Transforming Nursing Practice at Saint Josephs Hospital

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Transforming Nursing Practiceat Saint Josephs
Hospital

• Creating a Culture of Change
• Sustaining a Culture of Safety
• Summer 2009

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The Value of the Nurse

• Nurses are the principle front line caregivers in
  the US health system
• Nurses have a tremendous influence over a
  patients healthcare experience
• Specific characteristics of a nursing workforce
  influence healthcare quality including healthcare
  outcomes, patient safety, and safety of the work
  environment
• Increasing interest nationwide in measuring the
  contribution of nursing to quality outcomes
• National Quality Forum
• National Voluntary Consensus Standards for
  Nursing-Sensitive Care An Initial Performance
  Measurement Set 2004

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MAGNET Expectations
Mission Critical
ACT Initiatives
Professional Engagement and Commitment
Patient Satisfaction
Nurse Satisfaction
CORE Measures
Healthcare Reform
Regulatory Requirements
Soarian Implementation
Physician Satisfaction
Disease Specific Certifications
Nursing Recruitment,Retention,Turnover
Educational Preparation of Staff
Percentage of Certified Staff
Nurse Competencies
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Nursing Shared Governance Model1981- Present
Council
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Why do we need to Change?
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Ready or notHealthcare is Changing

• We need to redefine how we govern our nursing
  organization if we want to succeed into the
  future
• Our current model is no longer an effective or
  efficient way to transform nursing practice
• It is time to move from talking about outcomes to
  assuring nursing actions lead to positive results

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Sense of Urgency

• We have to get outcomes oriented to survive

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Our Current Shared Governance Model is Impeding
Change

• Focuses on the development of structure and
  processes, assuming outcomes will follow
• Accountability for outcomes is poorly defined
• Global decision making/information sharing
  structure
• Limited identification of unit specific issues
• Limited transparency of unit specific outcomes
• Staff interest in participating in the current
  model is waning
• Staff nurse representation is becoming
  increasingly more narrow and less representative
  of nurses at all levels and within all practice
  areas
• Poor tolerance for innovation, thinking outside
  the box, unique approaches to common issues

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A New Shared Governance Model to Drive Nursing
Outcomes

• Move toward a transformational leadership style
  at all levels within the nursing staff
• Develop a structure that supports nurse
  empowerment to make decisions that affect the
  outcomes of their particular unit/department
• Embrace new knowledge, nursing innovations and an
  environment of continuous improvements
• Expect exemplary professional practice

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Leadership

• It is easy to lead people where they want to go
• What is hard is leading people where they need to
  be to meet the demands of the future

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The Guiding Team

Developing the Vision and Strategy
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Our Journey..
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Nursing Mission and Vision
We are a community of professional nurses at
Saint Josephs devoted to providing excellent,
compassionate care that honors the Mercy mission.
We strive to be better today than yesterday, and
better tomorrow than today.
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Nursing Strategic Plan 2017
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Professional Model of Care
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The New Magnet Model
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Transformational Leadership

• Transformational leaders must change their
  organizations values, beliefs and behaviors
• Transformational leaders inspire commitment to
  achieve the vision of the future
• Transformational Leadership is a very effective
  leadership approach when
• change
• development
• initiative
• creativity
  
• 
  
• 
  are required.

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The New Shared Governance Model
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Transformational Leadership

• Transformational leaders must encourage and
  support atypical solutions, out of the box
  thinking
• Transformational leaders must work in an
  environment of controlled chaos for the immediate
  future
• Transformational leaders must understand changing
  nursing practice will cause turbulence

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The New Shared Governance Model
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Transformational Leaders
Nurse Manager
Directors
Clinical Specialists
Patient Educators
Change
Work Teams
Researchers
Nurse Educator
Exemplary Professional Practice Representative
Chief Nursing Officer
Care Managers
Patient Safety and Quality
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Transformational Leadership Council
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Transformational Leadership Council

• Provide active leadership in establishing Unit
  Based Exemplary Professional Practice Councils
• Meet monthly for the remainder of the year to
  address global nursing issues, problems,
  policies, procedures until the council
  transformations are complete
• Provide active leadership in establishing the
  remaining councils
• Evolve to adapt the roles of Transformational
  Leadership Council associated with the Magnet
  model and move forward in that capacity (2010)

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The New Shared Governance Model
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Unit Based Leadership Triad
Nurse Manager
CHANGE
Nurse Educator
Exemplary Professional Practice Representative
The triad works together to define practice and
educational goals within the unit which promotes
high quality care in a safe environment, in the
most efficient manner possible The triad meets
together to ensure all work teams are able to
move forward effectively on the defined
performance goals
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Manager Responsibility in Establishing the Triad

• Explore options with Director/VP
• Unit/Department forms own Triad
• Like Units/Departments join together
• Include nursing staff in nomination and selection
  of the UB - EPPC Rep
• Seek diversity of thought within the Triad
• Establish the Triad by September 12

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Unit BasedExemplary Professional Practice Council

• POWER TO THE PEOPLE
• STAFF INVOLVEMENT IN CHANGING THE OUTCOMES OF
  PATIENT CARE AND THE WORK ENVIRONMENT
• Change happens at the unit level
• Having a voice is meaningless if it does not
  result in action
• Actions lead to outcomes
• Need to develop focus areas, and learn to
  implement small changes quickly
• If nothing is tried, nothing changes

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Unit Based Exemplary Professional Practice
Council
Exemplary Professional Practice
Representative Facilitates Work Teams
Nurse Manager Facilitates Acquisition of Resources
Nurse Educator Facilitates Acquisition of
Credentials and New Knowledge
CHANGE
Work Team 1 Staff Nurse Team Lead Multidisciplina
ry Members
Work Team 2 Staff Nurse Team Lead Multidisciplina
ry Members
Work Team 3 Staff Nurse Team Lead Multidisciplina
ry Members
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Every Nurse Becomes a Change Agent

• Not enough anymore for professional nurses to
  answer to the question, what did you do today?
• Imperative for professional nurses to be able to
  answer to the question, what difference did you
  make today?

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Every Nurse Becomes a Change Agent

• All nurses can participate in transforming care
  at the bedside
• All nurses need to take ACTION
• All nurses can help lead the transformation
• All nurses must find a nichecarve a niche
• Everyone comes to this world with a gift
• All nurses need to be coached and mentored to
  share their gift

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Exemplary Professional Practice Oversight Council

• Will implement in October after units/departments
  have identified their UB- EPPC rep

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The New Shared Governance Model
Work in Progress
Work in Progress
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The New Shared Governance Model
First Congress By December
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Unit Based Leadership Triad
You Are Not Alone
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Team STEPPSStrategies and Tools to Enhance
Performance and Patient Safety

• Establishing unit leadership structure
• Identifying problem focused work teams
• Building shift based patient care teams
• Communication and team work
• TeamSTEPPS was developed by the Department of
  Defense Patient Safety Program, in collaboration
  with the Agency for HealthCare Research and
  Quality (AHRQ)

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The Institute for Healthcare (IHI) Improvement Map

• An interactive, online tool that distills the
  best knowledge available on the key process
  improvements that will lead to better outcomes
  for patients
• Builds on the work of IMPACT and the 100,000
  Lives and 5 Million Lives Campaigns, but the
  Improvement Map is a tool and not a new IHI
  program or campaign

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Georgia Medical Care FoundationCare Transitions
Program
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Communication to Staff

• Website
• Rolling Carts
• UB EPPC meetings
• Governance Councils and Committees
• Empirical Outcomes Congress

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Nursing Website
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Next Steps

• Establish the unit/department Triads (now to Sept
  12)
• Assign a TLC team to each unit/department Triad
• Develop an educational program through the TLC
  for Triads to attend as a team (Sept)
• Begin monthly TLC meetings (Sept)
• Hold first Meeting of the EPPOC (Oct)
• Focus on development of SE and NKII Councils
  (Now-Nov)
• Develop the EOC and hold first EO Congress (Dec)
• Revision of the Bylaws (2nd quarter 2010)

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The Nurses at Saint Josephs Hospital are
Transforming Nursing Practice For the good of
our patients and each other
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