Objectives: Nursing at RRMC. At the end of the presentation the audience will be able to:

Transcription

1 Objectives: At the end of the presentation the audience will be able to: Describe innovative methods of creating a culture in which excellence is the standard. Describe how operationalizing every nurse is a leader results in nursing excellence. Appreciate the critical role that employee engagement plays in achieving excellence. Rutland Regional Medical Center Established: September 6, 1896 Number of licensed Beds: 188 ADC 100 ER Visits: 36,000 Sole Community Hospital Nursing at RRMC Collective bargaining Unit 450 RNs Nationally Certified 45% ANCC Magnet Recognition

2 2005 The Definitive Care Unit 17 bed ADC 17, high turnover Complex patients RN turnover 34% Low employee satisfaction 31% RN certifications 6% High Utilization of agency staff No employee engagement 2006 Quote from exit interview of a resigning staff RN: Never enough staff, and the staff we do have are burnt. Very sick patients that come and go like a revolving door. Not a place I can continue to work Quote from Employee satisfaction survey of a Staff Member I love what I do but both patients and new staff come and go so quickly it is not worth the effort to connect with them. I am not sure how much longer I can tread water. 2

3 Staff behaviors Unsuccessful strategies Not for me to fix 3

4 How to engage the team? How to shift from a leader wish approach to a solution based team? Traditional Performance Improvement tools Proven success with Processes Data Root causes Special causes System & Process Inefficiencies Not proven with Appreciative Inquiry- Cooperrider A systematic approach to build from the positive core of what is present. What are our strengths and how can we build from them? a system or teams capacity to succeed is strengthened 4

5 Why It Works Doesn t focus on changing people Invites people to engage in building the kinds of organizations and communities that they want to live/work in/for. Helps everyone see the need for change, explore new possibilities, and contribute to solutions. Translates shared vision into reality and belief into practice. Learning that surfaces through AI shifts the collective image. Causes individual acts at both conscious and unconscious levels 13 Problem Solving What to fix Underlying language = problem, symptoms, causes, solutions, action plan Breaks things into pieces & specialties, guaranteeing fragmented responses Takes a lot of time and positive emotion to make real change. Assumes organizations are constellations of problems to be overcome Appreciative Inquiry What to grow-appreciating the best of what is. New language of the true, good, better, possible root causes of success. Problem focus implies that there is an ideal. AI breaks open the box of what the ideal is first. Expands vision of preferred future. Creates a pull - new energy fast. Assumes organizations are sources of infinite capacity and imagination 14 From the employee perspective Never ending process of frustration. We never get it right Change is always looming and threatening Feeling of no control become disengaged Continual process of improving our strengths we are good but we want to be better Change is expected, anticipated and exciting. Empowered to be part of the solution 5

6 The 5-D AI Change Processdynamic circular wheel Delivery: Implementing and Sustaining the Change D Definition: Decide what to learn about What you want more of D Discovery: The best of what is, illuminate the Positive Core D Design: Finding innovative ways to create that future D D Dream: Envisioning what might be; shared images for a preferred future 16 DEFINITION: WHO ARE WE? WHAT DO WE VALUE? Who are we??? Identity DCU to PCU RRMC Nursing Annual Mtg Alignment with AACN Embrace our specialty Operational Framework Synergy Model Medical Director Partnership Reframes how we see ourselves and how we are seen by others. 6

7 VISIONING DAY Initial Staff Response What are our values? Organizational values: Entrust Integrity Caring Teamwork Superior Service Working sessions team report outs Discover commonalities 7

8 Entrust: We entrust each other by empowering, mentoring and nurturing our team members to be successful. We cultivate a culture of open, constructive feedback. We recognize each individual s contribution to the quality of our service. Caring: We care for our patients and our team. We strive to be approachable, compassionate and forgiving Integrity: We say what we mean and we do what we say. Our communication is effective, honest and open. We respect our peers and are accountable for our own actions. 8

9 Teamwork: We achieve our common goal of providing excellent patient care by using skillful communication to teach, mentor and share knowledge and ideas. We work together as a strong solution-oriented team. The Outcome: Superior Service SUPERIOR SERVICE Behavioral Expectations Marie Manthy Commitment to My Coworker. Code of Conduct Adoption of AACN Healthy Work Environment Initiative Silent majority was finding their voice. The turning point 9

10 What does success look like? What is our shared vision? It is January 2010 and PCU is an amazing place to work. Employee satisfaction is high Staff retention is high Pt outcomes are world class Staff development is cultural and ongoing What structures must be in place to achieve this? What path should we take to get to our vision? 10

11 Discovery: Illuminate the positive core build from your strengths Excellence Framework: AACN HWE Initiative Beacon &Magnet Criteria Leadership Structures & Systems Appropriate Staffing & Staff Engagement Effective Communication, Knowledge, Learning and Development of Best Practices Evidence Based Practice & Processes Leadership Structures & Systems: Leading from Within Leadership Development Formal & Informal leaders Leading from Within/AACN EONMO/VONL Changes in leadership ( skills vs. tenure) Clear expectations and empowered to lead Monthly Meeting Core agenda for CM Standing session for relief charge Performance Appraisals Personal Development Plans (staff input) Quarterly mtg (two way communication) 11

12 Leadership Structure Nurse Director-Medical Director 4 Clinical Managers 2 7a-7p & 2 7p-7a Sunday night 7p-Saturday night at 7p Saturday 7p-Sunday 7p relief charge Clear accountability and expectations Coaching communication to give feedback in a timely fashion Appropriate Staffing Business case to align core staffing with other progressive care units. Anchored our identity as a progressive care unit. Education around productivity and the role each of us play to maintain fiscal solvency. No longer a barrier Leading From Within Organizational & PCU Teams Departmental Teams Professional Development Team Safety/Education Team Skin Care EMR Patient Satisfaction Team Nursing Councils Professional Development Council Professional Practice Quality Improvement Research MARC Informatics 12

13 Team Expectations Set measurable goals Quarterly report outs at staff meetings Clear posting of dates and times Posting of minutes/portal Staff led with leadership sponsor-their team Team Accomplishments Pt Satisfaction Advocate Program Call backs/sympathy cards Quietly We Heal Professional Development Team Values & Commitment to Coworker Debriefing Beacon GAP Analysis Beacon Application Team Accomplishments Safety Team Fall Free Days Busy Box Partner with Local Nursing Homes Rocking Chair Safety Police Ticket the good behavior 13

14 PCU Nursing Tech Team Purpose/Structure/Roles Brainstorm Determine Goals for FY2012 Survey so each LNA has a voice Lit Search-Prof Org Present results to entire team at Visioning PCU Nursing Tech Team I am so excited to have an LNA team, because I feel we are important too. Helen Parker LNA Tech/Secretary Solution Thinking.. 14

15 REWARD & RECOGNITION Staff Education & Development Partnership with Clinical Educator Thorough and ongoing education needs assessment Continued alignment with professional standards ANA Code of Ethics AACN Healthy Work Environment Magnet and Baldrige Criteria Performance Appraisal (CAP, certifications) Soft Skills: What every nurse needs to have Communication Personality Styles Conflict Resolution Role Playing Crucial Conversations Shared Code Words 15

16 Staff Developing Staff: a culture of learning PCCN Certification Course LNA Educational Day-RN led BLS/ACLS/Mock Codes What I have learned Continued Education Hire for Core Values Train for Technical Skills Behavioral Based Past behavior predicts future behavior Work Ethic Values Team player Caring Compassion Hiring Process: Who do want working next to you? Team Recruitment Screen Interview Job Shadow Team interview 16

17 Retention: Nurturing your new hires Orientation ~6month Skills, establish relationships, connect with coworkers, community Preceptor/trainee pairing Preceptor Training Formal VNIP Staff take accountability for developing their future team mate Mentoring Program Professional Development Team GAP Best Practice Maine Medical Team built structure Formal Education 1yr for GN post orientation 6 months for new hire post orientation Our current structure Daily briefings-briefing sheet Value Story Safety Tip of the week Quarterly Team mtg Monthly Leadership & Team mtgs Staff Reps on All Nursing Councils Dept Teams 17

18 Visioning Day Agenda Icebreaker Bold Voices Commitment /Beacon Gap Analysis Organizational Update CEO Nursing Update CNO & Councils PCU results/progress (NDNQI) Team Report (goals/progress/results) Dr Shapiro Educational Session over lunch Guest Speakers Team Building Exercises (Beacon, Personality, Dress, Games) Solutions Box Open Discussion review of previous yr, goals for next Likes/Wishes Team Building Games Children games are hardly games. Children are never more serious than when they play. -Montaigne 18

19 Beacon Application Process Feedback :progress to goals Post results Discuss results How can we do it better? Fall boards Chart Audit data Feedback Two street: Likes/Wishes The train is leaving.are you on board? TURNOVER HITS ALL TIME PCU RECORD 42%!!!! 19

20 2011 PCU SO where are we now? 18 bed Progressive Care Unit ADC 18 High Patient turnover Complicated patients 2010 PCU Employee Engagement Data-GPTW Change from measuring satisfaction to engagement Organizational restructuring-3n closing Survey was conducted at the same time Top 100 HC facilities in US 6,672 PCU 2010 GPW Survey Criteria GPW top 100 HC PCU Credibility Respect Fairness Pride Camaraderie Average of all scores Taking everything into 91 account this is a great place to work 94 20

21 NDNQI %RN Hrs Agency Staff National Mean PCU Q09 3Q09 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 NDNQI Controllable Turnover National Mean PCU Q10 2Q10 3Q10 4Q10 1Q11 2 NDNQI: Unit Acquired Pressure Ulcer National Mean PCU q09 2Q09 3Q09 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 21

22 NDNQI Restraints Goal: restraint free Dept National Mean PCU Q09 1Q10 2Q10 3Q10 4Q10 1Q11 NDNQI RN Certifications Q10 3Q10 4Q10 1Q11 The 90th percentile is PCU National Mean PCU 71% of all PCU eligible RNS are certified With another review course scheduled for this fall -6 more newly eligible RNs NDNQI FALLS/1000 pt days National Mean PCU 1 0 1q09 2Q09 3Q09 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 22

23 NDNQI: FALL INJURY/1000 pt days National Mean PCU Q09 3Q09 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 Our last fall with injury was Q skin tear 2010 PG MD Engagement survey Org Wide Quality of RN staff 99 th percentile Staff concern for your pts 96 th percentile Overall rating of physician nurse collaboration 99 th percentile Lets hear from the PCU staff 23

24 Delivery Sustaining the Change Next steps AACN BEACON AWARD LNA Development Team LNA education orientation, mentoring Silent Night-HCAHPS Mentoring program t/o org. Research Scholar Med Admin Interruptions Publish & share with others In summary: There is no OZ! The yellow brick road. Discovering and appreciating the very best in each other.. 24

25 Employee Engagement Building from the positive core and creating a shared vision results in a solution oriented team that is engaged. Define-who you are Discover-what you have in common Dream-what is your shared vision Design-how to get there Deliver-every day improving on the previous This ongoing process creates a culture that feels empowered, respected and driving the change by asking how can we did it better tomorrow? Special gratitude to Debbie Mills RN, BSN, PCCN PCU Clinical Educator March 25, 1960-March 31, 2011 It is amazing how much you can accomplish when it doesn t matter who gets the credit. Questions? I am willing to share any materials presented today please send me an jmarkowski@rrmc.org Subject Employee Engagement 25