UC Davis Health System
August 2004

UC Davis reinforces relationships with patients,
takes nursing practice to new level

Creative Health Care Management provides framework for implementing primary nursing

Ranked as one of the top 50 hospitals in America by U.S. News & World Report, UC Davis Medical Center is a shining star among health care industry peer organizations. For every year that the publication has surveyed hospitals, UC Davis has been among the top ranked facilities. Many of its specialty areas have also received recognition for exceptional quality.

Of the top 50 hospitals recognized this year, UC Davis had the second-highest nurse-to-patient ratio - almost three nurses per patient bed. (Only Mayo Clinic was higher.) Because it has more nurses per patient and meets highest nursing standards, UC Davis is also honored to be one of only 108 hospitals in the nation to receive Magnet Nursing Services Recognition by the American Nurses Credentialing Center.

How does a medical center top those important honors? And, more importantly, how does an organization maintain its reputation for greatness? For answers, UC Davis looked to Creative Health Care Management (CHCM) for an appreciative inquiry process that examines the dimensions and domains of the organization - and results in a program that would create a patient-focus acumen and take the organization to the next level.

Fighting complacency
It would be easy to sit back and bask in the glow. "I think one of our biggest challenges as a world-class health care organization is complacency," said Carol Robinson, senior associate director of clinics and director of patient care services for UC Davis. "People start to think, 'Well, we're already pretty good, so what more can we do?' What we really need to do is continue to get better."

From primary nursing to Re-igniting The Spirit of Caring
CHCM's founder and president emeritus, Marie Manthey, was asked to speak to UC Davis nursing leaders in September 2003. Manthey outlined how CHCM's newest approach to primary nursing, called relationship-based care, positively impacts patient outcomes by offering guidelines for effective and crucial relationships with colleagues, patients and their family members.

"Her talk made a huge impression. We had read Marie's book on primary nursing and had implemented the concept in our pediatric unit 10 years earlier," explained Robinson. "After hearing Marie in person, there was so much enthusiasm and excitement about nursing that we felt we wanted to proceed with a hospital-wide implementation. In November the contract was signed and by early December we began our planning sessions. It surprised me how quickly we moved forward - but we felt we needed to use the enthusiasm to seize the moment."

CHCM's appreciative inquiry process, which was conducted with both leaders and staff, helped UC Davis to examine successes in all dimensions of its patient care. What emerged was a heightened awareness of the voice of the patient.

"We have wanted to move toward more family-centered care. It was stated as one of our goals, but we weren't making much progress," said Robinson. "For instance we were designing new intensive care units and we wanted to build in the concept of allowing families to actually stay at the patient's bedside - and sleep there, too."

Among its most pivotal findings, the inquiry process affirmed that UC Davis is a learning organization that values teamwork and collegiality with a desire to take professional nursing practice to the next level. In addition, it encouraged a new focus on the staff's relationship with patients - and with one another.

CHCM's framework of services allowed UC Davis to begin to implement primary nursing throughout the entire medical center. The new organizational structure, as well as the pure definition of primary nursing, involves the development of a primary nursing role and relationships that result in a nurse assuming responsibility for planning the care of a caseload of patients while receiving care on a discrete unit and transitioning that caring relationship to the next area of service.

New mindsets, new skills
Implementing primary nursing requires several key steps. CHCM's Leading an Empowered Organization (or LEO) is a three-day program designed to further develop effective leaders and leadership teams. LEO equips leaders with skills unique to leading staff who own their professional practice. In addition staff were engaged in an organization wide program committed to improving patient and staff satisfaction. This program, entitled Re-igniting the Spirit of Caring, was offered for all nurses.

"Our nurses go off-site for three days and take time to enjoy the company of their colleagues. They learn from each other and recommit to why they became nurses in the first place. It's been really tremendous," said Robinson. The focus is caring behaviors for self, colleagues, patients and families.

CHCM recommended creating unit practice councils as the steering groups for implementing principles of a primary nursing care delivery system. The unit practice councils are made up of elected nurses who determine how the principles of primary nursing role responsibility will be implemented on their units, how the nurses select the caseload, roles for the primary nurse and associate nurse, and how they will work through issues. "CHCM guides the process, answers questions and keeps everything focused," said Robinson.

Measuring success
An annual staff satisfaction survey and ongoing patient satisfaction surveys are the primary indicators of success for UC Davis' primary nursing initiative. "Our recent patient focus groups gave us some important areas of measurement," explained Robinson. "They want to know that we're listening, we empathize with their fears and anxieties, that we're talking to them, listening to them and comforting them. They want us to take their needs into account, allowing them to have some control over the decisions that are made about their health care - and allowing families to be involved in the care."

UC Davis looks forward to positive outcomes in all the critical measurement areas: clinical safety and quality, patient and family satisfaction, staff and physician recruitment and retention - and a healthy bottom-line. "CHCM looks at an organization as a living organism," said Robinson. "They represent the professional nurse concept in everything that they do. It's a model that you don't find with other consultants - who mostly believe that a traditional business model is best. CHCM believes that effective relationships bring the greatest, most positive change."

To find out more about any of the CHCM services mentioned in this case study, contact us as 800.728.7766.

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