TL - Transformational Leadership

TL3: Strategic Planning. The strategic planning structure(s) and process(es) used by nursing to improve the healthcare systems:

  • Effectiveness and
  • Efficiency

The Value Analysis process was recently restructured to increase the amount of savings on the non-labor budget without affecting jobs. The CNO, Rita Smith DNP, RN, NEA-BC, and the CMO joined forces with the Purchasing Department to improve this process. The executive team researched best practices in this area from across the country. They reviewed examples of policy, structure, and format, Reference TL3-A and developed an interdisciplinary team consisting of physicians, nursing, purchasing and finance. The major goals of this committee are to make decisions on all expenditures with priorities on clinical appropriateness and user satisfaction. Clinical committees that report into the Value Analysis Committee are: Pharmacy and Therapeutics, Operating Room Management, Orthopedics and Interventional. When a new product is recommended by a nurse and/or physician, a multipart form is completed that includes information on the currently used product/technology, cost comparisons, usage figures, compatibility with currently used equipment and if there is consensus within the department on usage of the supply/equipment. The champion of the product presents it to this committee with the proper justification/rationale for usage. The Committee either suggests that the product/equipment be piloted on a unit for a specific period of time, or that more data on the product/equipment is necessary. See diagram below for collaborative process:

Collaborative Process

Recently, a consultant company, FTI, was hired by the hospital in order to review our efficiencies hospital-wide. A determination was made to utilize bi-monthly staffing productivity data in order to maintain an even, efficient staffing level on all nursing units Appendix TL3-A different criteria were established on each unit as a measure to quantify productivity. For example, productivity in the operating room is surgical hours, on the medical-surgical unit productivity is measured by average daily census. In order to ensure compliance with these measures, the Nursing Managers meet with the Department of Nursing’s Business Manager, Tom Fivek, in order to discuss the issues on a weekly basis. Mr. Fivek and the Nurse Managers develop an action plan based on spikes and declines in the census. A recent example occurred on the Cardiac Catheterization Laboratory (CCL), when Larissa Semenoff BSN, RN, CNOR Nurse Manager determined that she wanted to convert a Patient Care Technician (PCT) position to a secretarial position. Her rationale for this was that the PCT position was under utilized; a secretarial position would be less expensive and would be used more efficiently in this area. After discussing this issue with her staff, she determined that they were spending a great deal of time answering telephones, preparing paperwork, and scheduling procedures. This was poor utilization of their time and time taken away from their patients. Ms. Semenoff and Mr. Fivek went to the Human Resources Department in order to make the change.

The Operating Room Management Committee discusses and makes recommendations regarding operating room efficiencies and effectiveness. The Operating Room nursing management team, the CNO, the Chief of Surgery, and the Chief of Anesthesia attend this committee. The Committee recently addressed a Sterile Processing Department (SPD) issue related to efficiencies in the construction of Case Carts, Appendix TL3-B and this caused major dissatisfaction among the nursing staff and the surgeons. There appeared to be a lack of communication between the OR and SPD personnel. SPD personnel did not understand the impact that the lack of certain equipment had on the preparation and performance of certain procedures. The OR management team determined that a clinical liaison person that remained in the OR was needed to help facilitate the cases. This person would work hand-in-hand with the nursing personnel to ensure that all supplies and equipment were available for their procedures. A person was hired with the support of the OR Management Committee. This resolved the problems that were occurring and increased staff and physician satisfaction.

Effective communication across the Division of Nursing is facilitated through organization-wide committees and the Nursing Council Structure. The major nursing councils include:

  • Quality and Safety Council -This council contributes to the effectiveness and efficiency by reviewing data on the Rapid Response Team and the resulting decrease in Code Blues. The council members function as champions to discussions held in this council and take information back to their Unit Practice Councils
  • Research Council -This council is effective in promoting the use of evidence-based practice, and educates nurses on the effects of research on nursing practice through their Research Fairs and Poster presentations.
  • Satisfaction and Retention Council -This council contributes to effectiveness across the Division of Nursing by identifying those issues that will increase nurse satisfaction. This council is primarily responsible for the activities associated with Nurses Week. They also review the Nurse Satisfaction Survey and assist the Managers in the development of an action plan
  • Leadership Council -This council is effective in discussing and problem-solving the needs of the nursing units. Managerial decisions are made at these sessions and a plan developed on how to insure roll-out and implementation of new programs. Recently the Leadership Educational series from MC-Strategies was discussed and decisions made as to who would attend the first session
  • Nurse Practice Council -All nursing issues are processed through this council as well as policies and procedures. This contributes to efficiency because new items are communicated through the membership of this council to their respective units. This insures adequate communication of new issues. A recent problem evolved concerning the administration of Pneumovac on the units. They discussed ways to be more efficient and compliant with this vaccine
  • Unit Practice Councils- Most nursing/unit issues begin at this level. The UPCs discuss problems that occur on their units and have the representative from one of the major councils carry this information to their respective councils. A recent issue surfaced in the Cardiac Catheterization Laboratory (CCL) UPC which concerned methods on how to staff the unit more effectively

These councils are effective in ensuring that the units operate efficiently and effectively. Staff nurses are encouraged to participate in the overall management of their units as well as participate in one or more major councils. This council structure is designed to promote autonomy and clinical decision-making and provide effective communication both vertically and horizontally. These meetings are effectively scheduled on the same day every month so that it is habitual and hardwired into the system.

The DMAIC (Define, Measure, Analyze, Improve and Control) and the Lean-Six Sigma process is a performance improvement methodology. It is a rigorous and systematic process that seeks to improve organizational efficiency and effectiveness. The objectives of the Six-Sigma process are to eliminate defects and variation in the quality process. Six-Sigma utilizes a set of quality management methods, including the use of statistics and creates an infrastructure. DMAIC team’s address quality and process issues throughout the organization.

DMAIC teams are usually headed by a team member from the Performance Improvement area who is well versed in the tracking of the identified outcome metrics. DMAIC projects begin with a charter that clearly defines the problem, goals, benefits, timeline and expected outcomes. DMAIC/Six Sigma Teams include Sepsis, Ventilator Associated Pneumonia, and Obstetric Adverse Events Reference OO15-A.

DMAIC Performance Improvement Methodology

Lean Six Sigma Projects include the following: Central Line Associated Blood Stream Infection (CLABSI), Pain Management, Ventilator Associated Pneumonia (VAP), and Adverse Medication Events. An example of a DMAIC process on Early Warning Scoring System (EWSS) is shown below:

Executive Summary: Project Information

Scorecards are utilized to measure monthly progress on specific issues relating to safety and quality of care. Scorecards utilize tactics in order to develop strategies to address the problem or issue. Scorecards also assign accountability and a timeframe for accomplishing the overall goal. Progress on the scorecard is readily identified because it is color-coded. The colors are as follows:

  • Green: Meets or exceeds Target
  • Yellow: Within 5% of Target Variance
  • Red: Outside Acceptable Target Variance
  • Blue: No Target or Actual Results

In this manner you are able to have a visual of your progress on a particular issue.

The overall hospital council structure provides for effectiveness and efficiency organization-wide Reference OO25-A. The Councils include:

  1. Quality Management Steering Council-examines all quality measures for progress/improvement
  1. Patient Safety and Clinical Quality Council-addresses all staff and patient safety issues
  1. Engagement/Operational Process Council-addresses all patient, nurse, staff and physician satisfaction issues
  1. Strategic Growth Council-examines all strategic planning issues to include physician recruitment and the addition of service-line programs
  1. Business Expense Council-evaluates/examines all operational and capital expenses and explores cost saving initiatives.

Overall Hospital Council Structure

This process insures that everyone is involved in the management of the organization and everyone has input into the problems and issues.