With AONE 2014 conference coming up next week, I’m very interested to hear what nurse leaders are doing to address fatigue in their hospitals. This was a topic I blogged about coming out of last year’s conference – Capt. Sully made a passionate plea to the healthcare industry about patient safety, and there were several sessions that spoke to the need for fatigue management strategies as a way to reduce the risk of errors.
But since then, what has been happening? Have hospitals been making progress in creating and implementing fatigue management strategies? I talked last fall about the direct relationship between patient safety and fatigue management. Looking at healthcare news stories, patient safety continues to be a trend, but the only time I hear about fatigue management is when something bad happens. It’s not just patients either, as I saw in this very poignant story by Charleton Stanley about how a culture of ignoring fatigue has affected his family.
Many articles and presentations about fatigue end with some general recommendations and make a call to action, but what does that look like in practice? If you are a nurse leader (you can pretend for a moment if you are not), do you know what steps to take to get you from Point A to Point B? How do you get from “I know fatigue management is very important, but we are not doing much about it” to “We have a strong fatigue management strategy in place and a corresponding culture of safety”?
If you answered “Happier Employees,” then I hate to be the bearer of bad news, but that’s likely not going to be the result, at least at first. A few truisms I’ve learned working in and with hospitals all these years include that (1) nurses LOVE twelve hour shifts; (2) they LOVE the ability to earn extra pay by taking extra; and – most importantly – (3) nurses HATE change, especially to anything that affects their work schedules. A good fatigue management strategy is going to stir the pot with at least one of those truisms and maybe two or even all three. Of course, over time, nurses will adapt to the changes and the policies for fatigue will become their new normal. But in the meantime, don’t think that implementing fatigue management policies will make anyone “happy.”
Instead, implementing fatigue management should be most evident by…nothing happening. It’s a preventative measure to reduce the risk of Sentinel events and other negative outcomes. Fatigue management is not an antibiotic to cure an infection. It’s more like a prenatal vitamin to support a healthy pregnancy. You know it is working because the overall health of the hospital is better.
Another way you know it is working is because you went through the steps to successfully effect change in a hospital with staff. These are tried and true steps that we at Axsium are very familiar with, because we deal with them every day in helping hospitals with workforce management – how they schedule and staff employees and how employees get paid through their timecards. When we go into a hospital to implement a fatigue management strategy or any other scheduling oriented process change (like creating a centralized staffing office), we go through the following four steps to achieve success.
- Establish a vision. Every hospital is unique, and every strategy needs to be unique for that hospital and their culture. The vision comes jointly from nursing leaders and staff, with everyone getting on the same page on what is to be accomplished and why.
- Determine the current state. Not everything that is currently going on is bad behavior. Also, there may be union agreements or state requirements that affect policies. The hospital needs to know what they are doing now and what the constraints are before a strategy can be created to accomplish the vision.
- Create a strategy. This is the process of documenting what is to be accomplished in order to carry out the vision. Everything in the strategy must align to the vision and be in the context of the current state.
- Implement the strategy. There are workflow and policy changes to be executed for the strategy. That takes a change management effort to socialize and train the staff and managers on the new changes.
- Audit for compliance. Just because you train everyone and say “Now do it!” doesn’t mean that it will continue to be executed as the strategy designed. You need to have a mechanism to ensure compliance with new policies. Usually this takes the form of reporting against scheduling and timecard data to assess behavior.
Those are the steps to successfully implementing changes in a hospital that affect scheduling processes, including a fatigue management strategy.
Coincidentally, if you follow those all the way through, you don’t have to guess anymore at what a successfully implemented fatigue management strategy looks like! You know, because you are checking to make sure that the vision is being adhered to and that, to put it bluntly, nothing bad is happening, because that’s the real goal of a fatigue management strategy.