By Elaine Sanchez, Brooke Army Medical Center Public AffairsJuly 6, 2015
JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas (July 6, 2015) -- Brooke Army Medical Center's, or BAMC's, nurse leaders are trading their uniforms for scrubs each month to join their staff on the hospital frontlines.
The program is known here as "Suits to Scrubs;" however, many are dubbing it BAMC's version of "Undercover Boss," a TV show that features senior executives going undercover in their own companies to identify areas for improvement.
In this case, there's no disguise, but the goal is the same: pinpoint challenges and help find solutions, said Army Col. Richard Evans, BAMC's deputy commander for nursing. Once a month, leaders step away from their desk and onto the inpatient floor unannounced, taking on everything from patient bathing to patient transfers during a labor intensive 10- to 12-hour shift.
Evans implemented the program in March to get a better "pulse check" on the organization. "We wanted to see what we could learn by walking in the staffs' shoes," he said, noting he drew ideas from the February 2015 edition of Nurse Leader.
"At an executive level, we approve policy and implement technology," he said. "But we often don't have an appreciation for what those decisions do to work processes and work flow on the frontlines."
On the second "Suits to Scrubs" shift in April, Evans, other BAMC nurse leaders and special guest Maj. Gen. Jimmie O. Keenan, deputy commanding general (operations), Army Medical Command, and chief, Army Nurse Corps, reported for duty at 6 a.m.
Keenan, a 29-year Army nurse, recalled when she first arrived at inpatient ward 2 East for her shift. When Evans announced the general would be working a shift, the staff was surprised at first, but Keenan was quick to clarify her purpose.
"I'm not here as a 'gotcha!' I'm here to work as a nurse," she told them. "I'm here to learn your challenges and what we can do to improve the work experience for you and the patient experience."
During their morning huddle, Keenan encouraged nurses to ask every patient a question: "What is the most important thing I can do for you today?"
This simple question can go a long way toward patient satisfaction, she explained. Healthcare providers' goals are centered on medical care - prepping for a test, administering medications, gathering readings - but the patient's goals are often much different. "If we don't know what's important to our patients, our goals will be off from the start," Keenan explained.
Keenan asked one of her patients, who had been admitted a week prior, what she could do for her, and the patient responded she wanted nothing more than a shower that day. After care team coordination, Keenan and a nurse student donned gowns over their scrubs and helped the patient take a shower.
"I washed her hair; helped wash her back. It made a world of difference," the Army's top nurse said.
Research indicates if caregivers establish a personal connection with patients, rather than identify them as a bed number or a diagnosis, it can improve patient experience and reduce preventable patient harm, Keenan said.
"Evidence shows if you know your patient and see your patient as a person - Sgt. Maj. Retired Smith or Mrs. Jones - as someone's mother, sister, father or brother or they like to be addressed with their rank … just having a sense of who they are can help reduce preventable harm," Keenan explained.
Increasing care provider-patient interactions is one of the key reasons BAMC implemented "Suits to Scrubs," Evans said. "One of our goals is to cut back on challenges drawing providers away from the bedside and from that more personal care," he said, citing an issue he recently observed on a shift.
On one inpatient ward, the culprit was a malfunctioning lock on a linen room door, which caused staff to seek bed linens in a closet down the hall. But this closet was only stocked for a portion of the ward and the supply was quickly exhausted. At this point, staff would walk three floors down to hunt for linens. "Every sheet, every towel, was 20 minutes away from direct patient care," Evans said.
After each shift, Evans gathers his staff to discuss these types of challenges and possible solutions. "Through this program, we can help mitigate systems issues, interact more with patients and staff, role model expected behavior and, hopefully, solve problems on the spot," he said.
Evans has conducted four "Suits to Scrubs" shifts so far and has plans to expand the program to twice a month, including weekend, overnight and holiday shifts to ensure the most comprehensive picture of challenges.
Evans said the experience is well worth the investment in time.
"It is fun to connect with patients and assist in meeting some of their needs," he said. "By taking a few minutes to get to know our patients, we can learn incredible things about generations of service people and the sacrifices they and their family members have made."
Keenan said her "Suits to Scrubs" experience reiterated what she already knew: BAMC has a "phenomenal staff."
"We ask our people to do a lot each day and sometimes we don't stop as leaders to say thank you to everyone," she said. "But as we are on our journey to becoming a high-reliability organization, it's vital we value everyone on the team; it takes the entire team to take care of patients.
"At the end of the day, our patients are at the center of everything we do," she said. "I truly believe I have the best job in the Army because I get to take care of America's sons and daughters every day."