title: Nurse Knowledge Exchange Plus: Human-Centered Implementation for Spread and Sustainability.
abstract: BACKGROUND
  Kaiser Permanente implemented a new model of nursing communication at shift change-in the bedside nursing report known as the Nurse Knowledge Exchange (NKE) in 2004-but noted variations in its spread and sustainability across medical centers five years later.
  
  
  METHODS
  The six core elements of NKEplus were as follows: team rounding in the last hour before shift changes, pre-shift patient assignments that limit the number of departing nurses at shift change, unit support for uninterrupted bedside reporting, standardization for report and safety check formats, and collaboration with patients to update in-room care boards. In January 2011 Kaiser Permanente Southern California (KPSC; Pasadena) began implementing NKEplus in 125 nursing units across 14 hospitals, with the use of human-centered design principles: creating shared understanding of the need for change, minimum specifications, and customization by frontline staff. Champion teams on each nursing unit designed and pilot tested unit-specific versions of NKEplus for four to eight weeks. Implementation occurred in waves and proceeded from medical/surgical units to specialty units. Traditional performance improvement strategies of accountability, measurement, and management were also applied.
  
  
  RESULTS
  By the end of 2012, 100% of the 64 medical/surgical units and 47 (77.0%) of the 61 specialty units in KPSC medical centers implemented NKEplus-as had all but 1 of the specialty units by May 2013. The mean KPSC score on the NKEplus nursing behavior bundle improved from 65.9% in 2010 to 71.3% in the first quarter of 2014. The mean KPSC Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score for nurse communication improved from 73.1% in 2010 to 76.4% in the first quarter of 2014 (p < . 001).
  
  
  CONCLUSIONS
  Human-centered implementation appeared to help spread a new model of nursing handoffs and change the culture of professional nursing practice related to shift change.
authors.affiliation: Innovation Consultancy, Kaiser Permanente, Oakland, California, USA.
authors.forename: Mike
authors.initials: M
authors.lastname: Lin
authors.forename: Scott
authors.initials: S
authors.lastname: Heisler
authors.forename: Linda
authors.initials: L
authors.lastname: Fahey
authors.forename: Juli
authors.initials: J
authors.lastname: McGinnis
authors.forename: Teri L
authors.initials: TL
authors.lastname: Whiffen
mesh_terms: D002983:Clinical Competence; D003142:Communication; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D010353:Patient Education as Topic; D062209:Patient Handoff; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*