New London — On Unit 5.2 at Lawrence + Memorial Hospital, one of the five patients that registered nurse Sarah Prpich would care for on Tuesday had been alert and aware of her surroundings as she received oxygen therapy, but communicating with her was difficult.

“She’s oriented, but very hard of hearing,” Prpich told Nicolito Alex Vicente, a patient care assistant, as he took notes on that patient and the four others in the nurse’s care.

The face-to-face meeting between the two took place in the hallway of the unit where patients with respiratory and kidney ailments are cared for, just after Prpich began her shift and had met with the outgoing nurse, and Vicente had begun his.

It wouldn’t have happened just eight months earlier, before a new initiative to improve patient care and employee job satisfaction came to L+M. Called the Relationship-Based Care program, it was brought to the hospital by a Minneapolis-based health care consulting firm as a way to focus employees on how they can better serve patients and reconnect them with a sense of purpose about their work, said Karen Stone, director of patient care services at L+M.

“The focus is to treat each patient as an individual, and to recognize that the care we give each other impacts our care,” Stone said. “It’s re-ignited us to think about why we work in health care.”

Since its creation in 2003, the program has been implemented at more than 400 hospitals, nursing homes and other health care organizations nationally and abroad, from academic medical centers to small community institutions, said Catherine Perrizo, contracting officer for Creative Health Care Management.

The for-profit company provides written guides, consultants and individualized plans to clients on how to incorporate Relationship-Based Care principles in their workplaces, said Susan Wessel, consultant for the company. The core ideas of the program, she said, are to foster a hospital culture of collaboration and self-care hospitalwide, from front-line patient-care staff to administrators, that serves the “ultimate goal” — compassionate care for patients and families.

“While the values we teach do seem basic and ordinary,” she said, “the challenge for all hospitals is to translate them into day-to-day behaviors.”

Stone said one of the reasons the hospital decided to hire Creative Health Care Management to provide the program in the summer of 2015 came out of a period of soul-searching following the divisive strike and lockout in late 2013. Hospital administrators were seeking ways to repair the organization and bring about overall improvements.

“We realized we had relationships that needed to heal on both sides, the leadership and the staff,” she said. “We knew we needed to find a way to come together for the community.”

After learning about Relationship-Based Care at a leadership retreat, Stone said, L+M decided to hire the company to help make the program a reality. Since then, 12 hospital departments have formed “practice councils.” These are committees of staff at all levels who determine the kinds of changes that will make their units better for patients while building a sense of community among staff.

Eventually all departments, from hospital units doing direct patient care, to doctors, administrators and security and maintenance staff, will adopt Relationship-Based Care principles. With about 2,500 full-time employees, L+M is one of the city's largest employers. All staff at The Westerly Hospital also will go through the program.  

L+M officials declined to disclose the cost of hiring Creative Health Care Management for the program.

“We’re doing this to enhance our care, but also to transform our culture,” Stone said.

As part of the program, each hospital unit makes a presentation to colleagues in the rest of the hospital about how it is making Relationship-Based Care work in their area.

In the Labor and Delivery Department, for example, the practice council of 15 nurses, two unit coordinators and two surgical technologists enacted a series of big and small steps to “make our action plan come to life,” registered nurse Tiffany Skinner told a roomful of colleagues during a presentation in the hospital’s Baker Auditorium last week.

Some of the changes embodied abstract ideas — like deciding to represent the department as a tree under the theme of “Helping Families Grow One Leaf at a Time,” and having staff commit to each other in writing — while others were visible improvements. These included updated décor in patient rooms, a more comfortable break room for staff, better work spaces at nursing stations, new whiteboards in patient rooms to improve communications and the creation of a maternity department newsletter, among other actions.

“We’ve also re-allocated our patient assignments, to support better continuity of care from surgery to recovery,” Skinner said. With the new assignments, nurses and aides stay with the same patients throughout their stay.

During the presentation by the Food and Nutrition Services Department, members of the eight-member council took turns describing the steps they took: actions to improve communication and training for staff to reduce delays of meal deliveries to patients, and requesting new signs for patient rooms to better explain how to order meals, among others.

In Unit 5.2, nurse-manager Kelly Brennan said the impact of the Relationship-Based Care program first began being seen last January, and more changes have come since.

One of the most positive aspects, she said, is the “shared governance model” it promotes, empowering front-line staff to help reform their workplace for the better. The unit is now organized into three “pods” of 10 patients each, with two nurses and one patient care assistant assigned to each. Previously, nurses and assistants had more fluid patient assignments. At each shift change, the assistant meets one-on-one with each of the two nurses he’s assigned to for a report on the patients.

“It’s good for consistency,” Brennan said. “It’s better flow of communications, which makes a difference for the patients.”

After her hallway meeting with Vicente on Tuesday, Prpich said the new system works better than just leaving written instructions for the staff to find at the shift change. She also likes knowing that a specific assistant is assigned to work with her for each shift.

“If he has any questions, he can ask me right away,” she said, referring to Vicente. “And it’s better working with the assistants, because I know (he) is working with me for the whole night.”

Registered Nurse Chris Comfort was chosen by his peers to head the unit’s Relationship-Based Care council. It has resulted in volunteer projects to help the needy outside of work as a way of building a sense of community among the staff, and some tangible changes in the unit — new “comment boxes” for patients and families to submit praise and complaints in “real time,” staff surveys to solicit ideas for improvements and a bulletin board of “Wow Cards,” where staff members compliment one another for their work.

While the basic ideas are simple, he said, having the program provides a framework so staff make a conscious effort to carry them out.

“We get so wound up in the crazy chaos of work sometimes that you forget to take care of yourself and, most of all, the patients,” he said. “Our relationships with our co-workers have definitely improved, because we’re coming together as a team.”

Mike O'Farrell, L+M spokesman, said the effectiveness of the program already is being seen in improved monthly patient satisfaction survey scores from departments that have implemented it. Within the hospital, staff will continue to be reminded about the program in posters and in-house communications. 

"We'll keep it front and center," he said.

Stone said the goal is to make Relationship-Based Care a permanent part of L+M. The councils, she said, will continue to meet regularly to find and carry out new ways to improve.

“It’s an ongoing program,” she said. “It’s something we've become. It’s something we will do forever.”

j.benson@theday.com