Serving a System Leveraging the Synergy between DNP- and PhD-prepared Nursing Professionals

1

Mary-MichaelBrown,DNP,RN HusseinM.Tahan,PhD,RNVicePresident,NursingPrac>ceInnova>on VicePresident,NursingProfessionalDevelopmentand

WorkforcePlanning

Objectives

1.  Describe the emergence of the healthcare system chief nurse executive (CNE) role.

2.  Compare the contributions of DNP- and PhD-prepared professionals.

3.  Consider supporting roles for system CNE. 4.  Discuss the synergy created between these two

roles to advance quality patient care across a healthcare system.

2

Brown & Tahan 2016

Brown & Tahan 2016

MedStar Health

3

•  Largest healthcare provider in Maryland and the District of Columbia region

•  10 hospitals o  4 Baltimore-area o  3 other Maryland locations o  3 District of Columbia

•  3,000 sites of care delivery including prompt care, primary care practices, multispecialty centers, VNA

•  31,000 associates •  8,600 RNs •  4,700 physicians •  $5 billion enterprise

Mission, Vision, Values •  Mission: To serve our patients, those who care

for them and our communities

•  Vision: To be the trusted leader in caring for people and advancing health

•  Values: “SPIRIT” o  Service o  Patient First o  Integrity o  Respect o  Innovation o  Teamwork

4

Brown & Tahan 2016

Brown & Tahan 2016

Hospital Merger Movement •  Hospital merger activity has

increased exponentially in the U.S.1

•  Advantages2: o  Larger revenue base permitting

higher performing hospital-units to compensate for others

o  Easier access to capital at better rates

o  Ability to develop systems to measure quality and share best practices

5

1Defini>veHealthcare.(2015).Top10largesthealthsystemsbymemberhospitals.RetrievedfromhNp://www.defini>vehc.com/hospital-data/top-10-largest-health-systems-by-member-hospitals

2Brownetal.(2012).Currenttrendsinhospitalmergersandacquisi>ons.HealthcareFinancialManagement,66(3),114-120

Emergence of Health System Chief Nurse Executive (CNE) •  Oversees clinical performance and patient care

delivery across entire system.1 •  Encourages “systemness” to maximize efficiency

and consistency in practices.2

•  Embraces new models of care, shared leadership, and the role of advanced practice registered nurses.3

6

Brown & Tahan 2016

1Englebright&Perlin(2008).Thechiefnurseexecu>veroleinlargehealthcaresystems.NursingAdministra7onQuarterly,(32),3,188-194.

2SinkusClark(2012).Thesystemchiefnurseexecu>verole.Signofthechanging>mes?NursingAdministra7onQuarterly,36(4),299-305.

2AmericanOrganiza>onofNurseExecu>ves(2016).SystemCNEwhitepaper:Theeffec7vesystemnurseexecu7veincontemporaryhealthsystems:emergingcompetencies.Chicago,IL:AmericanOrganiza>onofNurseExecu>ves.RetrievedfromhNp://www.aone.org/resources/aone-system-cne-white-paper.pdf.

Brown & Tahan 2016

ChiefNurseExecu>veOct.2010

VPNursingPrac>ce

Innova>onDec.2012

ClinicalPrac>ceProgramSpecialist

Dec.2013

Prac>ceProgramSpecialistFeb.2014

VPProfessionalDevelopmentandWorkforce

PlanningDec.2014

DirectorNursingAnaly>csDec.2011

SeniorBusinessAnalystFeb.2013

ChiefNursingInforma>csOfficer

Dec.2011

MedStarCNOsInplace.

MedStar Health System Nursing

VPNursingOpera>onsJul.2016

Brown & Tahan 2016

Professional Practice Model

8

NursingCareDeliverySystem

InterdisciplinaryCollabora9on

ClinicalSupports Evidence-basedPrac9ce Organiza9onal/Managerial

StructurestoSupportNursingPrac9ce

ClinicalAdvancementand

Recogni9on

Brown & Tahan 2016

Collaborative Governance

9

ChiefNursingOfficerCouncil

NursingPrac>ceCouncil

NursingPa>ent/FamilyEduca>on

Council

NursingQuality&SafetyCouncil

NursingProfessionalDevelopmentCouncil

NursingProductEvalua>on&

Standardiza>onCouncil

NursingResearchCouncil

NursingInforma>csCouncil

AdvancedPrac>ceNursingCouncil

Brown & Tahan 2016 10

Strategiesreflecthealthsystempriori>es

Nursingstrategies

reflecthealthsystemstrategies

Brown & Tahan 2016

Doctoral Preparation

Vincentetal,n.d.hNp://www.webnponline.com/ar>cles/ar>cle_details/dnp-prepared-nurses-as-prac>>oner-researchers-closing-the-gap-between-res/

Improvepa>entcare

deliveryand

outcomes

Translateresearch,intoprac>ce

Disseminatenewknowledgeintoprac>ce

Conductuniqueresearchtoadvancescience/theory

Test/analyzemethodstodiscovernewknowledge

DNP PhD

DNPProject PhDDisserta>on

DrivechangeDrivechange

Brown & Tahan 2016

Vice President Nursing Practice Innovation Role •  Partner with CNE, system leaders

to lead clinical transformation. •  Standardize evidence-based

nursing practice. •  Reduce variability in nursing

practice. •  Use existing evidence and

contribute to new evidence in patient care.

•  Mentor clinical and administrative colleagues.

•  Offer expert consultation on nursing practice.

Responsibilities •  Adopt, adapt or create clinical

practice guidelines. •  Respond to serious safety events

with system alerts and practice recommendations.

•  Serve as chair of system Nursing Practice Innovation Committee, Nursing Peer Review Committee, Safe Patient Handling Committee.

•  Act as executive liaison to Nursing Quality & Safety Council.

•  Serve as member system Quality & Safety steering committee.

•  Complete other duties as assigned. 12

Clinical Practice Guideline Development

•  Reflect high risk, high volume conditions. •  Use pre-appraised evidence when available (AHRQ

National Guideline Clearinghouse, professional organizations). •  Conduct systematic reviews, integrative reviews, and

literature reviews when not available.. •  Appraise quality of evidence & strength of

recommendations •  Examples:

o  Adopted, adapted, created, and updated 17 clinical practice guidelines

o  CAUTI Prevention: Primary source SHEA guidelines o  Nurse-to-nurse bedside shift report: Conducted integrative and

literature reviews 13

Brown & Tahan 2016

Clinical Practice Guideline Dissemination •  Guidelines are reviewed & endorsed by a minimum

of three bodies: o System Nursing Practice Council o System Nursing Practice Innovation Committee o System CNO Council

•  Iowa Model selected as EBP model: 4 phases of dissemination1

14

I. Creating

Awareness & Interest

II. Building

Knowledge & Commitment

III. Promoting Action & Adoption

IV. Pursuing

Integration & Sustained Use

1Cullenetal.(2012).Evidence-basedprac>cebuildingblocks:Comprehensivestrategies,tools,and>ps.IowaCity,IA:UniversityofIowaHospitalsandClinics

Brown & Tahan 2016

Safety Alert Creation & Dissemination

15

Brown & Tahan 2016

Brown & Tahan 2016

Vice President Nursing Professional Development & Workforce Planning Roles •  Partner with CNE, system leaders to lead transformation.. •  Establish a vision and strategic plan for nursing professional development

and workforce management. •  Inspire and engage associates. •  Develop coordinated care and population health capabilities. •  Redesign the clinical care delivery model to impact quality, safety, patient

experience and cost. •  Strengthen financial performance through use of effective staffing models. •  Strengthen the system brand for MedStar Nursing. •  Mentor clinical and administrative colleagues. •  Offer expert consultation on professional development and workforce

planning.

16

Brown & Tahan 2016

Vice President Nursing Professional Development & Workforce Planning Responsibilities •  Implement evidence-based models for nursing professional development,

competency assessment/management, and evaluation of learning . •  Serve as chair of the system Nursing Professional Development Excellence

Committee and Nursing Workforce Planning Executive Committee. •  Facilitate the implementation of the strategic supplemental staffing provider

agreement. •  Act as a project lead for the implementation of the interdisciplinary model of

care including relationship-based care and primary nursing. •  Oversee the educational affiliation agreements with key schools of nursing •  Implement the New To Practice Nurse Residency Program. •  Act as executive liaison to Nursing Professional Development Council. •  Complete other duties as assigned.

17

Brown & Tahan 2016

MedStar Nursing Professional Development Functional Areas

18

NPDStandardsofPrac9ce&ProfessionalPerformance

Educa9on(Orienta9on,Ongoing,CEProvider)

CompetencyAssessment&Management

Partnerships(Internal&External)

CareerCounseling&Coaching

Evalua9on(Value&ROI)

Na>onalNursingStaffDevelopmentOrganiza>on&AmericanNursesAssocia>on.(2010).NursingProfessionalDevelopment:ScopeandStandardsofPrac>ce.SilverSprings,MD:Nursesbooks.org.

Evaluation of Learning Framework • ReturnonInvestment–ReturnonExpecta9ons–Value• BoSomLine($$$)Level5

• Opera9onalImpact–Results–Outcomes• QualityandSafetyOutcomesLevel4

• Behaviors–Performance–Competence• CompetencyAssessmentChecklist&Simula7onLevel3

• Training–Learning–Educa9on• TestofKnowledge(PretestandPosSest)Level2

• Reac9on–Impression–Percep9on• ProgramEvalua7onFormLevel1

19

Kirkpatrick,J.,&Kirkpatrick,W.(April,2009).TheKirkpatrickfourlevels™:Afreshlookamer50years,1959-2009.Medford,OR:KirkpatrickPublishing.Wargnier,J.(2009).Evalua>nganddemonstra>ngthevalueoftraining:Challenges,prac>ces,andtrendsattheageofnewlearningtechnologies.CrossKnowledgeCompany,hNp://www.crossknowledge.com.RetrievedonAugust12,2015.

EFFICIEN

CY

Hourso

fLearning,Num

bero

fLearners

Brown & Tahan 2016

Behaviors(CareInterven9ons)

Competency Management Framework

20

Personality&Character(Antude,Ap>tude,

Rela>onships)

Skills(Clinical

Reasoning,Cri>calThinking)

Knowledge(Theore>cal,Experien>al)

Acompetencystatementmustalwaysinclude:

1.  Expectedbehaviorevaluated

&2.Assessmentmethodapplied

Lucia,D.,&Lepsinger,R.(1999).Theartandscienceofcompetencymodels:Pinpoin>ngcri>calsuccessfactorsinorganiza>ons.SanFrancisco,CA:Jossey-Bass.Wright,D.(2005).TheUl>mateguidetocompetencyassessmentinhealthcare,3rdedi>on.Minneapolis,MN:Crea>veHealthCareManagement,Inc.

Brown & Tahan 2016

Workforce Planning & Management Model

StrategicPlanDevelopment

TalentAcquisi9on

WorkforceU9liza9on

WorkforceManagement

21

• MarketResearch&Trends• WorkforceAnaly>cs&Repor>ng• ModelingandForecas>ngNeeds• GapAnalysis• Ac>onPlanning

• Sourcing• Recruitment• On-boarding

• Reten>on&Recogni>on• PerformanceManagement• Career&Prac>ceDevelopment

• Opera>ons&Budgets• Staffing

Brown & Tahan 2016

Key Relationships for Success

22

NURSINGPRACTICE

(policies,procedures,standards,guidelines)

NURSINGINFORMATICS

(electronicdocumenta9on,technology,devices)

NURSINGPROFESSIONALDEVELOPMENT

NURSINGPRODUCTS&EQUIPMENT

STANDARDIZATION

(suppliesandequipment)

Brown & Tahan 2016

Synergy: Patient Fall Exemplar

23

Brown & Tahan 2016

Synergy: Hazardous Drug Exemplar

24

Brown & Tahan 2016

Synergy: CLABSI Reduction Exemplar-- In process . . .

25

Brown & Tahan 2016

Academic Partnership

26

Educational Affiliation Agreement

Brown & Tahan 2016

Our Joint Contribution

•  Driving strategic transformations •  Application of evidence-based approaches to care

delivery and strategic decision making •  Internal consultants •  Effective execution of nursing strategic plan and

annual goals •  Facilitation of “systemness” •  Networking and building partnerships across the

MedStar Health System and externally with key persons and organizations

•  Influencing patient care quality and safety outcomes 27

Brown & Tahan 2016

Synergy Success Factors

•  Partnership and joint ownership •  Shared consciousness: transparent and ongoing

communication •  Political savvy •  Emotional intelligence •  Recognition for our individual contributions and

collaborative influence •  Mutual trust, respect, and support

28

Brown & Tahan 2016

Questions?

29

mary-michael.brown@medstar.nethussein.m.tahan@medstar.net