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Rome Wasn’t Built in a Day: Building Organizational Foundation

Through Culture, Structure,

and Accountability

Presented By: Erica Rossitto,

MBA/HCM, BSN, RN, NEA-BC

Chief Nursing Officer,

Hospital Corporation of America

The Medical Center of Aurora

Aurora, Colorado

Roman Coliseum


• 346 Licensed Beds

• 4 Campuses

• 1,700 Employees

• 92,000+ ED Visits

• 80 Behavioral Health Beds

• Magnet® Designated

• Level II Trauma Center

2

About Us…


Our Mission

Above all else we are committed to

the care and improvement of

human life


• Changing Culture

• Leadership

Development

• Employee

Engagement &

Retention

• Patient Perception

• Evidence of Success

• Q & A

Presentation Outline

Building Organizational Foundation Through Culture,

Structure, and Accountability

Athens Acropolis Parthenon


• Verbalize two strategies to create

an environment in which improving

the patient perception is an organization-wide

responsibility

• Describe numerous tactics to reduce turnover and

improve employee engagement

• Explain the role structure and accountability play in

improving culture and outcomes

Learning Objectives

Building Organizational Foundation Through Culture,

Structure, and Accountability


Changing Culture

Ancient Roman Coliseum at dawn


I Am Why


“When a patient and his or her family consider a hospital stay, they think of the

person who provided that ‘wow’ moment. Often, that person is a doctor or a nurse.

But it could also be:

• The friendly intake professional who answered questions about confusing

insurance information

• The dietary worker who brought in a satisfying meal every evening

• The environmental services tech who made the patient’s room sparkle and did

so with a smile

• The pharmacist who came by as the patient was leaving just to make sure all

medication instructions made sense

• The discharge coordinator who called a couple days later to make sure follow-

up doctor appointments were all set”

Milton Johnson, Chairman & CEO

Hospital Corporation of America

Changing a Culture

It’s Everyone’s Job


8

A Healthy Level of Patience

Leadership Changes

0

2

4

6

8

10

12

14

2013 2014 2015 2016 YTD

Leader Turnover

Nursing Non-Nursing

Constantine the Great

Marcus Aurelius

Julius Caesar

Caesar Augustus


“Culture eats strategy for breakfast.”

~Dr. Peter F. Drucker

Changing a Culture


Leadership

Development

The Gate of Life at the Colosseum in Rome


• Planning Team

• Interdisciplinary Attendees

• Full Day

• Presentations

• Activities

• Linkage Grids

Facility Based for Front Line Leaders

Leadership Development Institutes


• Division-wide Leadership Development Institutes

• Clinical Nurse CoordinatorTraining Program

• Division Orientation

• Facility Orientation

• Structured Orientation Competency Inventory

• Navigator

• Culture of Excellence Off Stage

• Executive Coaching

12

Leadership Development


• Bi-annual 9 box of all leaders

• Cascaded goals

• 90 day plans

• Outcome based evaluations

• Outcome based incentive plans

• Minimum attendance

requirements at development

sessions

• Accountability Matrix

• Education Department coaching

& validation

13

Leadership

Accountability

Tactic Validation

Monthly Meeting Model Monthly

Goal Setting Annually

90 Day Plan Monthly

Departmental Monthly

Operating Reviews

Monthly


Employee

Engagement

& Retention

Santi Luca e Martina Church and Clivo Argentario Road


Where to Start?

Employee Selection


• Resume Review

• Behavioral Based Interview Tool

• Peer Panel Interview

• Job Shadowing

• Final Sign Off by HR & Senior Leader

Employee Selection


• Personalized welcome note from CNO for RNs

• Personalized welcome letter from the unit

• Orientation presentation by Senior Leaders

• Leaders eat lunch with new hire during orientation

• Personal welcome

• Schedule review

• HR round at day 15

• Benefit review

• HR round at day 60

• Q&A

• Leader round at day 30 & 90

• Studer Tool

• Survey

• Educator/Preceptor weekly check-in

• Nights and weekends included!

Onboarding


• First year turnover is a Sentinel Event

• HR Stay Interviews

• Transparency

• Walk-A-Mile Program

• Nightshift Breakfast

• Senior Leader Breakfast

• Cup of Joe with the CNO

• Quarterly Lunch with CNO/ACNO

• Quarterly Employee Forums

• Bi-annual Exceptional-Solid-Low Conversations

• Annual Development/Career Plan Review

And Beyond

Julius Caesar, Roman Emperor, did not rule for

long, but gave Rome fresh hope for the future


• Monthly data push to Leadership

Team

• Detail by department

• Includes employee name and

reason for leaving

• Monthly review during

Leadership Meetings

• HR review of all peer panel

interview packets

• HR review of all 30 & 90 day

rounding forms

19

Employee Engagement & Retention

Accountability

Tactic Validation

Stoplight Report Monthly

Employee Rounding Log Monthly

Thank You Note Log Monthly

Employee Engagement

Action Plan

Monthly

Senior Leader Rounding Weekly


Patient

Perception

Pantheon, Rome


Purpose

Patient Perception Meetings

To provide an opportunity for nursing, ancillary, and essential

leaders to work together to improve the patient experience

To hold all leaders accountable to the same standard

regarding the patient experience

To create transparency surrounding rounding and results


• CNO/ACNO, Chair

• Senior Leaders

• Inpatient Nursing Directors & Managers

• Ancillary & Essential Directors & Managers

• ED Leaders

• OR Leaders

Attendees



• Connect to Purpose

• Report Out

• 90 Day Plan

• Current Goal

• Current Performance to Goal

• Action Items

• Weekly Summary

• How many patients touched?

• What did you learn?

• What coaching/follow-up is needed?

• Who did you recognize?

• What key messages were shared with staff?

• What do you need from peers to be successful?

• What ideas do your peers have to help you be successful?

Agenda


“I attribute my success to this - I never gave or took any excuse.”

~ Florence Nightingale

https://www.goodreads.com/author/show/63031.Florence_Nightingale


Keys to Success


All leaders are challenged to have action plans targeted at specific areas where there is opportunity for improvement

Discrepancies between assumptions and data are discussed

True trust and collaboration among leaders

“Be the CEO of your unit”


Evidence of Success


Encounters with employees not demonstrating our

values are openly discussed, including loop closureSpecific discussions about

which support personnel are successful on which units

Leaders conducting patient rounds on units other than

their ownStaff being publicly recognized across

departmentsAccountability

Breeds

Response-Ability.

~Steven Covey

Dome of the Pantheon Temple


• Weekly Patient Perception

Meetings with 90 Day Plan

• Weekly CEO/CNO/ACNO

Nurse Leader Rounding

Validation & Coaching

• Weekly CEO/CNO/ACNO

Review of Rounding Logs

• Annual Competency

Station at Skills Labs

26

Patient Experience

AccountabilityTactic Validation

AIDET Quarterly

Nurse Leader Rounding Weekly

Patient Call Manager Weekly

Patient Communication

Boards

Daily

Bedside Shift Report Daily

Hourly Rounding Daily

Staff Communication

Boards

Monthly


David Leslie, MBA, BSN, RN, NEA-BCAssociate Chief Nursing Officer


One Leaders Perspective

One Leader’s Perspective


Evidence of Success

Arch of Septimius Severus


Employee Engagement: Overall Engagement

Evidence of Success: People

70%

72%

74%

76%

78%

80%

82%

2013 2014 2015 2016


Turnover

Evidence of Success: People

20.4%19.4%

11.2%

17.6%

30.5%

16.9%

9.2%

14.1%

2013 2014 2015 2016

First Year Turnover

All RN15.9%

15.2%

12.7%13.2%

19.2%

15.2%

12.3%

14.7%

2013 2014 2015 2016

Overall Turnover

All RN

54%

23%


HCAHPS

Evidence of Success: Service

7274

76

81

7879

1Q15 2Q15 3Q15 4Q15 1Q16 2Q16

Nurse Leader Rounding

71

66

72 7271

74

77

7473

77

1Q14 2Q14 3Q14 4Q14 1Q15 2Q15 3Q15 4Q15 1Q16 2Q16

Overall Rating of Care


Hospital Acquired Conditions

Evidence of Success: Quality

20

7

0

2014 2015 2016 YTD

CAUTI

6

21

2014 2015 2016 YTD

CLABSI

5

3

1

2014 2015 2016 YTD

MRSA

94 96

16

2014 2015 2016 YTD

CDIFF

Goal = Zero


Contract Labor

Evidence of Success: Finance

10M

8.9M

7.2M

2013 2014 2015

DOLLARS

137

114

94

2013 2014 2015

FTEs

Thank You!

Erica Rossitto, MBA/HCM, BSN, RN, NEA-BC

Chief Nursing Officer


[email protected]

Insert Your

Photo Here

“What would you attempt to do if you knew you could not fail”~Anonymous

Questions?

mailto:[email protected]


• Patient Perception Agenda

• Quality Meeting Agenda

35

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