Running head: LEADERSHIP PROJECT 1

Leadership Project

Bon Secours Memorial College of Nursing

NUR 4114

March 27, 2017

On my honor, I have neither given nor received aid on this assignment or test, and I pledge that

I am in compliance with the BSMCON Honor System.

Paula Gravitt

Leadership Project

Introduction

Effective communication is at the heart of good patient care. In an inpatient

setting, nurses are the first line of communication between the patients and their physicians as

well as other health care team members. For this reason it is important that nurses are provided

with appropriate tools and standards to use during hand-offs or transfer of care. In their article

Transfer-of-care Communication: Nursing Best Practices, Robin Chard and Martin Makary

(2015) state nurses are often in a natural leadership position to improve safe practices during
handovers (p. 330). They also point out that because patient transfers occur many times

throughout their stay, discontinuity can result during the transfer of patient information,

potentially leading to medical errors (Chard & Makary, 2015, p. 330). In an effort to improve

communication during hand-offs, hospitals are tasked with finding tools and defining standards

that are appropriate for each individual unit.

The purpose of this paper is to explore how I would implement a hand off quality

improvement (QI) project as a nurse manager on an acute care unit. My project will include

using the whiteboard in patient rooms as a communication tool between nurses, patients,

physicians, and other healthcare personnel. To ensure that appropriate information is placed on

the whiteboards, I will survey patients, nurses, and physicians to determine what information is

important to them. Other ways to communicate within the healthcare team include the use of the

electronic medical record (EMR), change-of-shift reports using SBAR format (situation,

background, assessment, and recommendation), and having available written forms with

pertinent patient information. My goal for this project will be improved communication and

reduction of sentinel events within the patient population.

This project is supported by literature. In February of 2017, the Nursing Quality

Outcomes Counsel at St. Francis Medical Center reviewed policy changes for the purpose of

provid[ing] accurate information and improve[ing] communication about a patients care,

treatment, or service when responsibilities are handed off from one care provider to another

(Nursing Process, 2005, p. 1). This counsel discussed the literature regarding sentinel events and

other errors that have occurred due to breakdowns in communication.

In this paper, I will discuss the ways a leader can employ the four domains of servant-

leadership as described in the book Lead Like Jesus (Blanchard & Hodges, 2005). Then I will
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describe the implementation of my QI project using the five practices of exemplary leadership as

discussed in the book The Student Leadership Challenge: Student Workbook and Personal

Leadership (Kouzes & Posner, 2013). Lastly, I will discuss are the implications of this project

for professional practice and briefly talk about evaluating the outcomes.

Heart

The heart of a servant-leader is where motivation and intent are found. As a leader, it is

important to know if you are a self-serving or servant-leader. A servant-leader is one who puts

their heart in the hands of G-d and leads following only His plan. Having the heart of a servant-

leader, they know that there are no plans other than His. In their book Lead Like Jesus, Ken

Blanchard and Phil Hodges (2005) say, The most persistent barrier to leading like Jesus is a

heart motivated by self-interest (p. 39). The leader who is motivated by self-interest is one

whose heart is motivated by an EGO that Edges Out G-d. They lead in a way that makes them

feel powerful and important and do not worry about the feelings or the thoughts of the people

they are leading. They separate from and compare themselves to others. They have a false sense

of security because they distort the truth. They are insecure and proud and feel the need to

always promote themselves. On the other hand, the servant-leader is motivated by an EGO that

Exalts G-d Only. They practice humility and put their confidence in G-d. They foster

community and fellowship. They are generous and trustworthy. This leader understands that

they do not own their position and choose to share it with others.

As a nurse manager utilizing the heart domain, I would encourage staff to think about the

benefits that come from open communication with all members of the health care team. In turn,

I would listen to the suggestions of the team and I would ask that they let me know what is

working and what is not. As a nurse manager, I would do research to find out what information
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the staff feels is important to include when they are handing off care of a patient to another

healthcare provider. It is important for them to know that I value their input and as a leader, and

it is my job to make sure that they are only doing what they as a team feel is necessary. It is

important for a servant-leader to bring the team together to foster a sense of community and

working together for the greater good.

Head

The head is where the leaders beliefs and perspectives about leading are held. A servant-

leader has a vision, which set[s] the course and destination (Blanchard & Hodges, 2005, p.

84). Once the course and destination are set, they switch to implementing. In order to

implement, they must provide support and empower others. To encourage my team to provide

better communication during times of transition, I would provide them with tools such as the

whiteboard in each patients room and whiteboard markers and erasers. They would be trained

on proper use of the EMR and how to give a shift change report using SBAR format. These

tools will empower them to be successful in reaching our goal of effective communication within

the healthcare team.

Hands

The hands of a servant-leader guide the activity of leadership. The heart and head come

together and guide the hands in becoming a performance coach. A performance coach,

provides direction, sets goals, aids people in achieving their goals, praises progress, redirects lost

efforts, and evaluates total performance (Blanchard & Hodges, 2005). A nurse manager utilizes

the hands by setting clear expectations. The goal of my hand off project is for each health care

provider to be completely up to date and informed about the patient in order to eliminate any

errors that could occur from miscommunication. As a nurse manager, I would help my team
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establish individual goals. For example, if a nurse is doing a great job with documenting in the

EMR, but is having difficulty keeping up with the whiteboard, I would help her set a goal of

whiteboard improvement. We would discuss where she thinks her difficulties lie and come up

with solutions to help her achieve her goals. Once we have set these goals, I would follow

through and praise her efforts when I see that she is improving. As a servant-leader, it is

important to spend time with each team member individually. This helps establish trust and is a

great way to coach the performance of others. After this nurse has or has not reached her goal, it

is time to evaluate her performance. If I have been a good performance coach, she will have met

her goals and we will be able to move on to making more.

Habits

Your habits are how you renew your daily commitment as a leader to serve rather than

be served (Blanchard & Hodges, 2005, p. 33). There are five habits that a leader can use to

counteract negative forces in their life. They are solitude, prayer, study and application of

Scripture, accepting and responding to G-ds unconditional love, and involvement in supportive

relationships (Blanchard & Hodges, 2005). With regard to executing my hand-off project, I

would make sure that I had a supportive team and family. It is important as a leader that your

team members support you. As a human being, it is important to have the support of your family

to come home to especially if you have had a trying day. Another habit I would use is solitude or

being completely alone with G-d. Being quiet and still is a way that I can refresh my soul and

recharge my energy. After a busy day of alarms going off and putting out fires, a leader needs to

take time to refocus and to be reminded of what is important. Taking time to be alone with G-d

reminds us that we are under His service and that our position is on loan. When we are able to

reflect on this, we are able to be His humble servant. Others see the habits we practice and when
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we are good at utilizing these habits, they may discover that they wish to practice them too.

When my team comes to me for guidance, I will share with them the habits of solitude and

supportive relationships. These habits will help me stay motivated with my QI project and will

give me guidance and support when I am struggling.

Model the Way

In their book The Student Leadership Challenge, James Kouzes and Barry Posner say,

Leaders not only talk about the way things should be done; they show the way they should be

done (Kouzes & Posner, 2013, p. 13). If a leader wants people to believe in the message they

are trying to convey, they must show that they believe in it first. To get my team members on

board with utilizing the best communication tools during hand offs, I would set an example by

filling in whiteboards with appropriate information. I would share any new tools we come up

with as a team with physicians, technicians, and any other healthcare professionals who are

involved in the care of our patients. One way I can model the way is by encouraging my team to

ask me questions about the tools we are using and to question whether I have been using them

myself. It is by my example that I will be able to inspire others to improve their communications

techniques.

Inspire a Shared Vision

How does a project become a reality? Can a leader make a project work without

involving their team? To bring a project to life, a leader has to inspire others to share their vision

of the future. When a vision is shared, the leader can guide the group to take action (Kouzes &

Posner, 2013, p. 54). In order to inspire my vision for effective communication during hand-offs,

I would communicate the details of the project and paint a picture of how I see this as being a

need on our unit. I would explain to my team that communication breakdown contributes to
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65% of sentinel events (Sehgal, Green, Vidyarthi, Blegen, & Wachter, 2010, p. 234). Informing

my team that we have an opportunity to change this will inspire them to come up with ways to

improve performance and be in compliance with current protocols.

Challenge the Process

When we challenge the process, we allow ourselves to find new opportunities and

innovative ways to improve (Kouzes & Posner, 2013, p. 3). To challenge the process, a leader

must take risks even if those risks could produce failed results. A good leader sees gains and

losses as learning experiences. I am challenging the process with the hand off project by asking

my team to come up with new ways to communicate with other team members. One way we can

do this is by creating a form for change-of-shift reports as well as other hand offs such as when

the patient is transported for testing. This form would include information pertaining to the

patients situation, background, assessment, recommendation, as well as allergy information,

code status, and any other pertinent information. By challenging the process and trying out new

ideas, a team might be able to find more effective ways to improve communication and patient

safety.

Enable Others to Act

A leader foster[s] collaboration by building trust and facilitating relationships (Kouzes

& Posner, 2013, p. 3). It is the job of a leader to boost others by increasing their autonomy and

helping them to become competent (Kouzes & Posner, 2013, p. 3). I will encourage my team to

work together on the hand off project. For example, if they see that one of their teammates is

struggling to complete his/her whiteboard communication, they will be encouraged to step in and

help that member out. Having open communication in the way of open forums, message boards,
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and ongoing conversations will foster their independence and show them that I value and trust

their opinions.

Encourage the Heart

To keep a team motivated, it is important for a leader to show them that they are

appreciated. A leader does this by celebrat[ing] the values and victories by creating a spirit of

community (Kouzes & Posner, 2013, p. 3). As I see my team implementing the aspects of good

communication and working together I will praise their good work. I will complement them

when I see that they are teaching others how to communicate with other health care providers.

When they have shown that they are using the whiteboards and EMR per protocol and our

sentinel events have gone down, I will treat them to lunches and speak highly of them to upper

management. I will work to get them raises and praises. This is how I can show them that they

are special and that I value them.

Professional Practice Implications

This quality improvement project has several implications for nursing practice. Two

important implications are improved patient safety and better productivity. As discussed earlier,

communication failures are a frequent cause of adverse events (Sehgal et al., 2010, p. 234).

Sehgal et al. researched the use of whiteboards as effective communication. Whiteboards have

become a common strategy among hospitals to aid in communication improvement efforts. The

researchers found that it is important to know what information should be included with

whiteboard use and it is important to know whom that information is geared toward. For

example, when a nurse writes that a patient has been given pain medication at 10:30am, that

information is there for the benefit of the nurses on the unit, the physicians, and the patient. This

type of communication can be used effectively as long as nurses are compliant with protocols for
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their use. Sehgal et al. (2010) gave recommendations for how whiteboard communications could

be improved. One of those recommendations struck a cord, buy and fasten erasable pens to the

whiteboards themselves (p. 238). This is something that is holding back nurses on the acute

care unit from being able to perform the task of updating whiteboard information. Most nurses

on the unit have purchased their own markers, but this should not be their responsibility. It is

also difficult to find erasers. Some rooms have them and some rooms do not. As a part of my QI

project, I would ask that nurses be provided with these tools. The whiteboard research found that

patient whiteboards did ultimately improve communication among the healthcare team and

improved patient safety.

The EMR provides a number of useful features that can help prevent errors (Bonacum

& Fong, 2007, p. 18). Because of the EMRs standardization capabilities many processes have

the ability to be streamlined. For example, when a physician orders a test for a patient, the EMR

sends this message to the nurse and she is able to acknowledge that order and perform the test

without ever actually speaking to the physician. When used appropriately, the EMR promotes

effective communication and increased productivity. The time it takes for a nurse to speak to a

physician and input an order has been reduced. There are still checks and balances in place to

ensure patient safety and reduce confusion. The EMR is a great tool because it holds all of the

patient information, from history and physical, to how much they have eaten, and how long they

have slept. This tool can be utilized for hand off reports by having the nurse who is taking over

care look up any information they did not understand or may have missed during change-of-shift

report. This ensures patient safety by being a secondary check for the nurse to ensure that he/she

has understood what care the patient has been receiving. The EMR is a vital part of health care

team communication.
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To achieve the goal of effective communication, the health care team must be

collaborators, negotiators, and team players. Communication is a two way street. Physicians

need to be willing to listen to the nurses and vice versa and both need to listen to their patients.

It is through effective communication [that the health care team] can gain each others trust and

respect in their determination to provide patients with safe care throughout their stay in the

hospital (Chard & Makary, 2015, p. 338).

Outcomes Evaluation

The hand off QI project will improve the outcomes of the patient population by reducing

the risk of sentinel events. According to the Joint Commission, communication failures

contributed to 65% of sentinel events (Sehgal et al., 2010, p. 234). By putting practices in place

to improve communication, these errors can be avoided. The project will aid in finding flaws in

the current system and help to find ways to correct or eliminate those flaws. Patient information

such as acuity, safety risks, and changes in status need to be delivered clearly and effectively for

the patient to be able to get the correct care and the best care. When nurses use tools such as the

EMR and whiteboard, they need to ensure that they are providing accurate information. The

safety of the patient depends on it. During hand offs, some information may be lost or

misinterpreted. This can be avoided with proper communication techniques and checks and

balances. With better communication, sentinel events, medication errors, and other life

threatening mistakes can be avoided.

Conclusion

In conclusion, communication during hand offs is a very important part of patient care.

Errors associated with communication breakdowns can be avoided when nurses and other staff

have the right tools and the right leadership. By working together on a project that fosters better
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communication, health care team members are able to provide patients with better care and will

create a better work environment. Being a leader on this type of project would be a great deal of

work, but in the end, it would be worth the effort put in. As a servant-leader, I would surround

myself with a team that wants to achieve the same ultimate goals and I would instill the values of

leading with the heart, head, hands, and habits. When these values are used and G-d is trusted,

projects such as this become a little bit easier.

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References

Blanchard, K., & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.

Bonacum, D., & Fong, K. (2007). Utilizing emr features to improve handoffs. Forum, 25(1), 18.

Retrieved from

https://www.rmf.harvard.edu/~/media/Files/_Global/KC/.../forumMar2007.pdf

Chard, R., & Makary, M. A. (2015). Transfer-of-care communication: Nursing best practices 2.1.

AORN Journal, 102, 329-342. http://dx.doi.org/10.1016/j.aorn.2015.07.009

Kouzes, J., & Posner, B. (2013). The student leadership challenge: Student workbook and

personal leadership. San Francisco, CA: John Wiley & Sons.

Nursing process & interdisciplinary plan of care [Policy brief]. (2016). St. Francis Medical

Center: Bon Secours Richmond Health System.

Sehgal, N. L., Green, A., Vidyarthi, A. R., Blegen, M. A., & Wachter, R. M. (2010). Patient

whiteboards as a communication tool in the hospital setting: A survey of practices and

recommendations. Journal of Hospital Medicine, 5, 234-239.

http://dx.doi.org/10.1002/jhm.638