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Bill Klaproth: (Host) So is there a time when the customer is not always right? Hmm. Let's find out with Janet Davis, vice president of operations, Northwestern Medicine, Central Du Page Hospital, and Jeanette Karon Performance Improvement Leader at Northwestern Memorial Healthcare. This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth, Janet and Jeanette, thank you so much for your time. It's great to talk with you, Jeanette, let's start with you. So the name of your session is When the Customer is not Always Right. So, when is the customer not always right?

Jeanette Karon: (Guest) So in healthcare, we don't always think of our patients as customers, but we wanted to build off that old saying of the customer is always right and say retail. And recently we noticed that many of our patients were exhibiting what we call disruptive behavior. They were using kind of verbal threats or verbal behavior that would impede patient care, being physical, other kinds of threatening behavior towards our staff. And we wanted to address this behavior for the safety of both, not only our staff but also other patients that are within the hospital and make sure that we're providing safe, effective care while also ensuring patient engagement, so that was the topic of our project.

Host: And then Janet, how do you manage disruptive patients like Jeanette was just talking about?

Janet Davis: (Guest) We have put together a very comprehensive toolkit and it includes, setting ground rules and providing support to staff, preventing a potentially bad situation from getting worse, and helping staff to act in the moment. So for instance, in setting ground rules, one of the things that we did was identify very appropriate signage to put throughout the facility, so that when our patients and families enter, we immediately set the stage about, entering an environment of health and healing and that we expect them to respect everyone's right to a safe environment. When you move more towards preventing a potentially bad situation from getting worse, one of the things that we have in place is a behavior letter. We initially expect our staff to verbally try to deescalate, but if that doesn't work, we do have a behavior letter that we expect our leaders to review with the patient, to set expectations. Other examples of that would be, evaluation of our entries, which we have completed that, and our entries are not as open around the clock as they used to be. And we've increased our lighting and then helping staff work in the moment. We have put in place a sprint response team, behavioral health individuals, security supervisors, that if a patient, behavior really requires such a direct intervention, that sprint team is called and they do come to the scene and interface with the patient. We've also done a lot more with our de-escalation training and we've put in place a behavior risk flag, that we make a determination if it's necessary, it flags the patient's chart, and lets other caregivers and workers know to be aware that there have been some behavioral issues. So that's a quick synopsis of the toolkit. There's a lot more, but those are some of the key highlights of what we've implemented.

Host: I love how you call it a toolkit. So then Jeanette for these solutions that have been identified, can you talk about the process of developing and implementing these improvements that Janet was talking about?

Jeanette: Sure, so one of the things we did at the beginning of the project that really set the stage for the rest of it was to do a staff survey. So we surveyed every different type of role within the hospital at the beginning of our project to find out what types of behaviors were happening in the healthcare environment, who it was affecting, and we were honestly a little surprised by the results. We thought that primarily this kind of behavior occurred say just in the emergency department or in a behavioral health setting. But we found out that really every staff member in every department was affected. So we tried to put together a really cross-functional team to come up with solutions that would not only just address maybe an acute situation in the emergency department, but help our inpatient staff and other staff, get the support that we need. So we included frontline staff, physicians, et cetera, to come up with some of these solutions. So for instance, Janet mentioned the signage. We involved actually our patients and family and that as well because we wanted to make sure that we weren't being too harsh with the sign language, but also that it was effective. With our sprit response, which is where we bring behavioral health staff to the bedside to help with a disruptive patient. We included inpatient staff in that as well, so that they knew that they would get the support that they needed, which typically they hadn't had before we did this project. So I'm pulling in folks from all different areas, I think helped us come up with this large toolkit that's effective for everyone within the organization. And then what also really helped was having executive support for this solution. So having our president of our hospital stand up in front of all of the staff and say, this is very important. And, I know you're concerned about patient engagement and patient satisfaction, but your safety comes first. So that really helped us to roll this out and be effective.

Host: Yeah, a really robust program. So, Janet, what have the results been to this point?

Janet: We actually have developed a dashboard, and we're monitoring the results and has seen improvement in many of the areas. Just to give you a snapshot of the things that we look at is, how often has our security department had to respond to a security alert? We measure staff assaults, how often have staff been harmed by an event? We measure our incident reports, to determine whether or not we see an increase or a decrease in the reporting. And as important is that we look at how our staff are feeling prepared to manage situations. So we've asked them questions like, do you feel supported by the organization in managing disruptive behavior by patients and families? Do you feel you have the tools to effectively manage disruptive patients and families and do patient satisfaction, scores influence your response to verbal disruption? That's just as a snapshot of what we measure. We also measure our number of sprint calls, evaluate the number of risk flags that we've put on patients just to name a few.

Host: And then Jeanette, if you could wrap this up for us, tell us more about your session when the customer is not always right.

Jeanette: What we'll share is how we gathered, what we're calling the voice of the customer. So I mentioned the survey that we did of staff. So I think that was very important for us and setting the stage for what we ultimately created and implemented and getting staff excited about, that we're listening to them and coming up with the solution. We're going to talk about how we did that. We're also going to talk in more detail about some of these solutions. We've mentioned the sprint response a couple of times that as well as the flag, and go into how we came up with these ideas and how they're working. So the goal is that people walk away with, some interventions you can try. If you're not on the journey yet, then here's how you can get started with a survey, with finding out what others are doing, et cetera.

Host: Jeanette and Janet, thank you both so much for your time. This was really interesting. And I think it's going to be a great session. Thank you both for your time today. We appreciate it.

Jeanette and Janet: Thank you very much. Thank you for having us.

Host: That's Janet Davis and Jeanette Karon. And for more information, please visit Aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics is of interest to you. This is Today in Nursing Leadership. Thanks for listening.