Selected Podcast
Procedural Bundling and Other Tips to Redesign Workflow
Every organization has a method for organizing the flow of work through its routines and procedures. Elizabeth McCarthy discusses the challenges nurses faced when these norms and routines were disrupted due to the pandemic and how nurses have had to redesign their workflow.
Featuring:
Elizabeth McCarthy, MSN, RN
Elizabeth McCarthy, MSN, RN is the Clinical Nursing Director of a medical-surgical unit that at one time focused on the care of GYN/ONC surgical patients. Elizabeth has been in nursing for over 25 years. Her career has included bedside nursing in several specialties including geriatric, cardiac and surgical as well as clinical research in electrophysiology and outpatient cardiac rehabilitative services. Elizabeth completed her MSN in Executive Leadership in 2017 and began her nursing leadership role as the manager of a large float pool that consisted of 120 FTEs. She became the Clinical Nursing Director of a 35 bed, GYN/ONC surgical unit in 2018. In March, 2020, as a result of the COVID 19 pandemic and the surge of sick patients, Elizabeth transformed the GYN/ONC surgical unit into a concentrated COVID care unit. Transformation of the unit included addressing the special needs of COVID 19 patients as well as altering the way nursing care was delivered. It continues to be a COVID 19 concentrated care unit to this day. Transcription:
Bill Klaproth: Leadership beyond the pandemic and care delivery innovations is supported by an unrestricted grant from the Johnson and Johnson foundation in partnership with the Johnson and Johnson center for health worker innovation.
Every organization, every unit has a method for organizing the flow of work through its routines and procedures. Some of these methods have been handed down over time. COVID challenge these norms. And when it came to entering and exiting patient rooms, workflows were adjusted to avoid overuse of PPE, mitigate exposures and more.
So let's talk about how these changes, including the innovative concept of procedural bundling, the changing of workflows and how all of these changes challenged nurses. So with us to talk about all of this is Liz McCarthy, Clinical Nursing Director at Saint Barnabas Medical Center.
This is leadership beyond the pandemic care delivery innovations. I'm bill clapper, auth.
Bill Klaproth: Liz, thank you so much for your time. It is great to talk with you. So first off, how has COVID-19 challenged nurses' perceptions of their role of providing patient care with all of the changes made due to the pandemic?
Elizabeth McCarthy: Thank you so much for having me. This is an exciting opportunity for me. I think that jumping right in as far as with the nurse's perception has been evolved since the beginning of our COVID experience. Traditionally, a nurse puts their patient first, needs of the patient first, their safety, their care.
And I think that COVID has given us the opportunity to stop and reevaluate that because our safety became paramount and incorporating our patient care equally with our own safety has really altered the way we think and to be kept on the same level, as in order to keep our patients safe, we also had to keep ourselves safe. I think that had one of the biggest impacts, at least on my unit with the nurses that I work with.
Bill Klaproth: COVID-19 has changed so much and has impacted everyone, especially our nurses. So let's talk about some of the changes that nurses have had to go through because of COVID-19. I know you use procedural bundling where meds, treatments and interactions are all consolidated. So let's talk about procedural bundling and the changes you made as you work through COVID-19.
Elizabeth McCarthy: So the bundling that we developed came directly from our experience in real time. A lot of these decisions were made as they were happening. So things like watching our PPE usage and trying to maximize our safety precautions while minimizing PPE use and waste. We had to really consider how many times we were entering a patient's room. And how many tasks we could actually perform at one time. And that involved something as basic as vital signs at the beginning of a shift, had to then be re-evaluated to incorporate, "Let's deliver their dietary tray at the same time. And while we're in there taking vitals, let's give them the medications that are due."
So that incorporated many disciplines. We had to get the dietary services involved. We had to get pharmacy involved and we had to really try to coordinate a timeframe in which we could maximize our time with that patient while minimizing our PPE use and also exposure of that nurse in that COVID room.
Bill Klaproth: Yeah, that makes sense. And with anything, there are pros and cons. And when you say kind of minimize the exposure of that nurse in the room, that would mean that some patients experienced isolation at times and more restful at other times. So what are some of the pros and cons of procedural bundling, if you will, through the lens then of the patient experience?
Elizabeth McCarthy: It's complicated. It's multifaceted. So you have the nurse coming in multitasking while at the same time delivering compassionate care. That same patient is then experiencing that and having to draw their hospital experience in short bursts. So yes, these patients with COVID felt lousy. And so sleeping was often what they did, but the amount of time alone, sometimes it's too quiet or maybe not so quiet in your head. I think it directly affected how much they appreciated the care that they were receiving because everyone understood the gravity of the situation.
I think that it made the patients very grateful for the care they're receiving and certainly they were very grateful to be going home, those who were lucky enough to go home. And even in the followup phone calls and talking with those patients, that's what they remember. They remember being scared. They remember being lonely, but they really held on to their interaction with their nurse. And we're so thankful for the care and compassion that the nurses were showing to them in this very dire, scary time in their lives. So I think, yes, they were lonely and, yes, it was scary for them alone in a room, but it almost accentuated how important the role of the nurse became to them.
Bill Klaproth: So it sounds like you're saying the patients really understood the risks that the nurses were taking by being in that room and they did appreciate it.
Elizabeth McCarthy: Yes. Very much so.
Bill Klaproth: Well, that is really good to hear. So from your experience, Liz, at Saint Barnabas Medical Center, help us out. How would someone construct a new workflow map that incorporates procedural bundling? Can you tell us how did you do that? How would someone go about constructing this?
Elizabeth McCarthy: I think that they have to look at it from a multidisciplinary approach. I think that when you are looking to create a workflow for a patient's care, you have to be aware of all the other factors that are contributing to that patient's care if they need testing, if they need blood work, if you know patients have to eat, they have specific medications that they have to receive at a certain time. All of that warrants a discussion on a level that will incorporate as many and all of the departments that it will influence.
I think that especially here at Saint Barnabas, we were able to notice that very early on in the process. And we set ourselves up for success that way and that everybody was on board to make this as safe as an experience as possible, not only for obviously the patients and the staff, but everybody who came in contact with that patient. So it really does take many hands to create this process.
Bill Klaproth: Right. So then can you give us your viewpoint of the past year from your work at Saint Barnabas Medical Center? Your final thoughts on the concept of workflow in the context of COVID and procedural bundling. Give us your overview of the past year and everything that's happened and all the changes that you've had to make.
Elizabeth McCarthy: I think my biggest takeaway from this whole experience really is in the people. And by people, I mean nursing for sure but it also incorporates physicians, the housekeepers, the lab technicians. I think the focus on quality patient care, surviving and really excelling through a pandemic situation is a group effort.
And I think that by listening to each other and seeing how one change can have a positive ripple effect throughout the care of a patient is really important to be open to. And you have to be able to look globally at something and really bring it into that point of care and realize that nurses had a front seat to this. Nobody was in it longer than a nurse. We saw the patients the most and, honestly, the staff were the ones who created a lot of this process and just as feedback of what was working well and what wasn't working. So I think really looking at many of the nurses' point of view and listening carefully was the key to the success of this program so far. And it's an ever-changing process even now.
Bill Klaproth: Right. Well, it sounds like you took the advice and the thoughts and the suggestions of the nursing staff when redesigning this workflow.
Elizabeth McCarthy: Yeah. Well, being part of being a strong leader is listening. And I take that very seriously. And no one knows it more than the staff nurses. That's for sure.
Bill Klaproth: Absolutely. Well, Liz, this has been fascinating. Thank you so much for sharing your experience with us about workflow and procedural bundling. We really appreciate it.
Elizabeth McCarthy: Thank you so much for having me.
Bill Klaproth: And that's Liz McCarthy. And for more information, please visit AONL.org. Once again, this podcast is supported by an unrestricted grant from the Johnson and Johnson Foundation in partnership with the Johnson and Johnson Center for Health Worker Innovation. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.
This is leadership beyond the pandemic care delivery innovations. Thanks for listening.
Bill Klaproth: Leadership beyond the pandemic and care delivery innovations is supported by an unrestricted grant from the Johnson and Johnson foundation in partnership with the Johnson and Johnson center for health worker innovation.
Every organization, every unit has a method for organizing the flow of work through its routines and procedures. Some of these methods have been handed down over time. COVID challenge these norms. And when it came to entering and exiting patient rooms, workflows were adjusted to avoid overuse of PPE, mitigate exposures and more.
So let's talk about how these changes, including the innovative concept of procedural bundling, the changing of workflows and how all of these changes challenged nurses. So with us to talk about all of this is Liz McCarthy, Clinical Nursing Director at Saint Barnabas Medical Center.
This is leadership beyond the pandemic care delivery innovations. I'm bill clapper, auth.
Bill Klaproth: Liz, thank you so much for your time. It is great to talk with you. So first off, how has COVID-19 challenged nurses' perceptions of their role of providing patient care with all of the changes made due to the pandemic?
Elizabeth McCarthy: Thank you so much for having me. This is an exciting opportunity for me. I think that jumping right in as far as with the nurse's perception has been evolved since the beginning of our COVID experience. Traditionally, a nurse puts their patient first, needs of the patient first, their safety, their care.
And I think that COVID has given us the opportunity to stop and reevaluate that because our safety became paramount and incorporating our patient care equally with our own safety has really altered the way we think and to be kept on the same level, as in order to keep our patients safe, we also had to keep ourselves safe. I think that had one of the biggest impacts, at least on my unit with the nurses that I work with.
Bill Klaproth: COVID-19 has changed so much and has impacted everyone, especially our nurses. So let's talk about some of the changes that nurses have had to go through because of COVID-19. I know you use procedural bundling where meds, treatments and interactions are all consolidated. So let's talk about procedural bundling and the changes you made as you work through COVID-19.
Elizabeth McCarthy: So the bundling that we developed came directly from our experience in real time. A lot of these decisions were made as they were happening. So things like watching our PPE usage and trying to maximize our safety precautions while minimizing PPE use and waste. We had to really consider how many times we were entering a patient's room. And how many tasks we could actually perform at one time. And that involved something as basic as vital signs at the beginning of a shift, had to then be re-evaluated to incorporate, "Let's deliver their dietary tray at the same time. And while we're in there taking vitals, let's give them the medications that are due."
So that incorporated many disciplines. We had to get the dietary services involved. We had to get pharmacy involved and we had to really try to coordinate a timeframe in which we could maximize our time with that patient while minimizing our PPE use and also exposure of that nurse in that COVID room.
Bill Klaproth: Yeah, that makes sense. And with anything, there are pros and cons. And when you say kind of minimize the exposure of that nurse in the room, that would mean that some patients experienced isolation at times and more restful at other times. So what are some of the pros and cons of procedural bundling, if you will, through the lens then of the patient experience?
Elizabeth McCarthy: It's complicated. It's multifaceted. So you have the nurse coming in multitasking while at the same time delivering compassionate care. That same patient is then experiencing that and having to draw their hospital experience in short bursts. So yes, these patients with COVID felt lousy. And so sleeping was often what they did, but the amount of time alone, sometimes it's too quiet or maybe not so quiet in your head. I think it directly affected how much they appreciated the care that they were receiving because everyone understood the gravity of the situation.
I think that it made the patients very grateful for the care they're receiving and certainly they were very grateful to be going home, those who were lucky enough to go home. And even in the followup phone calls and talking with those patients, that's what they remember. They remember being scared. They remember being lonely, but they really held on to their interaction with their nurse. And we're so thankful for the care and compassion that the nurses were showing to them in this very dire, scary time in their lives. So I think, yes, they were lonely and, yes, it was scary for them alone in a room, but it almost accentuated how important the role of the nurse became to them.
Bill Klaproth: So it sounds like you're saying the patients really understood the risks that the nurses were taking by being in that room and they did appreciate it.
Elizabeth McCarthy: Yes. Very much so.
Bill Klaproth: Well, that is really good to hear. So from your experience, Liz, at Saint Barnabas Medical Center, help us out. How would someone construct a new workflow map that incorporates procedural bundling? Can you tell us how did you do that? How would someone go about constructing this?
Elizabeth McCarthy: I think that they have to look at it from a multidisciplinary approach. I think that when you are looking to create a workflow for a patient's care, you have to be aware of all the other factors that are contributing to that patient's care if they need testing, if they need blood work, if you know patients have to eat, they have specific medications that they have to receive at a certain time. All of that warrants a discussion on a level that will incorporate as many and all of the departments that it will influence.
I think that especially here at Saint Barnabas, we were able to notice that very early on in the process. And we set ourselves up for success that way and that everybody was on board to make this as safe as an experience as possible, not only for obviously the patients and the staff, but everybody who came in contact with that patient. So it really does take many hands to create this process.
Bill Klaproth: Right. So then can you give us your viewpoint of the past year from your work at Saint Barnabas Medical Center? Your final thoughts on the concept of workflow in the context of COVID and procedural bundling. Give us your overview of the past year and everything that's happened and all the changes that you've had to make.
Elizabeth McCarthy: I think my biggest takeaway from this whole experience really is in the people. And by people, I mean nursing for sure but it also incorporates physicians, the housekeepers, the lab technicians. I think the focus on quality patient care, surviving and really excelling through a pandemic situation is a group effort.
And I think that by listening to each other and seeing how one change can have a positive ripple effect throughout the care of a patient is really important to be open to. And you have to be able to look globally at something and really bring it into that point of care and realize that nurses had a front seat to this. Nobody was in it longer than a nurse. We saw the patients the most and, honestly, the staff were the ones who created a lot of this process and just as feedback of what was working well and what wasn't working. So I think really looking at many of the nurses' point of view and listening carefully was the key to the success of this program so far. And it's an ever-changing process even now.
Bill Klaproth: Right. Well, it sounds like you took the advice and the thoughts and the suggestions of the nursing staff when redesigning this workflow.
Elizabeth McCarthy: Yeah. Well, being part of being a strong leader is listening. And I take that very seriously. And no one knows it more than the staff nurses. That's for sure.
Bill Klaproth: Absolutely. Well, Liz, this has been fascinating. Thank you so much for sharing your experience with us about workflow and procedural bundling. We really appreciate it.
Elizabeth McCarthy: Thank you so much for having me.
Bill Klaproth: And that's Liz McCarthy. And for more information, please visit AONL.org. Once again, this podcast is supported by an unrestricted grant from the Johnson and Johnson Foundation in partnership with the Johnson and Johnson Center for Health Worker Innovation. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.
This is leadership beyond the pandemic care delivery innovations. Thanks for listening.