurse Hostility, Second Edition, by Kathleen Bartholomew

Try the following exercise that I often use to encourage nurses’ self-esteem. I call it a “hierarchy of voice” because each step results in greater empowerment. Addressing specific behaviors that are a challenge to a nurse stimulates meaningful conversations about that individual’s stumbling blocks to empowerment and self-esteem.

In performance evaluations, share the following list and ask team members to pick 10 meaningful actions that they would like to [more]

A Simple Interprofessional Accountability Technique

Listening, validating and asking for a commitment

From Team-Building Handbook: Accountability Strategies for Nurses, by Eileen Lavin Dohmann, RN, MBA, NEA-BC

accountability scenario

When working with a group, I assume that people are rational and logical.

So, if I want them to do something, I just need to explain it and they’ll do it. When I don’t get the results I am seeking, I tend to think “Oh, I must not be explaining it well. Let me try it again.”

It’s taken me a long time to realize that what I was hearing as “not understanding me” was often someone’s polite way of telling me no. So, now when I find myself explaining the same thing to someone for the third time, I stop and ask the person what he or she is hearing me request. If I can validate that the person is hearing me correctly, I ask for the commitment: yes or no.

Validating… and asking for a yes or no

We can hold ourselves accountable, but holding other people accountable can be much more difficult. Consider this nurse-physician scenario and ask yourself [more]

Positive Pushback for Nurses

I’ve posted in the past on accountability strategies, communication techniques, and building team relationships, all of which can improve the workplace. Recently I ran across the term “positive pushback”—easy to remember thanks to those alliterative “p” words—and felt that the technique might be helpful in those potential conflict situations that arise from time to time.pushback2

The promise of positive pushback is that you can communicate your concerns in an unequivocally strong and clear manner that doesn’t damage your professional relationships. No yelling and certainly no retreating to an unassertive approach.

According to Susanne Gaddis, the Communications Doctor:

A “positive pushback” is the ability to deliver an appropriately assertive response to a potentially negative and/or harmful situation. A positive pushback is executed by looking someone straight in the eye, and saying with an even, non-stressed tone what you want or need. (If you want to be really assertive include the word “I,” such as “I really need for you to stop and review this now…”)

What resources do you need to use positive pushback? Self-esteem, self-confidence, and an ability to convey urgency without “emoting” your emotions. I highly recommend that you read this blog post from Susanne Gaddis, to see if this is a tool that you can add to your collection. As with all the “soft skills,” practice makes perfect.

If you try the techniques, please post a comment here to let us know how it worked out for you!

 


 

With thanks to Susanne Gaddis, PhD, CSP and CEO of The Communications Doctor, is an acknowledged communications expert who has taught the art of effective and positive communication since 1989.

The value of nursing staff satisfaction

There is a connection between nurses’ feelings about
their work environments and nursing quality and safety

Rebecca Hendren recently posted about a June 2015 Healthleaders magazine article focusing on steps organizations are taking to measure and improve nursing staff satisfaction. For anyone who hasn’t yet read it, I just want to share my favorite quote from the article. In it, Linda Aiken, PhD, a nursing workforce researcher and director of the Center for Health Outcomes and Policy Research (U. Penn) is quoted as saying that

Nursing “is the single biggest factor
in how patients rate their hospitals”

Do you agree with this statement? Have you seen the impact of improvements in nursing staff satisfaction on care quality, outcomes, and patient ratings? What tools or strategies have you used to improve staff retention and satisfaction? Please leave a comment sharing your experiences with your fellow nurse leaders.

 


 

For more details on the kinds of nursing staff surveys conducted by organizations that have received designation as ANCC Magnet Recognition Program® hospitals as well as those that have not, plus the source of the headline quote (which no one would dispute!), click here to go to the HealthLeaders article.