Saint Anthony Hospital staff worked hard to improve its Leapfrog Hospital Safety Grade from a D in 2014 to an A in October 2016. The nonprofit, community teaching hospital in Chicago found one key to success came in providing front-line nurse leadership with increased confidence and management tools that would help improve hospital standards and quality of care.
Finding the Right Curriculum
Saint Anthony’s development team was searching for a structured, in-depth learning program that would empower their nurses to take leadership to the next level. What they found was Catalyst Learning Company’s NCharge® Nurses Learning to Lead program. NCharge provided the detailed content and knowledge assessments they were looking for, with results that are measurable. By focusing on relevant leadership scenarios within the hospital, participants were able to easily relate and apply techniques to their everyday environment.
“Like most healthcare organizations, we are growing and changing. We were also in the process of reorganization. It was about sweeping clean on old ideas and looking for ways to be more efficient. Illinois is also tightening on funds and as a nonprofit hospital, we had to look at ways to be more efficient in how we were working and make our staff feel as if they have a way to advancement,” stated Jaqueline Napier, Manager of Talent and Development at Saint Anthony.
Leading with More Confidence
One important outcome noted by Saint Anthony management is the overall improved confidence among nursing leadership. Creating a more autonomous team has positively impacted the hospital environment and proven an effective influence regarding quality of care.
Sonia Haro, an ICU Staff Nurse and NCharge participant, committed her time to the NCharge series with specific objectives in mind. “I was looking for ways to communicate more effectively, especially when setting expectations for the team. Sometimes, not everyone feels like being a team player. I wanted to find a way to encourage my team but stay firm and reach expectations,” explained Haro. This was the type of leadership training that most staff nurses don't get with shadowing or clinical training. Haro was pleased with NCharge, which provided her with a better understanding of communication styles and techniques to handle a variety of situations confidently in the unit.
Haro wasn’t the only person who noticed a need for better communication and confidence from front-line nursing leaders. When Catalyst Learning surveyed nurse managers at Saint Anthony before the NCharge courses were implemented, less than 20% strongly agreed that the Charge Nurses in their departments displayed confidence when leading their teams. In addition, less than 30% agreed that Charge Nurses were cognizant of the key drivers of a positive patient experience. A few months after the training was held, the same nurse managers were surveyed and reported dramatic improvement with over 65% saying Charge Nurses were more confident and over 70% recognized key drivers in positive patient experience.
Cultivating Team Dynamics
A more efficient, collaborative environment was formed as a result of the NCharge leadership training. The team who completed training worked stronger and smarter together when handling obstacles. “I really wanted to work with others in the hospital in the same position. It’s nice to have others to lean on and run questions by, and share experiences with. Networking with my own colleagues was a great bonus,” stated Haro.
Elizabeth Negrete, Director of Perinatal and Pediatric Services, had staff who completed NCharge training. Staffing in OB, having the right number of staff and the right combination, had been a continuous issue. NCharge class participants looked at staffing and created plans to put the right skills and experience in the best combinations. “Now the staff are the ones doing the schedule, entering it in to the system and balancing. When the census goes down, they adjust appropriately based on the patient grid. This shows how they have been working more autonomously and are able to make important decisions with less guidance,” explained Negrete. “The Charge Nurses are working more in collaboration with the house managers. Before, staff managers were just telling them what the need was, but now the Charge Nurses are more empowered to speak up about needs.”
Haro reported that the rounding process has also gone through changes, giving the NCharge participants an opportunity to observe with fresh eyes what happens within the unit when everyone is not on board with a change. “It takes some buy-in from everyone, and there were days when we were just being run ragged. You could easily see that on days when the new process wasn’t being used, feelings and tensions were high,” conveyed Haro.
By equipping front-line leaders with the skills to embrace change, NCharge prepares staff for reaction from team members and how to move forward as a unit. This can be vitally important and impactful when trying to deal with the constant updates within hospitals. “There is always more trust from staff when changes come from Charge Nurses. There is more peer influence and impact. The staff has more of a buy-in because they know the Charge Nurses truly understand what the impact will be since they are on the frontline with them,” described Negrete.
Made evident in the impressive move of their Leapfrog Safety grade from a D in 2014 to an A in October 2016, the hospital seems to have found the key to success in increasing quality standards. Napier credits the NCharge series with being a factor in that improvement after implementation in early 2016.
The combination of increased confidence, more efficient staffing and adaptability to change have helped Saint Anthony become a more progressive, efficient hospital when it comes to patient care and standards. “The nurses are more cohesive as a team and moving towards a group environment where the charge nurses really stand out as leaders. They are really keeping their team members engaged. All of that correlates to the patient experience and how everyone is measured,” stated Napier. “Our people were skilled but now they have more confidence in those skills and their ability to engage the nurses on their team. They now understand how this all comes together to enhance the patient experience.” By giving front-line leaders new techniques to handle their day-to-day situations and changes, an environment of new ideas and proactive enthusiasm has been cultivated.
By investing in the front-line nursing leadership at Saint Anthony, stronger teams were built and the confidence instilled in the newly trained charge nurses was of great value. The return on investment for the Chicago hospital is shown through the recognition of receiving its first A rating from Leapfrog Hospital Safety Grade and becoming a top-rated hospital.
Hospital Acquired Conditions (HACs) are a major issue in healthcare today and it seems high on everyone's priorities to get good at preventing them. HACs like the ones in the infographic below, impact the patient's health, the family's perception of care, and the hospital's financial status - ouch!
*Image credit to NDNQI
Hospitals may take many steps to reduce the number of HACs including forming committees and work groups, improving documentation, data mining, and root-cause analysis.
The HR/OD Connection
Ultimately, most of our readers come in when a learning opportunity is revealed and leadership is asking for help. The role of OD in clinical education varies but they
may hear questions like these:
When a healthcare employee observes another who is not adhering to a Patient Safety standard, why are they not reporting it? Did they confront their colleague? If not, why? How can we enable a culture that fosters safety and accountability?
What Can I Do?
Explore the list of skills and behavioral competencies below that contribute to a safe treatment environment. Assessment and improvement in these areas can be championed by the HR or OD department - a challenge they may not be accustomed to answering! If HACs are a priority in your organization, you may find a new opportunity to improve the quality of care delivered by your frontline staff.
Competencies for a Culture of Safety in Healthcare
1 Zimlichman E., Henderson D., Tamir O., et al. Health Care-Associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System. JAMA Intern Med. 2013;173(22):2039-2046. doi:10.1001/jamainternmed.2013.9763
2 Wong, C., et al. (2011) The cost of serious fall-related injuries in three Midwestern hospitals. The Joint Commission Journal on Quality and Patient Safety. 27(2), 81-87. Retrieved from www.ncbi.nlm.nih.gov/ pubmed/21939135.
3 Spetz, J., Brown, D., Aydin, C., & Donaldson, N. (2013) The value of reducing hospital-acquired pressure ulcer prevalence: an illustrative analysis. Journal of Nursing Administration, 41(4), 235-241. Retrieved from www.ncbi.nlm.nih.gov/pubmed/23528690.
Situation: Like many other healthcare organizations, Cincinnati Children’s Hospital Medical Center (CCHMC) faced a skills gap among its administrative staff. This large group of almost 850 employees includes admin assistants, customer service representatives, program coordinators, schedulers and access service representatives. The requirements and skills necessary to be a successful in an administrative role had changed over the last several years, while the talent and career development for these staff lagged behind.
At the same time, the hospital faced a shortage of external candidates resulting in constant vacancies. Adding to the challenge, on a more global scale in the healthcare industry, was that the title administrative assistant no longer reflected the skills and abilities of the professional, nor did it necessarily match the requirements of individual units within a healthcare system.
CCHMC, recognized not only as one of the “Best Places to Work” in Cincinnati for many years, but as the third in the nation for Pediatric Hospitals by US News and World Report, was facing a talent shortage— one that if not addressed, could have a significant impact on operations, employee engagement and patient satisfaction. CCHMC made a strategic decision to implement a career ladder program to improve employee versatility, and ultimately patient care.
Solution: In order to assess the career development needs among its administrative staff, CCHMC conducted a Morehead Employee Survey in 2012. The survey found that a significant number of administrative assistants wanted more support with career development and advancement opportunities.
This feedback further supported CCHMC’s overall staffing needs, prompting management to offer a tool and career coaching resource to assist administrative staff with career development and advancement. CCHMC was already successfully partnering with Catalyst Learning on School at Work® and so they decided to integrate CareerCare® to meet the Admin staff’s career management needs.
“Career development within a healthcare setting requires a variety of tools available to fit the unique needs of the various employees including their work schedules, family situations and educational goals,” said Beth Smith, BSN, employment support specialist for CCHMC. “School at Work and CareerCare provide the flexibility and scope to be able to identify the specific needs of the employee and select the appropriate tool which best meet the needs.”
CareerCare quickly became one of CCHMC’s primary tools for career development of its administrative staff, using the program in conjunction with personal career coaching and academic advising.To publicize the new service, management met with the leadership of the Administrative Assistant professional organization (C-CAP) within CCHMC to explain the new career development focus. In turn, that organization invited senior leadership and the career coach to present at their monthly membership meeting to recruit candidates to participate in the self-directed CareerCare project with career coaching.
Management continues to value CareerCare’s web-based approach because it provides flexibility for employees with different schedules, goals and educational backgrounds. Moreover, CareerCare allows employees to have a structured tool to use at their own pace to assess current skills, explore educational options, realize obstacles to achieving goals, and develop a realistic plan.
Results: Based on the reviews from the program’s participants, providing career development tools like CareerCare is essential to driving employment engagement. Elizabeth, an Administrative Assistant at CCHMC said, “I was able to complete the tool, and I found it very useful to help me identify my goals and then set my SMART goals. I have been successful in achieving a new position (one of my top goals) in Sponsored Programs-Accounting and will begin my new job as a grant accountant.”
Melinda, also an administrative assistant, voiced her support for the program as well. “I am thankful for the opportunity to be a part of CareerCare,” she said. “From my experience, it helps a lot when you are looking for direction in your career and you’re not exactly sure which way you should go.”
Cincinnati Children’s Hospital Medical Center is the third best children’s hospital in the U.S., according to Parents magazine. CCHMC was also inducted into the Cincinnati Business Courier’s “Best Places to Work Hall of Fame” after making the annual list for several consecutive years.
For more information on CareerCare, please email Brittany Gearhart at email@example.com or visit the CareerCare product page.
By: Carolyn Hardy, Regional Manager, Catalyst Learning
What's the point? That's what you're wondering if you're anything like me - a skimmer. Well, I'll give you the gist; this is not about a quick fix to turn around your engagement scores or a miracle new process that promises to be the magic bullet for retention or patient satisfaction. This post is about a multi-year journey with an organization that placed a premium on culture and used accountability to take their place as employer of choice in the community. This is about the hard work and the metrics that prove the link between employee retention, investment and operational efficiency.
Rhonda is already talking as I enter the room, on this last day at the ASHHRA 2013 Conference. I begin to tune in to Rhonda's clear, strong voice.
"The focus is here: to make every employee feel that they are part of what we do, no matter if they are a nurse, a doctor, a housekeeper, a parking valet. Connecting is what we need to do, regardless of our industry."
We're listening to Rhonda Larimore, Vice President of Human Resources and Support Services at Children's Hospital of Pittsburgh (UPMC). She's an excellent speaker and we're all here to see what we can learn about "The Business Case for Employee Investment". Much of Rhonda's message can be summed up by what must be an easily recognizable state to us all; regarding the role of HR, she says, "There's two kinds of HR departments - ones that do the paperwork and ones that do the vision work."
Listeners are introduced to a series of areas that Children's Hospital of Pittsburgh identified for improvement in 2006 when Rhonda came on board. From annual turnover to patient satisfaction, from a lack of vision in learning and OD to a need to focus on values in daily practice, we got a pretty clear picture - Rhonda wanted to take it back to the drawing board.
So how did they do it? She shared CHP's strategic plan:
Of this plan Rhonda tells us, "It's about packaging it so that people see not just the ones-ies and twos-ies of what we do but the whole picture." She is speaking of the leadership in the organization as well as the employees who report to them. Getting an organization of that size on board with this kind of change can't have been easy and she relied on support from other leadership and a values-based approach on which everyone could agree.
As this story winds up, I'll highlight a couple of stories from items 1 and 3 in the strategic plan.
CHP wanted to hire talent whose values closely matched that of the organization. Enter Ted Kinney, Ph.D. and Director of Research and Development for Select International. These two formed a partnership and implemented a standardized hiring process and assessment. Hands flew up as Rhonda spoke of their success, their measures and their processes. In the end, everyone was quiet and you knew they'd been impressed by the staggering lack of complications or issues with the new process. Ted was present to answer questions and he had rapt attention from the audience; this guy was about to become very popular.
Since Catalyst Learning is a workforce development organization, I promised to address workforce development and here it is.
Learning & OD - 'How can I focus on MY career?'
Again our speaker describes a dichotomy positing that there are two types of employees:
1) those who want to grow their career,
2) those who want to be the best at who they are in their current role.
Either way, Children's of Pittsburgh focused on the growth of their employees by providing a continuing education fund for those that want to attend a conference or other learning opportunity. For loyal employees who want to stay in same position, the organization still challenges them to improve in that role every year.
CHP provides online learning opportunities, leverages leadership and mentorship programs in which over 1000 people participate each year.
Ted brought this all home by stating that, "Hospitals need highly skilled employees and Patient Satisfaction is still relatively new to the industry." He spoke of combining "top-down" and "bottom-up" approaches, identifying specific behaviors that drive outcomes, and building accountability through better staff communication which correlates with patient safety.
So, here is your challenge - where are you as an HR or OD professional doing "The Vision Work"? We're all being targeted for improvement these days. I hope this post has inspired you in some way to take things to the next level, whatever your role in your organization.