Mercyhealth Fiscal Year 2016 Nursing Annual Report
MESSAGE FROM THE PRESIDENT/CEO AND CNO
04 TRANSFORMATIONAL LEADERSHIP
08 STRUCTURAL EMPOWERMENT
TRANSFORMATIONAL LEADERSHIP TRANSFORMATIONAL LEADERSHIP at Mercyhealth ..................................4 Strategic Planning...........................................................................................6 Professional Practice Model ...........................................................................6
STRUCTURAL EMPOWERMENT STRUCTURAL EMPOWERMENT at Mercyhealth ..........................................8 Shared Governance.......................................................................................10
EXEMPLARY PROFESSIONAL PRACTICE
12 EXEMPLARY PROFESSIONAL PRACTICE
EXEMPLARY PROFESSIONAL PRACTICE at Mercyhealth .........................12 Relationship-Based Care...............................................................................14 PRACTICE Values..........................................................................................17 Professional Practice Model ........................................................................18 2015 Nursing PRACTICE Excellence Award Winners....................................19 Magnet Designation .....................................................................................21
24 NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS
NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS NEW KNOWLEDGE at Mercyhealth.............................................................24 Process Improvement ..................................................................................26 Nursing Research .........................................................................................27
It is my pleasure to present the 2016 Mercyhealth Nursing Annual Report. The articles and features are snapshots of the outstanding work our nurses do every day. I am proud of the way our nurses step forward to embrace new technologies, resolve emerging issues, and accept ever-changing roles in their profession. Their ongoing commitment to quality moves health care forward—what often begins as a solution for one patient, becomes an advancement that benefits countless others. 2015 was a busy and exciting year for our organization. Shortly after merging Mercy Health System and Rockford Health System, we announced plans to embark on the largest construction project in Rockford’s history. This new $500 million hospital and medical center campus will feature a women’s and children’s hospital, and will increase access to specialty and sub-specialty services for the residents of southern Wisconsin and northern Illinois. Our nurses will certainly play a critical role in the exceptional care that will be provided at this new campus. We also began our Magnet® designation journey as one integrated organization. The gold standard of nursing excellence, Magnet signals to our communities that we have the best trained and educated nurses caring for patients every day. Our nurses’ passion for making lives better knows no bounds, and we’re proud to be part of this important journey. Sincerely,
Javon R. Bea Mercyhealth President/CEO
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As we look back on 2015, it is wonderful to see the progress we have made as an organization and in nursing. Both Legacy Mercy and Legacy Rockford brought with it a team of dedicated and knowledgeable nursing professionals, and a wealth of ideas and strengths. For example, Legacy Rockford has a strong background in nursing research, professional development, nurse self-care and relationship-based care framework. As a MagnetŽ recipient, Legacy Mercy brought strengths in shared governance, professional nursing continuum, career advancement and recognition of excellence and the Professional Practice Model. As Mercyhealth, we are drawing on each other’s strengths and ideas to take nursing and patient excellence to even higher levels. We are in the process of creating combined nursing councils and committees, as well as a Professional Practice Model. Our nurses are working together to develop certification review classes, and sharing processes and standards of care between service areas. These and many other initiatives are just the beginning of our exciting journey to Magnet Recognition as an entire System. I am very proud of our nurses, and appreciate their passion for their work and their passion for making lives better.
Sue Ripsch BSN, MS, MBA, RN, NEA-BC Sr. VP and Mercyhealth CNO, COO
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Mercyhealth Rockton Avenue Hospital Rockford, IL Services: ED Trauma Center, Woman’s and Children’s, Medical-Surgical, Intensive Care, Ortho, Peri-Operative Services, Behavioral Health Mercyhealth Hospital and Trauma Center Janesville, WI Services: ED Trauma Center, Maternity, Medical-Surgical, Ortho, Peri-Operative Services, Behavioral Health, Treatment Coordination, Rehab and Transitional Care Mercyhealth Harvard Hospital and Medical Center Harvard, IL Services: ED, Medical-Surgical, Treatment Coordination, Peri-Operative Services, Long Term Care Mercyhealth Walworth Hospital and Medical Center Lake Geneva, WI Services: ED, Maternity, MedicalSurgical, Treatment Coordination, Peri-Operative Services Mercyhealth Ambulatory Clinics McHenry County, IL Rock County, WI Walworth County, WI Winnebago County, IL
Coming soon: I90/Riverside hospital and medical center campus Rockford, IL
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TRANSFORMATIONAL LEADERSHIP Strategic Planning Professional Practice Model
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TRANSFORMATIONAL LEADERSHIP
Evidence of transformational leadership in an organization is seen when leaders and staff raise one another to higher levels of achievement and excellence. Nurses want to work in environments where they believe their voices are heard, their input is valued, and their practice is supported. This summer we surveyed nurses across our system, and for the first time this will include our Rockford and Mercy nurses together. This is a demonstration of our recognition that nursing plays a significant role in patient outcomes, and the health care experience of the patient and family within our integrated system. We will use this input to influence change and to make Mercyhealth an even more exceptional organization. Our nursing leaders are strong advocates for their partners, and the patients and families they serve. They support their clinical nurses in their participation on councils and task forces and inspire them to innovate and achieve extraordinary outcomes. Our clinical nurses empower their patients and families by providing the education and resources they need to remain as healthy as they can be in their own homes and communities. It is a privilege to be a part of this exceptional professional team and all we have accomplished together in support of the Mercyhealth mission and our commitment to “a passion for making lives better.� Sincerely,
Deb Potempa, MSN, RN, NEA-BC VP and CNO, Mercyhealth Hospital and Trauma Center
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Mercyhealth nurses set goals and lay foundation for fiscal year 2017 (July 1, 2016-June 30, 2017) Strategic Planning is used to set priorities and focus energy and resources on common goals. Mercyhealth’s Nursing Strategic Planning Retreat was held on March 29, 2016. Clinical nurses, leaders and nurses in special roles came together to set goals for fiscal year 2017. Two exceptional nursing teams, Legacy Rockford and Legacy Mercy, reviewed both the System and nursing strategic plans and the goals housed within each pillar of excellence: Quality, Service, Partnering and Cost. The team also began the development of a united Professional Practice Model (PPM). Mercyhealth nurses reviewed and approved the PRACTICE values (see more on page 17), and decided on three foundational theories for our PPM: Relationship Based Care (RBC), the Clinical Practice Model and Florence Nightingale. Professional Practice Model Relationship-Based Care (see more page 14) is a culture transformation model and an operational framework that improves safety, quality, patient satisfaction and staff satisfaction by strengthening every relationship within an organization. In an RBC culture, clinicians get reconnected with the purpose and meaning of their work, teamwork is based on deep commitment rather than surface-level compliance, and patients and their families feel safe and cared for as clinicians commit themselves to making authentic human connections with all people in the care environment. Clinical Practice Model (CPM) was originally developed to meet regulatory standards while improving documentation and placing the focus back on the patient. The model has now grown to include a focus on preventing potential problems and omissions of care while delivering evidence-based care to the bedside of each patient. Patient care is enhanced by the use of the clinical practice guidelines (CPGs) as the foundation for our patient’s plan of care. As nursing and other disciplines utilize the guidelines during care planning, each clinician applies the best evidence, at the point of care, to support decision making. For this reason, CPM is the platform within our Professional Practice Model that illustrates our commitment to expert evidence-based patient care. Florence Nightingale was a guiding force in the field of nursing. She was a bright, tough, driven professional, a brilliant organizer and statistician, and one of the most influential women in 19th-century England. Nightingale published Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army among other transformational books on health and nursing. She used data to prove her point and was a pioneer in the graphical representation of statistics. MERCYHEALTH / 6 / NURSING ANNUAL REPORT FY 2016
Cost Pillar: Nursing Economics Nursing services are a major component in today’s health care costs. Payment reform will continue to focus on the ability of nurses to positively impact quality outcomes. This, in turn, will generate additional resources to support the services nurses provide.
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Anne Quaerna, MSN, RN NE-BC, CEN, TNS Director, Mercyhealth Janesville and Walworth Emergency Services, EMS, Trauma and SANE
STRUCTURAL EMPOWERMENT Shared Governance
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STRUCTURAL EMPOWERMENT
Structural empowerment is a core Magnet component that acts as a framework to create a practice environment that empowers nursing to cultivate a strong professional practice. Having solid structures and processes in place creates an innovative environment where strong professional practice flourishes. The mission, vision and values of the organization come to life allowing Mercyhealth to achieve exemplary outcomes reflective of our quality care. This also strengthens our ability to create and foster positive partnerships across the health care continuum to promote a positive image of nursing. Leaders play a key role in supporting career development and empowering nurses to actively engage in their development. Over the past year, our shared governance model has continued to evolve and empower nurses to become more actively engaged in defining their practice in support of nursing excellence, the primary focus of the Magnet program. This has allowed nurses to practice skills such as decision making and problem solving, as well as to use evidence and research as a basis for practice change. It has also allowed us the opportunity to integrate nursing at Legacy Rockford and Legacy Mercy and to work in partnership as we continue our Magnet journey. While we continue to evolve and change, one thing stays the same— our passion for making lives better. It truly is my privilege to work with such a dedicated group of nurses who give freely of their time and talents in order to act as advocates for each other, our patients, and Mercyhealth. As Helen Keller once said, ‘Alone we can do so little; together we can do so much.” With thanks and appreciation for all you do.
Jan Botts, MHA, BSN, RN, CPHQ, NEA-BC CNO, Ambulatory Services
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Mercyhealth Nursing Shared Governance Model Nursing Practice Council (NPC) was designed for collaboration among peers and charged with defining, implementing and maintaining the highest standards of clinical nursing practice quality and patient care initiatives utilizing a shared governance structure. Nursing Informatics Council assists in developing a technology based environment that supports the nurse clinicians. The council is committed to mentoring and coaching nurses to understand and use technology, including the electronic medical record, to support their practice. Nursing Leadership Council facilitates continuous development and evaluation of an environment conducive to delivery of patient care meeting the mission and objectives of Mercyhealth. All matters relating to the allocation, distribution and assignment of human, fiscal, and material resources to the individual units and the department as a whole shall be determined, defined and undertaken by the NLC. Nursing Research and Quality Council creates an environment that assures the integration of evidence based practice and research into clinical and operational processes. Advanced Practice Nursing Council assists Mercyhealth advanced practice nurses in providing excellent, evidence-based care to patients and promote health and wellness across the continuum of care. Nursing Professional Development Council (previously known as the Education Council) facilitates the professional development of each nurse within Mercyhealth. The council will assist nurses throughout the system in providing excellent, evidencebased care in an environment that fosters inquiry and innovation in nursing practice. Nursing Coordinating Council provides a framework of standards and practices to facilitate shared governance communication and collaboration among all councils; is accountable for continuous assessment of the effectiveness of shared governance councils, reviewing and assessing their impact on quality and empirical outcomes; and serves as a clearinghouse for issues needing follow up and intervention within the various councils.
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Partnering Pillar Being a leader is about empowering nurses and supporting them every step of their journey.
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Deb Sitter MEd, BSN, RN-BC Supervisor, Mercyhealth Walworth Hospital
EXEMPLARY PROFESSIONAL PRACTICE Relationship-Based Care PRACTICE Values Professional Practice Model 2015 Nursing PRACTICE Excellence Award Winners
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EXEMPLARY PROFESSIONAL PRACTICE
Nurses from Legacy Mercy and Legacy Rockford organizations have embraced collaboration, communication, sharing of improved practices and professional development in order to improve the care of our patients, families, and communities. We have found there are more similarities than differences within our nursing structures and our strengths complement each other. The annual nursing retreat, attended by over 140 clinical nurses, leaders and educators from both organizations, demonstrated alignment of nurses in our new Mercyhealth organization. The PRACTICE values, developed by Mercy in previous years, were validated, tweaked, and enthusiastically adopted by all. Clinical nurses from across Mercyhealth led a discussion of how Relationship-Based Care, a model used by Rockford, and the Clinical Practice Model, used by both, provide the theoretical frameworks for the development of an integrated Professional Practice Model. Those frameworks were also enthusiastically endorsed by the group. We look forward to the schematic that a group of our clinical nurses will design to show the linkage of the nursing mission, vision and values with the adopted frameworks. Multiple examples of Exemplary Professional Practice from all areas of Mercyhealth are being mapped as sources of evidence for our 2018 Magnet document submission. It is so exciting to see the passion, zeal and perseverance among our nurses to improve practice, safety, quality and culture. I am humbled to be a part of this nursing community and admire the work you do every day. Sincerely,
Sue Schreier, MSN, RN, NEA-BC VP and CNO Mercyhealth Rockton Avenue Hospital
MERCYHEALTH / 13 / NURSING ANNUAL REPORT FY 2016
Relationship-Based Care A Cultural Transformation Model Relationship-Based Care (RBC) is an operational framework that improves safety, quality, patient satisfaction, and staff satisfaction by strengthening every relationship within an organization. In RBC cultures, clinicians get reconnected with the purpose and meaning of their work. Teamwork is based on deep commitment rather than surface-level compliance. Patients and their families feel safe and cared for as clinicians commit themselves to making authentic human connections with all people in the care environment. RBC Improves 3 Critical Relationships: 1. The relationship between caregivers and the patients and families they serve. In RBC, the caregiver-patient/family relationship is one in which the caregiver consistently maintains the patient and family as his or her central focus. In an RBC culture, no caregiver activity is ultimately independent of this relationship, and the definition of caregiver is broad. For example, caregivers from environmental services change their focus from maintenance of a physical environment to providing the most comfortable surroundings possible for people who are suffering. When we change how we see the meaning and purpose of our work, our work changes. 2. The caregiver’s relationship with self. This relationship is nurtured by self-knowing and self-care. Without a clear understanding of one’s self, a person’s emotional reactions may adversely affect their capacity for partnering and teamwork. The relationship with self is fundamental to maintaining each individual’s optimum health, to having empathy for the experience of others, and participating as a productive member of the organization. 3. The relationship among members of the health care team. The delivery of compassionate quality care requires a commitment by all members of the organization within all clinical disciplines to accept responsibility for establishing and maintaining healthy interpersonal relationships. Quality care occurs in environments where the standard among members of the health care team is to respect and affirm each other’s unique scope of practice. In a culture of committed teams—a culture in which people are deeply committed rather than simply compliant—patients and their families are far more likely to commit to their own care rather than merely comply (or fail to comply) with their plans of care. The RBC model supports the American Nurses Credentialing Center’s requirements for practice, collaboration, and communication. Legacy Rockford and Legacy Mercy nurses, through our shared governance model, have committed to Mercyhealth nursing excellence. RBC’s emphasis on building authentic relationships within the care environment will nurture the transformative energy required to build our mutual nursing future. This transformative energy will radiate from our shared governance councils. MERCYHEALTH / 14 / NURSING ANNUAL REPORT FY 2016
Quality Pillar Nursing’s ultimate goal is to use evidence-based practices to provide the best expert care to our patients and their families.
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Gretchen Finley MBA, BSN, RN, BA, RNC, Director of Maternity Services, Mercyhealth Hospital and Trauma Center, and Walworth Hospital and Medical Center
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Mercyhealth PRACTICE Values Mercyhealth’s nursing mission and model of care are guided by eight dynamic and integrated core values that infiltrate the organization and are reflected in the work of nurses throughout the organization. Each value is supported by behaviors defined by clinical nursing partners.
P: Patient- and Family-Centered Care R: Respect A: Accountability C: Caring T: Transformational Leadership I: Interdisciplinary Collaboration C: Competence E: Evidence-Based Care
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PROFESSIONAL PRACTICE MODEL
Development of a MercyHealth Nursing Professional Practice Model (PPM) According to the Magnet Recognition Program, a PPM “… depicts how nurses practice, collaborate, communicate and develop professionally to provide the highest quality care those served by the organization;” and “A PPM illustrates the alignment and integration of nursing practice with the mission, vision, and values that nursing has adopted.” (ANCC Magnet Manual, 2014, p. 41) In the fall of 2016, nurses interested in this work, will come together to create a picture of Mercyhealth nursing. A PPM is comprised of:
Shared Governance An environment of clinical practice empowerment.
Model of Care The overriding principle for how the organization sees its model of nursing and its role in achieving positive patient and staff outcomes. It must be: • Integrated throughout nursing • A foundation for patient care • Based in evidence and nursing theory
Care Delivery System Details the way assignments, responsibility and authority are structured to accomplish patient care. Each area of practice may use a different model (primary, team, functional, etc.). MERCYHEALTH / 18 / NURSING ANNUAL REPORT FY 2016
Nursing PRACTICE 2015 Excellence Award Winners These nurses were nominated by their peers and selected for superiorly modeling the behavior in the value category for which they were selected. They were honored with a celebratory luncheon, PRACTICE Excellence lapel pin and a framed certificate (see photo on page 17). The PRACTICE Awards are sponsored by the Nursing Recruitment and Retention Committee.
P-Patient and Family-Centered
Eric Abbott, MHTC ICU Team Lead Excerpt from nomination: “Eric advocated for the family and all donor families through initiation of the flag raising ceremony when the OTD patients go to donation. He also worked with the OTD resource team to develop a plan for the family to follow once they decide on donation. It helps them anticipate what comes next and to be informed about the timeframe and the process. This has resulted in the reduction of donor-family fear, anxiety and suffering.”
Excerpt from Eric’s response: “What really means something to me is what the families get out of the flag raising for their grieving and healing.”
R-Respect
Nancy Wiskie, MHTC Case Management Excerpt from nomination: “I have personally watched Nancy stand up for patients and other nurses in tough situations with grace and dignity. She is someone I strive to be like both as a nurse and as a person. Thank you for all you do to help make Mercy a better place and nursing a better profession!”
Excerpt from Nancy’s response: “I am proud and passionate about being a nurse, and, as a patient navigator, I love being an integral part of helping patients feel important and involved in their care. In turn, I have tremendous respect for the caring nurses and staff at Mercy and I am honored to be counted among them.”
A-Accountability
Melissa Krueger, MHTC OR Team Lead Excerpt from nomination: “Melissa has been instrumental in the work she has done related to the Professional Nurse Continuum. It is an exciting and ground breaking project for MHS as a whole and I truly believe without this one individual’s dedication to MHS nurses and this project it would not be what it is today. The result is an amazing process for peer review for nurses at the bedside!”
Excerpt from Melissa’s response: “Winning this PRACTICE award makes me excited that people recognize others for their worth. Launching Mercy's Professional Nursing Continuum has been a bumpy road, but extremely rewarding.”
C-Caring
Annie (Andrea) Howe, MWH OPS/PACU/TCC Clinical RN Excerpt from nomination: “With a smile on her face, Annie goes about her busy day concerned only with the needs of her patients and of the staff around her. When she steps through the door and changes into her scrubs she leaves her home life and any issues she may have in her street clothes and puts them in her locker. She looks upon her charges with eyes that say "’I’m really concerned about you, how can I make your day better?’"
Excerpt from Annie’s response: “I feel so blessed to have the opportunity to work with such a fantastic group of nurses, with extremely high standards of patient care.”
T-Transformational
Kendra Rishling, Woodstock Team Lead Excerpt from nomination: “As the team leader for the clinic, Kendra influences and encourages her staff to continue their education. She works with her employees on their work schedules to accomodate their school/class schedules. Kendra is an innovator and is always raising the bar for her staff. MERCYHEALTH / 19 / NURSING ANNUAL REPORT FY 2016
2015 NURSING PRACTICE EXCELLENCE AWARD WINNERS “She understands her staff members need to have work-life balance. Her hard work and dedication to her staff members make us all strive to be better. She is patient, understanding, humble, and always looks for the good in people.”
Excerpt from Kendra’s response: “My belief as a Nursing Leader is that it is our responsibility to mentor and guide our Nurses to continue to excel in their Nursing practice and reach their highest potential in both education and in life.”
I-Interdisciplinary Collaboration
Julie Nelson, MWH OR Clinical RN Excerpt from nomination: “Julie successfully collaborated with six different departments to create a quick, easy bronchoscopy procedure workflow. Since the implementation of the workflow binder for bronchoscopies, we have had better collaboration between all departments during the procedures, little to know missing supply charges, no lab problems with specimens and a higher patient satisfaction.”
Excerpt from Julie’s response: “It feels good to know that the work I completed not only benefits me but the other nurses within the department as well as our patients.”
C-Competence
Cathy Onsrud, APN, MHTC Hospitalist Excerpt from nomination: “Cathy is continually seeking out new opportunities to learn and expand her knowledge. She is seen as a leader to others and is respectful and kind to those she interacts with, both patients and other staff members. Watching her care for others inspires me to keep learning and acquiring new skills and knowledge.”
Excerpt from Cathy’s response: “I cherish and value ongoing growth and education in nursing. I appreciate the opportunities to share thoughts, insights, and knowledge with a receptive audience here at Mercy.”
E-Evidence-Based Care
Alexis Sies, MHTC Maternity Clinical RN Excerpt from nomination: “Alexis has been an integral part in not only suggesting evidence-based care changes on our unit but she also helping to implement and champion those changes when rolled out on the unit. She contacted level III hospitals to confirm their practices and then brought her proposals to update our policies and protocols. Our unit is improving our practice to make a safer and a better experience for our patients.”
Excerpt from Alexis’ response: “The task of researching evidence based care and implementing those changes has been very fulfilling to me. I look forward to continuing in this practice to improve the care we give to our moms and babies!” MERCYHEALTH / 20 / NURSING ANNUAL REPORT FY 2016
Mercy Nurses Celebrate Magnet Designation during the Magnet Conference, October 2015 Mercy Health System, including Mercy Walworth Hospital, Mercy Harvard Hospital, Mercy Hospital and Trauma Center in Janesville, and Mercy ambulatory clinics in Rock, Walworth and McHenry counties, were granted Magnet Recognition® by the American Nurses Credentialing Center (ANCC) on October 21, 2014. The recognition is considered the highest honor in the country given to a health care organization for nursing excellence. In fact, Mercy Health System is one of a few organizations in the country to achieve Magnet for an entire health care system, including all components of the organization across the two states of Wisconsin and Illinois. “The decision to grant the designation was an easy decision by the credentialing commission. It demonstrates to patients and families that Mercy Health System, through its 70 facilities in 29 communities and two states, provides the highest level of care and is a model for all health systems,” said Deborah Zimmermann, DMP, RN, NEA-BC, FAAN, chair of the Commission of Magnet Recognition, in an announcement call to nurses and staff. “Mercy is among the best and is a model system for all health care organizations in the nation,” continued Zimmermann. “Mercy demonstrates to patients, their families and the community, it provides efficient, expert care at the highest level possible. This honor is a testament to Mercy’s commitment to doing what’s right for patients.”
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Magnet Re-Designation Timeline
20 015
• MW WH, MHH, MHTC, ambulatory clinics submit interim mon m nitoring report inclusive of demographic data • Collect Magnet stories
20 016
• MW WH, MHH, MHTC, ambulatory clinics submit interim mon m nitoring report inclusive of demographic data, nurse s sfaction, patient satisfaction and quality outcomes satis • Collect Magnet stories
• MW WH, MHH, MHTC, ambulatory clinics submit interim
20 017
mon nitoring report inclusive of demographic data •C Collect Magnet stories and write Magnet document • Sub bmit application of intent ent to redesignate as Mercyhealth, including all ll hospitals and clinics
20 018
•S Spriing: Submit Mercyhealth Mercyhea alth Magnet documentt to ANCC •F Fall or winter: Magnet appraiser site visit
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Service Pillar Providing exceptional service defines Mercyhealth. As we individualize the patient experience, we meet the expectations of those we serve.
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Theresa Hollinger MSN, MHA, RN, NEA-BC, Director Mercyhealth Harvard Hospital and Medical Center
NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS Process Improvement Nursing Research
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NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS
New knowledge, innovations and improvements are key components of the Magnet model. As a Magnet facility, Legacy Mercy is in a key position to advance the science of nursing, learning and to discover new ways to achieve quality and efficiencies that produce effective outcomes. The Mercyhealth research and quality committee is tasked with utilizing the component of new knowledge, innovations and improvements to assist the bedside nurse in being involved in research and evidence-based practice. Nurses involved in research have the ability to change policies, patient care and outcomes. Mercyhealth nurses are encouraged, supported and are provided with a mentor to help them evaluate and use research in their practice. This past year Mercy has focused on merging the nursing infrastructures with our new Legacy Rockford partners bringing new strengths to our Research and Quality Council. Focus groups were implemented and research projects were identified in various departments at Rockford Memorial and were shared at Research and Quality Council demonstrating the importance of the new knowledge, innovations and improvement Magnet component. Sincerely,
Caryn Oleston, MSN, MHA, RN, NEA-BC, FACHE CNO Mercyhealth Walworth Hospital and Medical Center CNO Mercyhealth Harvard Hospital and Medical Center
MERCYHEALTH / 25 / NURSING ANNUAL REPORT FY 2016
Working Together Process Improvement Legacy Rockford Quality Improvement Lean Lean is a process improvement approach born out of the manufacturing industry shortly after World War II. In the recent decades, it has expanded into other industries, including health care. The foundations of Lean process improvement remains consistent in every setting: eliminate waste (non-value added activities), empower those doing the work to make improvements, and continuously strive for further improvement. Whether a process improvement team meets for a few minutes, a few hours, or over several days, the overall process remains the same: 1. Define the issue/problem 2. Understand how the process is currently working and identify waste 3. Understand the waste at its root cause 4. Design a better process 5. Design and implement countermeasures (solutions) through strategies such as eliminating process steps, visual management, mistake proofing and standard work creation 6. Sustain the improvements Legacy Mercy Quality Improvement Plan-Do-Check-Act Legacy Mercy’s quality program incorporates the organization’s mission, vision, and values in support of four core components: patient safety, regulatory compliance, quality and performance improvement. We use an outcomes-based, measureable and benchmarked performance improvement process, which requires shared responsibility and accountability among all partners from executive leadership to the clinical nurse. Plan-Do-Check-Act (PDCA) is our standard approach to performance improvement. Clinical health care performance improvement activities are supported by several quality committees, including: Quality Council, Medical Staff Quality Review Committee, Clinic Medical Staff Committee, Patient Safety and Error Reduction Team, Safety Committee and Pharmacy and Therapeutics.
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MERCYHEALTH NURSING RESEARCH
Mercyhealth Ambulatory Nurse Residency Research Study The Ambulatory Nurse Residency program launched June 2016. The program was developed to increase confidence and aid in the transition of practicing and new graduate nurses to the ambulatory practice setting. A core team developed the research proposal which outlined the structure and processes for the program and was approved by the Institutional Review Board. There are four classes in total that focus on key strategies including communication, team-building, self-care, quality and evidenced based practice principles. Rotating classes are scheduled to be held over the next 18 months. Participants are surveyed at the first class, the fourth class and then eight months following the completion of the fourth class. Initial feedback has been positive and many shared they would be utilizing the information learned in their work environment to improve communication and build relationships.
Mercyhealth Critical Access Hospital Fall Prevention Research Study Preventing falls in the hospital is a difficult and complex issue. Falls lead to increased length of stays in the hospital, increase cost, and can result in injury or even death. Fall prevention tools are important to nurses because they play a key role in ensuring quality and patient safety. The critical access hospitals will conduct a study to validate the Hester Davis Scale (HDS) for fall risk assessment in the critical access hospital population. We will be using samples from both MercyHealth Harvard Hospital and Medical Center and Mercyhealth Walworth Hospital and Medical Center to determine if the HDS scale is able to accurately identify patients that are at increased risk for falls. Using accurate instruments to determine the patients risk for falls is essential to the nurses’ ability to initiate proper fall prevention measures. Current research on the topic of fall prevention assessment tools is very limited especially in the critical access hospital setting. Furthermore, the HDS has currently only been studied in the neuroscience population.
Mercyhealth Rockton Ave. Hospital Research Study Interdepartmental Transfers and Patient Experience This study examined the potential relationship between interdepartmental transfers and perceptions of the care received by adult patients who were admitted and discharged. As consumers, patients are more informed about their own health and are challenging the quality and service of care provided by hospitals. The Value-Based Theory was utilized as a framework to examine 12 hypotheses regarding patient experiences and interdepartmental hospital transfers. Handoffs and transfers of patient care are daily routines that occur in hospitals. Problems can arise when the responsibility MERCYHEALTH / 27 / NURSING ANNUAL REPORT FY 2016
As we move forward to become a more integrated System, we will become stronger and better. Our two organizations fit well with each other with contiguous boundaries, not overlapping geography. Our cultures are ones of quality and service. It is an exciting time as we take this Magnet journey together!
Sue Ripsch BSN, MS, MBA, RN, NEA-BC Mercyhealth Sr. VP, CNO, COO
for patient care is transferred from one health care professional or groups of professionals to another group during hospital transfer of patients from one unit to another unit. The results of the study showed statistically significant relationships of nursing communication, doctor communication, responsiveness to the call button, quietness, cleanliness and rating and recommending the hospital to number of transfers.
Mercyhealth Ambulatory Chemo-infusion Nursing Research Study Chemo-infusion nursing partners face many challenges in providing safe administration of chemotherapeutic agents to our patients. One of the situations they may need to address and manage during the infusion process is the occurrence of a hypersensitivity reaction by the patient to the various chemotherapy agents introduced during the treatment of their specific cancer. Because of the potentially life-threatening nature of this situation, the Oncology Department reviewed the literature and submitted a research proposal evaluating processes to minimize the occurrence of this potential complication which was approved through the Institutional Review Board in May 2016. The study, which started on June 15, 2016 with 12 consented patients, focuses on the administration of three common chemotherapy agents: Oxaliplatin, Rituxan and Carboplatin. The research study tests the hypothesis that the occurrence rate of hypersensitivity reactions will be reduced by introducing two variables into the administration of these agents: extended monitored wait times after administration of the pre-medications and a gentle jostling of the chemotherapy agent bag. The theory, if validated, will show that the introduction of these two variables will significantly reduce the occurrence rate of hypersensitivity reactions.
Mercyhealth Hospital and Trauma Center READI Research Study The READI (Readiness Evaluation And Discharge Interventions) Study is a multi-site study commissioned by the American Nurses Credentialing Center. Thirty-four Magnet hospitals across the United States participated in the study looking at the impact on patient outcomes, including costs, when nurses assess for discharge readiness as a standard practice. The purpose was to determine the impact on post-discharge utilization (Readmissions and ED visits) and costs of implementing discharge readiness assessment as a standard nursing practice for adult medical-surgical patients. The Surgical Pediatrics and Medical Units began submitting data to the READI Study research project on June 1, 2015. Data collection ended June 30, 2016 and our nurses at Mercyhealth Hospital and Trauma Center look forward to learning about the results of this nationwide study! MERCYHEALTH / 28 / NURSING ANNUAL REPORT 2013
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