C O R ECommitment to On-going

Regulatory Excellence

CORE Performance Measures

Establishes measurable (but reasonable) goals

CORE IS A PERFORMANCE MEASUREMENT SYSTEM THAT:

Provides feedback on whether boards of nursing in the U.S. are doing what they think they are doing

Creates a roadmap that others can follow for success

CORE IS A PERFORMANCE MEASUREMENT SYSTEM THAT:

Best Practices

Performance measurement is not just a tool.

It is an essential element in aligning resources with priorities

Source: “The 8th Habit” by Stephen R. Covey

Only 37% of employed people said they have a clear understanding of what theirorganization is trying to achieve and why.

Only 1 in 5 workers said they have a clear “line of sight” between their tasks and their team’s and organization’s goals.

If these results were applied to a soccer team, only 4 of the 11 players would know which goal is theirs.

Directing organizations is like flying an aircraft

What are the Key Indicators?

Am I going in the right direction at the right speed?

Rather than perception and anecdotal information CORE uses accurate measurements.

Are these lines the same length?

Purpose

To help Boards of Nursing improve their management and service delivery

Board of Nursing Roles

• Licensure

• Discipline

• Practice

• Education

• Governance

Stages in Model

INPUTSPROCESS/ACTIVITIES

OUTPUTSINTERMEDIATE

OUTCOMEOUTCOMES BOARD ROLE IMPACT

DefinitionWhat resources we invest

Actions taken to achieve the desired outcomes

Measurable products of a program’s activities

An outcome that is expected to lead to a desired end but is not an end in itself

Benefits to stakeholders, communities, systems, or organizations

Functions of the Board of Nursing

Are we achieving the right results?

Examples

TimeStaffMoneyPartnersEquipmentSpaceMaterialsTechnology

TrainFacilitateMeetingsWorkshops

PlansPolicyTraining

SkillsAwarenessKnowledgeAttitudesOpinionsMotivations

BehaviorPracticeDecision MakingPoliciesSocial Action

LicensureDisciplineEducationPracticeGovernance

Improved well-being for people

Sample

MoneyStaffPartnersTechnology

Train investigatorsInvestigate complaintsNegotiate consequences

Process reports of misconduct or incompetent practice in a timely manner

Guidelines for conduct and practice

Nurses are held accountable for safe and competent practice

Discipline

To safeguard the public’s health and well-being by providing guidance for and regulation of, entry into the profession, nursing education, and continuing safe practice

Metrics

Number of monitors

Number of investigators

Time from receipt of complaint to disposition of complaint

Length of time to complete a case

Recidivism

Logic Model

CORE

Data collected from boards of nursing and multiple stakeholder groups

1. Boards of Nursing2. Nurses 3. Educational programs4. Employers

1.9 1.9

Nurses and Employers Perception of the Board’s Effectiveness in Protecting the Public

Nurses Employers

Very Effective

Effective

Ineffective

Very Ineffective

Very Effective

Ineffective

Effective

Very Ineffective

4

3

2

1

4

3

2

1

Nurses’ and Employers Knowledge of How to Report a Suspected Violation of Nursing

Statute and Rules

2007

Nurses Employers

Percent who say they know how to report violation

64.5% 95.2%

Nurses’ Satisfaction with the Licensure Process

2.35

DissatisfiedVery

Dissatisfied SatisfiedVery

Satisfied

Nurses’ Satisfaction with the Renewal Process

2.36

DissatisfiedVery

Dissatisfied SatisfiedVery

Satisfied

Method Last Used to Obtain/Renew License

2007

Mail 39.2%

On-line for entire process 36.4%

Printed application from Board Web site and mailed/faxed in

10.3%

Other 9.8%

Walk-in 4.3%

Method Used by Employers to Verify Licenses

2007

Web-based verification system 79%

Phone – automated system 15%

Call-in 13%

E-mail 12%

Nursys 11%

Letter 5%

Fax 3%

2007 Too much regulation

Too little regulation

Please rate the degree or extent of regulation in this state in each of the following areas. (Scale: 4 =Too much regulation,3 = Adequate regulation, or 2 =Too little regulation)

Education Programs

Employers

Practice standards/scope of practice

2.6% 6.7%

Complaint resolution/discipline process

2.2% 17.4%

Education program approval/accreditation

10.8% 15.2%

Requirements for licensure 3.3% 9.2%

Ratings of Existing Statutes and Administrative Rules and Regulations

Using Information from CORE

Used the information to support purchasing a new $240,000 phone system - the prior number one dissatisfier/challenge from those surveyed in the state

Comparisons

Aggregate

State

Size (Number of Licensees)

Umbrella and Independent

Year AggregateA Board of

NursingVariance

2007 $48.80 $38.9120%

Below Avg.

Estimated Cost Per LicenseeBoard vs. Aggregate

Variable2002 2005 2007

Value Value Value

Expenses per licensee (total budget divided by number of nurse licensees)

 $36.42 $37.89 $38.91

Estimated Cost Per LicenseeBoard Results Across Time

YearIndependentBoards Avg.

A Board of Nursing

Variance

2007 $48.30 $38.9120%

Below Avg.

Estimated Cost Per LicenseeBoard vs. Other Independent Boards

Year

Boards with Between 50,000 to

99,999 Licensees

A Board of Nursing

Variance

2007 $48.89 $38.9120%

Below Avg.

Estimated Cost Per LicenseeBoard vs. Boards of Similar Size

PERCENTAGE OF EXPENDITURES BY FUNCTIONAL AREA

Aggregate A Board of Nursing

Investigations/discipline  33% 51%

Licensure 19%  5%

Educational Programs 7%    12%

Other Indirect Expenses

36%    36%

2007

AggregateAverage

A Board of Nursing

Variance

Days

Months

2287.6 months

2187.3 months

About 10 days below

avg.

Estimated Days & Months to Resolve A Case

Percentage of Cases Completed in the Last Year

Aggregate A Board of Nursing

66% 61%

Employer’s Perceptions of New Graduates Preparedness by Function

Scale: 4 = very well prepared; 3 = well prepared; 2 = poorly prepared; 1 = very poorly prepared

  AggregateA Board of

Nursing

Administer medication by common routes 2.88 2.97

Recognize abnormal physical findings 2.75 2.56

Communicate relevant information 2.75 2.59

Assess the effectiveness of treatments 2.69 2.54

Teach patients 2.69 2.61

Work with machinery used for patient care 2.67 2.56

Work effectively within a health care team 2.67 2.69

Respond to emergency situations 2.63 2.32

Do math necessary for medication administration 2.63 2.65

Perform thorough physical assessments 2.56 2.61

Create a plan of care for patients 2.5 2.64

Perform psychomotor skills 2.47 2.43

Recognize abnormal diagnostic lab findings 2.44 2.47

Supervise care provided by others 2.36 2.15

RN Perception of Education Program Preparation

50% 42%

57%

29%

0%

10%

20%

30%

40%

50%

60%

2002 2005 2007

Year

% V

ery

Wel

l Pre

pare

d fo

r P

ract

ice

Aggregate

A Board of Nursing

RN Perceived Preparation for Practice by Years of Licensure

0%

10%

20%

30%

40%

50%

60%

70%

80%

0 to 1years

1 to 2 years 2 to 5years

5 to 15years

15 to 25years

25 to 35years

35 or moreyears

Years Licensed

Per

cent

Ver

y W

ell P

repa

red

for

Pra

ctic

e

Perception of Board Functions by Nursing Education ProgramsScale: 4 = adequate; 3 = somewhat adequate; 2 = somewhat inadequate; 1 = inadequate

  2002 2005 2007

Time spent on site during visit 3.91 3.70 3.95

Time given to correct deficiencies 3.90 3.80 3.94

Preparation time for Board visits 3.82 3.80 3.94

Interval between Board visits 3.67 3.90 3.89

Overall benefit of approval process 3.90 3.80 3.84

Communication with Board staff 3.92 3.60 3.84

Timeliness of providing feedback 3.91 3.80 3.79

Feedback/evaluation provided by Board 3.91 3.70 3.79

Due process for disagreements re. findings 3.89 3.56 3.75

Comprehensiveness of feedback provided 3.91 4.00 3.74

Fairness in monitoring compliance 3.89 3.90 3.72

Fairness/objectivity of Board findings 3.91 3.90 3.63

2007

AggregateA Board

of Nursing

Received Sanctions or Faced Closure

11.3% 12.6%

Percentage of nursing programs that received sanctions, faced closure, or been

the subject of additional monitoring in the last 2 years

Education Program Investigation

How well Board kept them informed

2005 2007 Improvement

Nationally 3.41 3.47 0.06

State 2.50 3.80 1.30

Assistance provided by Board staff

2005 2007 Improvement

Nationally 3.85 3.85 0

State 3.85 3.88 0.03

Scale: 4 = very well informed; 3 = well informed; 2 = minimally informed; 1 = not informed at all)

(Scale: 4 = consistently helpful; 3 = occasionally helpful; 2 = rarely;1 = not helpful at all)

Education Program Investigation Process

   Fairness of Investigation Process

  2005 2007 Change

Nationally 3.54 3.62 0.08

State 3.00 3.80 0.8

Appropriateness of Outcome      

  2005 2007 Change

Nationally 95% 95% 0

State 100% 100% 0

Timeliness of Investigation Process      

  2005 2007 Change

Nationally 93.8% 92.3% -0.015

State 100% 100% 0

(Scale: 4 = very fair;3 = fair; 2 = unfair; 1 = very unfair)

• Education unit has improved on most parameters

• Need to ascertain why fairness/objectivity perception decreased

• Continue to communicate frequently and timely with programs

• Explore ways to assist programs achieve excellence

Conclusions/Future Actions

Action Plan

Administration, Curricula, and Program Evaluation Plan

Please rate your Board of Nursing’s review process in the following program areas. (Scale: 4 = very effective; 3 = somewhat effective; 2 = ineffective; 1 = not effective at all)  

2005 2007

Program Area n Rating n Rating

Administration 541 3.70 1,222 3.79

Curricula 542 3.67 1,224 3.76

Clinical facilities 526 3.58 1,192 3.74

Classroom/lab 519 3.48 1,187 3.75

Student/faculty policy 534 3.60 1,200 3.76

Program Evaluation Plan

497 3.46 1,209 3.74

Please rate your Board of Nursing’s review process in the following program areas. (Scale: 4 = very effective; 3 = somewhat effective; 2 = ineffective; 1 = not effective at all)  

2005 2007

Program Area Rating Rating

Administration 2.99 2.43

Curricula3.21

2.86

Clinical facilities 3.00

Classroom/lab 2.86

Student/faculty policy

2.86

Program Evaluation Plan

3.112.41

+0.4

+.86

+.83

Goal: Be within 0.5 of the aggregate rating

Ineffective Somewhat Very Effective

Effective

2007 2009

Compare 2007 and 2009 data (from the 2010 report) to determine if goals were met

1. Did response rate for education programs increase by 34%?

2. Did the ratings for administration and curricular requirements increase to within 0.5 of the aggregate results?

3. Did the rating for program evaluation plan requirements increase to with 0.5 of the aggregate results?

Were Your Goals Met?

No Discuss results with stakeholders and get ideas for improvement and revise action plan

Yes Move on to other results of concern, but continue to monitor these results

STRATEGIC GOAL: TO FACILITATE INFORMATION EXCHANGE BETWEEN THE BOARD AND ITS CONSTITUENTS

Objective: Effective communication with the public, including licensees, employers, policy makers, consumers

Performance Measure: If CORE findings indicate positive communications with

constituents

Incorporate into Strategic Plan

Interview boards in the upper 10% of respondents to determine what it is they do to get better results