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"Working sabbatical" benefits employees, hospital

Clinicians know that one of the best ways to improve the patient experience is to spend more time at the bedside. But with so many other duties demanding their attention, how can physicians, nurses and other clinicians spend more quality time with their patients?

That's one of the challenges three integration resources staff members set out to answer as part of an Operations Support program. Through the program, employees take a year off from their regular positions to work on projects under the direction of an experienced Operations Support consultant.

Last year, Katie Merwin, RN, Lynda Cook, RN, and Robert Domogala, RN, worked on several projects related to safe patient flow, transforming patient care, the Saint Raphael Campus integration, Epic implementation and regulatory preparedness. All of the projects were designed to improve patient safety, the patient experience and operational efficiency. One involved observing nurses and patient care associates on both campuses to gather information about their work flows and identify barriers that keep them from spending more time at the bedside.

Merwin, Cook and Domogala observed that the time clinicians spent on documentation was taking them away from patients. They reviewed results of their observation and analysis with employees and worked with them to develop changes in processes and procedures. As a result, nurses started documenting in real time at the bedside, using the workstations on wheels (WOWs). A similar initiative is under way with hospitalists and house staff.

"This project has helped improve patient safety in terms of documentation and medication administration," Cook said.

"These projects are very patient-centered," Merwin added. "Working with the clinicians, we have been able to come up with a number of ways to improve work flow and the patient experience."

For their projects, participants in the Operations Support program spend a lot of time observing fellow employees, including clinical and non-clinical staff, as well as physicians. During the safe patient flow project, Merwin, Cook and Domogala shadowed patient transporters at both campuses.

The goal with observation is not to evaluate individual staff members, but to examine the procedures, processes and systems they're using, then analyze the information collected to determine what improvements are needed. Operations Support program participants then work closely with staff to develop and test process improvements.

"We work to gain everyone's trust and build a rapport with staff," Cook said. "In some cases, we're asking them to use new equipment, processes, or — in the case of Epic — entirely new systems."

Started in 2008, the Operations Support program is a kind of "working sabbatical" that helps employees grow professionally, said Sandra Bacon, director, Operations Support. "This is a wonderful opportunity for employees interested in moving into leadership positions or exploring other aspects of a healthcare career."

Merwin, who previously worked on a Medical/Peritoneal Dialysis unit, and Cook, who was on the Surgical Step Down unit at the SRC, enjoyed the year-long program so much, they joined Operations Support as clinical nurse operation improvement leaders. Domogala returned to his position on the Stroke/Telemetry Medicine unit.

"The work participants do is extremely beneficial to the employees' professional development and the organization," said Maribeth Hayes, associate director, Operations Support. "Thanks to the 11 employee program participants we've had to date, the hospital has made significant improvements in quality, safety and efficiency and the patient experience."

Leaders recommend employees for the Operations Support program; Ena Williams, RN, vice president of Patient Services and associate chief nursing officer, recommended Domogala, Cook and Merwin. Operations Support leaders interview candidates and select participants based on their past contributions to the organization and future ambitions and interests.

During their year-long assignments participants are trained in observation-based design, data analysis, change management and executive leadership coaching. They are encouraged to take relevant courses through Yale New Haven Health System's Institute for Excellence.

"The most important thing we contribute to our projects is a clinical perspective," Domogala said. "Our backgrounds and experience give us insight into the issues we're examining and allow us to work closely with other staff members on solutions that will ultimately improve patient care."

Yale-New Haven Hospital news release

Yale-New Haven Hospital is a nationally recognized, 1,541-bed, not-for-profit hospital serving as the primary teaching hospital for the Yale School of Medicine. Yale-New Haven was founded as the fourth voluntary hospital in the U.S. in 1826. Today, the hospital's two New Haven-based inpatient campuses include Yale-New Haven Children's Hospital, Yale-New Haven Psychiatric Hospital and Smilow Cancer Hospital. YNHH has a combined medical staff of about 4,500 university and community physicians practicing in more than 100 specialties. YNHH's York Street campus and associated ambulatory sites are Magnet-designated by the American Nurses Credentialing Center.

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