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Trauma-informed leaders recognize that people, including themselves, will struggle due to traumatic experiences and they respond with compassion and empathy. Join the authors as they share what they've learned from listening to the experiences of more than 100 healthcare leaders from the beginning months of the pandemic to our current state.

Two inspirational workshops were developed to engage the hearts and minds of health care organization leaders and staff members as a part of implementing Relationship-Based Care™. The workshops were designed to employ innovative teaching methods reflecting the adult learning principle that learning should be grounded in respect for the wisdom of the learner. Learners engaged in diverse exercises and reflective practices to apply and internalize the content. The curricula focused on relational competence rather than clinical or technical skills. Caring practices for self, for co-workers, and for patients and families were translated into behaviors. Participants learned practices to develop therapeutic and compassionate relationships with others. Organizational and departmental metrics demonstrated positive outcomes from the workshops including decreased staff turnover as measured by human resources and higher patient satisfaction scores on patient surveys.

Mary Koloroutis, CEO of Creative Health Care Management, talks with Lois Swope, whose daughter Karly lived with Rett Syndrome until her death in 2012 at age 27. They spoke about the inestimable gifts of Karly’s life and the four lessons for people in health care that Lois learned while overseeing Karly’s care.

In this article, Dr. Brian Wong describes a patient-accountable culture as built around the question, What matters most to patients? He asserts that it is up to each health care professional to take responsibility for his or her positive impact on the culture with every single interaction. Each interaction needs to support what matters most to patients and to the well-being of the team. As all health care professionals get better at showing up in a patient-accountable way, everything else gets better: patient safety, patient satisfaction, employee engagement, and even the bottom line. Not because of a series of initiatives but because we ask one question . . . "What matters most to you?"Keywords: coaching; health care team; patient-accountable culture; TRUSTEDMary Koloroutis: Brian, we appreciate your taking time to share your passion and your expertise with our readers.Brian Wong: I appreciate the opportunity to share.Koloroutis: In your book Heroes Need Not Apply, you describe how to create a patient-accountable culture. I loved reading what you wrote and that you linked accountability directly to the patient. How do you define a patient-accountable culture and how do you differentiate it from the broader concept of accountability within an organization?Wong: A patient-accountable culture is based on a pretty simple idea: what matters most to patients determines how we practice as leaders. Patient accountability is centered on the idea that we are here to provide what matters most to each and every patient and that if we appreciate that-if we buy that-then it's really important to know what it is that does matter most to patients.I contrast that with organizational accountability. What I observe in many organizations is that they are too busy with their tasks-doing things-to take the time to understand what matters most to patients.Koloroutis: Right now, there is a presumption that we already know what the patient wants and an expectation that patients conform to what is in store for them.Wong: Well put, Mary. Our actions say, "I already know what you want, and I am here to give it to you, so if you would just be quiet and let me do my job, then I can be accountable." Taken to an extreme, "You are accountable to me to let me do what I do."Koloroutis: That's where the concept of compliance comes in. "You are accountable to me-I know what is best for you."Wong: Going back to organizational accountability, part of the question that led me down this path is, to whom and for what, exactly, am I accountable? Who is the organization? Is it my boss? Is it the CEO? Is it the mission statement? Then, what is it they are asking me to do? If we exist to provide what matters, we need to know what that means and know what matters. Those answers are quite simple and straightforward if we give ourselves five minutes to figure them out.Koloroutis: When I became a licensed professional nurse, for me, the license meant that I am accountable to the people I serve: patients. Organizational cultures either supported that accountability or detracted from it. But my commitment through my licensure was not negotiable. I selected where I would work, based on whether I could serve what I committed to under my licensure. That gets diffused when people become employees; licensure becomes subsumed in employment. It should be compatible and coherent.Wong: There's a phrase that sums up that tension, that conflict: "No margin, no mission." As if margin is elevated to or even superior to the level of the mission. If I'm accountable to the organization, am I accountable to its margin and to protecting its assets, or to the mission? Many people in health care, not just physicians and nurses but the entire work force, are in personal turmoil over this. I have a personal mission: I went into health care to take care of people, and I want to uphold my oath-my license-and yet the organization expects me to place something else above that. …

Based on Kristen Swanson's theory of caring, Caring Assessment for the Care Giver has been traditionally used in preparation for Relationship-Based Care (RBC) implementation; however, its reliability and validity were not known. This article discusses the psychometric testing of the instrument. Caring is the essence of nursing practice, provides the practical dimension of professional nursing, and is an important predictor of satisfaction (Dingman, Williams, Fosbinder, & Warnick, 1999). Nurse theorists have recognized that caring is essential to an individual's overall sense of well-being, emotional safety, and satisfaction (Dingman et al., 1999; Koloroutis, 2004; Swanson, 1993; Watson, 2002). Human beings have a certain set of expectations and know when they feel cared for, which further promotes a sense of security (Duffy, 2003, 2005). When the individual's expectations match the behavior received, then satisfaction will occur (Dingman et al., 1999). Therefore, when the patient's, nurse's, and physician's needs are met, relationships are forged and satisfaction flourishes. Listening is a key component of caring behaviors and relationship building (McCrea et al., 2003). Listening requires that we know how to be present, to be silent, to observe, to listen, and to be heard within the context of trust and respect (McCrea et al., 2003). Alternatively, when clinical tasks become the priority of the nurse's work, relationships with medication carts, computers, and intravenous pumps are paramount, placing the development of human relationships secondary to the tasks at hand (Duffy, 2005). It is in this moment, when tasks supersede human connection, that nurses must reevaluate, become truly present and attentive to the needs and desires of another human being, and forge caring and responsive relationships with their patients (Arman & Rehnsfeldt, 2007). Developing this human caring process requires that nurses understand and value the mind-body-spirit connection, are aware of their own strengths and limitations, and know how to comfort with compassion and empathy within the context of a caring relationship (Watson & Foster, 2003). The technical and economic demands of the health care system do not diminish the need for crucial relational care; in fact, the need for higher level caring skills and knowledge has escalated (Benner, Sutphen, Leonard, & Day, 2010). It is through these human-to-human relationships that people live and die, heal and grow, and work and rest (Duffy, 2003; Koerner, 2007). RBC is a model with practical action steps espoused by education and leadership to promote effective change (Koloroutis, 2004). The RBC model includes concepts of Leadership, Teamwork, Professional Practice, Care Delivery, Resources, and Outcomes. Re-Igniting the Spirit of Caring (RSC) is one of the mechanisms by which an organization operationalizes the RBC model (Koloroutis, 2009). THEORETICAL FRAMEWORK The Caring Assessment for the Direct Care Giver (CACG) was developed as part of Re-Igniting the Spirit of Caring, a seminar designed for people who work in health care (Koloroutis, 2003). Initially used as an educational assessment during the course, the instrument was not intended for use in nursing research, nor had it been tested for reliability or validity. The CACG is based on Swanson's mid-range theory of caring, which asserts that caring involves interrelated processes between the nurse-as informed caregiver-and the patient (Swanson, 1991). Inherent in the theory are five caring processes: (a) Maintaining Belief, (b) Knowing, (c) Being With, (d) Doing For, and (e) Enabling/Informing. The first two processes- Maintaining Belief and Knowing-provide the philosophical foundation for establishing a respectful relationship with the patient and family built on their inherent human dignity and an authentic seeking to understand the experience of the patient and family (Koloroutis, 2009). …

In recent years, hospitals have established home-care programs to provide care on a continuum, meeting needs in the hospital and home setting, whichever is most appropriate and efficient in response to defined patient needs. Hospital-based home-care programs with specialization in perinatal nursing have been established to meet the care needs of patients and their families during antepartum, postpartum, and neonatal periods. One of the greatest advantages of a hospital-based program is the internal availability of highly knowledgeable and skilled nursing staff. Physicians are more likely to refer patients to a program that is staffed with nurses they know and trust from the hospital setting. More cost-effective and coordinated care is achieved through the appropriate use of resources across the continuum.

The coaching process enabled me to take time away from my reactive day to think and plan and imagine. -Clinical Nurse Manager My telephone coaching practice began with a request from a chief nursing officer (CNO) to help a clinical manager who had been with her organization for less than a year. The manager was a skilled clinician, highly motivated and capable, with a strong commitment to professional nursing practice, but new to the manager role. She was dealing with staff conflict and dissension on the patient care unit, as well as an extremely tenuous and difficult relationship with a couple of key physicians. The CNO was a supportive mentor to the manager but recognized that the neutrality and objectivity of an external coach would provide a safe venue to engage in the personal reflection required for the manager to succeed and thrive. The CNO contacted me because of my background in relationship-based care and my experience as a nurse leader mentoring and supporting the growth of individuals and organizational teams. The manager and I committ ed to a year-long telephone coaching relationship. We identified as priorities, * exploring ways to improve care and morale on the unit, * improving relationships with medical staff , * clarifying the meaning and purpose of her work as a clinical nurse leader, and * learning how to grow and thrive in her leadership role and to balance competing requirements. Telephone coaching off ers distinct advantages for leadership support and development. Recipients report appreciating the ease of access and efficiency, the neutrality and safety of distance, the increased sense of ownership in guiding their own development, and the discipline of sett ing a time for themselves to reflect and gain clarity within the context of their work day. At first, recipients expressed concern about scheduling the time in an already busy work day. However, their concern quickly became a valued time set aside to focus on themselves, receive support, gain perspective, and identify strategies for calmer and more intentional leadership. The coaching time became one of reflection and stress reduction. IMPORTANCE OF CARE AND SUPPORT FOR THE CLINICAL MANAGER Clinical managers are vital to the quality of care delivered in their patient care areas and thus to the achievement of the organization's mission. Through the manager's leadership, standards of behavior and performance are articulated, expectations for patient care delivery are established, and accountability is sustained. Clinical managers are responsible for creating a unit culture that promotes healthy teamwork, professional nursing practice, and competent and compassionate care and service. Because their role is crucial to the successful provision of care and the success of the organization as a whole, many managers experience a chronic struggle to balance the demands of all the constituencies with which they are involved (Figure 1). In the course of facilitating leadership seminars, I have queried clinical managers and those they report to about how managers spend their time. The findings have been revealing. Most report that 80%-90% of their time is spent meeting the requirements of the broader organization: responding to organizational priorities, preparing quality data and other writt en reports, and att ending organizational meetings. The remaining 10%-20% of their time must be divided among activities devoted to leading care delivery, supporting their clinical staff s, and inspiring professional practice. These activities include hiring and retention; scheduling/staffing; counseling, coaching, and mentoring staff ; competency development and education; sett ing expectations and standards; dealing with the crises that inevitably surface; and following up with patient and family concerns. Some state that this portion of their time is oft en overtime hours. A smaller number of managers report spending as much as 40%-60% of their time leading and supporting clinical staff and directing care; these managers report clear boundaries that permit them to prioritize their time and to access some much-needed off -time and respite. …

Objectives 1. Describe the need and opportunity to improve the quality of dying in the intensive care unit (ICU). 2. Describe specific tools for high-quality family meetings, managing the transition to comfort care, and ensuring optimal pain and symptom management for actively dying ICU patients. 3. Describe how to create an environment within the ICU for the family that not only supports their grieving but also provides an opportunity to celebrate the uniqueness of their loved one’s life. Because up to 30% of hospital deaths occur in the intensive care unit (ICU), improving endof-life care in the ICU must become a priority to meet the needs of patients and their families. In this multidisciplinary, interactive, case-based workshop, participants will learn methods for the primary cardiac care unit team to integrate palliative care into daily work including tools to improve an actively dying patient’s pain and symptom management, safely discontinue mechanical ventilation, implement standardized evidence-based multidisciplinary family conferences, and effectively involve formal palliative care consultation into care. Participants will also learn how to support the patient’s family and friends through their sadness and grief while also exploring ways to create an environment within the ICU to recognize and celebrate the uniqueness of each patient’s life.