Patient Centered Care is fully implemented throughout Southwestern Vermont Medical Center. Implementation began in 1999 and benefited from the foundation of a nursing shared governance structure (in place for eight years) and an organizational culture that rewards individual employee initiative to improve patient care outcomes and satisfaction. Staff were actively involved in defining new roles. Estimated time for replication of the model is six to twelve months.
Qualities for success for all of the new nursing roles include clinical expertise, an understanding of the significance of the role, and excellent delegation and facilitation skills. RNs who have leadership desire have willingly come forward to fill the positions. The new roles are widely viewed as career opportunities.
Not all RNs want or have the appropriate qualities to become an RN Designee.
Southwestern Vermont Medical Center is highly committed to staff development and offers flexible scheduling and rich continuing education and tuition reimbursement benefits for all employees as an organizational value.
RN Designees attend collaboration training to enhance formal and informal communication and negotiation skills. According to the CNO, they learn to “hold out a chalice instead of a sword: effective communication reduces anger, pressure and anxiety.” In addition, the designees are participating in a two-year leadership development program through the Advisory Board Nursing Leadership Center to continue to develop and enhance the skills needed in this role.
Patient Safety Specialists attend off-site training, which underscores the importance of their pivotal role. In addition to the off-site training for the Patient Safety Specialists, SVMC is establishing an LNA Council that will hold monthly meetings to work on issues, identify improvements, and continue education.
Implementation of Patient Centered Care was 100% internally funded. SVMC recently received a $40,000 grant from the Vermont Department of Economic Development to provide Lean Process Improvement training for nurses to give them the tools to improve work processes and eliminate waste. The goal is increase the amount of nurse time spent on direct patient care.
SVMC leaders think that successful implementation of the new care model requires keeping the patient at the center of the care process. The focus on the patient helped reduce employee resistance and territorialism and engage employees in developing ideas to improve patient care. In addition, a culture of “synergy” developed between nursing and hospital administration, and both came to acknowledge that with respect to patient care processes, “nursing runs the show.”
While developed and refined in a rural setting, this model is ideal for all types of inpatient acute care settings.