PROG OGRAM RAMS: S: A SC SCOP OPING ING RE REVI VIEW EW - - PowerPoint PPT Presentation

EFF FFECTIVE TIVE APPROACHES CHES TO O DE DETERM RMINING INING RE RETUR URNS NS ON ON INV NVESTME STMENT NT IN HE N HEALTHC HCARE ARE LE LEADE DERSHIP RSHIP DE DEVE VELOP OPMENT MENT PROG OGRAM RAMS: S: A SC SCOP OPING ING RE REVI VIEW EW

Maya ya Jeyar yarama aman n & Ah Ahmed ed Abou-Setta• May 26, 2016

OVE VERVIE VIEW W OF OF THE HE PRE RESE SENT NTATION TION

1.

• 1. Study

dy sel elec ection ion pr proces ess 2.

• 2. Type

pes of studi dies es id iden entif ifie ied d (2 Type pes) 3.

• 3. Objecti

jective e 1 –ROI I det deter ermin inan ants ts as associ ciat ated ed wit ith hea ealthcare hcare lea eade dership ip qualit ity/sty y/style le 4.

• 4. Object

jectiv ive e 2 –ROI I det deter ermin inants ts associ ciated ed wit ith lea eade dership ip de devel elopm pmen ent t pr progr grams ms/tact /tactics ics 5.

• 5. Object

jectiv ive e 3 – ROI det deter ermin inants ts associa iated ed wit ith exis istin ing g ROI tools 6.

• 6. Conclusion

lusions

Title and Abstract screening (~11,000) Full text screening (~1,500) Included studies (198)

Study selection Study selection pr process

• cess

3 Objective 1 (73 studies) Objective 2 (125 studies) Objective 3 (11 studies)

Leader quality/style Staff outcomes Patient outcomes Organizational

• utcomes

Types ypes of

• f studies

studies (Objectiv (Objective e 1) 1)

4

Leader Individual & Organizational development

Types ypes of

• f studies

studies (Obje (Objectiv ctive e 2) 2)

Individual development Leadership development programs/tactics Evaluation

Program ram eva valuat luation ion to tools ls with metric rics

5

OBJECTIVE 1

• To identify and summarize evidence on ROI

determinants (factors, indicators and metrics) as associat ciated ed wi with th heal althc thcare are le lead ader ership ship

Leader quality/style Staff outcomes Patient outcomes Organizational

• utcomes

6

Interrupted time series 1.4% Mixed methods study 1.4% Pre-post study 4% Prospective study 1.4% Qualitative study 2.7% Survey 78% 0%

ST STUD UDY DE DESI SIGNS NS

~ 80% of studies are of Survey design

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

UK Australia Canada USA

5.6 % 9.7 % 37.5 % 47.2 %

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

UK Australia Canada USA

5.1 % 8.9 % 35.4 % 50.6 %

COU OUNTRIE NTRIES

~ 90% of studies are from Canada & USA

CEO 6% 6% Direct ctor

• r

4% 4% Execu cuti tive 4% 4% Leader er 1% 1% Manage ager 3% 3% Non-clinical clinical leader er 1% 1% Nurse se leader 77% Physi sicia cian leader 4% 4% ~ 80% of studies focused on Nurse leadership

LE LEADE DERS RS

0.0 10.0 20.0 30.0 40.0 50.0 60.0

Frontli tline ne leader Mid-level el leader Execu cuti tive e leader Emerg rgin ing g leader

16.9% 59.2% 14.1% 0% 0%

EMERGING GING VS EX S EXECUTIVE UTIVE LE LEADE DERS RS

~ 60% of studies focused on Mid-level leaders

Leadership quality/style

1. Transformational leadership (27.4%) 11. Management by exception (2.1%) 2. Effective/Good leadership (20%) 12. Relational leadership (2.1%) 3. Authentic leadership (10.5%) 13. Abusive leadership (1.1%) 4. Transactional leadership (10.5%) 14. Change-oriented leadership (1.1%) 5. Laissez-faire leadership (5.3%) 15. Exemplary leadership (1.1%) 6. Leadership practices (4.2%) 16. Managerial exclusion (1.1%) 7. Clinical nurse leader impact (4.2%) 17. Passive leadership (1.1%) 8. Emotionally intelligent leadership (2.1%) 18. Task-focused leadership (1.1%) 9. Leader-Member exchange (2.1%) 19. Visible-nursing leadership (1.1%) 10. Leader walk-rounds (2.1%)

11

LEADER ER QU QUALIT LITY/ST Y/STYLE YLE

1 2 3 4 5 6 7

Pa Patien ent t advers erse e event nts Pa Patien ent t mortalit ality Pa Patien ent t satisf isfact action ion Infect ection ion rates

Most reported patient outcomes

PATIENT IENT OU OUTCOMES OMES

Number of studies

5 10 15 20 25

ST STAFF FF OU OUTCOMES OMES

Most reported staff outcomes

Number of studies

1 2 3 4 5 6 7 8 9 10

Most reported organizational outcomes

OR ORGANIZ NIZATIONAL TIONAL OU OUTCOM OMES ES

Number of studies

• 1
• 0.5

0.5 1 1.5 2 2.5 3 3.5 4

Job satisfaction

Care quality

Adverse events Bullying

AUT UTHEN HENTIC TIC LE LEADE DERS RSHIP HIP (GOO OOD D LE LEADE DERSHIP) RSHIP)

• 3
• 2.5
• 2
• 1.5
• 1
• 0.5

0.5 1

TRANS NSFORM ORMATIONA TIONAL (GOO OOD) VS VS LA LAISSE SSEZ-FAIRE AIRE (BA BAD) D) LE LEADE DERS RSHIP HIP

SUMMARY OF RESULTS (Objective 1)

• Majority of studies:
• 1. Are surveys
• 2. Are published in USA & Canada
• 3. Are focused on Nurse leadership
• 4. Are focused on Mid-level leaders
• Good leadership quality/style has a positive impact on

healthcare outcomes (patient/ staff/ organizational

• utcomes)
• Bad leadership quality/style has a negative impact on

healthcare outcomes (patient/ staff/ organizational

• utcomes)

17

OBJECTIVE 2

• To identify and summarize evidence on ROI

determinants (factors, indicators and metrics) associated with heal althc thcare are le lead ader ership ship development elopment programs ams

Leader development Intervention Leader Individual development Organizational purpose Evaluation 18

Case e study 16% Clust ster er randomized

• mized

control

• lled

d trial 6% 6% Pre-post post study 60% 60% Survey 6% 6% Qualitati itative e study 6% 6% Longit itudin dinal study dy 1% 1% Mixed ed met ethod

• d

study dy 4% 4% Randomized

• mized post

test design gn 1% 1%

~ 60% of studies are of pre-post design

ST STUD UDY DE DESI SIGN

0.0 10.0 20.0 30.0 40.0 50.0 60.0

UK UK Aus ustral alia Canada nada USA New w Zealand and

14.4 7.2 17.6 60.0 0.8

Series1

~ 60% of studies are from USA

0.0 10.0 20.0 30.0 40.0 50.0 60.0

UK UK Aus ustral alia Canada nada USA New w Zeala land nd

14.4% 7.2% 17.6% 60.0% 0.8%

~ 90% of studies are from Canada & USA

COU OUNTRIE NTRIES

CEO 2% 2% Direc ector

• r

2% 2% Executiv ecutive 2% 2% Manag ager ers s 2% 2% Nu Nurse se leader der 54% 54% Pharma macy leader der 1% 1% Physic sician ian leader der 20% 20% Denta tal l fellows ws 1% 1% Leade der 16%

~ 50% of studies are focused on nurse leaders

LE LEADE DER

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0

Frontli tline ne leader Mid-level el leader Execu cuti tive e leader er Emerging ging leader

19% 34% 34% 6% 6% 28% 28%

EMERGING GING LE LEADE DER R VS EX VS EXECUTIVE UTIVE LE LEADE DER

Cont ntext xt of deliv iver ery y of leader dersh ship p develo elopment pment progra grams/ ms/tac tacti tics

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

Indivi vidual dual develop

• pme

ment nt Indivi vidual dual and organizat zationa nal develo elopme pment nt

66 % 34 %

23

0.0 10.0 20.0 30.0 40.0 50.0 60.0

Indivi vidual dual develo elopm pment nt Indivi vidual dual and

• rganiz

nizati tiona nal l develo elopme pment nt Broader der organizatio ationa nal purp rpose

• se

58 % 41% 3% 3%

CON ONTEXT EXT OF OF DE DELI LIVE VERY Y (PROG OGRA RAMS/ MS/ TACTICS) TICS)

~ Majority of studies focused on Individual development

10 20 30 40 50 60 70

70% 70% 6% 6% 7% 7% 10% 2% 2% 2% 2% 2% 2%

OU OUTCOM COMES ES RE REPOR ORTED ED BY P PROG OGRA RAMS MS

Leader Outcomes associated with leadership development programs/tactics

1. Increased leadership competencies 2. Ability to resolve conflicts 3. Increased assertiveness 4. Increased self-confidence & Self- awareness 5. People management skills 6. Decision making skills 7. Financial management skills 8. Communication with listening 9. Improved negotiation skills 10. Motivation to pursue higher education

26

LEADER ER OU OUTCOMES ES

SUMMARY OF RESULTS (Objective 2)

• Majority of studies:
• 1. Are pre-post design
• 2. Are published in USA
• 3. Are focused on Nurse leadership
• 4. Are focused on Mid-level and emerging leaders
• 5. Are focused on individual development
• Leader development programs/tactics show a positive

impact on individual leadership skills and an improvement in healthcare outcomes

27

OBJECTIVE 3

• To identify and summarize the evidence on

ROI determinants (indicators and metrics) from existing ROI evaluative instruments

28

INTERVE VENTI TION ON COUNTRY ROI - INDICA CATOR ORS

• 1. LEAN

UK 1. A mean reduction of 20 minutes from emergency department arrival to initial nurse assessment 2. LEAN Canada 1. Decreased emergency wait times 2. Decreased patient length of stay 3. Improved operating room usage 4. More radiology procedures per time period 5. Better infection control outcomes 3. IPIP (Improving performance in practice) USA 1. 1. Diabet abetes es me measu asures res (percentage

• f

sampled diabetes patients with a hemoglobin A1c level of less than 9%, blood pressure less than 130/80 mm Hg, low-density lipoprotein cholesterol level less than 100 mg/dL, yearly eye examinations, and annual nephropathy screening) 2. 2. As Asthma thma measures easures (percentage of asthma patients with an asthma control assessment, controller medicine use, influenza vaccination, and a bundled patient measure including all 3) 3. 3. Monthl hly practi tice ce change ge ratings ngs by by the coach

ROI OI - IND NDICATORS ORS & M METRIC RICS

{Fine et al 2009; Donahue et al 2013; Gorringe 2011}

INTERVE VENTI TION ON COUNTRY ROI -INDICA CATORS ORS 4. MI Program (Mentored Implementation Program) USA Glycem emic contro rol: 1. Day-weighted mean blood glucose 2. Percentage of glucose readings in desired range

• ver patient-stay

3. Percentage of patient-days or patient-stays with hypoglycemia (< 70 mg/dL)

• r

severe hypoglycemia (< 40 mg/dL) 4. Mean time to documented resolution of a hypoglycemic event Percentage of hypoglycemic patients suffering from recurrent hypoglycemia Pro roject ct BOOST ST: 1. Average length of stay 2. 30-day readmissions rate 3. Patient satisfaction parameters (HCAHPS) Veno nous us Thro romboemb

• embolism

sm preventio vention 1. Prophylaxis type: anticoagulant (green); mechanical (yellow); red (no prophylaxis) 2. Adequacy of prophylaxis in each category (green/yellow/red) Overall measure: percentage

• f patients with adequate VTE prophylaxis

ROI OI - IND NDICATORS ORS & ME METRICS RICS

{Maynard et al 2012}

ROI OI - IND NDICATORS ORS & ME METRICS RICS

INTERVE VENTI TION ON COUNTRY ROI - METRICS

• 1. McNally 2006

USA “Through the course of our coaching, a minimum of 4 clinical leaders

stated unequivocally that their engagement in the professional coaching prevented them from resigning from their positions. The average annual salary of a director is US$90,000. The approximate cost of providing the professional coaching program for 64 leaders was US$85,000. This figure is based on the external coach’s fees and the portion of the internal coach’s salary (one third of her full-time equivalent) dedicated to the

• program. Thus, it could be viewed that the cost of the coaching program

would be budget neutral if only 1 director was retained as a result of the coaching.”

2. Johnson 2010 USA

“Fall rate reduction from 6.45 to 3.8 per 1000 patient days $67,749. (This figure assumes a 30% injury rate.). Hospital-acquired pressure ulcer rate reduction from 1.62 to 1.12 per 1000 patient days $115,720. Patient satisfaction improvement priceless.”

3. Stone 2010 USA

“To calculate the ROI metrics for sending nurses to the E-EBP program, Manager Jones estimates that for a $14,000 investment, the hospital would save $36,000, translating to an ROI of 257%.”

4. Moffatt – Bruce 2014 USA

“Between July 2010 and July 2013 3,000 health system employees across 12 areas had been trained at an estimated cost of $3,557,000. The total number of adverse events avoided was 759 and savings ranged from a conservative estimate of $11,285,300 to as much as $24,634,140. Additionally, reimbursement bonuses totaled $4,971,700 and included third party payer incentives and Value Base Purchasing results. Therefore the overall impact had a net return in the range of $12,700,000 to $26,048,840.”

ROI OI - IND NDICATORS ORS & ME METRICS RICS

INTERVE VENTI TION ON COUNTRY ROI - METRICS

• 5. Tylor-Ford et al

2015 USA “The ANM turnover rate prior to intervention was 23%. At the conclusion

• f the intervention, ANM turnover was at 13% in the first year, which

includes all ANMs within and outside of the LPCP. This represents a 10 percentage point reduction in overall turnover and a cost savings of approximately $585,000 per year using Jones and Gate methods. Additionally, no program participants left their positions while in the program or at 6 months post-program, which represents a 0% turnover rate of those within the program. One participant was awarded a promotion within the organization at 6 months post-program.”

6. Harris et al 2008 USA

“Cost Benefit Summary - Before CNL After CNL Cancelled GI procedures 30% 10% Loss in revenue $195,000 $39,000 CNL annual cost $70,000 Total savings realized by CNL introduction - $86,000”

7. Kooker et al 2011 USA

“Using the updated Nursing Turnover Cost Calculation Methodology, the per RN true cost of nurse turnover is calculated to be 1Æ2–1Æ3 times the RN annual salary (Jones 2005). The findings indicate that the three highest cost categories were vacancy, orientation and training and newly hired RN productivity. At The Queen’s Medical Center, the annual salary of an experienced RN is currently $91,520. Therefore, using the Updated Nursing Turnover Cost Calculation Methodology, the per RN turnover cost is $109,824–118,976. As there was turnover of 62 RNs in 2006, their total turnover cost can be estimated at $6Æ8 and $7Æ4 million. Strategies to prevent or minimize external turnover clearly would have a positive financial impact on the

• rganisation in addition to the minimising human capital costs and

losses.”

Limitations

33 “In 2010 SHM began developing a data center for performance tracking to address these challenges” {Maynard et al 2012}

Thank you!