Nursing Leadership (Directorate's) - Key to Nursing Excellence
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1 Nursing Leadership (Directorate's) - Key to Nursing Excellence Abstract ID # Date/Time: Friday, September 26, 2014 ; 10:30 AM Session Title: Developing Clinical Nursing Leaders Dr. Prof. Jothi Clara J. Micheal, MSc N., RN RM., MBA HA., PhD N Group Director Nursing (GDN), Nursing Directorate (ND) Global Hospitals Group (GHG), India (Chennai, Hyderabad, Bangalore & Mumbai)
2 Learner objectives: Discuss the process of achieving Nursing Excellence through Nursing Leadership (Directorate's) by applying the GHC s framework on accreditation preparedness Key to Nursing Excellence Employer: Global Hospitals Group, India Acknowledgement: Dr. K. Ravindranath, Chairman & Managing Director Global Hospital Group, India Dr. G. Raja Sekhar, Head of Organization, Global Health City Chennai 1
3 EXCELLENCE IN NURSING Excellence of Nursing is measured in terms of quality of nursing care that is appropriately delivered at the right time and it is a continuum that enables one to compete with self (person/department/directorate) and propel forward. Nursing care excellence is achieved by fine balancing cost, quality & safety with Leadership and Empowerment 2
4 MEASURABLE OBJECTIVES OF NURSING DIRECTORATE 1. Increase patients & RNs satisfaction 2. Reduce ALOS (Average Length Of Stay) 3. Increase patient turnover rate 4. Lean waste and maximize resource utilization 5. Retain and develop nurses at all levels 6. Develop ethical and error prevention culture 3
5 MEASURABLE OBJECTIVES OF NURSING DIRECTORATE 7. Empower Nursing and develop Leadership 8. Build Image and popularity (Branding) for hospital and profession 9. Build new knowledge / innovations through projects and researches 10. Establish Global recognition through International collaboration and Memorandum of Understandings with Institutions of Repute. 4
6 ACCREDITATION IN NURSING INDIA NANE (National Accreditation for Nursing Excellence) - Conceptualization similar to Magnet Status Reshaping Nursing Profession in Indian Hospitals, on January 6 th, 2011 Representation from Quality Council of India, National Accreditation Board for Hospitals and Health care Providers, Global Group of Hospitals, State Nursing Council & 11 Nursing Leaders across India 5
7 EVOLUTION of NANE to NABH STANDARDS for NE First Nursing core committee Meeting Jan 6, 2011 National conference on Reshaping Nursing Profession in Indian Hospitals First draft for NANE Jan Feb and submitted to Quality Council of India on Feb Second, third Nursing core committee meeting - NABH Head office 2013 to build standards at Quality Council of India Fourth core committee meeting - Feb 2014, Launched as standards by NABH. First plan of Implementation (POI) is tentatively planned on October
8 GHC s FRAMEWORK A framework was conceptualized at GHC, applied and evaluated over the past 3 years incorporating Nursing, Medical and Operational excellence (TRIO concepts of HCO) to improve clinical outcome, patient safety and satisfaction of both patient and staff with a fine balance between cost, quality and safety 7
9 INPUT, THROUGHPUT, OUTPUT INPUT Structural Empowerment Transformational Leadership Vision, Mission and Objectives Philosophy & service excellence goal THROUGHPUT Clinical Excellence Continuous Quality Improvement Preventive and Proactive Approach Evidence Based Practice Error Prevention Ethical culture OUTPUT Error reporting & reduction Patients satisfaction & RNs job satisfaction Nursing care standardization Care, Quality & Safety 8
10 CQI STEPS IN THROUGHPUT 1. Identify standards of nursing care excellence set by accreditation body 2. Explore Gaps by matching existing practice with identified standards 3. Categorize gaps, identify relevant measures and metrics 4. Refine SOP s / policies Identifying strategies to fill gaps & Prepare quality task force 5. Monitor Quality Indicators / Conduct CQI, Nursing Care & Multidisciplinary Clinical audits 6. Raise the Bar of Quality indicator to reach higher level of Excellence 7. Benchmark care excellence 9
11 Error reporting & reduction Care, Quality & Safety Nursing care standardization Patients satisfaction & RNs job satisfaction Fig 1: GHC s Framework on Accreditation Preparedness Key to Nursing Excellence Author: Dr. Prof. Jothi Clara J Micheal, Group Director - Nursing, Global Hospitals Group, India Clinical Excellence Continuous Quality Improvement Preventive and Proactive Approach Evidence Based Practice Error Prevention Ethical culture Explore Gaps by matching existing practice with identified standards Identify standards of nursing care excellence set by accreditatio n body Categorize gaps, identify relevant measures and metrics Operational Nursing Nursing Care Excellence TRIO Concept of HCO Medical Refine SOP s/policies Identifying strategies to fill gaps & Prepare quality task force Nursing Administrators Nursing Middle Managers Nurses Transform Motivate Facilitate Evaluate Support Decide Direct Lead Monitor Quality Indicators/ Conduct CQI, Nursing Care & Multidisciplinary Clinical audits. Update Comply Sustain Perform Delegate Innovate Participate Self assess NURSING CARE EXCELLENCE CONTINUUM (INITIAL TO HIGHER LEVEL) Raise the Bar of Quality indicator to reach higher level of Excellence Benchmark care excellence Philosophy & service excellence goal Vision, Mission and Objectives Transformational Leadership Structural Empowerment 10
12 EVOLUTION OF NURSING QUALITY INDICATORS GHC 2014 : 65 Nursing Quality Indicators NABH 2014 : 23 Nursing Quality Indicators GHC 2013 : 63 Nursing Quality Indicators NABH 2013 : 23 Nursing Quality Indicators GHC 2012 : 50 Nursing Quality Indicators NABH 2012 : 20 Nursing Quality Indicators GHC 2011 : 10 Nursing Quality Indicators NABH 2011 : 10 Nursing Quality Indicators 11
13 OUTCOMES -1 After reinforcement of Richard Morgan s Early Warning Scoring system among RNs there was a rapid decline in Code blue occurence after 2012 Fig 2: Frequency distribution of Nursing Quality indicators at GHC, JAN(2010)-AUG(2014) 12
14 OUTCOMES -2 From 2012 there was 100% compliance to medication chart checking by MOM & Clinical Pharmacist Fig 3: Percentage Distribution of Nursing Quality indicators at GHC, JAN(2011)-AUG(2014) 13
15 OUTCOMES -3 After training and education of Nursing Bundle Care for VAP, CLABSI,CAUTI, SSI among the RN s showed a drastic decrease in HIC indicators Fig 4: Percentage distribution of HIC Quality indicators at GHC, JAN(2010)-AUG(2014) 14
16 OUTCOMES -4 After Improving the Empowerment among Nurses, resulted in improvement in implementing patient safety goals Fig 5: Percentage distribution of Self reporting, Error capturing & Nursing Empowerment among RNs at GHC, JAN(2011)-AUG(2014) 15
17 OUTCOMES -5 Application of king s goal attainment theory enhanced mutual goal setting, communication and satisfaction Fig 6: Percentage distribution of RNs Satisfaction & Patient s Nursing Care Satisfaction at GHC, JAN(2012)-MAY(2014). 16
18 OUTCOMES -6 DVT VAP Extravasation IV contrast Clinical Audit QIP PRE VAP NCP Job Satisfaction etc Intake & Output Audit IV Line compliance audit Fall risk awareness audit Hand washing compliance Audit Nursing care Audits Hospital Committee Membership Mortality & Morbidity Committee Pharmacy, OT, HIC, Grievence handling Committee Patient Safety Committee 17
19 2013- NABH ASSESSORS REPORT ON NURSING 18
20 PROGESS Replication of the application and evaluation of GHC s Framework on Accreditation preparedness - A key is on progress in other group hospitals at Bangalore, Hyderabad and Mumbai 19
21 REFERENCE: 1. NABH (2014), Standards for Nursing Excellence, 1 st edition, Volume 1, August NABH (2011), Guidelines for Excellence in Nursing, Issue 1, October. 3. Jothi Clara, Joy Kezia, Jincy Joseph, Ranjitham Anderson (2011), Journal of Nursing Trendz, Volume 2; Issue 1; September- December. 4. Jothi Clara (2011), Report on Magnet status at Indian Hospitals, Nursing Journal of India, Volume. CII No. 9, September, Nursing Core Committee, NABH, (2011), Nursing Accreditation for Nursing Excellence, Pillars of Nursing Excellence First Draft, February
22 Global Health City, Chennai
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