Highly Mobile, Flexible, Competent and Engaged Using a Multipronged approach to improve staffing in a multicampus nursing resource pool.

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1 Highly Mobile, Flexible, Competent and Engaged Using a Multipronged approach to improve staffing in a multicampus nursing resource pool. Session ID

2 Objectives By attending this presentation the learner will: Describe components of an organizational framework designed to address vacancy, traveler costs and engagement Discuss the strategies used to implement a new graduate nurse cohort into a resource pool. Discuss the importance of engaging front line staff in strategy development and program success.

3 Outline Background Project goals Design framework Design phases Results Lessons learned & next steps

4 Organization Overview Yale New Haven Health Pediatric Units within system campus Yale New Haven Hospital - 2 campuses

5 Background Acquisition of a 500 bed Catholic community hospital approximately six blocks away created campus 1541 bed hospital. Children s hospital unit 26 miles away 61 IP units Three major ED locations. Consolidation, expansion and realignment of services

6 Organizationally- Why Now? Integration strategy Recruitment Trends Multi-campus service Workforce flexibility Cost and Value State economy Ambulatory growth

7 Design a single innovative evidence based infrastructure Project Goals Increase Flexible workforce Improve stakeholder satisfaction Staff engagement Technology standardization/applications Reporting tools/dashboard Phases Phase I Phase II Phase III Scope In Patient Units Ambulatory Specialty System Resource Pool 7

8 The Organizational Design Framework Determining the Design Workflow Designing the Resource Center Developing the Details Implementing the New Design Mar 2014 Apr 2014 June 2014 Sept 2014 Oct 2014 Craig, W.T.; & Rains, J.(2007) Linking Strategy to Structure: The Power of Systematic Organization Design. Organization Development Journal, (25)2,p

9 Phase 1 Design Phase Design team SWOT Determining Determining the Design the Design Framework (CNO/CFO) Project Plan Subteams Design Globally, Operate Locally Right Nurse, Right Patient, Right Time 9

10 Design Team Executive Sponsor CNO CFO YNHHS Project Sponsor VP/ACNO Project Lead Nursing Director, Team Roles: Nursing Resource Center Project management Financial analysts Front line staff (CN) Patient Service Managers Nursing Director liaison Nursing Business Office Data Personnel Information Technology Human Resources Compensation Off shift Nurse leadership Nursing Director of Education Ambulatory representative Design Globally, Operate Locally Right Nurse, Right Patient, Right Time

11 Phase 1 - SWOT Analysis Strengths Weaknesses Opportunities Threats Support from Sponsors Skilled nurses & UAPs Skill mix Nursing Scheduling policies HR policies New grads Pool Policy adoption Consistent metrics Communication plan Proactive planning Managing expectations Experience with multi-location assignment Flexibility Technology Innovation- New program development Reduce open shifts Reduce agency staff Available resources Key Stakeholder Support Customer confidence Reluctant to Change Long implementation Financials 11

12 Phase 2 - Design Phase Focus Areas Define Scope & Service Refine current roles and responsibilities Concept of Service Define Roles Develop Comm. Plan Review scheduling and staffing policies Unit Scheduling Process Resource Center Design Focus Areas Structural Design Change language from Pools to Communities Standardize, revise staffing standards, policies, and practices Develop recruitment strategy for center Implement new nurse cohort program Evaluate strategies for flexible staff Hiring and Retention Strategy Data Analytics Complete scheduling standardization Develop reporting tools 12

13 Developing the Details SWAT Team Phase 2- Organizational Structure Nursing Resource Operations Center (203 FTEs) Deployment of Resources Business Function Clinical Staff IV Team Unit Scheduling Data Management Traveler Recruitment and Oversight Technology, oversight/mgt. All staff working in this unit will be fully engaged in the hospital and nursing strategic plans and will provide the highest customer service to the patient care areas. 13

14 Phase 2 Design Phase Hiring and Retention Strategy Designing the Resource Designing the Center Resource Center Data Analysis Sub-teams Charters Defining Focus Areas Stakeholder agreement 14

15 Phase 2 Hiring and Retention Strategy Sample Data Analysis Service Line Sick FTE's % Service Line Total Hours FTE % Behavorial Health - 0% Behavorial Health 1, % Children's % Children's 6, % ED 0.6 2% ED 4, % HVC & Transplant % HVC & Transplant 34, % Medical Critical Care % Medical Critical Care 29, % Medicine % Medicine 72, % Muscoskeletal & Neurosciences % Muscoskeletal & Neurosciences 17, % Oncology 0.4 1% Oncology 9, % Surgery % Surgery 29, % Other - 0% Other 48, % Total Sick FTE's % Total Hours Cross Charged 253, % Comparison of Request vs Deployed against budget 3/18/

16 Beds Phase 2 Design Phase Hiring and Retention Strategy Sample Data Analysis YNHH Combined Service Lines Graph : Sample Data Analytics Census Trends % 3% 9% 3% 9% 8% Surgery Neuro & Musculoskeletal Medicine Medical Critical Care Heart & Vascular Smilow Cancer Hospital Behavioral Health HVC, Medicine, MICU's & OBS Units SRC & YSC Budgeted ADC 8% Children's Hospital 26% Bridgeport Hospital Women's Services 500 7% Observation % 6% Total Versus Available Beds Nurse Recruitment Trends YNHH Total Beds Avail Beds EXP Nurse Service Lines New Grad

17 Phase 2 Design Phase Hiring and Retention Strategy Sample Data Analyses Agency Cost Premium spend Overtime spend 17

18 Developing the Details Phase 3 Design Details Hiring and Retention Strategy Highly Mobile & Flexible Environmental Scan Compensation New Nurse Cohort Per-diem pool Multigenerational Implications 18

19 Developing the Details Phase 3 Design Phase Methods and Milestones Evidence review On-line consultation Process Mapping Brainstorming Voice of customer Updated as of Project Sponsors: Sue Fitzsimons, Jim Staten Project Chairs: Ena William, Janet Marseglia shaded cells indicate the week is over Nursing Resource Center Project Plan Purpose: To develop a single evidence based infrastructure of nursing resource management for the purpose of ensuring the efficient use and deployment of resources to the patient care areas. Green= Complete Yellow cells=at risk of not completing as scheduled Team # Activity ACTIVITY Members Role WK1 10/6 WK2 10/13 WK3 10/20 WK4 10/27 WK5 11/3 WK6 11/10 WK7 11/17 WK8 11/24 WK9 12/1 WK10 12/8 red cells = project off schedule WK11 12/15 WK12 12/22 WK13 12/29 purple cells = extension needed to get on schedule WK14 1/5 WK15 1/12 WK16 1/19 WK17 1/26 WK18 2/2 WK19 2/9 WK20 2/16 WK21 2/23 WK22 3/2 WK23 3/9 WK24 3/16 WK25 3/23 WK26 3/30 WK27 4/6 WK28 4/13 WK29 4/20 WK30 4/27 IMPL DATE Nursing Resource Center Project Plan XX WEEKS Timeline chart 1 Concept of Service Ena William Chair/Team Leader a Define Scope of Service Janet Marseglia Chair/Team Leader b Operational Functions c Delineate user Expectation d Ensure the design supports the change the changing healthcare delivery environment 2 Structural Redesign Down Dowd Chair/Team Leader a Create a single department Rochelle Mikolinski Chair/Team Leader b Change Language from Pools to Communities Trina Boyce Chair/Team Leader c Evaluate Deployment Process d Define: Customer/Job Descriptions/Roles/Reponsibilities e Define: Job Descriptions/Roles/Reponsibilities/Compensation f Geographical Location g Technology Frame Work Frame Work Design Details Implement Design Details Implement Tracking and monitoring of progress 3 Data Analytics Joanne Reilly Chair/Team Leader a Complete KAS Implementation Dave Annunziata Chair/Team Leader b Identify and Define Appropriate Metrics c Develop Dashboard d Develop Dynamic Tracking Tools and Reports e Open Shift Bid Communication 4 Hiring Strategy Sheila Coonan Chair/Team Leader a Create a New Nurse Cohort Program Laura Jansen Chair/Team Leader b Develop Marketing Strategy c Evaluate Tiered Program d Compensation Review e Define traits for Highly Mobile, Flexible and Friendly Frame Work Frame Work Design Design Details Details Implement Implement Standard team charter template and 5 Unit Scheduling Process Joanne Reilly Chair/Team Leader a Clarify Roles and Responsibilities of Scheduler Pat Byrne Chair/Team Leader b c d Review Scheduling and Staffing Policy and Procedures Reevaluate Scheduler Workload and Service line Alignment Develop Performance Metric on Scheduling Processes Frame Work Design Details Implement reporting template 19

20 Developing the Details Phase 3- Design Details Graduate Nurse and Per-diem Pool Program Planning 20

21 Developing the Details Phase 3 Design Details Graduate Nurse Program C21

22 Developing the Details Phase 3 Design Details Graduate Nurse Program Interdisciplinary Planning Recruitment Selection Development Screening Criteria Hiring Event Interview process Orientation Plan Pre-screening Behavioral interview Standard questions Same day hiring decision Candidate Ranking Interview References Licensure verification Orientation Preceptors Mentors 22

23 Implementing the New Design Developing Developing the the Details Details Phase 3 Design Details Graduate Nurse Program Applicants Prescreened Recruitment event Behavioral based interviews Shadow Experience Debrief & candidate selection Single Day Event

24 Developing the Details Phase 3 Design Details Graduate Nurse Program Competent clinician Enthusiasm to precept new RN Preceptor Selection Models professional behavior Demonstrates positivity and is a team player New preceptor education Ongoing leadership support Preceptor Development Building competency and confidence AACN Mentorship Program 24

25 Developing the Details Phase 3- Design Details GN Orientation Cycle - What it Looks Like Final Transition Rotation 1 Initial Transition Rotation 2 Rotation 3 25

26 Implementing the New Design Phase 4 - Implementation Front line staff involvement Focus Team Member Interview, Shadow Orientation and Mentorship Lived Experience (Interview day & Lunch and learn) 26

27 Phase 4 - Implementation Define Scope & Service Refine current roles and responsibilities Concept of Service Define Roles Develop Comm. Plan Review scheduling and staffing policies Unit Scheduling Process Resource Center Design Focus Areas Structural Design Change language from Pools to Communities Standardize, revise staffing standards, policies, and practices Develop recruitment strategy for center Implement new nurse cohort program Evaluate strategies for flexible staff Hiring and Retention Strategy Data Analytics Complete scheduling standardization Develop reporting tools 27

28 Implementing the New Design Phase 4 Implementation, Per-diem Pool Design Flex Tiered Experience RN Program Compensation 1). Hours of commitment 2). New- Competency Pods/Communities Orientation Scheduling 28

29 Implementing the New Design Results New Graduate Nurse Identified additional resources with no added budget (17 CN positions) Recruitment of 41-FTE s 48% CN vacancy reduction in pool- despite additional FTEs added 100% BSN (supports 80% BSN by 2020) strategy Retention - 85% 29

30 Implementing the New Design Results Per diem Pool Flex Tiered Experienced Hiring of 38 flex (non-benefited) RNs Cross campus orientation and assignments Per-diem commitment compliance Avg. 143% Winter volume surge support 30

31 Implementing the New Design Additional Overall Results 21,840 additional hours deployed or 10.5 FTEs New model for service line recruitment Standardized Dashboard 25,000 hours agency reduction of approximately 12FTEs or 8% Potential of $900,000 savings reduction annualized in agency in agency use Standardized scheduling and open shift management systems Leadership realignment Employee engagement result above benchmark

32 Lessons Learned Right Sponsor Stakeholders Collaboration Voice of customer Staff engagement Let the data guide you validate the story Be open and flexible 32

33 Next Steps The Virtual Unit Service line model Ambulatory strategy System pool 33

34 Contact Information : Ena Williams, MBA/MSM, BSN,CENP, Vice President/Associate Chief Nursing Officer Janet Marseglia, MSN, RN CENP, Director Sheila Coonan MN,RN CNML, Patient Service Manager Laura Jansen, MSN, RN., Patient Service Manager Lois Peszke MSN RN CNS CMSRN, Service Line Educator Post inspiring moments from the conference to the mobile app! #AONE2016

35 References : Anderson, R., Ellerbe, S., Haas, S., Kerfoot, K., Kirby, K., & Nickitas, K. (2014). In J Mensik (Ed.), Excellence and evidence in staffing: A data-driven model for excellence in staffing (2nd Ed) Nursing Economic$, 32(3, suppl.), 1-36 Building a more flexible workforce. Retrieved on January 2016 from Craig, W.T.; & Rains, J.(2007) Linking Strategy to Structure: The Power of Systematic Organization Design. Organization Development Journal, (25)2,p Fitzpatrick, T., Trish, A., & Martinez Soto, E.(2013). Nurse staffing: The Illinois Experience. Nursing Economics, 31, (5), Kerfoot, K., Anderson,R., Douglas, K. (2013) Staffing Excellence in the Decade of disruptive Innovation in Health Care,, Nursing Economics, 31(5) Stanley,D. (2010), Multigenerational workforce issues and their implications for leadership in nursing, Journal of Nursing Management 18, p Schoessler, M., Waldo, M. (2006).The First 18 Months in Practice: A Developmental Transition Model for the Newly Graduated Nurse. Journal for Nurses in Staff Development, 22(2) p The highly productive organization, retrieved on January 2016 from

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