| Leadership - leading people to create and maintain the planned change |
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“We had an incident occur and she was involved in that incident, so I walked her through how had a huddle been used in that incident, the end result may have been very different, and she totally agreed.” (Hospital I) “Then we go over wins, to celebrate positive things that have been said, because I think you’re quick to hear what you did wrong, but you’re not quick to hear what you did right.” (Hospital G) “My position is over Quality and Patient Safety and the other people are clinical…So I took the lead because I felt like my schedule and my focus on my job allowed me to do some of that legwork for them.” (Hospital J) |
| Buy-in - ensuring support and engagement from the relevant stakeholders |
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“Small departments, small wins. We thought that would be the easiest way to start and I think we also are starting with the departments with the most flexible managers, who are willing to get behind it.” (Hospital I) “Sometimes the message on why is this task important and why are we doing these actions gets missed…We make sure that our physicians know [it is for patient safety]. Then they buy in and go, yep, I need to be doing that.” (Hospital J) “We had total buy-in from all the managers and staff, but it took time. We educated the staff, we took them off site. We…educate [them] on basically our culture.” (Hospital A) |
| Customization - improving the fit between the intervention and organization’s circumstances |
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“We want to make sure that we look at the process thoroughly and find out how we can set up to take the least amount of time for the staff, be efficient, and get the appropriate documentation on the chart.” (Hospital B) “There’s instructions at each huddle board…[and] all the boards are made the same…It’s very uniform so you can know what to expect from one huddle to another to another.” (Hospital C) “We can make small changes. If they don’t work we can change again. We’re small enough…and we have a lot of freedom to modify and use it as we see fit.” (Hospital J) |
| Accountability - monitoring and evaluating the implementation and use of tools |
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“We do audits every once in a while to make sure the in-room whiteboards [used in shift-change handoffs] are updated.” (Hospital H) “You have to see whether [the bedside shift handoff] is occurring. I don’t need to come every day, but I will randomly show up every once in a while, willing to call them on it to say, “Why isn’t this happening? Are you uncomfortable with speaking in front of the patient? What can I do to make it so that you can give report?” (Hospital D) “They’ve been turning in their log sheets [for briefs] to Administrator A, so we went through those and we saw that the nurses were not necessarily doing them all the time.” (Hospital I) |
