Rapid Mortality Review in the Intensive Care Unit: An In-Person, Multidisciplinary Improvement Initiative

Background Significant resources have been allocated to decreasing the number of preventable deaths in hospitals, but identifying preventable factors and then leveraging them to effect system-wide change remains challenging. Objective To determine the ability of a novel in-person, multidisciplinary “rapid mortality review” process to identify deaths that are preventable and action items that lead to improvements in care. Methods Rapid mortality review sessions were conducted weekly for patients who died in the medical intensive care unit. Patient data and clinician opinions regarding preventable deaths were discussed and recorded. Bivariate analyses were done to detect associations between case variables and the formation of an action item. Results From 2013 to 2018, 542 patient deaths were reviewed; of those, 36 deaths (7%) were deemed potentially preventable. Facilitators identified issues in 294 cases (54%). A total of 253 action items were identified for 175 cases (32%); 60% of those action items were subsequently completed and led to tangible systemic change in 29 instances (11%). Action items were more likely to be identified for patients who had not been receiving comfort care (P < .001), for patients who had received cardiopulmonary resuscitation (P < .001), when the treatment team (P < .001) or the rapid mortality review facilitator (P < .001) had care-related concerns, and when the patient’s death had been preventable (P < .001). Conclusions Even in settings with low reported rates of preventable deaths, an in-person multidisciplinary mortality review can successfully identify areas where care can be improved, leading to systemic change.

Specific acts of appreciation valued by employees

Purpose Although managers agree that showing appreciation to their employees is important, many do not know how to do so effectively. Languages of Appreciation have been identified that uniquely convey that the recipient is valued when appreciation is expressed in the “language” they prefer. Moreover, a wide range of specific actions can be effective within a given appreciation language. Therefore, the purpose of this study was to identify the top ten action items within each language of appreciation to discover the actions preferred most frequently by employees. Design/methodology/approach Of the over 200,000 individuals who have completed the Motivating by Appreciation Inventory, approximately 1% of respondents were randomly selected to represent each primary language (Words of Affirmation N = 1,000, Acts of Service N = 500, Quality Time N = 500 and Tangible Gifts N = 300). Respondents’ action item preferences were then tallied. Findings Numerous themes were identified, along with the most desired acts of appreciation within each language: Words of Affirmation: acknowledge when I have handled a difficult situation well; Acts of Service: offer to do some menial tasks that will allow me to focus on higher priorities for me; Quality Time: go to lunch together and not talk about business issues; and Tangible Gifts: gift cards (visa gift card or to favorite store/restaurant). Originality/value To the best of the authors’ knowledge, this is the first study to report on the specific actions most desired by employees within their preferred appreciation languages. The results can help inform actions that are most likely to be successful in showing appreciation to colleagues in the workplace.

Integration of Continuous Quality Improvement Methods Into Annual Program and Institutional Evaluation

ABSTRACT Background The Accreditation Council for Graduate Medical Education's Next Accreditation System requires continuous program improvement as part of program evaluation for residency training institutions and programs. Objective To improve the institutional- and program-level evaluation processes, to operationalize a culture of continuous quality improvement (CQI), and to increase the quality and achievement of action items, the Wayne State University Office of Graduate Medical Education (WSU GME) incorporated CQI elements into its program evaluation process. Methods Across 4 academic years, WSU GME phased the following 4 CQI elements into the evaluation process at the program and institutional levels, including the annual program evaluation (APE) and the annual institutional review: (1) An APE template; (2) SMART (specific, measurable, accountable, realistic, timely) format for program and institutional goals; (3) Dashboard program and institutional metrics; and (4) Plan-do-study-act cycles for each action item. Results Action item goals improved in adherence to the SMART format. In 2014, 38% (18 of 48) omitted at least 1 field, compared with 0% omitting any fields in 2018. More complete action items took less time to resolve: 1.7 years compared with 2.4 years (t(43.3) = 2.87, P = .003). The implementation of CQI in the APE was well received by program leadership. Conclusions After leveraging CQI methods, both descriptions of institutional- and program-level goals and the time required for their achievement improved, with overall program director and program coordinator satisfaction.

Highlighting Collaboration in Living the Art of Nursing

Collaboration is a frequently cited concept and also cited as a call-to-action item required among team members to improve the status of healthcare for persons and communities. With a humanbecoming paradigmatic lens, freedom is established to elevate the idea that community provides an essential component upon which collaboration can be built. Community is conceptualized as oneness of humanuniverse and is highlighted as an artful aspect of providing care to persons by keeping in the forefront the three humanbecoming change concepts of moving-initiating, anchoring-shifting, and pondering-shaping.