Eighth&Naonal&Doctors&of&Nursing&...

Eighth Na)onal Doctors of Nursing Prac)ce Conference

“How to be a Be;er DNP in 3 days”

Michelle Pendleton, DNP, RN

Steven Brockman-‐Weber, DNP (c), MSN, MS, FACHE, NEA-‐BC

The value of a DNP as a change agent in developing “tes)ng labs” for process, prac)ce or product.

Objec)ves: 1.  Discuss innova)ve roles and strategies of DNP prepared

nurse to improve health outcomes. 2.  Iden)fy strategies to make changes within your own

healthcare organiza)on that can lead to sustained improvements.

3.  Recognize a;ributes of "tes)ng areas" the DNP must foster to influence change.

• Volume (’14): 2.4 Million Visits 63,135 Admissions 50% Market share*

• Net Revenue (’14) $1.9 Billion • Hospitals: 5 (1,837 licensed beds; staff 1,420 beds)

• Kosair Children’s Hospital • Norton Hospital • Norton Audubon Hospital • Norton Brownsboro Hospital • Norton Women’s and Kosair Children’s Hospital

• Outpatient Centers: 20 • Employees: 12,000 (Louisville’s

3rd largest employer) • Physicians: 2,000+

• Consolidated Medical Staff • 700+ Employed/ 200+ Sites

* Based on state data for Louisville hospitals-YTD Q3 2014 3

Norton Healthcare Profile Louisville, KY

Care Con(nuum NHC Service Offerings

Diagnos(c Center

Post Acute Care Skilled Nursing; LTAC; Rehab

Home Health Care

Acute Care Hospitals

Primary Care & Specialty Physician Network; Urgent Care Centers; Employed Physician Offices; Outreach Clinics; Telemedicine

Cancer Resource Center; Church & Health Ministries; Preven(on & Wellness Programs

Acuity

Ambulatory Surgery Centers

Con(nuum of Care

Pa(ent

209 Combined

Sites

1 Site

5 Sites

6 Sites 0 Sites

0 Sites

400+ Sites

Change…is there a problem?

Na)onal Center for Advancing Transla)onal Sciences (2015), a division of the Na)onal Ins)tute of Health

(NIH)

Process of developing a new interven)on or treatment currently takes? 14 $2 Failure rate exceeding %

years billion

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Na)onal Center for Advancing Transla)onal Sciences (n.d.). Retrieved from h;p://www.ncats.nih.gov.

Alpha Units: The Concep)on “ See a need, fill a need” Bigweld, Robots Movie

Why do we need Alpha Units?

Create successful, fast, evidence-‐driven organiza)onal change

Lack of buy-‐in of proposed change

“We are different”

phenomenon. Invalidated varia)on

Change and adop)on of evidence into prac)ce is “too slow”

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Alpha Units

Less Cost with trial vs. full roll-‐out

Concept development

Spring 2013 Summer 2015

Cross system team

convened

Evidence review; current na)onal

assessment

Unit characteris)cs

recommended to CNOs

Data plan Educate Imple

ment Trial Adapt Alpha concept

Alpha Units

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Define

Measure

Analyze Improve

Control

A component of the Nursing 2020 Strategic plan Norton Healthcare (NHC) PI Model (DMAIC)

Using alpha units for the test

What is an alpha unit? •  What does alpha mean?

–  The first test version: describes the first working version

•  Characteris)cs of an alpha units –  Willing to Challenge Status Quo –  Innova)ve & Crea)ve –  Work to Solu)on –  Evidence & Data Focused –  Able to Manage Ambiguity –  Honest in Feedback –  Willingness to try –  Adapt, Adopt and Overcome

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Alpha Units – The What

•  Solu)on: –  Cover the core subspecial)es (i.e. cardiac, medical, surgical, telemetry, cri)cal care, etc.) to create virtual hospital

–  Provide “tes)ng” labs for new process/standardiza)on change in system to enable rapid cycle change and the development of prac(ce based evidence (qualita)ve -‐conducted in context of real-‐world prac)ce)

–  Leadership team educated and supported with change and DMAIC training

–  Each unit supported by DNP in Systems Leadership

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Non-‐Nego)ables

Ac)ve Leadership and staff

engagement as change agents

DNP prepared nurse leader to

advise and support alpha units

Rapid change that is based on

meaningful, iden)fied criteria

Deployment of posi)ve change to

other units

Change is measured as well as adopted,

adapted, or abandoned

ALPHA UNITS

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Deliverables

Rapid cycle of change (30-‐60-‐90 days) Replica)on Plan

and Communica)on

Budget neutral

3 days change management and process improvement

training

Criteria for success are

iden)fied prior to change being implemented

Aner test, change is adopted, adapted, or abandoned

Data and pa)ent

outcome driven

Alpha Unit Selec)on

•  Manager Traits –  Leadership style –  Employee engagement scores –  Previous response to change –  Strong ANMs

•  Unit Traits –  Percent BSN and cer)fied – Unit based councils –  Turnover/vacancy –  Culture of safety scores

Alpha Units – The What

Solu)on: •  Two kinds of change

•  Specialty •  Organiza(onal

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Virtual Hospital (adults & kids)

Intensive Care

Medical/ Surgical

Transi)onal Care

Opera)ng Room

Emergency Room

Psychiatric

DNP role in alpha units? Transla)on

DNP role in alpha units? AACN 2006 DNP Essen)als

•  Translator of change •  Help to develop the plan for implemen)ng change •  Integrate components for successful implementa)on and

dissemina)on •  DNP possesses the ability to translate knowledge quickly

and effec)vely (Porter-‐O’Grady. 2003) •  DNP uses science-‐based theories and concepts to

evaluate concepts DNP creates and sustains change at the organiza)onal and policy level

•  Is able to help translate research into prac)ce (DePalma & McGuire, 2005)

•  Design and implement process to evaluate outcomes of prac)ce

Criteria for Alpha Test

• Recognize/Iden)fy Problem • Evaluated the evidence? • Subject Ma;er Experts • External Literature/Summary of Evidence Table

Idea Submission

• Educa)on • Communica)on • Data Collec)on • Go-‐live checklist

Planning • Adapt, Adopt, Abandon • Full implementa)on • Monitoring

Recommenda)on

To test or not test? Pilot Test if: -‐The impact is broad (scope) -‐The process may vary -‐Resistance is an)cipated

No Pilot Test if: -‐Scope is small i.e. one unit -‐Straight forward change -‐Stakeholders do not expect much resistance

Pilot Test?

No Pilot Test?

Past Project Examples

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The Final Check-‐Say It Out Loud Say out loud the last 3 digits of the MR# on the patient’s ID band and the Specimen label.

3 Numbers Can Save Lives

PSRS Technical Tes)ng

Remote Pa)ent Management

Lab Specimen Labeling

Project: Lab Specimen Labeling

Specimen Label Enhancements

Alpha Unit Specimen Label Non-‐Alpha Unit Specimen Label

Armband Enhancements All armbands include these modifica)ons: 1.  DOB and MRN EP # were moved to top of armband 2. MRN EP # was bolded

New Arm Band Old Arm Band

Specimen Labeling Common Cause Analysis

Themes Iden(fied •  Unlabeled Specimens

–  Label in bag – MRN comparison before a;aching label –  Urine specimens brought to staff

•  Mislabeled Specimens –  Staff had two or more pa)ent labels at bedside

•  Overall Process Failures –  Distrac)ons and interrup)ons –  Down)me –  Pulled to alpha unit without training in process

Best Prac)ces/Lessons Learned •  Valida)on/Cer)fica)on Process •  Look for non-‐value added steps to remove •  ID/mi)gate impact of parallel processes •  Baseline data pre-‐project •  Best prac)ce outside organiza)on •  Regular touch points/weekly )ps •  Dedicated educa)on resource •  Alpha team recogni)on/ CNO rounding •  Technology pre-‐test •  Standard summa)on of end results to staff


What? •  U)lizes technology (Jabber

Video via iPad) to assist all bedside nurses in providing )mely, evidence-‐based pa)ent care

•  Timely clinical support and exper)se

•  Expert clinical nursing consulta)on to prevent delays in care

The tes)ng ques)on: Will staff use a “telemedine-‐type” technology to answer nursing ques)ons


Why? •  RPM is a complement to your current expert resources, not a replacement •  RPM APRNs provide readily available, )mely expert consulta)on in

support of direct care-‐givers •  RPM APRNs will u)lize exis)ng standing orders (i.e. Rapid Response order

set) to help you intervene on behalf of your pa)ent

Pa)ent /Staff Benefits

•  Facilitates evidence-‐based pa)ent care when )me is of the essence

•  An educa)onal resource to promote growth in clinical nursing knowledge

•  Supports bedside nurses who are caring for complex pa)ent


RPM results from test

•  Recommenda)ons from test –  iPad freezing due to the steel and metal within the frame of the door

– Central loca)on for ipads-‐place in secure box – Visual clues at every PC monitor with the Remote Pt Monitoring contact informa)on

– Staff ability for hands-‐on return demonstra)on – Create scenerios for use

Staff concepts of Alpha Unit

Survey Monkey Results (from lab project)

•  106 respondents •  82 (77%) bedside caregivers •  24 (23%) leadership

Ques(on % Very %Some what

% Not Very

% Not at all

En)re team commi;ed to process 68.97% 25.86% 4.31% 0.86%

Your level of engagement 85.45% 12.73% 0.91% 0.91%

Survey Monkey Results

Recommenda)ons Ques(on % Very % Some

what % Not Very % Not

at all

Do you see value in tes)ng a process on some units (Alpha Units) prior to house-‐wide implementa)on?

80% 15.45% 2.73% 1.82%

Adopt Adapt Abandon

A decision is made to adopt, adapt, or abandon all alpha projects at their comple)on. What would your recommenda)on be for this par)cular project?

60.38% 31.13% 8.49%

Did we meet our original goals?

Process for designating projects for a rapid cycle of change (30-60-90 days) that is evidence-driven

Yes

A positive, healthy work environment is maintained TBD Replication and communication plan is in place for all changes that are adopted or adapted that includes identified barriers and a control plan to sustain change

•  Yes as it relates to recommendations to adapt. Formal replication and communicant of implementation is the responsibility of originator

•  At the completion of each alpha project a summary of completion was distributed

Criteria for success identified prior to change implemented

Yes

At the end of the test of change, change is adopted, adapted, or abandoned

Yes

Resources are available to assist with staff education and the implementation of alpha projects

Yes

A doctoral-prepared person with experience in change management is in place to advise and support the alpha projects, encourage involvement with practice governance, and drives according to the evidence

Yes

Deliverable (from original 2013 leadership presenta)on) Met?

Next Steps/ Future Recommenda)ons

•  More clinical prac)ce issues to test •  Staff and leadership survey on alpha process and its impact (4Q 2015) (asses characteris)cs)

•  Re-‐evaluate the role of the DNP consultant •  Encourage new project ideas/submissions from CNOs, Councils (prac)ce and research), Matrices

•  Test concept of specialty change (all projects have been organiza)onal)

Alpha Units

•  I am always doing that which I cannot do, in order that I may learn how to do it. – Pablo Picasso

•  It is not the strongest of the species that survives, nor the most intelligent. It is the one that is the most adaptable to change. – Charles Galton Darwin

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Ques)ons?

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