developing a clinically integrated health system: a system chief nurse executive perspective -...
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Developing a Clinically Integrated Health System
A System Chief Nurse Executive Perspective
March 7 and 8, 2016
10 Hospitals
>10,000 Employees
1,061 Staffed Beds
147,910 ER Visits
$168 million Charity
7,422 Home Health
Admissions
45,884 Hospital
Admissions
1,200 Physicians
4
Vision 2020
Patient Centered, High Value
System of Care
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SLHS Professional Nursing and Clinical Structure
Structural Framework *Saint Luke’s Hospital Designation
2
Level of Care Nurse Executives
Critical Care Medicine Surgery
Maternity/NICU
Emergency
System Directors Allied Health Professions
Pharmacy Laboratory Radiology
Director of Professional Practice
• Magnet Coordinator
• Pathways to Excellence Consultation
• Shared Governance
• Clinical Advancement Program
System Chief Nurse Executive
System Coordinating Council
System Level of Care Practice
Councils
Surgical
Medicine
Critical Care
Ambulatory
Behavioral
Post-Acute
Emergency
Neonatal
Peri-Natal
Cardiac Rehab
Specialty Councils
Falls
Value Analysis Team
SVAN
Wound Care
Saint Luke’s Care Connection with
System Level of Care Practice Councils
System Clinical Advancement
Council
System Nursing Research Council
System Chief Nursing Officer
Council
Clinical Leadership Council Connection
with CNO/CNEs
System Clinical Quality Connection
with CNO/CNEs
System Advanced Practice Provider
Council
Clinical nurse representation at
these Councils.
SLHS Professional Practice Model
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Entity Shared Governance Executives
• System level outcomes with two measureable system outcomes
• BSN Requirement by 2020 for existing RN’s
• All new promotions must have BSN
• Certification required
Level 4
• Outcomes involving more than one unit through informal and formal leadership.
• BSN Requirement by 2020 for existing RN’s
• All new promotions must have BSN
Level 3
• Unit based outcomes through informal and formal leadership
Level 2
• Novice Registered Nurse
Level 1
System Clinical Advancement Program (CAP)
CAP Key Changes
Clinical Advancement and maintenance now have the same requirements
Level IV promotions all reviewed and approved at System CAP Council
4% increase between each level of promotion and $0.50/hour differential for certification
Strategic Plan Linkage
Individual Goals/Clinical Advancement Program
Department Goals
Entity Strategic Plan
Saint Luke’s Health System Nursing Strategic Plan
Saint Luke’s Health System Strategic plan
Integrated Electronic Medical Record
Chief Nursing Informatics Officer
EMR
System Education Department
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System Director of Education Services
Jamie Luark
Program Coordinator
Jessica Walker
Med Surg
Kristin Carlson
Makenzie Stuck
OR
Cheryl Fisher
SLH
Amy Adkison
Meagan Randle Robinson
SLN & Smithville
1.0 FTE Entity
Director of Research
Jacque Carpenter
SLHS CNE
Kathy Howell
SLHS Patient Care Services Clinical Education Specialists
ER
1.0 FTE
Intermediate
Alisa Barker
Colleen Lad
Critical Care
Kristin Sollars
Marci Ebberts
Women’s / Children’s
Julie Mitchell
Kim Dishman
Program Coordinator
Nancy McEntee
Administrative
Assistant
Anna Hawthorne
Level of
Care
SLEH
Michelle Rennolds
1.0 FTE
SLS & Anderson County
Kathleen Bennett
SLCH
Brenda Potter
HMC & WMH
Jewell Harris
Jenni Kennebeck
CES at SLCH, HMC, WMH and ACH are responsible for all staff education CES at SLN, SLEH, SLS and SLH are responsible for nursing education
Neuroscience Productline –Grant Funded
Donna Hunt
Education Solutions Specialist
Christina Carlos-Moke
Productive Hours
Specialty Unit Registered Nurse Ratios Nursing Assistant Ratios
Medical Surgical Day Shift: 5:1 Night Shift: 6:1
Day Shift: 8:1 Night Shift: 10:1
Intermediate Day Shift: 4:1 Night Shift: 5:1
Day Shift: 8:1 Night Shift: 10:1
High Acuity Intermediate (Located in SLH)
Day and Night Shifts: 3:1 Day Shift: 8:1 Night Shift: 10:1
Intensive Care Unit & NICU Day and Night Shifts: 2:1 Day and Night Shifts: 1 per Unit
Mother and Baby (Varies slightly by facility based on AWHONN Standards)
Day Shift: 1:1 (Land D); 3:1 (Couplet) Night Shift: 1:1 (Land D); 4:1 (Couplet)
Day and Night Shifts: 1 OB Tech
Standardized: Productive and Other Productive Hours
Established both productive and other productive hours standards across all facilities by levels of care
Other Productive Hours
Medical Surgical
Intermediate Intensive Care Unit
Mother and Baby
Labor and Delivery
NICU
Education (per FTE)
24 hours 24 hours 24 hours 24 hours 24 hours 24 hours
Meetings (RN) 8 hours 8 hours 8 hours 8 hours 8 hours 8 hours
Orientation 220 hours 292 hours 436 hours 220 hours 724 hours 580 hours
Workflow Redesign – Central Staffing Office
Decentralized
Model
Variability of staffing
functions and structure
Inability to share staff
resources
Competition for available
float and/or agency staff
Sub-optimal
understanding of nursing
demand & capacity
Central Staffing
Office Model
Standardization of staffing
function and structures
Ability to share staff across
System entities
Resources dedicated to
staffing projections and
analytics
System-view of demand
and capacity
Key Staffing Functions
Self-Scheduling
Schedule Leveling
Assign PRNs, Float staff
and Agency
Predictive Analytics
Daily Staffing
JIT Needs Management
Assign Agency
Assign Float Staff
Track & Back-Fill Call-Ins
Future Needs Projections
Open Shift – Post/Approve
Long Term Needs – FMLA
Agency Competencies/Files
Centralized Float Pool Tiered Pay Structure
Tier 1* Tier 2* Tier 3*
Registered Nurse
Staff will only be required to work at
one entity
Pay differential is $2.00 above base
salary
It is estimated 60% of staff will be
allocated to this Tier
Staff will be assigned to work at two
entities
Pay differential is $4.00 above base
salary
It is estimated 25% of staff will be
allocated to this Tier
Staff will be assigned to work all four
entities
Pay differential is $6.00 above base
salary
It is estimated 15% of staff will be
allocated to this Tier
Nursing Assistant and Information Associate
Staff will only be required to work at
one entity
No pay differential
It is estimated 70% of NA staff will be
allocated to this Tier
Staff will be assigned to work at two
entities
Pay differential is $1.25 above base
salary
It is estimated 20% of NA staff will be
allocated to this Tier
Staff will be assigned to work at all four
entities
Pay differential is $2.00 above base
salary
It is estimated 10% of NA staff will be
allocated to this Tier
Additional Pay Differentials
All other pay differential will continue per system policies:
- Evening shift differential
- Night shift differential
- Weekend pay differential
- Holiday pay differential *Only applies to full-time and part-time staff. PRN staff will remain at current rates
All float staff will start in Tier 1 on 11and 4
System Float Pool Management Structure
Director of Central
Staffing & Float Pool
Entity Nursing House
Supervisors *
Central Staffing
Office
Manager
Float Pool Clinical
Nurse Managers
System Float Pool
* House Supervisors will still report to their specific entity
Sr. VP and CNE
Central Staffing
Office Coordinators
Clinical Analysts
Manual to Automated Analytics
Manual to Automated Analytics
System Policies and Procedures
Care Progression – Overview of Model
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Care Integration
Case Management
Hybrid approach consisting of utilization review and
discharge planning
Social Work
Identify barriers to transition and facilitate
placement into appropriate care setting
Care Coordination
• Unit based Care Coordinators
• Overcoming obstacles to delivery of care and ensuring care progression
Utilization Review
• Centralized Utilization Review RNs
• Utilization review, referral authorization, and denials management.
Social Work
• Identify barriers to transition and facilitate placement into appropriate care setting
Care Progression
New Model Former Model
System Care Progression
Chief Nursing Officer, Ambulatory Nursing and Advanced Practice Providers
Ensure all APP’s are practicing to the full extent
of their licensure
Executive Sponsor of the System APP Council and
Ambulatory Nursing Council
Ensure consistent standards of care throughout all
ambulatory clinics.
Quality Outcomes
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0.40
0.60
0.80
1.00
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SLHS Sepsis Mortality O/E Ratio (SLE, SLH, SLN, SLS)
Financial & Productivity Results
2013 2014
Patient Care Services 15.17 14.87
Laboratory 0.09 0.09
Pharmacy 0.04 0.04
Radiology 1.24 1.29
Respiratory Therapy 0.63 0.70
0.56 0.66
Emergency Services 2.76 2.77
Savings by Year $ 21,096,980 $ 17,996,028
• APP Fellowship
• New Graduate Residency and Preceptor Enhancements
• Central Logistics Center
• Ambulatory Float Pool
• System wide Nursing Peer Review
• Quality – Zero Patient Harm
Clinical Integration 2016 Strategic Priorities
• Katherine Howell, MBA, BSN, RN, NEA-BC
Sr. Vice President, Chief Nurse Executive
Phone: 816-932-1585
901 E 104th Street, Mailstop 900 N
Kansas City, MO 64131
saintlukeshealthsystem.org
Contact Information