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Nurse Leader and Abbott Northwestern Hospital Essay

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Updated: Jun 15th, 2022

Introduction

Performance outcomes primarily reflect the effect of hospital services on patient experience areas, clinical processes, and financial viability. The measures indicate the organization’s progress made in patient safety and quality care. They also enable a hospital to determine the changes needed to improve employee engagement and performance – finances or customer satisfaction. The management uses outcome measures to identify priority areas for improvement and related drivers to achieve desired performance levels. This paper aims to develop a performance data scorecard and explore ways of improving outcomes that are below national benchmarks as a nurse leader.

Patient Population

The population served are post-op spine and joint (knee and shoulder) surgical patients on the Orthopedic and Spine floor unit at Abbott NorthWestern Hospital (ANWH), Minneapolis, Minnesota. ANWH is a 668-bed teaching hospital founded in 1882 and currently serving over 200,000 post-op patients in Twin Cities and nearby areas (Allina Health, 2020). It is a part of the Allina Health healthcare system and provides varied specialty services, including mental health and addiction treatment, Minneapolis Heart Institute, Orthopedic Institute, and Surgical Services. ANWH’s mission is to serve communities through high-quality care, prevention, and restorative health. The population addressed includes patients with post-surgical needs at the unit. The aim is to provide safe, quality care that reflects empathy, respect, and dignity.

Outcome Measures

Indicator Outcome measure Drivers
Performance Decrease 30-day readmissions to the Orthopedic and Spine Unit – Reduced complications that necessitate readmission
– Better transition to primary healthcare
– High quality of care
– Improved outcomes – HICAHPS scores
Quality Provide care based on unique post-op patient/family needs – Enhanced patient/family participation in care
– Timely and appropriate follow-up after an inpatient stay
– Decreased length of stay
Patient safety Reduce pressure injuries and fall rates through evidence-based practice (EBP) – Enhanced nurse awareness and responsiveness to pressure injuries and falls
– Ability to identify high-risk patients
– Reduced length of stay
Employee engagement Increasing the number of RNs with Medical-Surgical Nursing and Orthopedic Nurse Certification – Enhances employee engagement and retention through career advancement opportunities
– Encourages EBP nursing interventions

Necessary Processes

Performance

Effective initiatives to reduce readmissions after a knee or shoulder surgery will be help drive the unit’s performance outcome. As a nurse leader, the first necessary processes for achieving this goal is a root-cause analysis to identify risk factors for readmitting patients at the facility based on hospital data. Subsequent collaboration with facility management will ensure a stronger policy to address those predisposing variables, including medical comorbidities (diabetes and obesity), patient age, type of procedure, pain, and infection. These issues account for a majority of post-surgical readmissions and must be minimized.

The necessary process is creating new protocols for better post-operative pain and infection control. Again, partnership with specialists – orthopedic surgeons and neurosurgeons – can help implement measures to minimize the risk. Physician buy-in for the initiatives will be gained by revealing the cost data related to post-op readmissions. Subsequently, readmission rates will be captured to track performance improvements due to the change. Readmissions are losses under the pay-for-performance model, and therefore, root-cause analysis and new protocols addressing risk factors are necessary processes for the performance goal. Finally, the results will be revealed to hospital management and third-party payers to enhance support for the initiatives.

Quality

The goal for this indicator is to decrease surgical-site infection rates, improving the inpatient experience. The nurse leader will include baseline screening as a pre-op routine or intervention to identify patients with a history of difficult-to-treat infections, such as methicillin-resistant Staphylococcus aureus. Positive cases will be referred to specialized preoperative treatment before surgery. Additionally, the pre-op admitting nurse will be required to care for the patient throughout the inpatient stay. Minimizing the number of contacts through this isolated treatment fashion can dramatically reduce infection. Hand hygiene protocols and stricter policies at the post-op unit will be necessary for achieving the quality goal. Patient/family education on wound care, including dressing and measures to prevent infection of the surgical site and post-operative pain, will also be implemented. The goal is to foster the patient’s experience and self-care capacity upon discharge.

Patient Safety

The goal is to reduce the risk of post-op pressure injuries (PIs) and fall rates. The nurse leader will take several interventions to achieve this outcome. Safety protocols for positioning patients or the flip process will be adopted to reduce friction or skin injury during turning. A minimum of two nurses will be involved in patient transfer and changing position in bed to avoid PIs. Additionally, prescribed exercises for post-op patients, including walking, will involve an assistive device or a physical therapist to reduce the fall risk. Based on assessed needs, a rehabilitation nurse will make arrangements for follow-up upon discharge from the unit.

Employee Engagement

Ensuring that nurses are optimally engaged in their roles will enhance organizational outcomes. The nurse leader will undertake three actions to drive employee engagement at the post-surgical unit. The first intervention is setting measurable goals that reflect individual performance metrics. Goals for HICAHPS scores will indicate to a nurse his or her contribution to the patient experience. As a result, the staff will feel motivated and obligated to meet them. Another intervention is investing in the professional growth and development of employees. Individual goals based on specific practice roles at the unit will help develop the required skills. Lastly, a reward system will be adopted to appreciate and motivate high performers in quality, safety, and patient experience.

Additional Indicators

The complexity of healthcare demands the use of many indicators to measure processes and identify opportunities for advancement. An additional indicator that will help drive outcomes in the scorecard is the staffing level. The high risk of re-injury during positioning and exercise will require well-staffed multidisciplinary teams. The nurse leader will need to monitor staffing regularly to ensure that the safety protocols for the flip process are implemented to reduce PIs and falls (a safety outcome measure) at the unit. Another indicator is patient-rated pain, which could indicate post-operative complications. Monitoring pain is important for the nurse leader to implement patient/family-centered care to improve inpatient experience (a quality outcome measure) at the unit.

Advantages

A balanced scorecard (BSC) is an innovative tool for improving an organization’s competitive position. In healthcare, the BSC’s customer-centric approach can enable hospitals to create value for patients, staff, and payers. A key advantage of this tool is that it gives structure to organizational strategy (Mehralian et al., 2018). It aligns the entity with a customer-focused approach to the market, supporting adjustment to regulatory and industry changes and measuring specific metrics. Fot instance, monitoring and evaluation of employee performance for reward and recognition can be accomplished with this tool. The alignment of departments and divisions is another advantage of BSC. It supports communication and collaboration in monitoring and assessing the strategic goals of the organization.

A third potential benefit of using the BSC tool is that it helps employees understand how individual goals contribute to organizational strategy. By assigning accountability to each individual at every level, BSC enhances communication quality and reduces the lead time to care delivery, improving the inpatient experience (Soysa et al., 2019). Another advantage is that it supports continual measurement and evaluation of initiatives against industry standards. Thus, it allows managers to quantify short-term financial gains in order to create long-term value for clients.

Current Trends

Employee engagement is critical to creating a motivated and productive workforce to drive organizational goals. Organizations must employ effective strategies to improve morale in the workplace, job satisfaction, and retention in the current competitive environment. A major trend in the healthcare industry is the use of attractive health benefits. Flexible, incentive-based wellness plans are provided to help employees with chronic illnesses attain a better health status (Gibson et al., 2017). For example, most employers may offer onsite behavioral and lifestyle programs, including weight loss and smoking cessation programs based on staff characteristics – disease risk and healthcare spending. High rates of engagement are achieved when employees can develop individual health goals, and incentive points are awarded (Gibson et al., 2017). The health promotion initiatives are meant to boost staff morale, enhance productivity, and reduce healthcare spending.

Given the complex and evolving nature of healthcare, a contemporary trend is availing opportunities for educational enhancements. Nurses require lifelong learning to gain new knowledge in order to practice competently. According to Gibson et al. (2017), employers facilitate or finance educational opportunities for staff, such as on-the-job training, specialty certification, conferences, workshops, and participation in quality committees as an engagement strategy. The goal is to equip employees with up-to-date clinical and leadership skills, which makes them more satisfied and confident in their roles, reducing the intention to leave the organization. Profit-sharing through bonuses and rewards for those meeting specified performance standards is an extrinsic engagement strategy. In this case, quality indicators are used to recognize and celebrate exceptional individuals.

Relationship

Employee engagement is a significant driver of quality outcomes in hospitals. Highly engaged teams involved in the Orthopedic and Spine unit will enhance patient care by participating in the quality and patient safety committee. Their active participation in the interdisciplinary group will ensure the alignment of clinical activities with institutional priorities and standards (Carthon et al., 2019). Consistent surveillance involving the employees will ensure early detection and treatment of complications or surgical site infections in post-op patients.

Additionally, the nurses’ educational enhancement through professional workshops and on-the-job training will enable staff to practice efficiently and effectively. As a result, patient outcomes, such as reduced fall rate and PIs and lower readmissions, will be obtained at the unit. For example, providing competent care will lead to fewer medical errors and wound infections, which will enhance the inpatient experience, contributing to more favorable ratings of the facility. Additionally, a patient safety culture will be created at the unit due to nurse-led interventions related to employee engagement in lifelong learning.

Current Tools

Employee job satisfaction can predict process, quality, and patient outcomes. ANWH does not use any tools to measure employee engagement internally, but the Allina health engagement surveys completed annually rated the hospital at 59% (Gesensway, 2016). Several instruments for measuring how well the staff is engaged or disengaged are available. A suggested tool for ANWH is the National Database of Nursing Quality Indicators (NDNQI) that collects data for 14 different outcome measures (Dempsey & Reilly, 2016). It measures quality indicators, such as fall rates and PIs, and staff mix. The RN satisfaction survey is a critical component of the NDNQI that helps nurse leaders to assess the nursing environment to promote their engagement and retention efforts (Dempsey & Reilly, 2016). Hospital data collected in each quarter are submitted electronically to the NDNQI database. Quality checks are conducted, and quarterly reports are generated for a facility desegregated at the unit level, allowing employers to identify performance and satisfaction levels. Thus, the RN satisfaction survey can provide the nurse leader with adequate data for employee engagement efforts.

Another viable engagement tool is the Great Places to Work Survey – a confidential web-based solution that can be used to measure corporate culture and staff morale levels. Using this tool, employers can create customized surveys and obtain feedback by unit, department, or site (Great Places to Work Institute, 2020). It captures and analyzes employee comments, empowering managers to make data-driven decisions. Therefore, this tool can provide the nurse leader with adequate data on employee engagement efforts at the Orthopedic and Spine unit.

Improving Employee Engagement

A plan to improve employee engagement based on the performance data scorecard developed in section A2 includes goals, strategies, evaluation, and timelines.

Goals

  • To increase the number of Medical-Surgical Nursing certified RNs.
  • To raise the population of orthopedic-certified nurses at the unit.

Strategies

  • Provide a flexible shift-specific education or training for eligible nurses at the unit.
  • Consulting staff nurses and supporting them meet personal development goals.

Evaluation

  • Quarterly turnover at the unit compared to the overall organizational rates.
  • The number of staff completing the training modules at the unit.
  • Participant surveys to measure nurse satisfaction with the education plan.

Timelines.

Quarter 1 Developing a plan for increasing orthopedic-certified RNs
Quarter 2 Notify staff and enroll participants in a training program
Quarter 3 Complete the education plan and prepare nurses for certification exam
Quarter 4 Evaluate the effectiveness of the training – participant surveys

Leadership Best Practices

Ensuring that workers feel supported and valued is an important human resource function of leaders. Available opportunities to enhance employee engagement range from wellness programs to recognition. Fostering trust and supporting teamwork are best practices in this area (Dempsey & Reilly, 2016). Accountability and empowerment through career growth opportunities create trust-based relationships based on respect. Multidisciplinary teams that work collaboratively to meet patient needs exhibit higher engagement levels than individuals operating alone. Other best practices include promoting communication and transparency of information or data on quality and acknowledging high performers through tangible rewards and genuine praises (Dempsey & Reilly, 2016). Supporting a proper work/life balance through flexible schedules is also critical in creating a highly engaged workforce to drive the outcome measures set for the organization, department, or unit.

References

Allina Health. (2020). Web.

Carthon, J. M. B., Hatfield, L., Plover, C., Dierkes, A., Davis, L., Hedgeland, T., Sanders, A.

M., Visco, F., Holland, S., Ballinghoff, J., Del Guidice, M., & Aiken, L. H. (2019). Journal of nursing care quality, 34(1), 40–46. Web.

Dempsey, C., & Reilly, B. (2016). OJIN: The Online Journal of Issues in Nursing, 21(1), 2–8. Web.

Gesensway, D. (2016). Today’sHospitalist. Web.

Gibson, T. B., Maclean, J. R., Carls, G. S., Moore, B. J., Ehrlich, E. D., Fener, V., Goldberg, J., Mechanic, E., & Baigel, C. (2017). Preventive Medicine Reports, 7, 86–90. Web.

Great Places to Work Institute. (2020). . Web.

Mehralian, G., Nazari, J. A., & Ghasemzadeh, P. (2018). Journal of Knowledge Management, 22(4), 802–823. Web.

Soysa, I. B., Jayamaha, N. P., & Grigg, N. P. (2019). Total Quality Management & Business Excellence, 30(9-10), 1005–1025. Web.

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