While working as a clinical nurse in the Silberman Family Special Care Nursery , Amy Sawyerr, M.P.H., B.S.N., R.N.C.-L.R.N., who is now Sibley’s director of nursing systems, strategy and operations, took part in a nurse-led task force focused on developing a system for clinical nurses to provide peer feedback to each other. This task force wasn’t simply a hospital-based initiative. Instead, it brought together nurses from every hospital in the Johns Hopkins Health System (JHHS) with a big goal: Find a way to bring a system for clinical nurse peer feedback to all six hospitals at the same time.
This collaboration is just one example of many where, rather than single-hospital silos, the health system convenes the expertise of clinicians and leaders from all its hospitals to tackle shared challenges.
Sawyerr’s clinical peer feedback task force collaborated for more than two years to create a tool and forms that standardize the peer feedback process. They also designed an educational program to help clinical nurses learn how to use the system and to provide their peers with constructive feedback. The program piloted in 14 units across hospitals, including one unit at Sibley. After the pilot concluded, the task force revised the tools based on the pilot’s outcomes.
“We learned just how important peer feedback is and how much it benefits a nurse,” says Sawyerr. “Feedback from a peer nurse can really show you what your strengths are and it’s really encouraging to hear from your fellow nurses.”
Soon, every clinical nurse in a JHHS hospital will regularly receive feedback and input from two nurse peers — feedback that research shows can make a huge difference in how nurses perform their jobs.
Approaching challenges at the health system level is most successful when the work is fueled by input from people doing the work. Sometimes, an effort already underway at one hospital trickles up through a work group or committee to feed change across the system.
For example, Sibley’s director of excellence in nursing practice and education Allison Steinberg, M.S.N., M.P.H., O.C.N., N.P.D.-B.C.C, brought the hospital’s custom nurse education learning bundle to a health system work group. The group was tasked with finding better ways to fulfill the health system’s annual education requirements. Sibley’s bundled content strategy for nurses was adopted and will now be included in learning modules for all the hospitals.
The collective approach can also be particularly powerful when used to address shared quality and safety challenges. Steinberg sits on several groups, most of them led by nurses, dedicated to nursing sensitive indicators. These groups have reviewed standards and best practices for issues such as skin integrity and infection-reduction protocols. This type of collaboration leads to more uniform practices across the health system, including better compliance with established protocols. For example, a focus on infection reduction led to improved hospital compliance with routine chlorhexidine gluconate (CHG) bathing for patients with central lines.
Larger multidisciplinary work groups of nursing staff, pharmacists and physicians from the JHHS hospitals are poised to take on even bigger challenges. For example, Steinberg co-leads a group studying how to standardize a protocol for discharge medication reconciliation, one of the largest undertakings she’s been involved in at the system level so far. While establishing a process that works for everyone is a significant undertaking, she says that getting this process right is “critical to ensuring that the care of patients is the best that it can be from the time of admission through discharge and beyond.”
Harnessing the power and dedication of clinical experts from every corner of JHHS has led to better protocols and more efficient decision-making that benefits patients. Bringing the voice of clinical nurses into this work ensures that the practices that work best for patients will remain a major focus for future initiatives.
