AT THE NEXUS OF STRATEGY AND IMPLEMENTATION SCIENCE: WORKFORCE, REFORM, AND NURSING

Transcription

1 AT THE NEXUS OF STRATEGY AND IMPLEMENTATION SCIENCE: WORKFORCE, REFORM, AND NURSING National FORUM of State Nursing Workforce Centers Hartford, CT June 12, 2014 Michael R. Bleich, PhD, RN, FNAP, FAAN

2 HEALTHCARE TRANSFORMATION IS SERIOUS BUSINESS

3 The Report STRATEGIC BLUEPRINT: Scope of Practice Learning & Advanced Education for Societal Benefit Workforce Development & Data Capture Expanded Competencies FULL partnership with physicians & others to redesign the healthcare system Visit to view the report

4 ADVANCES, RETREATS, STRATEGY Advances are real: Workforce Public acceptance Enhanced roles Scope of practice Educational standards Science-base for practice Retreats are equally real: Workforce imbalance with public need Infrastructure issues Contextual knowledge of the system lacking Cohesion within the discipline Public knowledge

5 NURSING DEFINED (BLEICH, AHNA BEGINNINGS, FEBRUARY, 2012, P. 5) Nurses must unify to express this message: we are the sole health discipline that approaches health, disease, illness and chronic care management with knowledge drawn from a model of holistic care. We make decisions, provide and orient treatments, and take other critical actions based on independent observations and team-based plans. We are the sole discipline that hardwires the perspective of the patient/client within the context of family and community, and care is coordinated and managed according to this context.

6 EACH DISCIPLINE HAS A LENS FROM WHICH THEY SEE & ASSIST PATIENTS Nursing: holistic, health & disease, family & community Social worker: family therapy & social support Physical Therapist: mobility expert Pastoral care: for the spirit Physician: science of disease & cures Psychologist: individual therapy of the mind/meaning

7 THE ROLE OF POPULATION HEALTH Curley states: There is a growing awareness of the need to provide evidence-based care and to design interventions that have a broad impact on the populations that nursing serves. Population health obligates healthcare professionals to implement standard interventions, based on the best research evidence, to improve the health of targeted groups of people. Ann L. Cupp Curley, ed. In Population-based Nursing: Concepts and Competencies for Advanced Practice. 2012, Spring Publishing Company

8 Geographic? Disease/Illness category? Socio-economic? Cultural/Ethnic? Age? Gender? Urban/Rural Other? HOW TO DEFINE POPULATION?

9 CALIBRATING INFORMATION TO BALANCE BOTTOM LINES

10 ANALYTIC STAGES MODEL Analytically impaired Localized analytics Analytical aspirations Analytical companies (schools?) Analytical competitors (Davenport and Harris, Competing on Analytics)

11 Analytics and a Reformed Health System REQUIRES: PhD/DNPs who can: Engage with other organizational, statistical, and complexity scientists Shape clinical care delivery systems Enter into the organizational decision-making arena Doctoral Level expertise to answer: Why is this happening? What if these trends continue? What happens next? What s the best that can happen?

12 FACILE USE OF DATA Maneuver Internal Clinical Data Bases drawn from patient populations Integrate Global External Data Bases to compare/ contrast (Cochrane Collaboration, The Joanna Briggs Institute, Centre for Reviews and Dissemination) Marketing and Census Collections Time compression in decision-making Science is outdriving the art of care mass customization

13 EXAMPLE ED admission projects LOS Aggregates to compare patterns of disease/illness trajectory Projects staffing numbers and competencies needed Makes seasonal adjustments Determines economic impact within various setting options Brand loyalty projected The capacity is largely present today. But systems don t integrate; human modelers needed.

14 BLEICH MODEL FOR WORKFORCE ANALYSIS Supply Data captured within reasonable geographic clusters Entering Students Retiring Nurses Attention to mid-careerists

15 BLEICH MODEL FOR WORKFORCE ANALYSIS Demand Data Every person needs access to a nurse Not every need aligns with paid positions Competition in health systems leads to challenges in projecting paying positions Consider care given outside of the system and try to recapture

16 BLEICH MODEL FOR WORKFORCE ANALYSIS Competency Determination Without knowledge of competencies needed, a genericallyprepared workforce will not solve issues surrounding need Competencies are nested systems and workforce center leaders must set the level of development needed Competency development may not be suited, in all cases, for academics unless there is change in the competence of faculty and facility in adapting curricula

17 BLEICH MODEL FOR WORKFORCE ANALYSIS Staging the Workforce Pipeline Development is static, relatively speaking, in a rapidly changing environment ACA makes health system leaders wary of job creation, elimination or replacement The role of labor is increasingly complicated The role of workforce centers can be at risk based on messaging around shortages, using only numbers

18 IN MY ESTIMATION, THERE IS NO WORKFORCE PLAN WITHOUT THE FOLLOWING ELEMENTS: Supply Demand Competency Assessment Staging Interprofessional Resources

19 IN SUMMARY Your work has NEVER been more critical The depth and breadth of work is becoming more clearly defined MUST become analytically driven and have staff competencies that can model predictive capacity MUST create models that synthesize variables BEYOND supply and demand

20 Contact Information Michael R. Bleich, PhD, RN, FNAP, FAAN President, Maxine Clark and Bob Fox Dean and Professor Goldfarb School of Nursing At Barnes-Jewish College 4483 Duncan Avenue St. Louis, MO Phone: