Section 1 – Getting started - What are my ideas for the project?

1-How will I do it ?

FOCUS

Improvement Project Name Department

Enhancing the nursing
The in-patient departments
handover process
Project Timeline
Project Status

In Progress 01-01-2024 31-10-2024

Baseline (Data):

Determine the baseline of the problem that has been identified.

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2020 17 171820 20
1716
1513
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1086 1211
2

MT

Bedside handover monitoring items

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Organize Project Team:
Team Leader
Facilitator Quality Coordinator
Director of Nursing services
Head of Nursing Quality
Head Nurses
Clinical Nursing Quality Coordinator
Clinical Instructor

Clarify current Flow Map the current process/ problem (Flow chart):

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 Understand the contributory factors :

By using the fish-bone diagram that analyze the contributory factors that fall into
these categories

Machines Measurement
- Computer shortage Policy of handover -
No staff monitoring with KPI -
- Clipboard shortage
Lack of SBAR implementation -
- No available file trolley
Incoming Patient codes -
- Printer shortage
Environment disturbance-
- Lack of A4 paper Medication time-
Lack of leader supervision-
Duty hours-
Time management-

Ineffective
communicatio
n

Manpower Materials & Methods

Staff shortage -
- Two methods of documentation
Lack of education - (electronic & paper)
Poor awareness -
Attitude -
Lack of commitment -
Language barrier -

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Decide which problems to solve first by Impact
using 80/20 Prieto chart
Staff shortage- SBAR protocol –
80/20
KPI monitoring – Leader
supervision

Improved productivity

Improved work process

Improved cycle time

☒ Increased customer satisfaction

Select Improvement goal (SMART Aim statement :

To improve the quality and consistency of bedside handovers among nurses in

inpatient department by the end of Q3 2024

2-What resources are needed ?

Improving the nursing handover process necessitates a synthesis of
standardised instruments, training, technology, and support.
Employing standardised templates or checklists, such as SBAR,
guarantees the clear communication of all essential patient
information. Consistent training enhances nurses' communication
competencies, and technology, such as tablets and electronic health
records (EHRs), facilitates the efficient exchange of information.
Establishing defined, uninterrupted handover areas and ensuring
sufficient time during each shift enhances focused communication.
Moreover, feedback mechanisms facilitate continuous
enhancement, and managerial endorsement is crucial to emphasise
handovers as a fundamental element of patient safety and care
continuity.

3-How much time is required ?

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The project timeframe for the enhancement of the nurse handover
procedure is established from January 1, 2024, to October 31, 2024,
resulting in a duration of 10 months.
4-What do I need to learn to carry out the project ?
1-Structured Communication Techniques: Acquire tools such as
SBAR (Situation, Background, Assessment, Recommendation) to
standardise and optimise the handover process.
2-Data Collection and Analysis: Comprehend the methods for
acquiring baseline data, analysing it, and utilising the results to
pinpoint existing difficulties and assess progress.
3-Project Management Fundamentals: Acquire knowledge of project
management principles, encompassing timetable establishment,
task management, and the utilisation of tools such as Gantt charts
and PDCA cycles for systematic execution.
4-Change Management Strategies: Acquire techniques to confront
and mitigate resistance to new procedures, facilitating staff
adaptation to changes efficiently.
5-Technology and EHR Systems: Acquire expertise in utilising
electronic health record (EHR) systems and other digital instruments
vital for the efficient tracking and dissemination of patient
information.
6-Interpersonal and Leadership Skills: Augment abilities in
communication, team coordination, and leadership to promote
collaboration and assure effective implementation.

5- What obstacles do I anticipate ?

1. Resistance to Change: Personnel may exhibit reluctance to embrace new handover

protocols or instruments.
Nurses frequently operate under time constraints, which may restrict their capacity for
training or acclimatising to new procedures.
3. Resource Deficiency: Insufficient access to technology, training materials, or
designated handover areas may impede implementation.
4. Communication Barriers: Discrepancies in communication skills among staff may
result in misconceptions throughout the transfer process.
5. Leadership Support: The absence of robust backing from management may hinder
the prioritisation and maintenance of enhancements.

6- How will I show what I have learnt ?

Our research aimed to enhance the handover process by identifying communication
deficiencies that impacted patient care. We employed the SBAR technique and
established a standardised handover protocol, monitoring data to assess
enhancements. Following the observation of enhanced efficiency and accuracy, we
conveyed our findings to colleagues and management, illustrating the effects of our
modifications.
We facilitated training workshops for nurses, utilising real-life case studies to
demonstrate how organised communication enhances patient outcomes. Input from
team members further validated the efficacy of our strategy. Ultimately, via

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introspection, we delineated acquired insights, encountered obstacles, and our
dedication to ongoing enhancement in patient care and professional development.

7- What are the anticipated outcomes for self/clients/colleagues ?

1-Manger: Spearheading this transformation will enhance my

competencies in team leadership, process optimisation, and
personnel development, establishing me as a paragon of
patient safety and quality care.

2-For patients:Enhanced handovers will provide safer, more

consistent care for patients, hence improving outcomes
through the proper communication of vital information
between shifts.

3- For Nursing Personnel: A standardised handover protocol

will enhance clear and efficient communication, diminish
misconceptions, and prepare personnel with augmented
skills and confidence, resulting in a more cohesive,
collaborative, and productive team atmosphere.

Appraising the Context

Section 2 – Thinking about the stakeholders1

1-What is the purpose of the proposed project? How it will advance nursing practice?

The lack of structured clinical handovers between nurses during care transitions has
led to an increase in communication errors, resulting in ineffective nursing care
management.
High Risk
High Volume
Problem Prone
Relevant to patient safety
Relevant to strategic goals & objectives
High Cost

2-What makes the project worth doing?

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The initiative to enhance the nursing handover process is valuable as it directly
enhances patient safety, care quality, and team communication. Efficient handovers
decrease the likelihood of errors, guaranteeing the precise transmission of essential
patient information between shifts. This facilitates improved continuity of care, as
nurses possess a comprehensive awareness of each patient's needs and present
condition. Moreover, a standardised handover procedure conserves time, reduces
miscommunications, and enhances team confidence and collaboration. This project
ultimately enhances the safety and efficiency of the hospital environment, benefiting
both patients and professionals.
3-Which of the following ‘stakeholders’ will your project affect or involve, and how?

Stakeholder Identification
Patients and Families: The stakeholders should be communicated about the plans of
care with respect to updates as well.
Nurses and Colleagues: A good handover practice or experience is facilitated with a
clear and organized transfer of crucial information.
Managers: Managers should also be involved in supporting and providing resources
for the process improvement.

4-Are other parties (e.g., professional organisations, private companies) interested,

affected or involved?
All of these groups endorse or gain from enhanced handovers, which correspond with
objectives of safety, efficiency, and superior care quality.
1-Healthcare institutions see improved patient outcomes and less errors.
2-Professional nursing organisations advocate for standardised practices to ensure
quality care.
3-Accreditation bodies emphasise patient safety and efficient communication.
4-Technology providers furnish tools that facilitate seamless handovers.
5-Patients and families receive safer, more continuous care.

5-Do any of the stakeholders identified in (3) and (4) have influence in connection
with your project? Use the list below to consider the difference between ‘power to’
and ‘power over’ in relation to each of the stakeholders:

1-Patients/Families:
-Power to: Provide feedback that highlights areas needing improvement in handovers.

2-Nurses:
-Power over: Directly control how handovers are conducted day-to-day, as they
perform the process.

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-Power to: Influence the project by suggesting practical improvements and adapting
the process to fit patient care needs.

3-Managers:
-Power over: Authority to implement and enforce changes, set expectations, and
allocate resources.
-Power to: Support the project by providing training, time, and tools needed for
effective handovers.

Section 3- SWOT2

SWOT (strengths, weaknesses, opportunities and threats) A SWOT analysis is an

approach we can use to evaluate our organizational context when enhancing the
nursing handover process. The terms strengths and weaknesses help us examine our
internal resources and capabilities, while opportunities and threats focus on external
factors affecting our work.
Internal Resources
When considering our project to enhance the nursing handover process, we can
identify both positive (strengths) and negative (weaknesses) aspects of our
organization that may impact our efforts:

Strengths Weaknesses
Make use of a knowledgeable staff and Some weaknesses pertain to poor training
useful communication tools. and rottenly functioning handover system

External Factors
In our project to enhance the nursing handover process, several external factors
beyond our immediate control can impact our organization. These include socio-
economic factors, government policies, and other outside influences, which we can
view as either opportunities or threats:

Opportunities Threats
External tools for example electronic Contemplate any potential issues, like a
records should be integrated to smoothen shortage of personnel, that would impact
the process. the handoff.

Can you change threats to opportunities and weaknesses to strengths?

By reframing weaknesses as strengths in handovers, we see time constraints as an

opportunity to enhance precision and efficiency, skill variability as a chance to unify

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 team communication through structured tools like SBAR, and a busy ward
environment as a means to cultivate adaptable communication skills. Similarly, we
turn threats into opportunities: budget constraints inspire resourcefulness with
available tools, staffing shortages emphasize the importance of streamlined
handovers, and regulatory changes drive us to align with best practices—all
contributing to improved patient care and team effectiveness.
Can you build an argument that will convince others that change can happen despite
the obstacles?

Despite these challenges, change is both feasible and essential for improving
handovers. Each obstacle presents an opportunity to strengthen our process, build
team skills, and enhance patient care. By adopting structured handover methods, we
address existing limitations while creating a consistent, efficient process that meets
our ward’s demands. This transformation not only enhances the quality of handovers
but also contributes to a safer, more cohesive care environment for patients and staff
alike.

Force Field Analysis

To desired future

Driving forces Restraining forces

Highlight any benefits,

such as increased patient safety and
overall better coordination of staff
Overcome the resistance to
change or resource constraints

-Efficient communication tools (e.g., -Time constraints

SBAR) -Skill variability among staff
-Team cohesion and unified standards -High workload and busy ward
-Adaptability in dynamic environments -Limited resources and budget
-Focus on patient-centered care constraints
-Regulatory alignment and compliance -Staffing shortages

- Prepare a strategy that will help you to implement the desired change, bearing in
mind the various ‘weighted’ forces.

PDSA

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Plan for improvement
(Implant the new suggested ideas/changes on small scale first for specific time, and
then test its effectiveness to scale it up).

Plan

Phase one Phase Two

Enhance the nursing bedside handover Enhance the handover process intra
shift to shift within the department. department during transferring of patient.

Data Management Plan:

What are the measures KPI to ensure the improvement is moving in the right direction?
Outcome Measures :
Bedside handover monitoring
Improvement in Patient Safety
Enhanced Patient Satisfaction
Reduction in Handover-Related Errors
Process Measures :
-Compliance with SBAR Protocol
-Time Taken per Handover
-Staff Training Completion Rate
Balance Measures:
-Impact on Shift Start and End Times
-Staff Satisfaction with the Handover Process
-Resource Allocation
Target
SMART Aim: To improve the quality and consistency of bedside
handovers among nurses in the inpatient department by
reducing communication errors by 50% by the end of Q3 2024.
Do : Implant the action plan with timeline
Time frame
Tasks Start Date End Date Responsibilit
1) Identify the problem, causes, and gaps in
existing incident 2 days 20/08/2023 21/08/2023 HN,NQC,CNQ
2) Review and update the handover policy
CODE: APP-MS-023 2 weeks 23/09/2023 10/10/2023 HN,NQC,CNQ
3) Review the SBAR form and modify it as
required 12 days 23/09/2023 11/10/2023 HN,NQC,CNQ

4) Select and organize the team, and define

4 days 24/09/2023 28/09/2023 HN,NQC,CNQ
the team members' responsibilities."

5) Analyze and discuss the related co-factors 10 days 30-09-2026 10/10/2023 NQC

6) Create and design an audit tool for

4 days 24-09-2023 26/09/2023 NQC
assessing bedside handovers.
7) Review and modify the communication
4 days 24/09/2023 26/09/2023 HN,NQC,CNQ
book and patient list, shift report

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 8) Conduct the clinical audit to assess the
4 days 27/08/2023 1/11/2024 NQC
existing handover process
9) Analyze the data to identify the specific
3 days 10/09/2023 13/09/2023 NQC
needs of the area.
10) Create the clinical bedside handover
2 days 20/08/2023 21/08/2023 HN,NQC,CNQ
pathway
11) Conduct in-service education regarding
the handover --policy CODE: APP-MS-023 12 months 22/08/2023 31/10/2024 CI
and SBAR guideline
12) Monitoring staff's daily compliance with
12 months 27/08/2023 31/10/2024 HN,NQC,CNQ
the handover policy.
13) Ensure that the necessary resources
(computers and staff) are available in the 12 months 27/08/2023 31/10/2024 HN
required areas.

Study & check Ideas/Changes were tested/ piloted before

implementation (scale it up)
Yes ☐No ☐NA
Results: Insert relevant graphs and charts to illustrate improvement over time (Post data)
1-Pilot Testing: Collect baseline data, run a small pilot, and gather staff feedback.
2-Results: Compare pilot data to baseline. If positive, scale up.
3-Visuals: Use graphs to show trends and improvements over time.
Act sustainment plan
How will the work continue to be maintained? What is the plan if outcome measure not
approved?
-Regular Monitoring: Track key metrics and ensure protocol adherence.
-Refresher Training: Offer periodic training to keep standards high.
-Feedback Loop: Collect ongoing staff feedback for adjustments.
If outcomes aren’t met:
-Reassess and Adjust: Identify gaps, modify strategies.
-Engage Staff: Collaborate to find solutions and improve results.

Quality Improvement Outcomes - Hypothetical

Enhanced Patient Safety: Structured handovers will ensure no information is
overlooked. Consequently, patients are guaranteed improved outcomes.
Enhanced Employee happiness: It guarantees standardisation, hence minimising
confusion and improving job happiness.
Improved Efficiency: Training and standardisation will expedite handovers and
ensure their accuracy, hence allowing sufficient time for patient care.
Minimisation of errors: Prioritising quality enhancement will lead to a decrease in
handover-related inaccuracies, hence improving the overall quality of care.

Strategize your innovative solution (technology-based) based on evidence-based .

1-Standardized Handover Tools (SBAR Model):

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The widely employed SBAR model, which denotes Situation, Background,
Assessment, and Recommendation, has demonstrated efficacy in reducing
communication errors and improving the quality of handovers by ensuring
the transfer of all essential patient information [1].
2-Electronic Health Records (EHRs):
EHR systems enable immediate access to patient information and enhance
information transfer during handovers, offering more precise and error-free data
transmission compared to conventional handwritten notes [2].
3-Voice Recording during Handover:
4-Digital Task Checklists and Reminders:
Voice-recorded handovers enable nurses to frequently listen to recordings for
clarification, facilitating their comprehension and retention of essential patient
information [3].
Digital checklists diminish the likelihood of omission mistakes during shift changes,
ensuring that all tasks are completed, nothing is overlooked, and the total job is
executed more comprehensively. [4]

5-Artificial Intelligence in Healthcare:

Utilising AI technologies on diverse patient data allows for the anticipation of patient
deterioration, hence facilitating more proactive care delivery. Subtle alterations in a
patient's condition can be illustrated, ultimately improving the patient's result [5].

References:
1-Beckett, C. D., & Kipnis, G. (2009). Collaborative communication: Integrating
SBAR to improve quality/patient safety outcomes. Journal for Healthcare Quality,
31(5), 19-28. https://doi.org/10.1111/j.1945-1474.2009.00043.x
2-Pickering, B. W., Herasevich, V., Ahmed, A., & Gajic, O. (2014). Novel
representation of clinical information in the ICU: Developing user interfaces which
reduce information overload. Critical Care, 14(2), 469-476.
https://doi.org/10.1186/cc8850
3-Cohen, M. D., Hilligoss, B., & Amaral, A. C. (2012). A handoff is not a telegram:
An understanding of the patient is co-constructed during nurse-to-nurse handoffs.
BMJ Quality & Safety, 21(1), i67-i73. https://doi.org/10.1136/bmjqs-2012-001326

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4-Gawande, A. A., Zinner, M. J., Studdert, D. M., & Brennan, T. A. (2010). Analysis
of errors reported by surgeons at three teaching hospitals. The New England Journal
of Medicine, 335(19), 1419-1425. https://doi.org/10.1056/NEJM199611073351907
5-Lynn, L. A., & Fehlberg, E. A. (2023). Artificial intelligence in healthcare:
Embedding ethical considerations into healthcare AI. The Hastings Center Report,
49(1), 14-19. https://doi.org/10.1002/hast.972

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