Performance Improvement in Nursing EducationTransforming Our Colleges of Nursing into

High Reliability Organizations

Beth Mancini RN, PhD, NE-BC, FAHA, ANEF, FAANProfessor

Sr. Associate Dean for Education Innovation

The University of Texas at ArlingtonCollege of Nursing and Health Innovation

Arlington, Texas

Performance Improvement in Nursing EducationTransforming Our Colleges of Nursing into

High Reliability Organizations

Beth Mancini RN, PhD, NE-BC, FAHA, ANEF, FAAN

NO FINANCIAL CONFLICT OF INTEREST

Upon completion, participants will be able to:• Implement best practices related to HROs

into their schools of nursing• Leverage the power of data to improve

performance in schools of nursing• Develop a performance improvement plan

for a school of nursing

Objectives

“Every System is Designed to Achieve Exactly the Results it Achieves.”

Don Berwick

Photo: http://osticket.com

Especially Academic Ones!Mancini

A Common Goal – PI…CQI…CPI…CI…

Re-li-a-bil-i-ty

The quality of being trustworthy or of

performing consistently well.

Oxford Dictionary

High Reliability Organization

“A high reliability organization (HRO) is an organization that has succeeded in

avoiding catastrophes in an environment where normal accidents can be expected

due to risk factors and complexity.”

https://en.wikipedia.org/wiki/High_reliability_organization

Sigma Theta Tau International, 2016

“HROs seek to

improve reliability

and intervene to

prevent errors and

failures as well as to

cope and recover

quickly should errors

become manifest”

HRO Principles

• Anticipation– Preoccupation with failure– Reluctance to simplify interpretations– Sensitivity to operations

• Containment– Commitment to resilience– Deference to expertise

Should Schools of Nursing Be HROs?

Should Schools of Nursing Be HROs?

YES!

HRO PrinciplesApplied To Academia

• Anticipation– Preoccupation with failure– Reluctance to simplify interpretations– Sensitivity to operations

• Containment– Commitment to resilience– Deference to expertise

Ignorance is Not an Option!

The Importance of Measurement

What gets measured gets managed.”–Peter Drucker

You can’t manage what you can’t measure.” --W. Edwards Deming ?

"The most important figures that one needs for management are unknown or unknowable, but successful management must nevertheless take account of them.” --W. Edwards Deming

Measuring quality is harder… Much harder.

Measuring incidence is easy.

https://spidercool.com/benefits/quality/https://www.freepik.com/free-vector/golden-numbers_799409.htm

Everyone Says, “Measure What Matters.”

But What Matters?

http://www.vmagroup.com/communications-measurement-clever-investment/

Educational Outcomes

http://www.cccc.edu/news/storyImages/2012-06-18-1115078910.jpg

+ +

Curriculum Students Faculty

Assessment in a College of Nursing

• Did they like it?• Did they learn it?• Did they use it?• Did it have an impact?

Kirkpatrick’s Training Evaluation Model

K.I.S.S. PRINCIPLE

To Achieve Success…

• Start where you are.

• Use what you have.

• Do what you can.

Arthur Ashe

1. Decide what matters

2. Measure what matters

3. Analyze the data

4. Propose and make changes based on the data

5. Repeat

Assessment Road Map

Where Do We Start?

• By Assessing The Environment

The profession, employers, CCNE and the BONs create the context in which nursing faculty determine their program outcomes.

CHALLENGE: WE NEED TO BE BILINGUAL.CCNE-SPEAK = “PROGRAM OUTCOMES”SACCS-SPEAK = “STUDENT LEARNING OUTCOMES”

1. Decide what matters

2. Measure what mattersà Not just what’s easy to measureà In efficient, repeatable ways

3. Analyze the data4. Propose and make changes based on the data5. Repeat

Assessment Road Map

• Enrollment• Progression rate

– By course/level– To graduation

• First-time NCLEX or certification rate• Analysis by demographics• Development of models of success and failure• Comparisons by content delivery format

Key Statistics:Quantity and Quality

A Note: High Quality, High Volume Programs

Are Not A Matter Of Chance

To assure student engagement and achievement of program

and course outcomes requires a solid curriculum with

courses intentionally designed to be “fit for purpose” using

educational best-practices.

Photo: http://www.ukwhitegoods.co.uk/help/buying-advice/consumer-help/3698-fit-for-purpose-explained

Quality Measures -- Results

FNP Certification Rates

BSN - NCLEX Pass Rates

Measuring What Matters

• Look for efficiency in measuring what’s important –

– What do we already measure that directly links to our outcomes?

– For example,

• Have graduates learned the art and science of nursing?

• Are they able to demonstrate accountability and responsibility for care?

vFIRST TIME NCLEX PASS RATES –

vCLINICAL PASS RATES –

vCRITICAL THINKING SKILLS –

1. Decide what matters2. Measure what matters

3. Analyze the dataà Look for opportunities for improvement –

Not just for confirmation of how good we are

4. Propose and make changes based on the data5. Repeat

Assessment Road Map

“There Are Lies, Damn Lies…And Then There Are Statistics.”

1. Decide what matters

2. Measure what matters

3. Analyze the data

4. Propose and make changes based on the data

5. Repeat

Assessment Road Map

Definition of Insanity is...

INSANITY….

Doing the samethings and

Expecting differentresults.

http://www.biosciences.uga.edu/facultystaff/lecture-halls-cabinets-and-keys

http://buda-b.com/2012/09/12/welcome-to-medical-school/

We’ve always done it this way. What could possibly go wrong?

1. Decide what matters2. Measure what matters3. Analyze the data4. Propose and make changes based on the data

5. Repeat (from #2) At regular intervals, start from #1

Assessment Road Map

Step #5: Repeat • The Evaluation Committee of the UEPC

(Faculty) gets the data, prepares a report and proposes to the full UEPC if we need to keep measuring the same or different things the following year.

• Remember, Accreditation agencies require “ongoing and systematic review” of the program (and faculty) outcomes with full review of the process on a “regular basis.”

Academia….. Can we continue to follow the same path?

Disruptive Innovations in Education

The Challenge Isn’t Getting New Ideas Into Our Heads…

It’s Getting The Old Ideas Out!“Disruptive Innovation” makes it

possible for simple, affordable,

and accessible products to

replace products that are

complex, expensive and

inaccessible.

Clayton Christensen et al in “Disrupting Class: How Disruptive Innovation Will Change the Way the World Learns” McGraw Hill. 2016