Small stories, huge improvements

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Health system’s journey to excellence shows human touch

The road to ANCC Magnet Recognition Program® (MRP) status is not a new journey for University Health System (UHS) in San Antonio, which in 2004 began searching for ways to improve its quality of care, develop champions, and start a strategic plan while analyzing components the program would require. 

“Through the years, we worked on shared governance, looked at our nursing councils, found ways to support those developments,” says Evelyn Swenson-Britt, MS, RN, clinical research director and MRP project director at UHS. 

In 2004, UHS did not have a lot of unit councils and needed to develop a much more unit-based council concept. The goal was to make sure every unit had a voice and interaction with the council structure within the system. 

“During that time, there were tremendous things we were able to develop and learn,” says Swenson-Britt. “I know this is said so often, but the real reason for the journey is your patients, so you can become more focused and put the priority on excellence in patient care. We learned so much about ourselves.” 

This meant questioning existing processes—asking, “Why aren’t we doing things a certain way?” and then starting over to figure out the right way to make change happen. 

“Our staff wasn’t really involved with research,” says Swenson-Britt. “We had a chance to develop that council.”

The facility has partnered with its sister university to help develop stronger research processes. 

“Our faculty have been wonderful mentors, working with staff on different units to build knowledge, skills, and confidence so they can do research for themselves,” says Swenson-Britt. 

The staff are also now involved in evaluating the clinical practice guidelines not only for their own facility, but for the consortium UHS belongs to. 

“We are also involved in developing [clinical practice guidelines] we’re missing—the staff are learning what it means to do evidence-based practice guidelines, but at the same time, all of it leads to better outcomes for our patients,” says Swenson-Britt. “It has been a lot to learn, but all of these changes have been positive, developing new knowledge that has an effect at the bedside.”

But where the facility really shined in its most recent survey was the demonstration of individualized care for its patients. 

San Antonio 

Every community has its unique issues, and every community hospital must evolve and react to provide care for those who face community-specific challenges. In the San Antonio area, Swenson-Britt explains, there is a huge diabetic population due to a number of factors, including diet and poverty. 

On the macro scale, UHS has a diabetic institute, which provides nurses a means to distribute education on diabetes and to work with the community to help improve the diet habits that lead to such a high diabetic population. 

“We have a [diabetic] population that is younger than you would find in other parts of the country, but they come in so sick,” says Swenson-Britt. 

UHS acts unofficially as the community hospital for the area. “We really are the county hospital and safety net,” she says. 

UHS serves more than 20 counties in the San Antonio area. “We take all comers and have a great number of uninsured,” says Swenson-Britt. “We have a very large number of patients that have never had the benefit of preventative healthcare. They come in very sick, and we’re doing a yeoman’s job dealing with this critically ill population.” 

The combination of illness and poverty provides UHS nurses a perspective Swenson-Britt feels is unique and, in some ways, profound. 

“I think the nurses here have unique skills and abilities. I don’t think every nurse knows what it’s like to do a discharge plan for a patient who literally lives under a bridge,” she says. 

To help develop this perspective, UHS works with theorists to create plans for unique individuals that help them understand and maintain the care of their health. Use of these personalization skills has shown very tangible results. 

For example, the ED had a frequent visitor, a homeless man living with severe diabetes. 

“His diabetes wasn’t controlled. He’d come in with fleas,” says Swenson-Britt. 

Staff knew the only way to help this individual was to understand his situation and help craft a plan for him to maintain his own health. They sat down with the theorists and attempted to figure out how to stand in his shoes for a while in order to understand the challenges he faced to stay healthy. 

“Obviously, it’s not easy to take care of a patient like him,” says Swenson-Britt. Although the nurses found him particularly challenging and off-putting at first, they eventually warmed up to him. “They came to find he was very funny—the staff actually really enjoyed him,” she says.

When the nurses began personalizing his care, they took into account the man’s living situation and found clues explaining many of his recurring health problems—including the discovery that he was living in his car with his dog. 

“This let us know where the fleas were coming from,” says Swenson-Britt. 

But the man loved this dog and did not want to part with him. Nursing staff connected with the humane society to get the dog cleaned up and “flea bomb” the car to remove the remaining insects. 

A more complicated challenge was controlling the man’s diabetes. His food came almost entirely from the local food shelter. Rather than maintaining the steady, planned diet his diabetes required, the man was eating on the shelter’s schedule. 

The nurses connected with a dietitian, who convinced the soup kitchen to fix little portions of food for him to bring from the shelter. This would maintain his blood sugar levels when the shelter was closed. Some nurses also went out to provide a “home visit” to his car to give him his medications. 

“He went from frequent readmissions to a period of six or eight months before he had to come in again,” says Swenson-Britt. 


On the other end of the spectrum, UHS also treats severe trauma victims. The nursing staff has found ways to personalize and connect with these patients to help them through the life-altering events that brought them to UHS. 

During UHS’ most recent MRP survey visit, one nurse related a story describing that personalized touch and almost brought the surveyor to tears, says Swenson-Britt. The nurse started out by giving the hard facts of one  patient’s case: a middle-aged male with severe trauma from an automobile accident. The description was straightforward, and everyone listening was lulled into professional attentiveness. And then the nurse changed her descriptive tactics. “She said, ‘Now let me tell you what really happened,’ ” says Swenson-Britt. 

The nurse launched into a narrative that gave a portrait of the patient, his life, his injuries, and his fears. “This is Alex,” she said. He was driving to work when the accident happened. He has a wife and two children. He was paralyzed by the accident. 

“His life was forever changed,” says Swenson-Britt. 

The nurses began to talk with the patient about how they would work with him and explore the aspects of his life to get a better understanding of the kind of personalization his treatment would require. 

“He was from south Texas,” says Swenson-Britt. “There is very little out there in south Texas, along the border.” 

The nurses spoke with the patient about personal issues that would be the biggest challenges to overcome in his recovery. They found that he had always wanted to play professional baseball and that the game was a lifelong love. They used these facts to help him believe he would be able to do these things again. 

“He could throw a baseball with his kids,” Swenson-Britt says. “We were going to help him work through all these things.” 

Although the accident was, without a doubt, a traumatic and life-altering event, what the nurses wanted to offer the patient was a chance to understand what he would not lose—there were physical issues to overcome, but they wanted to help him keep as much of his life as possible. 

“They knew what he wanted to do, they worked with his spirituality, they spoke with his minister,” Swenson-Britt says. “They knew all of his details, so they could really help him on the road to recovery.” 

Because of this, the nurses were not only able to help him prepare to return home by first entering rehab, but they also saw him as a unique individual regardless of all the technical jargon surrounding his condition. 

“We have all kinds of technology and processes, and people can get lost in it,” says Swenson-Britt. 

The nurses need to be able to see the individual beyond the technology. “What you need are nurses who can deal with that technology, understand how to react to and with it, to save lives,” she says. “It’s what the whole model is about: seeing that unique person. We want to understand and paint a picture of patient care until they were able to get to a state of equilibrium.”