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• #Shift exchange austin series#

This subject was also treated at the meeting with the ICU managers and the team decided to complete a month of use with the pilot version of the document, while a refined version to be used from the following month was prepared. One observed factor was the misunderstanding that the change was top-down (from the organization to the technician), and some technicians felt invaded, showing resistance. This fact, could result on undesired influence over other collaborators.

Collaborators who did not take part on the training meetings showed considerable resistance in supporting the project and changing their routine. A suggestion emerged of separating the items in a more visual way. The participants observed that the order of the items in the checklist was not clear, creating doubts about which items had been properly reported or executed. After the third week, a meeting among the researchers and the nursing manager was conducted to evaluate the change process and the produced work. The research team accompanied the activities during three weeks, clarifying any doubts. Three meetings, one per shift, were conducted with the teams of nursing technicians, aiming to explain the process changes in their routines, why the change was being made, and what would be the benefits for the different involved actors. For the first implementation test, the Medium Complexity area was selected as the first pilot. A synthesis of the steps followed in this stage can be observed in Figure III. The implementation stage was carried out during 4 months. This shows the difficulty of implementing changes in the Healthcare context, especially when it straightly involves control and care of the patient’s health. The new Vital Signs Sheet was also appreciated by the ICU’s management team, but its implementation was not recommended by the managers for the following reasons: (i) it contains patients’ control data and its implementation affects all ICU’s processes, which would be too complex for the project horizon (ii) the current Vital Signs Sheet is a formal document archived by the hospital, for proving the administration of the treatment and external actors can also have access to the registered information (iii) it would depend on a specific approval of the Medical Registers Committee.

Version 3 was officially sent to the Medical Registers Committee of HDM, for formal approval. A total of 3 versions of the checklist were developed. The refined prototypes were then presented to the ICU’s management team for assessment, adjustment and approval. The benefits the team estimated from the Duty Transition Checklist developed were: (i) standardization of a fundamental process regarding the patient’s safety (ii) promotion of changes in the behavior and engagement of the technicians (iii) standardization of a duty transition routine, based on documental remarks and (iv) promotion of explicit definitions and formal training (for instance, standard organization procedures). The estimated achievements of the new versions were: (i) increased space to inform the patient’s evolution (ii) a specific space for the technician’s description of events at each shift (morning, afternoon and night) on the same day (iii) horizontal orientation of the page, for easier handling (iv) increased space for exams, patient’s belongings, visitors registration, and other information (v) elimination of deprecated fields, according to the current protocol. Improvements on the Vital Signs Sheet were also made. Throughout the meetings, rapid service prototypes were made focusing on better layout and information organization.

#Shift exchange austin series#

The prototype was analyzed and refined with the technicians in a series of focused meetings. After the first co-creation meeting, the researchers summed up a checklist with the relevant items for the routine management of the technicians. The participants suggested also improvements on the already existing Vital Signs Sheet. Other subjects of discussion were the Vital Signs Sheet (a document in which the technicians monitor the care indicators during the entire work shift), and the Checklist of Activities and the causes of deviance of such protocol. This can also be caused by a permissive behavior about the work standardization of the shift transition protocol (iii) relationship: the lack of complicity between nurses and technicians potentially generates non-value-added activities. In such cases, information is passed through other colleagues, indirectly (ii) complicity: technicians tend to perform unfinished tasks from colleagues holding the station in previous shifts, leading to work-and-rework. needs to leave their station, in order to respect the assigned working hours.