Allegheny General Hospital and SEIU Healthcare PA RNs

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Allegheny General Hospital and SEIU Healthcare
PA RNs
Balancing Unit and Hospital Quality Improvement
Collaborative Work
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Outline for Discussion

• Background on Quality Improvement Structures at
  Unit and Hospital Level
• Previous Theory and Outcomes
• Pivot Point
• New Approach and Initial Outcomes
• Summary of Lessons Learned

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Background
Background

• Allegheny General Hospital
• Level 1 Trauma Center
• Academic Medical Center
• Flagship of West Penn Allegheny Health System
• 1,400 RNs represented by SEIU Healthcare PA

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Background

• 7 years hospital level and unit level
  structures in contract
• Nurse Collaboration Council (NCC)
• Patient Care Committees (PCCs)
• Professional Practice Partnership (2 years)

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Nurse Collaboration Council

• 7 staff RNs and 7 nurse managers and union staff
  representatives
• Monthly Meeting
• 4 hours (used to be 1 hour before most recent
  contract)
• Purpose The parties acknowledge and agree
  that the Nurse Collaboration Council (NCC) shall
  oversee the work of the PCCs in the following
  relevant strategic initiatives as described
  below
• 1) Achieving excellence in patient care and
  service
• 2) Nursing retention and recruitment
• 3) Workplace Health and Safety
• 4) Operational and Quality Initiatives and
  Patient Flow
• 5) Professional Education and Training
• 6) Advancement of the art and science of nursing
• 7) Pursuing relevant grants or examining
  important developments in industry standards
  (e.g. Health Information Technology)
• 8) Helping achieve organizational goals and
  directives

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Patient Care Committees

• Unit Level Structure
• Structure can vary but includes staff RNs and
  nurse manager and Division Director
• Monthly meetings for 1 hour on unit
• Shared Goals for Effective PCC
• Led by staff RNs
• Collaboration on agenda with manager and staff RN
• Communication of process and outcomes

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Professional Practice Partnership

• Shared Governance Structure
• 6 Hospital Level Councils with formalized
  structure and participation guidelines
• Coordination of PPP and PCC in CBA
• PCCs are work-engine of PPP/unit level
  connection
• PPP councils are tools of the PCC
• Coordinating Council of PPP includes NCC chair
  staff RN chair

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Balancing Unit and Hospital WorkPrevious
Theory

• Unions focus was on expanding unit level
  committees
• Way to engage nurses and build unionfocusing on
  RN concerns
• Way to respond to issues
• Have problems filter up from PCCs to NCC
• Start with a few successful PCCs and then expand
  outward
• Train RNs in a basic evidenced based approach
  around the issues that nurses wanted to address

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Results

• Handful of units with strong and sustainable PCCs
• Several other units with PCCs that started and
  then faded
• Lack of collaboration and coordination with NCC,
  PPP, PCCs
• Frustration between Union and Management Mistrust

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Examples of PCC work

• 9A
• Evidence Based Project on Remote Telemetry
  Patients
• Neuro ICU
• Evidence Based Project related to Pharmacy
  Process
• Addressed pulling issues and general work
  environment issues in 2 different physical
  locations of same unit
• 8C
• Ratios
• Grab n Go Respiratory Bags
• Regular Staff Huddles

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Balancing Unit Level and Hospital Level
Challenges
Challenges for Unit Level
Arguments for Focus on Unit Level

• Takes time and energy to make sustainable
• Need time and energy to share results Across
  Hospitals
• Several unique goals make it harder to get
  hospital focus
• Solutions may lie at Hospital Level

• Easier to get started and get some results
• Easier to innovate pilots
• Good way for RNs to see the action

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Pivot

• Contract Negotiations
• More explicit discussion of goals and theory
• Less focus on specific structures or answers but
  did make some changes (longer meetings, budget
  time and resources for sharing and training)
• Retreat
• Continued to share independent and common goals
  and vision
• Identified a joint umbrella project that both
  sides have a strong stake in

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New Approach to Balancing Unit Level and Hospital
Level

• Umbrella Project at Hospital Level
• Length of Stay
• Dont Rush the Unit Level
• Develop clearer, collaborative strategy on PCC
  sustainability
• Maintain focus on evidenced based nursing and
  also balance with Hospital level strategic goals
• Engage RNs at Unit Level
• Walk Around Process

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Walk Around Process

• Manager and Staff RN from NCC visit all units in
  day and engage in structured discussion/data
  collection with RNs and Manager
• Initial Walk Around to gather initial data from
  RNs on
• What barriers do nurses encounter that impact
  patient flow?
• What impacts LOS on your unit?
• Diagnostic Testing Impact?

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Walk Around Process

• Initial Data led to Action Plan for NCC at
  Hospital Level
• Nurse Aide Consistency project
• Pilot on monitor tech team devoted to transport
  for testing procedures
• Case Management simple process improvementspaperw
  ork, ancillary support
• Another Walk Around to continue to Build RN
  Engagement around other Hospital Initiatives
• LOS target in computer charting system
• Starting to find ways that PPP can be helpful
  tool in carrying out NCC/PCC work

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Walk Around Part 2

• Continue to Engage RNs at Unit Level
• Update RNs on NCC work
• Educate RNs on importance of Length of Stay
• Verbal Survey
• Have you noticed that on sunrise now it indicates
  information on Length of Stay and expected
  discharge date?
• Given that RNs play a critical role in the
  coordination of care and discharge, how could
  that information be useful for RNs?
• Do you have any other ideas on what could change
  to help improve patient flow and more timely
  discharge of patients?

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Initial Outcomes

• Had RNs look at countdown tool
• Example On 6C, 3 out 5 in an assignment were
  already beyond discharge target, nurses not
  really focused on
• Led to a discussion about role of RNs and Aides
  which tied to work in progress around Nurse aide
  role
• More data and ideas on LOS and patient flow
• Information to help shape other pilot projects
• Idea for changing taping of report on transfers
  between units
• RNs to round with physicians on units
• Opportunities to explain to RNs about PCCs
• 6C boomerang re-admissions

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Summary of Lessons Learned

• Need to have both unit level and hospital level
  activity happening
• Cant be one or the other
• Explicitly collaborate between Union and
  Management on the strategy for that balance
• Best if they complement one another
• At some point hospital level work can help to
  drive the unit level work
• In the mean time have a plan to continue to
  engage RNs at the unit level

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Next Steps

• Implement ideas from both Walk-Arounds
• Refine and Develop PCC strategy
• Enhanced coordination of PPP and PCCs/NCC
• Unit level RN engagement/education while building
  PCCs
• Walk around and other trainings