1. Creating the New Culture through
Relationship Based Care
Barbara J Cashavelly, MSN, RN, AOCN, NE-BC, Nurse
Director, Lunder 9
Adele Keeley, MA, RN, Nurse Director, Phillips 21

2. Thank You
(It takes a village!)
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Jeanette Ives-Erickson, DNP, RN, FAAN
Debbie Burke, MSN, RN, MBA
Colleagues from the Institute for Patient Care
Barbara Blakeney, MS, RN, FNAP
The interdisciplinary teams of Lunder 9 and
Phillips 21

3. Objectives
• Describe how innovation based care
transforms practice to create a healing
environment
• Understand how leadership influences
culture change at the unit level

4. Unit Overview
Phase One Innovation Unit
• Lunder 9
• 32 Bed
Medical Oncology Unit
• Relationship Based Care
Model
• Dedicated interdisciplinary
team
AONE CIT Grant/Phase
Two Innovation Unit
• Phillips House 21
• 20 bed
Gynecology/Oncology unit
• Relationship Based Care
Model
• Dedicated interdisciplinary
team

5. Innovation at the Unit level
• Relationship Based Care
• Influence of Leadership
• Influence reflected in focus groups (videos)

6. Relationship-Based Care
“We experience the essence of care in the moment when
one human being connects to another. When
compassion and care are conveyed through touch, a kind
act, through competent clinical interventions, or through
listening and seeking to understand the other’s
experience, a healing relationship in created. This is the
heart of Relationship-Based Care.”
-”Relationship-Based Care, A Model for Transforming Practice”, Mary Koloroutis, 2004.

7. Relationship Based Care
A model for transforming practice~

8. Relationship-Based Care:
Enhancing Collaborative Practice
From:
To:
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Independence
Hierarchical relationship
Parallel functioning
Medical plan
Resisting change
Competing
Indirect communication
Interdependence
Collegial relationship
Team functioning
Patient’s plan
Leading change
Partnering
Direct communication

9. Relationship-Based Care:
Care Team Model
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Knowing the patient
Coordination of care
Consistency of teams –improved performance of teams
Building plan of care around the patient
Clinical support aligned around patient populations rather than
transactions
Learn lessons from the past
Consistency = Continuity = Coordination = Efficiency/Quality

10. Adams Influence Model (AIM)
• Influence is essential in optimizing practice/work
environments and outcomes
“Influence is the ability of an individual to sway or affect
another group about a single issue based on
authority, status, knowledge based
competence, communication traits and or use of time or
timing.”

12. Innovation Unit
“Leading the way to transformational change”
Inpatient units were:
•Testing ground for change
•Ideas were adopted, adapted or abandoned

13. Innovation Units Focus
•Improves quality of care and clinical
outcomes
•Enhances patient and staff satisfaction
•Increases
safety, effectiveness, efficiency, timeliness,
equitable, that is patient and family focused
•Reduces costs and length of stay

14. Innovation Interventions
• A few examples of many interventions…
– Attending Nurse Role
– Quiet Hours/Noise at Night
– SharePoint Site
– Admit to Chemo-in project

15. Lunder 9
• Integrating the ARN role on the unit
• Chemotherapy project

16. Hold for video

18. HOLD for run chart

20. HOLD for run chart

21. Data Run Chart

22. LOS and Chemo In

25. HOLD for run chart

28. Lunder 9
Focus Group Themes
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Anticipating the Unknown
Preparing for the Change
Experiencing New Opportunities
Establishing a new culture – before and after
Leadership support
Identifying more opportunities

29. Phillips 21
Clinical Innovation and Transformation
(CIT)
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Brainstorming
Quiet at Night
SharePoint Site
“If it’s not broken…….”

30. Hold for video

32. Hold for video

34. Hold for video

37. Quiet at night scores
• Scores went from 30% to 75%; sustained
75% since May 2013
• > than the 90th percentile

38. Phillips 21
Focus Group Themes
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Teamwork
Small wins led to big success
Staff seek out innovation
Leadership support
Opportunity for making a difference
“We didn’t know it was broken until we fixed it.”

39. Hold for video

41. Influence of Leadership
Leaders inspire others when they have clarity
of vision and purpose, confidence, and
ability to influence others to share their
vision, and a laser focus on what matters
most: caring and healing relationships at
the point of care.
Koloroutis, M. Relationship Based
Care

42. Leadership Reflections
• Nurse Leaders have the ability to influence
culture change by engaging staff.
• Success depends on nurse leaders
creating a safe environment for staff to risk.

43. Culture Change for Units:
Before and After
• Problem focused
• Fear of failure
• Satisfied with
status quo
• Resist change
*Solution focused
*Learn from failure
*Innovative thinking
* Embrace change

45. Summary
Endpoint
• Leadership begins at the bedside
• Innovation is the forefront of healthcare
• Staff are excited and embrace change

46. Hold for video

48. HOLD for run chart