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Leadership QI Project

Crystal Owens

Bon Secours College of Nursing

Servant Leadership

Barbara Ellcessor, DNP, RN, RNC-OB

February 23, 2018

I pledge
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Leadership Project

Preventing patient falls in the hospital setting has been a goal for many hospitals across

the nation and the med surge oncology unit I am doing immersion on, also has this goal.

Medicare and Medicaid do not reimburse hospitals for the cost of care related to injuries

sustained in the hospital. The average cost for a fall is over $30,000 according to the CDC

("Costs of Falls Among Older Adults | Home and Recreational Safety | CDC Injury Center,"

2016). After beginning my immersion, a patient managed to flip himself out of his bed during the

night and unfortunately it was a patient walking down the hall that saw him there and alerted me.

It was scary going into a room seeing a person laying facedown in the floor moaning and not

having any information about him. This unit is busy and in the last month already had two

documented falls. Many wonder why this is such a big problem, and one article states “The

challenge of fall prevention is increasing as the inpatient population ages. Both the overall risk of

falling and the likelihood of being injured from a fall increase as people age” (Butcher 2013).

This is a problem that needs more attention but it’s hard when there is not enough staff and the

patients need high levels of care.

Heart

A self-serving leader would first be concerned with the costs associated with caring for

those who experienced a fall while staying at the facility. They would also be worried about the

reputation of the hospital as being unsafe because of high fall numbers. A servant leader uses

their heart with pure motives to prevent fall injuries. They are concerned with patient and staff

safety as a priority. They realize the focus should be what’s best for the patient population they

are serving. A servant leader will encourage the hearts of those around them and clear the path

by being a good role model to them. Seeing someone selflessly serve in many cases is the best
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way to motivate others. When educating others on preventing falls by not just focusing on the

financial repercussions of a patient fall and the damage to the reputation you’re making it more

about the patient and what’s best for them. To effectively model the way as a leader you must

have a clear understanding of your own values. No one wants to follow someone who doesn’t

practice what they preach so it’s important that you that are standing up for something you truly

believe in implementing.

Head

The leaders’ beliefs and perspective have a big impact on how they influence those

around them. In the book Lead like Jesus it states: “To engage the hearts and minds of others,

you must be able to communicate these three things: 1. Your purpose, 2, Your vision of the

future, and 3. Your values” (Blanchard & Hodges, 2008, p. 85). Giving a clear definition of your

purpose is important so that everyone you are leading is on the same page. In this case

preventing harm to those you are helping by stopping falls is the goal. Sharing your vision of a

safe and fall free facility can give those around a clear picture of what is expected. Knowing the

values of the company gives employees a blueprint of what is expected so there is no question of

the standard of care they are expected to provide. This is the time you want to inspire others and

enlist others with similar values to get on board with the vision that they have for the long-term

goals of the unit. Therefore, it’s important to work for a company that shares the same values

that you do. You cannot expect to force your views and values on others, but you can try to

inspire them to be more self-motivated. Thinking of ways to increase the budget to hire more

nurses to reduce nurse patient ratios would be a great start to fixing this problem. Many nurses

feel they don’t have enough time to spend with their patients because they have too many to

check on.
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Hands

This is where the action of the servant leader comes into play. Now they must not only

make their goals and values known but they must evaluate the progress and performance of the

people they are leading and serving. In the case of reducing the risk of falls on the unit the

manager would look at the number of falls that occurred to see if the goal was met or at least see

a decline in the number over a period of time. It’s not just a periodic check in but requires “Day

to day coaching and observing their performance, praising progress, and redirecting efforts that

are off base” (Blanchard & Hodges, 2008 p.121). Watching to see what employees on the unit

doing and stepping in to help is part of challenging the process. Watching to see what is working

and what isn’t while looking for opportunities to prevent falls is the only way to figure out what

steps should be implemented. A good manager will talk to their employees to find out what

obstacles they are having in providing safe quality care. In the case of the unit I am doing

immersion on, most nurses are complaining of nurse patient ratios and acuity affecting the

amount of time and attention they can spend with each patient. By hiring more nurses and

reducing the nurse patient ratios nurses will have more time to round more frequently, be able to

respond more quickly to patients’ requests, and respond to bed alarms faster preventing falls

from patients who are attempting to get up and doing things for themselves.

Habits

Today it is very easy to become stressed out and frustrated especially if you are in a

leadership role. Making time in your daily routine to ground yourself and relax is important to

avoid burnout. Habits such as prayer, meditation, and yoga are great practices for reducing stress

and centering the mind. Being centered and calm helps you become a better leader who can

encourage the heart of others. A good servant leader will recognize and show appreciation to
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those around them who do a good job. Public recognition can reinforce good work performance

and encourages others to want to be successful as well. After an inpatient fall there should be a

huddle to discuss the event to try and figure out what went wrong, and how to prevent it from

happening again without placing blame.

Professional practice implications

Nurse patient ratios, staff retention, and recruiting more nurses I feel is key to keeping

patients safe. Having more staff allows nurses to have more time to do their job more effectively.

According to an article published last year; “Authoritative research supports the fact that

strengthening nurse staffing improves quality of care” (Kuwata, K. 2017). If you have too many

patients it makes it harder to implement hourly rounding and provide the good care that is

required to keep our patients safe. By having better ratios nurses will be more likely to stay on

the unit and will have better outcomes and reduce the risk of falls because they will have more

time to devote to the problem at hand. They will have more time to explain to patients the

dangers of getting up by themselves while they are taking certain medications that may cause

drowsiness or dizziness. Nurses do not often have time to discuss all the possible side effects of

each medication they patient may be taking.

Outcomes and Evaluation

Periodic evaluations will help to determine if the goal is being accomplished and to

understand which implanted strategy is working or not working. The outcome results should

speak for themselves by looking at the numbers to see if the fall rate has been reduced but the

numbers alone should not be the only thing considered in an evaluation. During these evaluations

the servant leader should talk to staff members about their perceived success in preventing falls

or problems that they feel are not allowing them to keep their patient safe. By allowing staff to
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express their successes and addressing their concerns they are more likely to feel valued. Happy

staff members that feel valued are more likely to stay on their unit helping with staff retention. I

believe that once staffing levels are improve, nurses will be better equipped to keep closer eyes

on their patients and be able to respond faster to situations where falls could occur.
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References

Blanchard, K. H., & Hodges, P. (2008). Lead like Jesus: Lessons for everyone from the

greatest leadership role model of all time. Nashville, TN: Thomas Nelson.

Butcher, L. (2013). The no-fall zone. Hospitals & Health Networks, 87(6), 26.

Costs of Falls Among Older Adults | Home and Recreational Safety | CDC Injury Center.

(2016, August 19). Retrieved from

https://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html

Kuwata, K. (2017). SPREAD TOO THIN: THE CASE FOR FEDERALLY

MANDATED MINIMUM NURSE-TO-PATIENT RATIOS IN HOSPITALS. Loyola Of Los

Angeles Law Review, 49(3), 635-659.