Implementing consistent screening and assessment requires careful planning, resource allocation, and modification of existing work practices to achieve its intended benefits.
Before you consider how to implement consistent screening and assessment, be sure you are clear on what you expect to gain. You’ll need to be firm on the expected benefits or you might not implement it effectively.
Why implement consistent screening and assessment?
- To consistently detect complexity and geriatric problems that often remain undetected (and increase the risk of adverse patient outcomes and errors).
- To consistently prioritize scarce geriatric resources for patients most in need.
- To minimize assessment burden on front-line clinicians (i.e., remove duplicate and unnecessary assessment and screening).
- To provide new staff with a practice routine that is consistent with your ED’s practice.
- To reinforce an efficient language for patient-related communication for verbal communication, charting, shift change, and post-discharge information sharing.
There are a few steps you should consider before implementing new assessment.
- Get the support of your staff
No one likes having ‘new things’ dropped on them out of nowhere, so make sure you consult with your staff beforehand. You need to describe why (see above), get support for a realistic vision and plan, and make sure that staffs have meaningful input on how the implementation will occur. Make sure your clinical practice leaders are invested. You’ll need enough consensus to move forward.
- Get the leadership onboard and the resources you need
Work with your administrative leaders to position the implementation as part of their quality improvement agenda and describe the resources and timeframe you’ll need (‘on paper’). Be realistic in your goals and timeframes. Make sure you have the technology, education, and infrastructure support needed. Don’t start until you achieve a firm commitment.
- Prepare yourself
Every implementation has challenges, even when a good outcome is certain. You’ll need to be firm in your plan and not waiver when the inevitable challenges and distractions come. Turn the barriers into positive input to improve your project.
With the necessary support and resources, you can now work toward your plan. Based on experience, the following features will increase your success.
- Establish assessment driven actions and protocols
Assessments that lead to concrete actions are self-reinforcing. Map assessment findings to new or existing senior-friendly care practices and protocols. Make sure that assessment findings are shared with all relevant team members (e.g., electronic record, tracking board, etc.) to inform care and avoid duplication. Make sure that the entire assessment process is mapped out in a very clear and concise way.
- Eliminate Redundancy
Ensure that any existing assessments and screening tools, which do the same task, are eliminated from the new assessment practices to avoid duplication and frustration. It’s sometimes easier to ‘add one more thing’ than to take something away, but that will cause problems in the long run. You might be amazed at the amount of redundancy and needless work you can eliminate.
- Your practice leads are your champions
Get explicit endorsement from your clinical practice leads (i.e., geriatric specialists, advanced practice clinicians, etc.) by including them in the project leadership. Make sure that practice leads are publicly supportive of assessment practices and implementation timelines. You will need multiple champions to lead the entire staff.
- Clearly communicate expectations and timelines with the staff
Deadlines reinforce actions and commit everybody to a common goal. Set concrete deadlines for implementation and stick to them. If you and your practice leads don’t have concrete dates, then they will always be pushed further and further into the future. Some people take to change readily whereas others need a ‘push’. Some will only adapt to the new assessment process if they see that there is no getting around it. Soft deadlines and soft directions only create avoidance behaviors.
- Create social contracts with staff
Staff should identify plans to change their assessment practices verbally, and especially for those staff that are having trouble making the change. Keep staff accountable by integrating the new assessment practices in your team rounds and huddles. Do periodic audits to make sure that new assessment practices are being followed and that any old practices are being eliminated. As much as possible try to engage each staff member in a conversation about the new assessment practices. Change happens one person at a time.
- Make sure that education and support is available
Make sure you are available to staff as a resource to support them and solve issues that will come up. You’ll need to be available or have practice leads available on an ongoing basis to avoid frustration. Lead by example. Solve the big problems and then move to the small problems. Don’t neglect details, but don’t obsess over them.
- Celebrate success
Give public recognition to those who are achieving the new assessment standards. Provide meaningful recognition for their effort. Make it fun.
References and Resources
- Quality Improvement Essentials Toolkit. Institute for Healthcare Improvement
Cambridge, Massachusetts, USA http://www.ihi.org/resources/Pages/Tools/Quality-Improvement-Essentials-Toolkit.aspx