What is a Vision? - RNAO · All hospitals use NPs to admit, treat and discharge. Expanded RN scope...
Transcript of What is a Vision? - RNAO · All hospitals use NPs to admit, treat and discharge. Expanded RN scope...
What is a Vision?
A vision is a compelling image of the preferred future that sets
out a group’s or organization’s highest aspirations in clear and
powerful, language. It is what futurist Clement Bezold calls “a
future for the heart.” It is more than an idea. When people
really take a vision seriously, it becomes an inspirational force
in their lives…acting as a self-fulfilling prophecy.
ICN 1999
There are Infinite Possible Futures…
A good scenario set should
provoke the imagination,
stretch world views, and
make explicit deeply-held
values.
ICN 1999
Three Alternative Future Scenarios
1. Business as Usual
2. Crisis and Opportunity
3. Visionary Leadership
Following the ICN model, these
RNAO scenarios identify key
trends including:
Nursing
Health and Health Care
Political Economy and
Society
Sustaining Our Publicly-Funded,
Not-For-Profit Health-Care System
Determine the
strategic milestones along the path to the preferred vision in the short, medium and long-term.
Consider enablers including health human resources, ethics, and technology.
Consult with members.
Action Plan
Action Plan: Primary Care Outcomes (Short-Term, 2012-2015)
In response to the growing need to critically examine the role of Primary Care RNs and RPNs, RNAO led the ground-breaking provincial Primary Care Nurse Task Force.
Action Plan: Primary Care Outcomes (Short-Term, 2012-2015)
All Ontarians have consistent access to nursing knowledge, skills and competencies in every primary care setting.
Primary care organizations accommodate larger client volumes, while effectively leveraging scarce health-care resources and maintaining quality of care.
Care co-ordination and health system navigation led in primary care by 2015.
Approximately 3,500 Case Managers, previously working in CCACs, transition to primary care, with their salary/benefits intact.
Action Plan: Primary Care Outcomes (Short-Term, 2012-2015)
Supporting Activities:
- Phase 1: Organizations, planners and decision-makers create environment to embrace full scope of practice and utilization.
- Phase 2: Legislative and regulatory changes enable RNs to provide an expanded scope of practice with added education
- A Transitional Primary Care Secretariat is established within the LHIN to organize 4000+ primary care entities into local networks.
- A robust labour management strategy is crafted for all CCAC case managers/care co-ordinators that secures salary/benefits
Action Plan: Primary Care Outcomes (Mid-Term, 2015-2020)
Fee-for-service and capitation remuneration are replaced with salary as one component of primary care global budgets
Primary care RNs are fully engaged in care co-ordination with expanded scopes of practice (e.g. diagnosing and prescribing).
By 2020, all Ontarians have same-day access to inter-professional primary care and walk-in clinics are eliminated.
Supporting Activities:
- Negotiations have occurred with government to introduce salary-based compensation from global budgets.
- Current AHACs, CHCs, NPLCs and FHTs are expanding where infrastructure capacity exists and new organizations have begun where no infrastructure capacity exists.
Action Plan: Primary Care Outcomes (Long-Term, 2020-2030)
A province-wide network of inter-professional primary health care hubs (PHC hubs) anchor the health system to ensure integrated, co-ordinated, comprehensive, continuous, client-centred health care from pre-conception to death; consistent with Declaration of Alma Ata.
Full representation of all professions occur within teams; each practicing to full scope.
Supporting Activities:
- Ongoing development, strengthening and integration of Ontario’s primary care system and implementation of RNAO’s ECCO model
Action Plan: Home Health Care Outcomes (Short-Term, 2012-2015)
The autonomy of providers has increased, providing access to care and support in the community while strengthening continuity of care and continuity of caregiver.
Supporting Activities:
- CCAC structure fully transitioned by 2015
- Contract renewal based on quality outcomes, successful accreditation and ability to offer comprehensive services
- Implementation of RNAO’s ECCO model
Action Plan: Home Health-Care Outcomes (Mid-Term, 2015-2020)
Access to home health-care and support is increased, with strong linkages to primary care.
Not-for-profit home health-care service providers deliver the majority of service.
NPs have an increasing presence in home health-care delivery, and CNOs are mandated in each organization to facilitate uptake of evidence-based nursing practice.
Supporting Activities:
- Wage parity
- Implementation of RNAO’s ECCO model; administrative savings are re-invested into direct home health-care delivery and support services.
Action Plan: Home Health Care Outcomes (Long-Term, 2020-2030)
All Ontarians are able to access a range of home health care and support services regardless of where they reside.
Evidence-based practice culture is embedded in all home health care.
Supporting Activities:
- Home health care nurses are mostly baccalaureate-prepared and practise to full scope, which includes prescribing.
- Establishment of multiple primary health-care hubs.
Action Plan: Public Health Outcomes (Short-Term, 2012-2015)
PHNs play a key role in advancing primary health care by mobilizing their communities to improve health, decrease health inequities and challenge unhealthy environmental and social policies.
Supporting Activities:
-PHNs work with communities in policy development and other community efforts.
-Public Health Units are under LHIN mandate (funding remains intact).
Action Plan: Public Health Outcomes (Short-Term, 2012-2015)
Designate one masters-prepared Chief Nursing Officer (CNO) per Public Health Unit by January, 2013.
Transition mental health and addictions nurses in district school boards from CCACs to Public Health Units.
Supporting Activities:
- CNOs partner with nurse educators to improve access to MN programs.
- Implement RNAO’s ECCO model.
Action Plan: Public Health Outcomes (Mid-Term, 2015-2020)
NQuIRE data demonstrates that PHNs play a pivotal role leading evidence-based nursing interventions that improve health outcomes.
Enhanced linkages between public health and other areas of the health system, including primary care.
Supporting Activities:
-NQuIRE is available to all public health units.
-Implement RNAO’s ECCO model
Action Plan: Public Health Outcomes (Long-Term, 2020-2030)
PHNs mobilize to further reduce social inequities, revitalize universal services, and strengthen democracy to improve population health and decrease health inequities.
Supporting Activity:
- CNOs and PHNs are making expert recommendations for the implementation of “Health in All Policies” at the system level within municipalities, LHINs, the province and the nation.
First Peoples: Self-Determination Improves Health and Democracy
Action Plan: Acute Care Outcomes (Short-Term, 2012-2015)
80 % of hospitals maximize NPs to admit, treat and discharge patients improving patient access, flow and safety.
All hospitals provide continuity of care & continuity of caregiver as each patient is assigned an RN or RPN based on patient complexity, stability and predictability.
Protected funding sustains expanded and advanced RN practise.
60 additional RN First Assistants (RNFAs) work in operating rooms, bringing the total to 140 across the province.
Supporting Activities:
- RNAO NP Expert Panel promotes activities of NP early adopters.
- CNEs promote appropriate staff mix with quality committees and hospital boards
Action Plan: Acute Care Outcomes (Mid-Term, 2015-2020)
Only the most acute and complex health care challenges are cared for in hospitals by an inter-professional team.
All hospitals use NPs to admit, treat and discharge.
Expanded RN scope of practice is common and established.
More CNEs are VPs and CEOs
Nurse anesthetists who independently administer 70 per cent of anesthesia free up anesthesiologists for complex cases.
Supporting Activities:
- CNEs support advanced and expanding roles.
- Funding models ensure ongoing training, education and protected positions for NP-Anesthesia in the province.
Action Plan: Acute Care Outcomes (Long-Term, 2020-2030)
RNs are now admitting, treating, transferring and discharging patients.
RNs routinely use BPGs and decision support tools (e.g., order sets) to develop evidence-based care plans that are integrated with primary care providers and other sectors.
Supporting Activities:
- NQuIRE indicator database is released to all hospitals.
- RN training, support and implementation of RNAO Order Sets.
Action Plan: Long-Term Care Outcomes (Short-Term, 2012-2015)
Evidence-based legislated minimum nurse staffing standards require no less than 4.0 hours per resident day (hprd), .59 RN hprd, 2 RNs 24/7 and one NP per LTC Home (prorated 1: 120 residents).
DOCs are recognized as CNOs
Supporting Activities:
- Legislation mandates CNOs and minimum nurse staffing ratios in LTCHs.
- Legislation enables NPs to write admission and discharge orders in all Ontario LTCHs.
Action Plan: Long-Term Care Outcomes (Mid-Term, 2015-2020)
LTCH placement co-ordination occurs in partnership with primary care co-ordinators and the LHINs. As a result, timely LTC is available for all who need it.
RN prescribing and diagnosing are common.
Supporting Activities:
- Implementation of RNAO’s primary care report.
- Implementation of RNAO’s ECCO model.
Action Plan: Long-Term Care Outcomes (Long-Term, 2020-2030)
Fewer LTCHs are needed as seniors have appropriate supports and high quality services to live at home
Timely access to high quality publicly-funded not-for-profit LTC continues for all in need.
Some LTCH residents have been “matched” with families to live in their home, smaller group home facilities or hospices.
Supporting Activity:
- Matched families are provided training, ongoing support and subsidized according to resident acuity / RUGs.
Key Enablers
Enabler: Nursing Workforce Short-Term (2012-2015):
70 per cent full-time employment of nurses in all sectors
9,000 more RNs needed to help Ontario catch up to the average RN: population ratio in the rest of Canada
Consistent funding is available for every eligible and qualified LCNI and NGG nurse.
Medium-Term (2015-2020):
20,315 more RNs are hired (including 360 NPs each year).
Long-Term (2020-2030):
44,440 additional RN positions have been created since 2010, keeping pace with population growth and the average RN:population ratio throughout Canada.
Enabler: Healthy Work Environments
Systemic implementation of RNAO’s Healthy Work Environment BPGs has improved health outcomes for both clients and staff, stabilized the nursing and inter-professional workforce by improving morale and decreasing attrition; saving thousands per nurse in staff turnover costs.
Enabler: Technology Implementation of a fully
functioning, integrated electronic health record provide nurses with timely, accurate, evidence-based information to optimize continuity of care, clinical decision-making, and client outcomes.
Smart technology / decision support tools, such as nursing order sets.
Enabler: Ethics In 2030, as in 2012, nurses
grapple with how to best live out their ethical responsibilities in a fluid environment with constrained resources and multiple competing demands.
An equity lens is increasingly used in all sectors.
Enabler: Education
Funding increases in short-term to increase nursing enrolment:
2500 undergrads/yr
360 NPs/yr
10 PhD and 100 masters/yr
Nursing education has been reoriented to embrace PHC principles. It stresses health promotion, disease prevention, social and environmental determinants of health, but NOT at the exclusion of illness care.
Enabler: Research
Rapid implementation of NQuIRE database by RNAO Best Practice Spotlight Organizations contributes to the evidence-base of nursing-sensitive outcomes.
NQuIRE will establish independent, evidence-based benchmarks and facilitate knowledge exchange of best practices locally, nationally, and internationally.
Consultation Process RNAO home office is coordinating membership engagement on where we are going and how to get there:
Meetings and informal discussions with BOD and home office staff
RNAO Visionary Leadership Consultation Series via webinar
Online survey
Social media and “tweet-ups”
Discussion Questions
Is this doable?
Is this speaking to your sector?
Is anything missing, or is there anything else we should be thinking about?