2017 National DNP Conference. Breakout Session: Wednesday, September 13, :00 11:00 THE NEW STANFORD HEALTH CARE

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1 THE NEW STANFORD HEALTH CARE 2017 National DNP Conference Breakout Session: Wednesday, September 13, :00 11:00 Next in Line: Developing Future Nurse Leaders Using an Evidence-Based Succession Planning Framework Janette V. Moreno, DNP, RN, CCRN-K, NEA-BC Anita Girard, DNP, RN, CNL, CPHQ, NEA-BC Stanford Health Care Patient Care Services Stanford, California, USA

2 No Conflict of Interest Disclosure 2

3 The Next in Line

4 Learning Objectives } Replicate the succession planning integration into an organization s existing shared governance.

5 Who we are } Non profit Academic Medical Center } #1 Hospital in California } #15 US Best Hospitals } Licensed beds } Clinics 147 } Ambulatory Care Visits 1.2M } Admissions 28,000 per year } Emergency visits 73,000 per year } Third Magnet Redesignation

6 Background Knowledge } We are challenged with nurses unprepared to assume key leadership positions. IOM report: Largest workforce with the greatest potential to lead Nurse Manager: Complex role New Nurses: Lack interest in role Predicted nursing shortage 6

7 Nursing Workforce Forecast The forecasted growth of the nursing profession may not meet future needs! 2.7 million FTE RNs million FTE RNs million anticipated retirement % (333,000) managers 17% predicted growth in ,000 Managers by 2024

8 Cost of Turnover Cost to cover vacant position: Cost of productivity ramp-up: Soft Costs: loss of productivity: $80,000 $68,800 Cost to fill vacant position: $30,247 Cost of onboarding & orientation: $58,260 $20,860

9 Intended Improvement Decrease number of days to fill vacant position by 50% (215 to 100 days) Increase internal promotion of clinical nurses to formal leadership positions Integrate evidence-based succession planning into existing Shared Leadership Council

10 Review of the Evidence Search Strategy: English Articles Search Criteria Interchangeable Terms Succession Planning Succession Management Talent Management Leadership Development Professional Development Career Planning Replacement planning Related Terms Definition:! Succession planning is a strategic process involving identification, development, and evaluation of intellectual capital, ensuring leadership continuity within an organization (Titzer and Shirey, 2013)!

11 Review of the Evidence The succession planning framework by Titzer & Shirey (2013) guided the integrated review of evidence.

12 Review of the Evidence Barginere, et. al., 2013 Case Studies in the US Setting! Ponti, 2009 Wendler et.al., 2009 Abraham, 2011 Titzer et.al., 2014 Rush University Medical Center Northern Michigan Regional Hospital Illinois Memorial Medical Center Mayo Clinic Rochester, Minnesota St. Mary s Medical Center Southwestern Indiana Rothwell s Seven-Pointed Star Model for managers to nurse executives Gundersen Lutheran health system s tiered competency model for all levels of nursing Developed an internship program for nurse managers From the frontline staff to the nurse managers; used the novice-toexpert theory From the frontline staff to the nurse managers; used novice-to-expert theory

13 Review of the Evidence Case Studies in US Health Systems Bernard, 2014 Lewis, 2009 Centura Health System Baylor Health Care System Blended learning residency program for nurse executives in 23 facilities Five-stage development cycle for managers to top executives in 15 facilities

14 Review of the Evidence Tertiary Hospitals in Sydney, Australia Brunero et al., 2009 Manning et al., 2015 Prince of Wales St. George Hospital Frontline staff to nurse manager based on literature review Frontline line staff to nurse manager for nursing/midwifery unit management program

15 Stanford Three-Step Succession Planning Conceptual Framework

16 Kanter s Structural Empowerment Theory Integration of the succession planning framework within the Shared Leadership Councils, the epitome of structural empowerment. Power Structures Formal power Informal Power Empowerment Structures Access to: Opportunity Resources Information Support Impact on Employees Control over practice Autonomy Shared decision making Work Effectiveness Job Satisfaction Organization Commitment Unit Effectiveness Quality of care Patient safety Influence Leads to Results in

17 Assessment Phase } Visionary leadership } Culture of professional advancement & leadership development } Coaching & mentorship environment

18 Assessment Phase Stanford Operating System (SOS) Professional Practice Model (PPM) Strategic alignment with SOS and PPM, which embodies the core values and ethical principles within the strategic interventions of the project.

19 Assessment Phase

20 Planning the Intervention Strategic Alignment Workgroup Teamwork and Collaboration Integrated in strategic plan Executive leadership Council SLC Coordinator Chief Nursing Officer Magnet Program Director Director of Practice & Education Director of Talent Acquisition Partnership with the frontline staff Shared Leadership Councils

21 Planning the Intervention Strategic Plan SWOT Literature Review A3 development

22 Planning the Intervention Scope of the Project Pre- Assessment Survey Leadership Competency

23 Planning the Intervention Participant perception Leadership competency Internal processes Financial growth

24 Strategic Communication Clinical Nurses Rewards & Recognition Managers Leaders as teachers Interprofessionals Support & resources Executive Leaders Balanced scorecard

25 Implementation Integration within the Shared Leadership Councils! Leadership Development Sessions Coaching Mentorship Experiential Learning

26 Implementation Integration of Strategic Interventions within Shared Leadership Councils

27 Strategic Interventions Leadership Development

28 Implementation! Leadership Development Sessions Model of the Professional Role! Transformational Leadership S t a n f o r d Operating System Magnet principles Evidence-Based Practice Research IRB process Literature review Leader Scientist Practitioner Transferor of Knowledge C o n t i n u o u s P r o c e s s Improvement ActiveDaily Management MeetingFacilitation Delegation E f f e c t i v e Communication Abstract Writing & Publication Presentation Skills Completing an A3

29 Implementation

30 Coaching/Mentorship! Implementation Advisors Housewide Chairs Unit- Based Chairs Council Member s UB chair 1 UB chair-elect 1 HW chair 1 Clinical Practice or Management Accountabilities UB chair 2 UB chair 3 UB chair-elect 2 UB chair-elect 3 HW chair 2 UB chair 4 UB chair-elect 4

31 Outcomes Monitoring Phase

32 Method of Evaluation A Balanced Scorecard Participant Perspectives Leadership Competency Structural Empowerment Participation Leader Scientist Practitioner Transferor Internal Processes Financial Measures Leadership Bench Strength Number of Days to Fill Internal Promotion Turnover Cost

33 Results Participant Perception 88% 80% 96% Project Participation (p 0.04) Committee Participation (p 0.03) Perception as a Leader (p ) Indicate increase participation in more than one house-wide project Indicate increase participation in more than one house-wide committee. Indicate increase in participant perception as a leader

34 Results Structural Empowerment I am empowered to do my job effectively because I have access to: Information (p 0.05) Support (p 0.02) Resources (p 0.02) Opportunities for growth and learning (p 0.03) Chi square test (p < 0.05)

35 Results Leadership Competency LEADER PRACTITIONER Lead & Facilitate a Meeting Delegate & Distribute Work Use of Shared Decision Making Domain Action Request Management Complete A3 tool Conduct Continuous Process Improvement (PDSA) 100% (p 0.117) 100% (p 0.02) 97% (p 0.003) 87% (p 0.004) 87% (p 0.178) 82% (p 0.001) Chi square test (p < 0.05)

36 Results Leadership Competency SCIENTIST & TRANSFEROR OF KNOWLEDGE I question what I am doing. I systematically investigate I measure an outcome. I make a decision. I disseminate within and outside my organization (4.08, 4.13) (p 0.776) (3.56, 3.82) (p 0.208) (3.51, 3.82) (p 0.142) (3.67, 4.05) (p 0.059) (3.87, 4.16) (p 0.143) Chi square test (p < 0.05)

37 Results Internal Processes Leadership Bench Strength Professional Nurse Development Program Clinical Nurse III/IV Clinical Nurse III/IV

38 Results Internal Processes Number of Days to Fill Asst. Patient Care Manager Position ( )

39 Results Financial Measures 21% Internal Promotion 89% Decrease in Number of Days to Fill 50% Return of Investment 15 Asst. Patient Care Managers (APCM) 16 Other formal leadership positions 215 days to 23 days number of days to fill vacant APCM positions Total cost savings $3,750,000 from internal promotion of 15 APCMs

40 Insights from SLC members in Asst. Nurse Manager Role Face time with nurse leadership made me feel heard and gave me confidence to keep working to improve things. Thank you to our leadership for always making time to attend! I appreciated having a seat at the table, which built my confidence. Opportunities & exposure (SLC) have improved communication skills and engagement and made me better at facilitating, delegating, and making quick decisions. Skills Acquisition Seeing the big picture

41 Summary Evidence-based Succession Planning framework Structural Empowerment Theory Strategic Interventions within Shared Leadership Councils Balanced Scorecard

42 Conclusion nil Next in Line (nil): Preparing the nurse leaders of tomorrow

43 Thank you Questions? Are you ready to lead the way? 43

44 Contact Information Janette Moreno, DNP, RN, CCRN-K, NEA-BC Program Manager for Nursing Excellence Anita Girard, DNP, RN, CNL,CPHQ, NEA-BC Magnet Program Director Stanford Shared Leadership Council 44