Healthcare Transformation & Innovation: Nurse Leader Perspectives

Transcription

1 San Diego Summit October Healthcare Transformation & Innovation: Nurse Leader Perspectives Dave Hanson, MSN, RN, ACNS-BC, NEA-BC Providence Health & Services Southern California Regional Director of Nursing Practice, Education & Professional Development October 13, 2016

2 Describe the key role nurses play in today s healthcare environment. Learning Outcomes Identify seismic shifts in nursing and healthcare. Review the key messages from the Institute of Medicine (IOM) Report -- The Future of Nursing: Leading Change, Advancing Health. Discuss the structures and processes within Providence Health & Services Southern California to advance Nursing s agenda.

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4 Healthcare is held together, glued together, enabled to function by the nurses. -- Lewis Thomas

5 Nursing s Pivotal Role Nursing profession has grown from 3.1 million registered nurses to 3.6 million nationwide and according to the American Nurses Association this number is still growing Nursing is nation's largest healthcare profession

6 Nursing s Pivotal Role For the 13 th year, nurses have been ranked as the most trustworthy profession in the annual Gallup Honesty & Ethics Poll An overwhelming 80% of Americans rated nurses honesty & ethics standards as either high or very high 15% points above any other profession

7 The Times They Are a-changin

8 Seismic Shifts: Practice Outcomes focus Cognitive work Safety & quality Expanded scope of practice Nurses as equal partners Evidence-Based care Nursing Research

9 Seismic Shifts: Education Research linking Nursing education to patient outcomes suggests the need for more highly educated nursing workforce

10 Educational Preparation Matters International Journal of Nursing Studies (June 2009) found significant association between the number of baccalaureate-prepared RNs on cardiac care units & in-hospital mortality Data revealed 4.9 fewer deaths per 1,000 patients on ICUs staffed with higher percentage of nurses with bachelor s degrees

11 Educational Preparation Matters Health Services Research (August 2008) found nursing education level was significantly associated with patient outcomes Data found RNs prepared at baccalaureate-level were linked with lower mortality and failure-to-rescue rates

12 Seismic Shifts: Economic & Political Healthcare 17.2% of gross national product $2.8 trillion on healthcare costs Balancing costs with quality & safety Patient Protection and Affordable Care Act Move from volume-based to value-based care Accountable Care Organizations

13 Seismic Shifts: Economic & Political Shift in focus from individual-level to population health Adoption of the Quadruple Aim as a compass to optimize health system performance

14 Seismic Shifts : Socioeconomic Technology expansion CMS Medicare and Medicaid Meaningful Use Transparency / Public reporting California Healthcare Compare Medicare.gov Hospital Compare California Quality Care

15 Seismic Shifts: Socioeconomic Disruptive innovation Coined by Harvard professor Clayton Christensen in his research on the disk-drive industry and later made popular by his 1997 book The Innovator s Dilemma Phenomenon by which an innovation transforms an existing market or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost are the status quo

16 Institute of Medicine is an independent, nonprofit organization IOM functions in adviser capacity to the nation to improve health Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine The Future of Nursing: Leading Change, Advancing Health report released October 5, 2010 What roles can nursing assume to address the increasing demand for safe, high-quality and effective health care services? Produced four key messages & eight recommendations One of the most-viewed online reports in IOM history

17 What s important here is that we are educating nurses better for wider responsibilities. -- Donna Shalala, Chair, IOM Future of Nursing Committee & President, University of Miami

18 IOM Report Key Messages Nurses should practice to the full extent of their education & training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the U.S. Effective workforce planning & policy making require better data collection & information infrastructure.

19 IOM Recommendations Physicians, nurses and other health professionals work in a teambased model of care delivery Increase the proportion of nurses with BSN, MSN and doctorate degrees Implement nurse residency programs Promote life-long Prepare nurses to lead improvements in healthcare quality, safety, access and value Interprofessional education, training and practice Nurses reflect patient population in terms of gender, race and ethnicity

20 Everyday throughout the Providence Health & Services Southern California Region our 6000 nurses make a significant difference in the lives of patients and contribute greatly to advancing our mission. Kathy Harren, MSN, MHA, RN, NEA-BC Providence California Regional Chief Nursing Officer

21 Vision: To inspire excellence and empower innovation to transform professional practice through education, research, evidencebased practice and technology. Developed on October 18, 2011 By CNOs, RCNO, Educators & Clinical Informatics

22 Education & Professional Development Dave Hanson, MSN, RN, ACNS-BC, NEA-BC Mary Olivas, MSN, RN, CEN Transition Into Practice (TIP) Dr. Jan Keller-Unger, PhD, MS, RN, CENP Debra Stillwell, MSN, RN, OCN Nursing Research & Evidence-Based Practice (EBP) Dr. Sherri Mendelson, PhD, RNC, CNS, IBCLC Nursing Institute Kathy Harren, MSN, MHA, RN, NEA-BC Regional CNO Patient Care Orientation (PCO) Lydia Wong, MSN, RN Clinical Education Affiliation Agreements Kathy Harren, MSN, MHA, RN, NEA-BC Dave Hanson, MSN, RN, ACNS-BC, NEA-BC Clinical Practice Standards (CPSs) Dave Hanson, MSN, RN, ACNS-BC, NEA-BC Carol Miles, MS, RN Rose Pelikan, MSN, RN, CNS

23 Individually we are one drop, but together we are an ocean. -- Ryunosuke Satoro

24 PH&S Southern California Region Professional Practice Model

25 Education Approach to Practice Changes

26 Nursing Institute Accomplishments Clinical Practice Standards Domain PolicyStat deployment across 6 ministries in July 2015 Migrated more than 5,500 clinical practice standards to PolicyStat Dave Hanson, MSN, RN, ACNS-BC, NEA-BC serving as Co- Lead of system-wide Nursing Clinical Decision (CDT) Evolved organizational structure development Universal Focus Team Infusion, Transfusion, Lines & Device Team Specialty Teams (e.g., Glycemic Management, etc.)

27 Nursing Institute Accomplishments Clinical Practice Standards Domain (Continued) Regional standardization of more than 70 clinical practice standards IV Insulin Infusion Protocol Pressure Ulcer Prevention Plan of Care Catheter Associated Urinary Tract Infection Prevention Bundle Central Line-Associated Bloodstream Infection Prevention Bundle Clinical Alarms Assessment and Documentation Guidelines Medication Reconciliation Critical Elements of Patient Hand-Off

28 Nursing Institute Accomplishments Clinical Education Affiliation Agreements Domain Manage 125 agreements across 6 ministries Transition Into Practice (TIP) Domain Didactic content includes 11 clinical specialties Online curriculum AACN, AAP, AORN, AWHONN, ENA & ONS Integrated clinical simulation scenarios 732 through January 2016 cohort 2016 TIP programs to include January, April & September Exceptional outcomes 95% retention rate one-year post-tip >82% retention rate two-year post-tip

29 Clinical Simulation

30 Nursing Institute Accomplishments Nursing Research & Evidence-Based Practice Domain Annual Providence Southern California Nursing Institute Evidence-Based Practice & Research Day 4 th annual symposium held in September 2016 had more than 110 participants Dr. Sherri Mendelson, PhD, RNC, CNS, IBCLC is part of systemwide Nursing Research Council Patient Care Orientation (PCO) Domain Successfully standardized PCO across all 6 ministries Optimization Phase 3 now underway

31 Nursing Institute Accomplishments Nurse Leadership Development 100 individuals successfully completed the Regional Charge Nurse Course in 2014 Provided total of 5 Preceptor Courses in 2014 and 5 again in 2015 Successfully launched the Mentorship Program with 20 mentor & mentee partners

32 Don t wait for something big to occur. Start where you are, with what you have and that will always lead you into something greater." -- Mary Manin Morrissey

33 Dave Hanson