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Team-Based Care Design

Tools and resources leaders can use to help support the review, design or redesign of team-based care models.

Practice Environment

A Practice Environment (PE) Assessment defines the context in which care is provided. Understanding this context is essential to helping reduce the risk of wasting resources (for example, health human resources [HHR], materials) and effort (for example, misalignment of process/practices/provider requirements with care context and required patient/provider outcomes).

The Practice Environment can include both internal (for example, practice setting size, layout, service mandate, occupancy rates, etc.) and external factors (for example, provider regulatory requirements) that can have both a positive and/or a negative impact on the care team’s ability to optimize their role and provide safe, competent person-centred care.

 

Required Practice Environment (PE) Information

The data points for assessing the PE are multifaceted and can vary from one practice setting to another.

The information under the Structure, Process, and Practice tabs is generalizable to many practice settings. It highlights minimum considerations from a structure, process, and practice perspective. 

Schedule
  • Confirm the schedule type (set rotation/self-schedule). This results in efficient and effective use of available staff resources. 
  • Ensure an appropriate skill mix, competency, and minimum required NHPPD (See NHPPD Calculator below).
  • Monitor how often the baseline planned staffing mix is met (e.g., RN and LPN mix) and the complement (number of staff).
  • Confirm the scheduling practices support an adequate balance of staff experience and competency mix. 
  • Ensure adequate access to the required IP team (Pharm, Respiratory Therapist, PT etc.).
  • Ensure adequate access to support roles (UA/UC/CTA/HSA, Housekeeping, Porter Services).
Resources/Equipment
  • Assess the availability of additional resources for the unit team (Physician, NP, Lab Phlebotomist, EKG tech).
  • Assess access to a rapid-response team.
  • Ensure staff have access to adequate amounts of required equipment such as:
    • BP cuffs
    • Stethoscopes
    • POCT devices
    • Patient safety equipment (e.g., lifts)
Clinical Leadership (CL)
  • Ensure purposeful daily rounding by the HS Manager to assess safe, competent care provision.
  • Assess appropriate critical thinking strategies of the CN/TL.
  • Provide purposeful daily connection with novice nurses to assess their progression with their transition to practice (TTP) plan.
  • Be readily accessible to support staff during escalating/critical situations (patients/family/staff)
  • Clearly define the expectations for the role of Charge Nurse/Team Lead:
    • Ensuring patient assignment meets the nurse’s skill and competency level
    • Facilitating patient care rounds
    • Ensuring standard operating processes are working well
    • Regular checking in with novice/new staff to support their TTP
    • Facilitating staff break times
  • Assess hours of coverage for Clinical Leadership roles to ensure adequate accessibility of CL support.
Clinical Safety
  • 4P rounding, safety huddles, bullet rounds 
  • Documentation practices
  • TOA /shift report
  • Care Planning
Operational Effectiveness
  • Regular review of Key Performance Indicators (KPI) – Patient Safety Reports
  • MEWS review
  • HR activity (retention, staff turnover) 
  • Patient attendant/sitter usage (utilization of Patient Attendant Tool Kit)
  • Travel nurse/agency utilization
  • Clinical Capacity Report review
  • C3 data review
Practice Development
  • Ensure competency development opportunities are available for unit staff:
    • Preceptor workshops
    • CN workshops
    • LMS training
    • Care of older adult workshops/training
    • NVCI
    • Trauma-informed care workshops
  • Ensure onboarding/preceptorship/mentoring practices are in place and working well to consolidate the execution of providing the fundamentals of care:
    • Pain management 
    • Toileting regimes
    • Movement/mobility
    • Nutrition 
    • Compassion/therapeutic communication
  • Ensure appropriate use and availability of practice support roles:
    • Clinical Practice Leader
    • Unit Resource Nurse
    • Clinical Nurse Educator
  • Plan for adequate numbers of nurses with beyond-entry-level competencies, to ensure safe patient care delivery:
    • Certifications
    • Post-grad courses, e.g., CCNP, IMCU, ENP, PONP
  • Establish a unit-based/service-based practice council to:
    • Progress evidence-based practice at the point of care
    • Review standards of care
    • Consult on unit issues that impact patient care

Practice Environment Tools and Resources

Team Communication and Care Processes

Bullet Rounds:

SAFER-f Patient Flow Medicine Bundle 

Elder Care

P Rounding/Purposeful Rounding

Safety Huddles

Practice Environment Assessment Tool

You can use the PE Assessment Tool (linked below) to gather staff feedback about the current practice environment. The tool can be modified as required (for example, a leader could modify it for pre/post evaluation of design/redesign of a team-based model).