St. Andrew's War Memorial Hospital

St Andrew’s War Memorial Hospital is a 240 bed facility, with 14 theatres & 3 Cardiac Cath labs, and is part of a UnitingCare Health (UCH) – a five hospital system in Queensland, Australia.

UnitingCare Health is a service group of UnitingCare Queensland, the health and community service provider of the Uniting Church which supports more than 14,000 people throughout the state every day of the year.

With over 15 000 staff in more than 400 geographic locations across Queensland, UnitingCare Queensland is one of Australia’s largest non-profit health and community service providers, with an annual operating budget in excess of one billion dollars.

1. St Andrew’s was the pilot site for the UCH ‘Living Values’ (Studer Group Evidence-Based Leadership^SM) program.
2. The hospital Executive equates the significant improvements in compliance with the ‘staff safety bundle’ and hand hygiene compliance through increasing manager accountability and focus via the Monthly Accountability Meetings (MAM’s). Compliance with MAM’s sits consistently at >97% across more than 46 senior managers & teams. Monitoring compliance with the ‘Living Values’ initiatives monthly and tabling the results at monthly Executive meetings ensure that accountability is role modelled and driven from the Executive Team.
3. This hospital has been hourly rounding for 12 months –The pilot unit (a 30 bed general medical unit, averaging greater than 50% of patients being identified as high falls risk) has seen significant reductions in call bells (over 2000 in the first 12 weeks of implementation) and a significant reduction in falls of greater than 35%.These reductions have been maintained over the last 12 months. Similar outcomes are being observed with the other units which have commenced hourly rounding in the past year.
4. Uniting Care Health is the first healthcare group in Australia to achieve full ISO9001 certification in under twelve months – the success of which they attribute to the ‘Living Values’ program and Studer Group partnership.
5. St Andrew's is the only hospital to have won the Australian Private Hospital Association's National Award for Excellence in Hospitals over 70 Beds more than once, and their Cardiac Services department won the Australian Private Hospital Association's National Award for Excellence for a team.
6. Published in Australian Private Hospital Association Journal - 2013

Living Values:

Living Values has been a motto at St Andrew’s War Memorial Hospital for approximately 2 years which encompassed the values of Compassion, Respect, and Justice, Working together and Leading through learning.

• Compassion - through our understanding and empathy for others we bring holistic care, hope and inspiration.
• Respect - we accept and honour diversity, uniqueness and the contribution of others.
• Justice - we commit to focus on the needs of the people we serve and to work for a fair, just and sustainable society.
• Working together - we value and appreciate the richness of individual contributions, partnerships and teamwork.
• Leading through learning - our culture encourages innovation and supports learning.

St Andrew’s War Memorial Hospital ‘Living Values’ program aimed to achieve the following:

• Improved patient safety through
  • Reduction in patient falls.
  • Reduction/prevention of pressure ulcers.
  • Reduction in medication errors.
• Improved staff satisfaction through
  • Decrease in call bell use by patients.
  • Reward and recognition for staff efforts and commitment.
• Increase in patient satisfaction
  • Increase number of compliments received through phone calls and letters.

In order to achieve these goals the Senior Clinical Team embarked on focus groups with staff at all levels to discuss our aims and how we felt we could get there. The need for uniformity within clinical wards was discussed and the importance of patients understanding the care elements we were trying to achieve. It was important that we engaged patients in the journey and addressed the perception elements that were often lacking rather than just the implementation of task based changes. Some of these elements that we needed to address were:

• How do we ensure patients feel secure and confident that we are addressing their needs?
• How do we ensure that patient’s pain requirements are being met?
• How do we respond to the patient’s needs in an appropriate fashion?
• How do we develop relationships with our patients such that we are able to reassure them and explain how their recovery is going?
• How do we co-jointly develop goals with our patients to enable them to be a part of their recovery?

This was complex given a workforce that is multi-generational and has become quite task focused over many years. These were the intangible elements that we wanted to achieve along with the direct patient benefits of reduced falls, decreased pressure ulcer prevalence and medication errors.

Using the information generated it was decided that we would implement Hourly Rounding® as a way to achieve the cultural, behavioral and clinical outcomes desired.

The introduction of Hourly Rounding® at St Andrew’s War Memorial Hospital, Brisbane, has resulted in significant improvements in patient care, safety and levels of satisfaction.

Hourly Rounding® was first implemented in September 2012. Within two months, patient falls in the ward decreased by 30% and there was a reduction in patents using their nurse call balls by 2,000 call bells per month. There was also an increase in patient satisfaction levels by 5% points.

Continuous improvements are being seen as Hourly Rounding® is progressively rolled out throughout the hospital with the system expected to be embedded in all eight wards by the end of 2013.

During each hourly patient visit staff follow the two Ps and two Rs: Position/Pain, Personal Needs, Reach and Respond.

Central to the Hourly Rounding® system is staff filling in, and updating, newly introduced Patient Communication Boards for each patient. These whiteboards are very much about keeping patients informed. Each board has the name of the ward’s staff and information such as the procedures a patient is having on a particular day, their diet, how they are mobilising and identification of key risks such as falls.

Critical to ensuring that our objectives are being met is to ensure that all managers and staff are held accountable. All process measures, e.g. nurse and manager rounding, are diligently audited and non-compliant staff held to account. In particular, nurse rounding is readily able to be audited through automated rounding software that highlights instances where rounding has not occurred on a timely basis. Of course it also depicts compliance.