Amy Elliot and Barbara Frank
The single biggest problem in communication is the illusion that it is taking place. — George Bernard Shaw
“Know each person” is a cornerstone of Pioneer Network’s values and principles, but how do we know a person in the context of providing care? Deep and focused communication is truly the key to knowing each individual, but let’s face the facts. Although an individual receiving care interacts frequently with multiple staff for any number of reasons, there are rarely communication systems in place for every one who cares for that person to routinely share information based on those interactions. Information conveyed is often focused on clinical concerns leaving out individualized aspects of information that have a big impact on clinical and psychosocial well-being. So, even as each team member is diligently working to achieve the best outcome, the power of the team’s combined knowledge isn’t harnessed to know each person in their care. This represents a missed opportunity that is pervasive in long-term care, and it’s not because the team isn’t trying. It’s a problem of inefficient communication.
How do we achieve better communication? Advanced systems in nature and technology teach us that the best forms of communication are “hardwired” into the operational system. Think of how the nervous system communicates messages from our brainsto other parts of the body or how plants convert sunlight into life-producing energy through photosynthesis. Each communication process is seamlessly hardcoded into the very fabric of the interaction. Technology and computer networks also provide examples of hardcoded communication as data flows across devices with the click of a button. Although healthcare is now prioritizing communication through electronic health records and improved care transitions,the challenge of communicating what we know about each person cannot be resolved solely by an electronic health record, because to share what we know about each person requires face-to-face communication. Only when staff can routinely talk together about current dynamics can we truly achieve high quality individualized care.
Can we engineer an individualized communication system in long-term care environments? Pioneer Network in partnership with B&F Consulting set out to study that question through aNational Learning Collaborative. During the Collaborative, forty-nine nursing homes convened and facilitated by five state Culture Change Coalitions and four nursing home corporations, implemented B&F’s relational coordination method of four foundational organizational practices –consistent assignment, huddles, involving CNAs in care planning, and QualityImprovement (QI) closest to the resident.
How does it work? With consistent assignment, staff are able to be dedicated to the residents they serve and know them well. As they know residents, huddles allow teams to do on-the-spot problem solving to catch problems and opportunities early and intervene effectively to prevent declines and promote well-being. As staff in the homes knew residents more deeply, they were able to make individual adjustments in care delivery to align with residents’ customary routines. The huddles among staff closest to the residents evolved into forums for sharing observations and problem solving– essentially on-the-spot assessment and care planning. Homes used staff’s knowledge of residents in QI huddles to find individualized care solutions to address clinical issues. Through QI huddles and CNA involvement in care planning, interdisciplinary teams worked together to follow residents’ rhythms of life in waking, sleeping, eating, bathing, and daily activity.
What did we learn? It works! These practices engineered and hardcoded a communication infrastructure to “know each person” into daily operations. The improvements the homes saw include: increased mobility for residents; fewer falls; reduced use of bed and chair alarms and antipsychotic medications; stronger relationships between staff and residents, and among staff within and across shifts and departments,as well as between management and staff; and most importantly, improved quality of life for those in their care.
The key was real-time, two-way communication hardcoded and engineered though these practices with a goal of knowing each person to provide individualized care.
Check out our free Engaging Staff inIndividualizing Care Starter Toolkit and a Communication Map developed from this project for a blueprint of this communication infrastructure in practice.