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December 29, 2015/Nursing/Nursing Operations

Establishing Cleveland Clinic Nursing Care in Abu Dhabi

A closer look at nursing at CCAD

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Bringing Cleveland Clinic’s unique and unparalleled U.S.-based model of care to Abu Dhabi in the United Arab Emirates and tailoring it to local needs and culture has been years in the making. For Cleveland Clinic Nursing, it took more than a year to onboard new staff as part of the caregiver team. Time was needed to bring our patient-centered healthcare model to the Abu Dhabi population to meet its health and wellness needs.

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Timeline for onboarding new staff

Starting in January 2014, more than 6,000 RNs from around the globe went through the interview process to work at Cleveland Clinic Abu Dhabi. In the spring of that year, new Chief Nursing Officer Ann Williamson, PhD, RN, arrived on the job. At that time, there were about 50 Nursing employees. Today her team is 600 nurses strong, representing almost every specialty and 37 countries.

During the fall/winter from 2014 to 2015, Dr. Williamson and her clinical team went through a rigorous orientation to learn processes, equipment, technology and the physical plant within the hospital. This included the hospital’s Healthcare Information and Management Systems Society Stage 6-enabled electronic medical record.

For the two months before opening, a series of mock operations took place — at both the organizational level and the unit level. Completing mock operations gave caregivers a chance to practice simulated high-risk and low-volume activities as well as daily workflows on patient care units. This allowed the team to identify gaps in the physical plant and/or supplies and procedures.

Valuable lessons learned

As an example of lessons learned from the mock operations, Dr. Williamson stated, “Our stroke team activation protocol looked good on paper, but as we simulated this high-risk activity, several gaps were uncovered and mitigated to make sure we were meeting the highest patient safety and quality standards. Issues identified included lack of pharmaceuticals in some areas and inadequate communication plans with imaging services.

“Our nurses took a lead role in planning and executing unit-based mock operations,” says Dr. Williamson. “A good lesson I learned as a leader in an international startup environment like this was to trust the frontline team to really own the workflows while ensuring best practice standards were met.

“Trying to ‘over manage’ can result in a sense of powerlessness or favoritism, especially with a multicultural team,” she adds.

Best practices that led to the successful startup

A strong “buddy” program was implemented. All new caregivers were partnered with unit colleagues who lived in Abu Dhabi for a while and were committed to welcoming their buddy and guiding them through settling in a new country.

“We feel very fortunate,” says Dr. Williamson. “Our nurses, physicians and allied health providers did a lot of teambuilding activities that were good for developing strong working relationships, which we have sustained since opening.”

The nursing team implemented a robust rounding program at the institutional level and on units. Patients receive hourly rounding by nurses and daily rounding by nurse managers. Dr. Williamson and her team round several times a week to show support, and once a month, leadership team members complete executive rounds — a Cleveland Clinic practice that is proving highly successful in Abu Dhabi.

“Prior to opening the hospital, we were in a unique situation in that caregivers had time to get to know each other before clinical work took precedence,” says Dr. Williamson. “Nurses, doctors and other members of the care team worked closely together and continue to learn together.”

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Making good hires was a priority. Cleveland Clinic Abu Dhabi nurses go through the same new-hire assessments as those at all other Cleveland Clinic health system hospitals, including competency assessments, the Performance-Based Development System (to assess critical thinking), Safe Medicate, an immersion program and an electrocardiogram competency test. Additionally, a shared governance structure is being patterned after the health system’s.

For more information about Abu Dhabi Nursing, see this Q&A with Dr. Williamson.

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