Enhancing Resilience, Building a Stronger Patient Safety Culture

During the past two years, several units at UNC Hospitals have implemented resiliency tools to better protect themselves and their patients. As we prepare to take the 2015 Patient Safety Culture Survey, read about the role of resilience, 3 Anderson and the power of positivity, and why you should take the survey!

Take the 2015 Patient Safety Culture Survey

Research shows that building resilience among health-care workforces can reduce stress and emotional fatigue, which affect patient care quality. Bryan Sexton, PhD, associate professor of psychiatry and behavioral sciences at Duke University School of Medicine and director of the Duke Patient Safety Center, is a leading expert in the relationship between resilient workforces and patient care.

“In 2015, health-care workforce resilience looks like the most robust predictor of clinical and operational outcomes in the peer-reviewed literature – so ‘try harder’ hasn't been working for a while now,” says Sexton, who will serve as the keynote speaker at the 16th Annual Leadership Development Session for UNC Medical Center leaders in November. “In other words, we do well by our patients to provide our workforce with the tools and the protected time they need to bounce back.”

At UNC Hospitals, many units have been implementing tools that enhance resilience. For the past two years, 3 Anderson has focused on the power of positivity in building a strong patient safety culture, boosting morale among staff by strengthening their relationships with each other and their patients, and developing stronger resilience.

“As human beings, we sometimes focus on the negative, which can lead to additional stress,” says Paige Roberts, CNIV, who notes that caregivers often face unique and stressful patient-care challenges at work.  “And as nurses, we may already have a greater tendency to think negatively because we’re trained to actively search for negative signs and symptoms such as hypertension, elevated potassium level or a high white blood cell count.”

Roberts and her colleagues found that they can overcome the effects of negative emotions by acknowledging positive ones. The first positivity tool she introduced to the unit was “Three Good Things.” Each day staff members share something good that happened during their shift, even when they’ve had a particularly difficult day. Roberts collects the feedback in a central document and shares the contributions with staff in an email and the unit’s weekly newsletter.

“We’ve seen that the most challenging days produce highest amount of participation in ‘Three Good Things,’” she says.

Research has shown that when individuals participate in “Three Good Things,” a tool commonly used in other workforces, for two weeks, the positive effects have a lasting impact for up to six months.

“If we were to ask employees to list all the bad things that happened on a busy day, the pages would be packed,” she says. “By highlighting the good things that happen, it motivates us to place our energy on the positive aspects of our work.”

The tool has become part of the culture on 3 Anderson, and the unit has spread its use to other units, including the Cardiac Catheterization Laboratory, which provides 3 Anderson with roughly a third of its patients.

3 Anderson
For two years, members of 3 Anderson have been using positivity tools and other techniques to build resilience and strengthen the patient safety culture on the unit.

“We’ve exchanged ‘Three Good Things’ with each other, about each other, and our relationship with them has improved greatly,” says Roberts. “It’s helped us learn more about each other and our work and led us to pick up shifts for each other on our units, and that makes a big difference.”

Patients also experience negative emotions while hospitalized. To help shift conversations between patients and staff away from illness and health, 3 Anderson has implemented “Getting to Know You” boards in each patient room. Patients are encouraged to write something personal they’d like to share about themselves on the board.

Nurses share information about themselves by placing personalized magnets on the board. Each magnet includes a photo of the nurse along with their name and two facts about themselves, one personal and one professional.

“These boards are great for opening up new conversations for the physicians, staff and patients,” Roberts says. “My magnet says that I have a soft spot for pit bulls, so I always end up talking to patients about dogs and other pets.”   

During the next month, from Sept. 20 to Oct. 17, UNC Hospitals, the hospital at UNC Health Care Hillsborough Campus, and Nash Healthcare will take the 2015 Patient Safety Culture Survey. As staff prepare to take the survey, it’s important to note that building positivity has proven an important resiliency tool for 3 Anderson, demonstrated by improved patient safety culture scores, noted with the 2013 Patient Safety Culture Survey after six months of practice using different resilience tools.

“Our scores went way up,” says Roberts, who co-presented research on positivity tools at a critical care nursing conference in San Diego earlier this year and co-authored an article in American Nurse Today explaining positivity techniques that help build better teams and enhance organizational performance. “We’ve been able to tell our staff that we saw a difference. Whether our unit is going through good or bad times, these techniques make a huge difference in maintaining a good relationship with our patients and each other.” 

Strong participation in the Patient Safety Culture Survey, administered Sept. 20 to Oct. 17, will provide an excellent measure of organizational and unit resilience and patient safety perceptions.


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