Running head: QUALITY IMPROVEMENT

Zachariah E. Bingham

Quality Improvement

Professional Role Development: Servant Leadership

NUR 4144

October 17, 2017

Dr. Ellcessor

I pledge Honor Code

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Quality Improvement: Bedside Schmid Tool

Patient safety within health care systems combines a variety of approaches. Design,

tools, accessories and protocols are adopted by each health care system to ensure the safety of

each and every patient. Joint Commission, State, external and internal inspection teams routinely

inspect and review health system safety policy, measures and interventions. The safety of staff

and clients should reside atop every managers radar. Sentinel events, events causing death

injury or harm to a patient, are major safety issues plaguing health care. In many cases sentinel

events are due to falls. According to The Joint Commission falls with serious injury are

consistently among the Top 10 sentinel events reported to The Joint Commission Sentinel

Database (The Joint Commission, 2015).

The Progressive Care Unit (PCU) of Bon Secours has seen an increase in falls over the

last quarter. Bon Secours Richmond Health Systems Policy defines a falls using three terms:

Fall, Assisted Fall (staff member minimizes fall impact and helps patient to ground) and

suspected intentional fall (patient falls on purpose) (Bon Secours Health Systems Inc, 2017).

Each type of fall runs the risk of becoming a sentinel event. Due to the severity of falls and an

alarming increase in the amount of recent falls, the manager of PCU implemented a Bedside

Schmid Tool. Utilizing the four domains of leadership and the five practices of exemplary

leadership, this paper will address the implementation and outcomes of the Bedside Schmid

Tool.

In the book, Lead Like Jesus, written by Ken Blanchard and Phil Hodges, managers gain

insight into the four domains. The heart, head, hands, and habits are direct reflections of the

style of leadership one uses with Jesus as a role model (Blanchard, K. & Hodges, P. 2005). In

this domain the heart and head drive decisions. These internal factors are influenced by a
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persons desire for change, prior experiences, learned knowledge and inspirations. The hands

and habits represent external factors. These factors are what allow managers to set and achieve

goals, measure the need for change and direct or support their motivation for the change.

Combining the domains create a better leadership approach. Used appropriately, together the

four domains reflect integrity and openness. This allows employees and others to better

understand what drives a managers desire for change, as well as grant insight into why the

change is being driven.

Lead like Jesus

Prior to instituting a change the manager must accept and understand how the change is

received personally and by the unit. In Lead Like Jesus, we are told internal domains, the heart

and head, are domains which reflect the individual. These are the domains that drive a person.

Internal domains are the reason why managers want to better the care of their patients and staff,

driving their desire to care. Combined with external domains, the hands and habits, managers

can motivate others to follow.

Implementation of the bedside Schmid tool can be linked to the heart domain through the

managers responsibility to his or her patients and staff. The manager is responsible for taking

care of the patients on the unit in their times of need. Equally important is the managers duty to

keep staff safe. Establishing an assessment tool used to reduce falls, the manager is calls on the

head domain. Instituting this new tool into practice has involved much thought and planning.

The manager must understand how to motivate his or her staff to accept the tool into their

respected practices. Use of the bedside Schmid should be described as a tool used to benefit the

units patients as well as the staff.

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Motivated by internal domains the managers roll out of the new tool is accepted by all.

Dedication to patient safety and the benefits of the new tool is reflected in the managers hands.

Combined with evidence of how the Schmid can reduce falls, the manager now has concrete data

he or she can used to back their internal desire for implementation. As the staff begins to use the

tool, it is important that they are reminded of the tools benefits. Relying on the habits of a

servant leader the manager must study and improve applications as needed. The manager then

has the responsibility of reviewing data with the staff. This open communication allows for

supportive input from staff and can be used to improve the tool moving forward.

Exemplary Leadership

Acting as a servant leader the manager can use the five exemplars of servant leadership to

guide and motivate implementation of the bedside Schmid tool onto the unit. Found in the

power points covered in Dr. Barbra Ellcessors class Professional Role Development: Servant

Leadership, the exemplars are model the way, inspire a shared vision, challenge the process,

enable others to act, and encourage the heart (Ellcessor, PPT, 2017). Acting within the heart

domain, the manager is able to model the way by educating the unit why this tool is an important

asset for individual and unit practice. The manager explains the impact falls have on the patient,

unit, health system and health care as a whole. To inspire a shared vision the manager may

remind the staff of their responsibilities to cause no harm and how the bed side tool solidifies this

commitment. Allowing the unit to own and accept their responsibilities for increased safety will

allow staff to reflect on their practice and share the vision of reducing falls. Implementation of

the new bedside Schmid tool challenges the process. Falls are occurring and causing harm to our

patients. Motivated by the Bon Secours Health System Value of innovation, the manager can

empower staff and patients to seek solutions to falls. In this case the Schmid tool has moved
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from connect care to the wall of the patients room. In some cases there may be staff following

different process on other units or specialties. In these cases, the manager must enable others to

act. Fostering collaboration through specialties will only improve patient safety. In the case of

the bedside Schmid tool, other specialties can now see patient mobility in the room. The teams

no longer need to call or seek nurses to ask mobility questions. Furthermore, some specialties

may be able to instantly update the patients bedside Schmid tool, allowing the patient more

movement privileges, reflecting the Bon Secours value of quality care. Finally, the manager

must continue to motivate his staff, or encourage the heart. Show support when and if fall

numbers are reduced. Allow for continuous improvement and input from staff across the health

system. Set the expectation for the unit and update the unit frequently. By seeing the results of

their work the unit will feel more inspired to improve each and every day.

Professional Practice Implications

Adjustment to this new policy may take time. As a professional leader it is important to

motivate change, allowing the staff to invite the change as a positive. In some cases added steps

may seem burdensome on the nurses already lengthy assessment. In this case the manager of

PCU has taken the time to teach the staff the proper use of bedside Schmid tool and how it aids

in reducing falls. With proper use, the manager showed how the bedside Schmid tool allowed

the nurse to quickly determine patient fall risk.

Finally the nurse manager was able to link the new Schmid tool with patient education.

By taking charge of their care nurses were reminded to educate the patient about their new

environment, available resources to request assistance and the importance of using safety

equipment when ambulating. Regardless of how a patient ambulated at home or outside of the

hospital, the Schmid tool should be used during daily assessments. Previously independent
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patients should be reminded why their fall risk may be increased while in the hospital. Nurses

should educate the patient on how new environments; medicines or recent procedures may

impact their gait and movement. Educating the nurses on the benefits and positives behind the

new practice allows for minimal resistance and increased individual implantation of the new tool

into each nurses respected practice.

Outcomes Evaluation

Implementation of the new bedside Schmid tool is expected to reduce the amount of falls

occurring on the unit. When combined with Bon Secours Dionnes Egress Test, an assessment

tool used to document patients up ad lib privileges, the tool should enhance patient mobility

safety. Furthermore the bedside tool alerts other staff members to the patients fall risk. Found

easily at the bed side, the Schmid will tool will reduce falls due to staff transporting patients

unknowingly, as well as reducing the time it takes to find a nurse to ask about a patients gait or

fall risk.

Understandably the new assessment tool will take time to show its full impact. By

monitoring the units Hospital Consumer Assessment of Healthcare Providers and Systems

(HCAHPS) scores and falls documented the manager should begin to see trends. Information

gathered from these trends will show if the new tool has reduced falls. Units can then measure

their fall numbers against those of other units. If the data shows a decreased amount of falls the

manager may suggest other units adopt the bedside Schmid tool, which will provide further

evidence supporting implementation of the Bedside Schmid Tool.

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References

Bon Secours Health Systems Inc. (2017). Adult fall prevention. HSO

Policy / Procedure

http://spweb/localsystems/virginia/locations/maryimmaculate/policiesandprocedures/Provision%

20of%20Care/Falls%20Prevention%20Policy%20BSHSI%20w%20MIH%20Addendum.

pdf

Blanchard, K. & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.

Ellcessor, B. (2017). Five Practices of Exemplary Leadership [PPT].

The Joint Commission. (2015). Sentinel Event Alert 55: Preventing falls and fall-related injuries

in health care facilities. http://www.jointcommission.org/sea_issue_55/