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Connecting the why…….October 3, 2017
Nursing Management Congress 2017 Conference Patrick Baker, RN BSN, MHA, MAFormer VP Patient Care Services & CNO at UC Health West Chester HospitalRetired LTCOL United States Air Force
Objectives
� Understanding the purpose behind your work as a nurse leader
� Connecting the meaning between the work you do and impact it has on the patient and organization
� Inspire nurses to be love their work and find meaning behind the work they do
2
Agenda Connecting the Why:• Ellie’s Story. What I learned from
Ellie and our personal journey.
• Battlefield to the Board Room
• Connecting the Why: • Regulatory Compliance & Dealing
with Change• Accountability• Employee Engagement
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Nursing Humor
4
Nursing Humor Terry Foster, RN
Nurses who need to go to the hospital: • “Wait, let me call and see who is
working. Darn, we need to wait until 7pm.”
1An inebriated man told the ER staff that he discovered the patient at home in the FECAL position.
2Obtaining a Patient’s History: • How old are you?• Do use any recreational drugs?• Are you pregnant?• When was your last period?• Are you sexually active?
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Connecting the Why
Empathy & Compassion
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Change is hard—so hard, in fact, that most of us avoid it at all costs
How do people feel when they walk into a hospital ?
Ellie’s Story7
Ellie’s Journey• Admit to level 3 NICU when
born. D/C home as a well baby after 9 day admission
• Readmit to Hospital a few days after discharge with major heart defect diagnosis
• 1st Open Heart Surgery:• Ativan mistake/Morphine
overdose• A line not checked
permanent burns to arm
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Ellie’s 2nd
Open Heart Surgery• We did our homework
• We interviewed pediatric cardiac surgeons
• Philadelphia• Boston• Michigan• Cincinnati
• Day of Surgery – Comments from the surgeon before and after surgery
• Post op day 1 & 2
• Discharge day: The ungrateful patient/parent
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Ellie Today!!10
Why is it so hard to be nice to our patients?
Patient Rounding Story75 y/o GI patient
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e
Kindness will never be forgotten……
Kathy’s Story
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Military Leadership
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Military Discipline15
Training Exercises16
Joint Base Balad, Iraq
Jan 2009 – July 2009
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Hero’s Highway
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Trauma Call
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Surgeryat Joint Base Balad, Iraq
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Fallen Solider at Joint Base Balad Trauma Hospital
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Surgery for Children
at Joint Base Balad, Iraq
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Children at Joint Base Balad, Iraq
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Battlefield to the Board Room
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What is UC Health – Established in 2010
• UCMC – 500+ bed academic medical center • WCH – 179 bed community hospital • Drake – 269 beds (166 Long-term acute care, 103 skilled) • LCOH – 48 short-term acute beds plus residential services
Healthgrades® Outstanding Patient Experience Award™ 2012, 2013, 2014, 2015, 2016
• Distinguished as top 5% of hospitals nationally
• Based on patients’ responses to HCAHPS survey
This Style doesn’t work in Healthcare!!
You don’t need a Title to be a “Leader”
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Crucial Conversations
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Crucial Conversations
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Crucial Conversations
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• Requires training• Listening• Strength to have difficult
conversations• Eliminating emotion
from the conversation• Understanding your
audience• Assume Good Intentions
• Pizza Story with RNs
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Nothing gets done without relationships
Quote from a previous boss & mentor:
“You can be smart and have great
ideas…………but, it doesn’t mean anything if
you don’t have good relationships with
others.”
Quint Studer: Hardwiring Excellence
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Purpose
Worthwhile Work
MakingA
DifferencePurpose
Worthwhile WorkMaking a Difference
Housekeeper, Sterile processing, & Patient Sitter
Connecting the Why
Regulatory Compliance & Change
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Change is hard—so hard, in fact, that most of us avoid it at all costs
Keeping up with all the Regulatory Standards in Healthcare……..
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Regulatory standards & the impact on Healthcare
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How some nurses feel about regulatory agencies
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Understanding Change
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One study mentioned that 77% of all people
are resistant to change.
No matter what the change is
Change
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Connecting the Why
Accountability
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Change is hard—so hard, in fact, that most of us avoid it at all costs
Staff HML Assessment Results - % (Studer Group)
42
28
65
7
0102030405060708090
100
HighPerformers
MiddlePerformers
LowPerformers
Percent of Current Staff
Item Goal Month Month Month Month Month Month Month Month Month Month Month MonthJan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Employee evaluationsComplete evaluations and turn into HR prior to due date
Leadership meetingsAttend leadership meetings & committee meetings as assigned
Staff meetings Conduct monthly staff meetings
MCH CARES High-Middle-Low talks (Quarterly)
Employee Rounding
Round with each direct report at least once a month (submit rounding logs to Sr.Leader every month)
Physician Rounding Round with physicians or other "Key" customers
Employee RecognitionSend ____ thank you note and/or gotcha cards per week
Employee RecognitionManage up ____ employees to your Sr. Leader per month
Key Words at Key TimesScripting: 1. Hospital wide 2. Department
Press Ganey
Sharing information with your staff on regular basis and implementing goals based on feedback
30 & 90
30 & 90 day reviews completed on time and turned into Sr.Leader
Follow up phone calls
Discharge phone calls or Post-Visit phone calls *if applicable
Crucial Goals
Goal Setting within your department to align with "crucial goals" determined by the hospital's strategic plan
LEADERSHIP ACCOUNTABILITY GRID -- Madison County HospitalEmployee: Supervisor: Date: Department / Cost Center:
Accountability Grid for Leaders
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Why Discipline and accountability matter
• Karen’s story – OB director• Michelle, RN in PACU
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We/They phenomenon
• What is this?
• Who does it?
• Usually not done on purpose…………
• …..…..it is usually done because nobody trained me
is usualle NOT to do it.
• Donna’s Story (12 hours vs. 8 hour shift)
Appreciative Inquiry
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• A host of organizations, including British Airways, Verizon, and NASA, have embraced Appreciative Inquiry
• Strategy based on the idea that focusing on what's working is a better way to fix what's wrong
• Asking questions about process vs. placing blame
Connecting the Why
Employee Engagement
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Change is hard—so hard, in fact, that most of us avoid it at all costs
Change is hard—so hard, in nn n nnnnnn factctttctcttfaf cttfafffafa tfaffafaa t, th, at most of us avoid it at aat at attt aat at aaaaatt aattt aaaaat at attat ll clllll cl cll cll l cl cll cllllll clll cll cl cll cll cll clll cccll ccllll cll cll cccooosostsstststststsstsoststtosoooosoooos sooos soooostsoooooosossststsooosoooooooosooossoossst
Humor
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Understanding Productivity & ChangeNew Schedule vs. Old Schedule
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Overstaffing hours
0102030405060
3/19 3/20 3/21 3/22 3/23 3/26 3/27 3/28 3/29 3/30 4/2 4/3 4/4 4/5 4/6 4/9 4/10 4/11 4/12 4/13 4/16 4/17 4/18 4/19 4/20
Overstaff ing hours per day
Old Schedule
New Schedule
Scheduled Hours
100
150
200
3/19 3/20 3/21 3/22 3/23 3/26 3/27 3/28 3/29 3/30 4/2 4/3 4/4 4/5 4/6 4/9 4/10 4/11 4/12 4/13 4/16 4/17 4/18 4/19 4/20
Staff scheduled hours per day
Old Schedule
New Schedule
A Step Ahead in Patient Safety
Impr
ovin
g ou
tcom
es, Q
ualit
y, &
Saf
ety
Triad Leadership
New Staff Utilization Guidelines –
Contingency model
Charge Nurse with no assignment
Video Sitters Vs. Physical sitters
Patient Movement Center
No pass zone
New Patient Care Model
Admission RN’s
Additional PCA’s
Additional Transporters
Additional Sitters
New Patient Care
Delivery Model
A Step Ahead in Patient Safety
Need for a new Staffing Utilization Guideline“Out with the Old and in with the New”
The Old nursing grid wasn’t working
Nurses would come into work and immediately check out the census and # of RN’s working
Staff Utilization Guidelines
Goal Stretch Level 1 Level 2 Level 3 Level 4 Level 5(D) RN w/1:4-5, CN NO Assignment
(N) RN w/1:5-6, CN NO Assignment
(D) RN w/1:5, CN NO Assignment
(N) RN w/1:6, CN NO Assignment
RN w/1:5CN w/1-2 pt
(N) RN w/1:6, CN w/ 1-2 pt Assignment
RN w/1:5CN w/1-2 ptAdmit RN w/1-2 pt
(N) RN w/1:6, CN w/ 3-4 pt Assignment
RN w/1:5 CN w/3-4Admit RN w/ 2-3
(N) RN w/1:6, CN w/ 5-6 pt Assignment
**Consider ON-Call
RN w/1:5 CN full assignmentAdmit RN w/ 3-4
**Consider ON-Call
Consider all unit resources as acuity or unit census dictatesNurse EducatorClinical CoordinatorClinical ManagerDirector
**Consider ON-Call
Employee Engagement: Charge Nurses
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• Goal – no assignment, available to assist staff, physicians, families
• Monthly Charge Nurse meetings with Nursing Leadership
• Special Name badge
• Role of the Charge Nurse at WCH• Leaders of the unit 24/7• Lead Daily safety huddles• Lead 4am staffing huddle with other charge nurses• Attend multidisciplinary rounds & assist with discharges• Help manager productivity / NHPPD• Assist with Quality, Core Measures, etc.
Pre OP Charge Nurse Story
Employee Engagement: Admission Nurses
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• Role of the Admission Nurse
• Initially stationed on every inpatient unit
• Moved to the ER and works from there to assist at the point of entry
• Works clinically on the inpatient one day per week
• Big Nurse Satisfier!!
• Can leave the admission role and take a full assignment on the inpatient unit if needed
• Goal – Assist the front line staff RN
Stop pulling your PCA’s to be Sitters
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• Increased demand for sitter cases
• Pulled PCA/STNA’s to be sitters = left nursing short
• Nurses would get frustrated with the lack of PCA support
Reviewed the literature and found no evidence that physical sitters reduce fall rates and/or improve outcomes
• Implemented Video sitters • 1 video monitor can watch 8 pts.
• Impact – More PCAs at the bedside
Employee Engagement: Taking care of your people
Sitter ticket:
Something simple and small = made a big difference
4
A Step Ahead in Patient Safety
Thank you notes
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West Chester Hospital Monthly Leadership Team Report
Department/Unit:
Submitted by:
Date:
1. List one accomplishment that you want to celebrate.
2. List one issue or opportunity you anticipate for your area during the next month AND that you need the support of others to accomplish. List 1-2 high impact tactics you are pursuing to accomplish each of our goals:
a. Quality b. Service c. People d. Finance e. Growth f. Community
3. Physician Engagement
4. Describe above and beyond actions of one employee, physician or
volunteer who has gone the Extra Mile
5. Report on one discovery you learned from purposeful rounding.
Please send your report to: � Patrick Baker � Your supervisor
Karen’s email
Is it Possible
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Patrick BakerCEO & Founder Palarum, [email protected]
www.palarum.com513-218-6315 Cell
