A New Age for Healthcare

Transcription

1 A New Age for Healthcare If you want to build a ship, don t drum up people to gather wood, saw it and nail the planks together. Instead, build in them a passionate desire for the sea.

2 The Future of Professional Governance Professional Practice for the Future Tim Porter-O Grady, DM, EdD, ScD, APRN, FAAN, FACCWS

3 After 25 Years, What we Know: 5 Principles and the Critical Elements for Sustaining Professional Practice presented by: Tim Porter-O'Grady, DM, EdD, ScD(h), APRN, FAAN

4 Validated Principles for Sustainable Professional Governance (The Non-negotiables and the foundations) 4

5 NEW RESOURCE FROM THE NATION S LEADING VISIONARIES Interdisciplinary Shared Governance Tim Porter-O Grady, DM, EdD, ScD, APRN, FAAN Call or Order From Amazon s Website: Or jbpub.com

6 5 Magnet Principles

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8 Creating Sustainable Value Balancing the Value Equation Outcomes Quality Time Work = Value Cost Resources

9 Value-driven Practice Good infrastructure Fit process - outcome Know your user(s) Evidentiary Excellence Fiscal fit Knowledge capital Value equation Validation of value Resource Engine Partnership Care Ownership Integration Engagement

10 Build Sustainable Value Establish floor for cause & effect goodness-of-fit System for measuring performance / outcomes Clear established protocols for best practice The ability to change practices quickly Drive new ideas for relevant solutions Lean/Hossen, etc. is a foundation, not ceiling

11 Lean and Hoshin Lay Foundations

12 Many different approaches

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16 Global Issues in Nursing & Health Care People Recruitment and Retention Unit Based Practice Councils To be compassionate and caring professionals fully engaged in proudly serving humanity to honor God Compassion Accountable Respect Integrity Nurturing Giving Knowledge, Innovations & Improvements Service Quality Finance Growth Community Empirical Outcomes Patient Experience Clinical Practice Quality and Safety Policy and Procedure Informatics Education and Research Community Med Surg Critical Care Facility Based Practice Councils Emergency Services Service Line Councils Perinatal Care Perioperative Care Rehab Shared Governance Steering Committee Nurse Executive Board Cardiology Telemetry Transformational Leadership Structural Empowerment Serving Humanity to Honor God July 23 rd, 2012

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18 Professional: Definitions Mature profession (Magnet ) Not employee work group Professions are a social contract Greater than the workplace Personal obligation (person and profession are one) 1 8

19 Definition of Shared Governance Shared governance is a professional practice model, founded on the cornerstone principles of partnership, equity, accountability, and ownership that form a culturally sensitive and empowering framework, enabling sustainable and accountability-based decisions to support an interdisciplinary design for excellent patient care. 19

20 Laying the Foundations Equity Transition (Chaos) New Accountability Partnership Age Adaptation Ownership Driving Forces Socio-political Economic Technical

21 Principle 1: Decisions Its about making decisions Change IS a profession s work Professionals judge/decide/act Evidence-driven Purposeful

22 Bylaws Clearly describe the professional model Outline authority for specific decision-making Define the professions relationship to the organization Distinguish between clinical and management authority for decision/action Enumerate the relationship of the professional organization to the institutional structure

23 PG Decision Cornerstone Right decision Right person(s) Right place Right time Right purpose

24 Principle 1: PG Foundations Standardization is NOT excellence The clinical ladder is the vehicle for performance Demonstrate not regulate (evidentiary) This IS professional governance Must link to the organizational structure

25 Principle 2: Staff Driven Power of any profession is in its practice SG by expectation, not invitation Structure for sustainable behavior Driven at the unit/service level

26 Principle 2: Staff Driven: Obligations of Membership Profession is a membership community Participation is a requisite of membership Participation is not an option for members Participation must be a part of the structure Participation in SG should be built into staffing

27 27 Principle 3: Accountability Essence at the core of profession governance Secured in roles by staff producing fit Facilitates partnerships for sharing decisions Accountability grid, (shared agreement)

28 Accountability vs. Responsibility Accountability Outcome defined Self-described Embedded in roles Relies on partnership Evaluation shared Value in contributions Responsibility Relates to functions Delegated by another Dictates specific routine Isolates work and staff Evaluated by supervisor Tasks driven/focused 28

29 Accountability Characteristics Accountability and consequence A culture of accountability Accountability, structure, and impact 29

30 Accountability Elements Autonomy-the right to decide and act Authority-the power to decide and act Competence-the ability to decide and act 30

31 Principle 4: Locus of Control Management (context) Profession (content) Resource driven Practice-based Human Fiscal Quality/Evidence Materiel Competence Support Knowledge Systems

32 Principle 5: Managers are critical to success Focus on creating context Agent of the decision (both staff and management) Responsible for success of SG Develops staff leaders (mentors them, too) Helps staff evaluate/change/adapt Must live shared governance 32

33 Leadership Characteristics Enthusiastic Embracing / Modeling From Control to Engagement Learning SG roles/processes together Managing Context Guiding/facilitating skill, techniques, methods 33

34 Leadership & Power Old Power ( 20 th Century) Currency Held by few Downloads Command Leader-driven Closed New Power (21 st Century) Current Made by many Uploads Shares Peer-driven Open Jeremy Heimans

35 New Power Values Collaboration Participation Networked Governance Transparency Do It Ourselves Speed Fickle More Affirmative Jeremy Heimans

36 Leadership & Accountability You are leading a profession not an employee work group

37 Don t Manage People Manage relationships Manage interactions Manage intersections

38 New 21 st Century Leader Skills Quantum leader skills Willingness Setting the table (gathering) Tough love language Confronting dependencies Leading movement Storytelling the journey Transferring skills for practice Making the journey safe

39 New Language Of Leadership Vulnerability to the risks Approachable to others Intuition and good signpost-reading Empathy with passion and truth Care about the work of healthcare Skill-development not charisma

40 Practice Coucil Basics Focus on standards of practice Factors affecting unit clinical work Control all practice decisions Define specific nursing role Impact on care and patient experience 40

41 Service Units and Team Accountability (Unit Council) Coordination NursingPractice Medical Administrative Interpretation & Application Standards of Practice Interdisciplinary Relationships Decision Processes Problem Solving Service Quality TEAMS Protocols Practices Relationships Partnerships Work Processes Magnet Clinical leaders CNS Nurses Physicians Providers

42 Interdisciplinary Professional Governance Affirms centrality of Nursing Strengthens lateral decisions Build essential intersection for evidence Build ground of disciplinary contribution Integrates essential locus-of-control 42

43 Laying the Foundations Equity Transition (Chaos) New Accountability Partnership Age Adaptation Ownership Driving Forces Socio-political Economic Technical

44 System Division/ Discipline Unit/Pointof-Service Frames for Locus of Control

45 System Interface & Intersection Whole Profession Generic Standards & Direction

46 Sample System SG Coordinating Councils Coordinating Council AUTHORITY: aimplement system and strategic initiatives aset general policy frame for the profession acommunication and linkages at point of service, unit and system aprovides intersection with the clinical / administrative system

47 Executive and Senior Leaders Support for distributive decision-making Advocacy for profession and its decisions Translating strategy and performance to both staff and senior leaders of system Executive member of the Coordinating Council 47

48 Professional Governance Division/ Discipline Council structure Management Structure Decision-making Structure

49 Council Accountabilities Coordinate With: Generic Practice Standards Systems Interaction Policy / Directives Inter-council Conflicts Best Practices Framework Accountability Nursing Medical Administrative Community Associates Other disciplines FOCUS: Direction Evidence Decisions Systems Clinical Effectiveness Clinical leaders CNS Unit staff Associates Staff Nurses

50 Service Units and Team/Individual Accountability Coordination Nursing Medical Administrative Standards of Practice Interdisciplinary Relationships Decision Processes Problem Solving Service Quality TEAMS Protocols Practices Relationships Partnerships Work Processes Clinical leaders CNS Nurses Physicians Accreditation Staff

51 Sample Council Structure: Practice, Education, Research, Quality and Management QA/EBP NE/RC NPC Core PG Councils NMC

52 Division Managers Modeling willingness and support to make shared governance work Assure competence and support of first line leaders Guiding the development of specific managers Evaluating outcomes and impact of operations fit with staff and unit decisions 52

53 Unit-based Shared Governance Unit/Pointof-Service Practice Council Full Staff Engagement Individual Membership Accountability

54 Unit Managers Modeling willingness and skills to make shared governance work Assure competence and good process of unit staff decision-making Presence and monitoring of unit council and staff role in decisions and actions Evaluating and guiding performance and impact of staff skills, decisions and actions 54

55 Professional Shared Governance: A Complex Responsive System Governance RN Councils RN RN TEAM TEAM TEAM RN RN Practice Quality Research Education Service/Unit Service/Unit Service/Unit Management

56 The End 56