morning rounds Culture Change Workshop
The Mayo Clinic Trauma/Surgical Intensive Care Unit (T/SICU) was attempting to establish a multidisciplinary rounding practice, but found it extremely difficult to implement. My team was recruited to uncover the roadblocks to establishing new rounding practices and provide suggestions on ways the T/SICU team could overcome those challenges.
I acted as primary researcher for the duration of embedded time with the T/SICU team, developed the workshop activities and agenda, designed the co-creation assets, and documented the workshop outcomes. This work lead to a report of future product development delivered to the leadership of the T/SICU.
Uncovering The Story
By embedding with the T/SICU staff, I was able to see problems from the inside out, so as to understand the issues from each person's perspective.
Four weeks of shadowing in the T/SICU during morning and afternoon rounds, plus two days of shadowing a different SICU to understand their rounding practices
Both formal and informal interviews were conducted with care providers from 14 different roles within the T/SICU. This discovery process lead to an understanding of common themes stemming from each role's perspective.
Insight: Patient care plans are developed in a vacuum
there are 19 people actively involved in each patient's care every day in the T/SICU. Of those 19 staff members only 5 are directly involved in determining the patient's care plan for the day.
Insight: Communication is intensely fragmented
DAILY COMMUNICATION MAP
Line weight indicates the robustness of the conversation (collaboration) between stakeholders. Dashed lines indicate communication through a mediator (e.g. Consultant to Resident to Nurse)
THE MAJORITY OF PATIENT CARE DIRECTIVES ARE CONVEYED THROUGH SECONDARY OR TERTIARY SOURCES
The daily care plan for each patient is not discussed face to face with the T/SICU staff. The care plan is solely noted in the EMR. The staff must constantly log in and out, checking the EMR for updates, changes, or alerts...
External solutions to complex problems usually fall far short of true change, especially when cultural shifts are required. Co-creation workshops leverage the expertise of those on the front lines of the problem to develop real solutions that stick.
Synthesis & Implementation Planning
FUTURE ROUNDING TOOL CONCEPTS
In the workshop, the participants developed a number of concepts to assist with the implementation of multi-disciplinary rounding in the T/SICU. We developed an implementation plan that started with simple to test ideas and took iterative steps toward prototypes that required more development resources. This way the T/SICU team developed a robust multidisciplinary rounding culture they believe in.
T/SICU room “smart boards” allow access to EMR clinical notes as well as collaborative patient notes.
In-room mobile education for residents utilizing tablets connected to the EMR and secure internet.
Integration with hand-held devices for on the fly notations and enhanced collaboration.