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Eighth Na)onal Doctors of Nursing Prac)ce Conference
“How to be a Be;er DNP in 3 days”
Michelle Pendleton, DNP, RN
Steven Brockman-‐Weber, DNP (c), MSN, MS, FACHE, NEA-‐BC
The value of a DNP as a change agent in developing “tes)ng labs” for process, prac)ce or product.
Objec)ves: 1. Discuss innova)ve roles and strategies of DNP prepared
nurse to improve health outcomes. 2. Iden)fy strategies to make changes within your own
healthcare organiza)on that can lead to sustained improvements.
3. Recognize a;ributes of "tes)ng areas" the DNP must foster to influence change.
• Volume (’14): 2.4 Million Visits 63,135 Admissions 50% Market share*
• Net Revenue (’14) $1.9 Billion • Hospitals: 5 (1,837 licensed beds; staff 1,420 beds)
• Kosair Children’s Hospital • Norton Hospital • Norton Audubon Hospital • Norton Brownsboro Hospital • Norton Women’s and Kosair Children’s Hospital
• Outpatient Centers: 20 • Employees: 12,000 (Louisville’s
3rd largest employer) • Physicians: 2,000+
• Consolidated Medical Staff • 700+ Employed/ 200+ Sites
* Based on state data for Louisville hospitals-YTD Q3 2014 3
Norton Healthcare Profile Louisville, KY
Care Con(nuum NHC Service Offerings
Diagnos(c Center
Post Acute Care Skilled Nursing; LTAC; Rehab
Home Health Care
Acute Care Hospitals
Primary Care & Specialty Physician Network; Urgent Care Centers; Employed Physician Offices; Outreach Clinics; Telemedicine
Cancer Resource Center; Church & Health Ministries; Preven(on & Wellness Programs
Acuity
Ambulatory Surgery Centers
Con(nuum of Care
Pa(ent
209 Combined
Sites
1 Site
5 Sites
6 Sites 0 Sites
0 Sites
400+ Sites
Na)onal Center for Advancing Transla)onal Sciences (2015), a division of the Na)onal Ins)tute of Health
(NIH)
Process of developing a new interven)on or treatment currently takes? 14 $2 Failure rate exceeding %
years billion
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Na)onal Center for Advancing Transla)onal Sciences (n.d.). Retrieved from h;p://www.ncats.nih.gov.
Why do we need Alpha Units?
Create successful, fast, evidence-‐driven organiza)onal change
Lack of buy-‐in of proposed change
“We are different”
phenomenon. Invalidated varia)on
Change and adop)on of evidence into prac)ce is “too slow”
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Alpha Units
Less Cost with trial vs. full roll-‐out
Concept development
Spring 2013 Summer 2015
Cross system team
convened
Evidence review; current na)onal
assessment
Unit characteris)cs
recommended to CNOs
Data plan Educate Imple
ment Trial Adapt Alpha concept
Alpha Units
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Define
Measure
Analyze Improve
Control
A component of the Nursing 2020 Strategic plan Norton Healthcare (NHC) PI Model (DMAIC)
Using alpha units for the test
What is an alpha unit? • What does alpha mean?
– The first test version: describes the first working version
• Characteris)cs of an alpha units – Willing to Challenge Status Quo – Innova)ve & Crea)ve – Work to Solu)on – Evidence & Data Focused – Able to Manage Ambiguity – Honest in Feedback – Willingness to try – Adapt, Adopt and Overcome
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Alpha Units – The What
• Solu)on: – Cover the core subspecial)es (i.e. cardiac, medical, surgical, telemetry, cri)cal care, etc.) to create virtual hospital
– Provide “tes)ng” labs for new process/standardiza)on change in system to enable rapid cycle change and the development of prac(ce based evidence (qualita)ve -‐conducted in context of real-‐world prac)ce)
– Leadership team educated and supported with change and DMAIC training
– Each unit supported by DNP in Systems Leadership
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Non-‐Nego)ables
Ac)ve Leadership and staff
engagement as change agents
DNP prepared nurse leader to
advise and support alpha units
Rapid change that is based on
meaningful, iden)fied criteria
Deployment of posi)ve change to
other units
Change is measured as well as adopted,
adapted, or abandoned
ALPHA UNITS
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Deliverables
Rapid cycle of change (30-‐60-‐90 days) Replica)on Plan
and Communica)on
Budget neutral
3 days change management and process improvement
training
Criteria for success are
iden)fied prior to change being implemented
Aner test, change is adopted, adapted, or abandoned
Data and pa)ent
outcome driven
Alpha Unit Selec)on
• Manager Traits – Leadership style – Employee engagement scores – Previous response to change – Strong ANMs
• Unit Traits – Percent BSN and cer)fied – Unit based councils – Turnover/vacancy – Culture of safety scores
Alpha Units – The What
Solu)on: • Two kinds of change
• Specialty • Organiza(onal
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Virtual Hospital (adults & kids)
Intensive Care
Medical/ Surgical
Transi)onal Care
Opera)ng Room
Emergency Room
Psychiatric
DNP role in alpha units? AACN 2006 DNP Essen)als
• Translator of change • Help to develop the plan for implemen)ng change • Integrate components for successful implementa)on and
dissemina)on • DNP possesses the ability to translate knowledge quickly
and effec)vely (Porter-‐O’Grady. 2003) • DNP uses science-‐based theories and concepts to
evaluate concepts DNP creates and sustains change at the organiza)onal and policy level
• Is able to help translate research into prac)ce (DePalma & McGuire, 2005)
• Design and implement process to evaluate outcomes of prac)ce
Criteria for Alpha Test
• Recognize/Iden)fy Problem • Evaluated the evidence? • Subject Ma;er Experts • External Literature/Summary of Evidence Table
Idea Submission
• Educa)on • Communica)on • Data Collec)on • Go-‐live checklist
Planning • Adapt, Adopt, Abandon • Full implementa)on • Monitoring
Recommenda)on
To test or not test? Pilot Test if: -‐The impact is broad (scope) -‐The process may vary -‐Resistance is an)cipated
No Pilot Test if: -‐Scope is small i.e. one unit -‐Straight forward change -‐Stakeholders do not expect much resistance
Pilot Test?
No Pilot Test?
Past Project Examples
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The Final Check-‐Say It Out Loud Say out loud the last 3 digits of the MR# on the patient’s ID band and the Specimen label.
3 Numbers Can Save Lives
PSRS Technical Tes)ng
Remote Pa)ent Management
Lab Specimen Labeling
Armband Enhancements All armbands include these modifica)ons: 1. DOB and MRN EP # were moved to top of armband 2. MRN EP # was bolded
New Arm Band Old Arm Band
Specimen Labeling Common Cause Analysis
Themes Iden(fied • Unlabeled Specimens
– Label in bag – MRN comparison before a;aching label – Urine specimens brought to staff
• Mislabeled Specimens – Staff had two or more pa)ent labels at bedside
• Overall Process Failures – Distrac)ons and interrup)ons – Down)me – Pulled to alpha unit without training in process
Best Prac)ces/Lessons Learned • Valida)on/Cer)fica)on Process • Look for non-‐value added steps to remove • ID/mi)gate impact of parallel processes • Baseline data pre-‐project • Best prac)ce outside organiza)on • Regular touch points/weekly )ps • Dedicated educa)on resource • Alpha team recogni)on/ CNO rounding • Technology pre-‐test • Standard summa)on of end results to staff
Remote Pa)ent Management
What? • U)lizes technology (Jabber
Video via iPad) to assist all bedside nurses in providing )mely, evidence-‐based pa)ent care
• Timely clinical support and exper)se
• Expert clinical nursing consulta)on to prevent delays in care
The tes)ng ques)on: Will staff use a “telemedine-‐type” technology to answer nursing ques)ons
Remote Pa)ent Management
Why? • RPM is a complement to your current expert resources, not a replacement • RPM APRNs provide readily available, )mely expert consulta)on in
support of direct care-‐givers • RPM APRNs will u)lize exis)ng standing orders (i.e. Rapid Response order
set) to help you intervene on behalf of your pa)ent
Pa)ent /Staff Benefits
• Facilitates evidence-‐based pa)ent care when )me is of the essence
• An educa)onal resource to promote growth in clinical nursing knowledge
• Supports bedside nurses who are caring for complex pa)ent
Remote Pa)ent Management
RPM results from test
• Recommenda)ons from test – iPad freezing due to the steel and metal within the frame of the door
– Central loca)on for ipads-‐place in secure box – Visual clues at every PC monitor with the Remote Pt Monitoring contact informa)on
– Staff ability for hands-‐on return demonstra)on – Create scenerios for use
Survey Monkey Results (from lab project)
• 106 respondents • 82 (77%) bedside caregivers • 24 (23%) leadership
Ques(on % Very %Some what
% Not Very
% Not at all
En)re team commi;ed to process 68.97% 25.86% 4.31% 0.86%
Your level of engagement 85.45% 12.73% 0.91% 0.91%
Survey Monkey Results
Recommenda)ons Ques(on % Very % Some
what % Not Very % Not
at all
Do you see value in tes)ng a process on some units (Alpha Units) prior to house-‐wide implementa)on?
80% 15.45% 2.73% 1.82%
Adopt Adapt Abandon
A decision is made to adopt, adapt, or abandon all alpha projects at their comple)on. What would your recommenda)on be for this par)cular project?
60.38% 31.13% 8.49%
Did we meet our original goals?
Process for designating projects for a rapid cycle of change (30-60-90 days) that is evidence-driven
Yes
A positive, healthy work environment is maintained TBD Replication and communication plan is in place for all changes that are adopted or adapted that includes identified barriers and a control plan to sustain change
• Yes as it relates to recommendations to adapt. Formal replication and communicant of implementation is the responsibility of originator
• At the completion of each alpha project a summary of completion was distributed
Criteria for success identified prior to change implemented
Yes
At the end of the test of change, change is adopted, adapted, or abandoned
Yes
Resources are available to assist with staff education and the implementation of alpha projects
Yes
A doctoral-prepared person with experience in change management is in place to advise and support the alpha projects, encourage involvement with practice governance, and drives according to the evidence
Yes
Deliverable (from original 2013 leadership presenta)on) Met?
Next Steps/ Future Recommenda)ons
• More clinical prac)ce issues to test • Staff and leadership survey on alpha process and its impact (4Q 2015) (asses characteris)cs)
• Re-‐evaluate the role of the DNP consultant • Encourage new project ideas/submissions from CNOs, Councils (prac)ce and research), Matrices
• Test concept of specialty change (all projects have been organiza)onal)
Alpha Units
• I am always doing that which I cannot do, in order that I may learn how to do it. – Pablo Picasso
• It is not the strongest of the species that survives, nor the most intelligent. It is the one that is the most adaptable to change. – Charles Galton Darwin
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