Relationship-Based Care Satisfies Both Patients and Hospital Staff

Lynda Francis

Lynda Francis , NP

ED Nurse Practitioner, Saint Agnes Medical Center

Published April 14, 2016

A few weeks ago on Perspectives, we featured Vituity's collaborative learning initiative aimed at growing a top-tier PA and NP practice. The ED team from Saint Agnes Medical Center in Fresno, Calif., was among the participants. One of their goals was to increase PA's and NP's sense of ownership and engagement through involvement in hospital committees.

Perspectives recently sat down with Saint Agnes NP Lynda Francis to talk about how committee work helped her make a difference in her organization while finding new meaning in her practice.

Tell us a little about yourself and your hospital.

I've worked in the Saint Agnes ED since 1991. I started as a technician and took on different roles as my education moved along. I've been an NP here for about 16 years.

Saint Agnes is a great place to practice. Our PA/NP team is really cohesive. We all know what's happening in one another's lives, and we bend over backward to help one another out during tough times. CEP America has been staffing our department for about three years, and the physicians have been very supportive of us from the start.

We also have our challenges. Our ED sees over 90,000 visits a year, so our jobs are quite demanding. Healthcare reform has definitely stepped up the pace of change, which can be stressful. Lately, we've been hiring a lot of new people — some experienced, some inexperienced — which has required a lot of adaptation from all of us.

How did you become interested in committee work?

Dr. Alan Givertz suggested I join the new Relationship-Based Care (RBC) committee that was starting in our department. To be honest, I didn't jump at the chance. I'd held other leadership roles in the past, and I worried about having too much on my plate.

But the more I learned about RBC, the more it appealed to me. I've always loved the social aspects of ED work. Having the opportunity to interact with patients from every socioeconomic and cultural background has really helped me grow as a person, and it's a big source of job satisfaction for me. The idea of helping colleagues deliver patient-centered care while finding more meaning in their work, seemed like a worthy cause.

I was also impressed with the makeup of this committee. The chair, Savannah Pronovost, is a fantastic nurse who has done RBC work around the hospital. And the early members were really solid professionals who were happy in their careers and sincere in helping their colleagues. If they were involved, I wanted to be involved.

What is RBC?

It's a cultural transformation model that helps caregivers move from being task-oriented to relationship-oriented.

To do this, we focus on a triad of core relationships. The first is between the patient and the caregiver. To be effective at our jobs, we really need to put the patient at the center of everything we do. Second, is our relationship with ourselves, which encompasses self-awareness and self-care. And third, is our relationship with colleagues. We're strongest when we commit to a shared mission and respect each person's contributions.

RBC asks us to nurture all three of these relationships in order to deliver great care and find meaning in our work. Experience suggests that RBC can improve patient satisfaction as well as staff satisfaction and retention. It can also impact metrics like LOS and readmissions.

What does the RBC committee do for the department?

For one thing, it brings together people of different disciplines to improve the culture. Savannah and I are the current chair and co-chair, and our core members include providers, nurses, technicians, scribes, and care coordinators. At first, we recruited members, but lately people have been asking to join, which is great.

A lot of the things we work on sound simplistic, but we find that small details can make a big difference in relationships. For example, we had the idea to equip the entire department with rolling stools. That way, caregivers can easily come down to eye level with patients during conversations rather than standing over them. It's a subtle difference that symbolizes a greater level of care and connection.

We also work hard at staff appreciation and acknowledgement. For example, we've had several techs become nurses and nurses become NPs recently. Celebrating those milestones has been fun and has brought us closer together.

Finally, we've had the opportunity to collaborate across the hospital. Our committee includes several ad hoc members — the chaplain, the ED nursing director, a social worker — who advise us and assist with different projects. As co-chair, I also attend the ED medical staff meetings to update them on our work and share suggestions and feedback from the team.

I understand you recently presented before the Saint Agnes Foundation with some surprising results. Tell me about that.

The ED team was invited to give a status update and talk about our current needs. Dr. Givertz and the scribe director Dr. Claypool talked about our challenges around space and the ED's physical layout. My job was to cover staff morale.

I took some time to prepare my remarks, because I felt like it was a huge responsibility to speak on behalf of my committee coworkers. I spoke passionately about how amazing our team is, how they come from all walks of life yet pull together to get the job done. They're strong, smart, and hardworking. They’re salt-of-the-earth types who handle some of the hardest stuff in life — then go in the next room, and do it again.

One thing I emphasized was how our caregivers put themselves last, and as a result, they don't take many breaks. Even if they're working the night shift, they don't have time to walk down to the cafeteria for a cup of good coffee. They barely have time to go to the bathroom.

The foundation members were really appreciative of the work our committee was doing. One day later, they partnered with one of our volunteer groups to donate about $5,000 to the RBC cause. One private donor actually pledged an industrial coffee machine for the ED break room, plus supplies, for one year. So that was a huge cause for excitement and gratitude.

I don't take any credit for any of this. It was the committee's hard work and spirit that inspired the donation. But it was very rewarding to be the catalyst that united their efforts with the good intention of the foundation.

What's next for RBC?

We have a lot of projects in the pipeline, including a staff picnic and a quarterly recognition program. And starting tonight, our scribes are spearheading a new initiative around the humanities. Some of them thought it would be great to talk about how we use art, writing, music, and so on to cope and express some of our ED experiences. So tomorrow we're having our first meeting, which is open to the department, at my house.

Do you feel that serving on this committee has enhanced your practice?

Definitely. As I mentioned above, I've really enjoyed being a catalyst. RBC has given me the opportunity to help all of the talent I see in our department find expression. When we bring great people together and encourage them to put their ideas into practice, it's amazing what happens.

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