Staff Engagement in Quality Improvement

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1 Staff Engagement in Quality Improvement Hudson Hospital & Clinics, Hudson, Wisconsin 36 point Times New Roman 26 point Arial

2 Birth Center Nursing ranks at 99 th percentile for friendliness and attitude scores among Press Ganey hospitals (1,800 hospitals) Overall, rank at 97 th percentile Births up 11% YTD 2010, 500+ annual volume Meet the Team Erica Hanson, RN Birth Center today s speaker

Overall, rank at 97 th percentile Births up 11% YTD 2010, 500+

3 Staff Engagement in Satisfaction & Quality Inpatient Press Ganey survey Comment cards Comment line, Facebook and letters Department Goal Every birth is personalized, emotionally rewarding and a healthy event for the family We have cultivated an attitude of innovation and willingness to learn to learn from each other Increasing Skill and Service Level Obstetrical drills Emergency cesarean delivery Shoulder dystocia Infant code Infant abduction VBACS

have cultivated an attitude of innovation and willingness to learn to learn from each other Increasing Skill and

4 Indicators for Chart Audits Indicators for Chart Audits Staff encouraged to submit charts for audit All aspects of patient care evaluated OB Committee Physicians, staff nurses, lactation consultant, childbirth educators and leadership Review standards of care and policies and procedures Case studies Educational programs for physicians and nurses

nurses, lactation consultant, childbirth educators and leadership Review standards of

5 Unit Practice Council Nurse retention and job satisfaction Innovative scheduling Nurse to patient ratios Education and training Monroe Clinic Hospital Tiffany Emberson, RN, CMSN Erica Wand, RN

6 Not-for-profit multi-specialty integrated health network 11 Clinics located in WI and IL 100 bed hospital 1,039 employees 2009 Charity Care totaled $2.5M Why I am Passionate About Improving Quality Outcomes Every Patient, Every Encounter, Every Time My Profession My Place of Employment My Role

7 Collaborative Practice Model (CPM) CPM is a philosophy and framework that helps employees co-create a healthy workplace culture. A workplace that is the best place for us as employees to be and work, as well as, the best place for our patients to seek service and receive holistic care. How CPM Keeps My Colleagues and Myself Engaged Central Council Purpose Membership Departmental Council Purpose 1 to 5 reporting structure

A workplace that is the best place for us as employees to be and work, as well as, the best place for our

8 Departmental Councils Improving Quality Med/Surg Council Implementation of bedside report Improvements in pressure ulcer prevention Improvements in discharge process Departmental Councils Improving Quality (cont.) FBC Council Improved perinatal patient education Designed a new staffing plan Created a shared work team with both Women's Health clinics

Departmental Councils Improving Quality (cont.

9 Strategies to Encourage Staff Engagement Insist on two-way communication from council representative to employee Kaizen events Keep quality data visible Med Surg Nursing Dashboard 2010 Nursing Practice Dashboard--MedSurg Meets or exceeds target Within 5% of target Off target by >5% and <10% Off target by >10% Core Strategy Med Surg Measures Data Source Freq 2009 Average J F M Q1 '10 A M J Q2 '10 J A S O Target/ Benchmark 1 Patient Satisfaction - Overall Med/Surg PG Q th percentile Satisfaction 2 Overall Satisfaction with Nursing Care PG M mean 3 Overall Satisfaction with Discharge Process PG M mean 4 Staff Satisfaction - Turnover Rate HR Q WIP 5 Unit Acquired Pressure Ulcers NDNQI Q 6.7% 0% <NDNQI mean Quality 6 Total Falls/1000 Pt Days NDNQI Q 0.7% 0.9% <NDNQI mean 7 Patient Satisfaction with Pain Control PG M mean 8 Cost/Patient Day Flex Budget M $428 $446 $396 $399 $412 $401 $473 $421 $421 $440 $438 < budget Financial 9 Net Margin Flex Budget M $87,000 $58,000 $34,000 $70,000 $6,000 $67,000 $27,000 $89,000 > budget 10 Overtime Rate Bud. Var. M WIP Time 12 Med Surg Discharges within 2 hrs of written order M/S data M 51% 49% 53% 48% 50% 59% 51% 55% 55% 65% 70% 85%

Q2 '10 J A S O Target/ Benchmark 1 Patient Satisfaction - Overall Med/Surg PG Q 79 69 85 90th percentile Satisfaction 2 Overall Satisfaction with Nursing Care PG M 91.3 91.2 88.2 90.5 89.9 89.1 94.

10 Strategies to Encourage Staff Engagement (cont.) Allow employees to choose quality initiatives Utilize employees who have expressed interest Include the night shift QUALITY THROUGH THE EYES OF A STAFF NURSE By Marge Gessler, RNC Aspirus Wausau Hospital

employees who have expressed interest Include the night shift

11 Background Labor and delivery staff nurse in the Birthing Center at Aspirus Wausau Hospital for 5 years Unit quality council member for the past 4 years HousewideQuality Council unit representative for the past 3 years Chair of the HousewideQuality Council since May 2010

the past 4 years HousewideQuality Council unit representative for

12 Quality Involvement Perfectionist at heart Detailed Encouraged by unit leaders to become involved in one of the unit councils education, practice or quality/research Allowed more involvement within the unit Desired to contribute to improve patient care within my unit, leading to improvement of overall hospital wide outcomes Quality at the Unit Level What do we do?? PI (Process Improvement) monthly monitoring Examples are: anticipatory rounding, maternal and newborn pain assessments, iv monitoring, epidural time out and breastfeeding rate Monthly data is collected by a point person for each area and is tabulated Weakest areas are focused in on, presented at our collaborative unit meeting and then disseminated back to the unit staff Once an area proves to no longer need monitoring a new focus area is chosen and the same process takes place Barriers: Staff accountability Why??

? PI (Process Improvement) monthly monitoring Examples are: anticipatory rounding, maternal and newborn pain assessments, iv monitoring, epidural time out and breastfeeding rate Monthly data is

13 How does this improve patient care at the unit level?? Serves as a reminder to perform tasks that at times are omitted Are the tasks performed but not documented? Are the tasks not performed and not documented? Improves patient outcomes Allows specific problem individuals to be identified early Additional education to specific staff or department Serves as a trigger on additional areas that can be improved Quality at the Housewide Level What do we do?? Hospital Audits Examples: skin assessment, critical lab values, sedation, hand hygiene, pain Monthly data collected by each unit representative and entered in a hospital data base Each audited area has its own taskforce made up of 2-3 HWQ members

Improves patient outcomes Allows specific problem individuals to be identified early Additional education to specific staff or department Serves as a trigger on additional

14 Quality at the HousewideLevel (con t) Data reviewed Task forces break out Analyze data Brainstorming/discussing/plans Why?? How does this improve patient care at the Housewide level? After the data is analyzed we can see where some of the breakdown is in our practice Additional education may be needed (example locating new flow sheets for accurate documentation). Department specific?? Housewide issue??

After the data is analyzed we can see where some of the breakdown is in our practice Additional

15 How to engage staff nurses in quality? For some it is just a part of them for others a little encouragement is required Make it fun!! Be inspiring Show results Provide incentives Energetic leader Summary Make data collecting interesting and show results Obtain staff buy in Quality improvement starts and ends with the bedside nurse

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