The Academy Date: October 2015 0 Brief Summary of Project In 2012 - - PowerPoint PPT Presentation
Designing an Evidence-Based Data Driven Nursing Resource Center Fellow: Ena M Williams, MBA, BSN, RN, CENP Mentors: Sue Fitzsimons, PhD, RN, CENP, CNO James Staten, CFO, YNHHS Institution: Yale New Haven Hospital The Academy Date: October
Fellow: Ena M Williams, MBA, BSN, RN, CENP Mentors: Sue Fitzsimons, PhD, RN, CENP, CNO James Staten, CFO, YNHHS Institution: Yale New Haven Hospital Date: October 2015
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In 2012 Yale New Haven Hospital acquired a 500 plus bed Catholic community hospital approximately six blocks away creating a two campus 1541 bed hospital. During the post acquisition first 24 months, services were consolidated, realigned across campuses and services expanded. These many changes required adjustments to support staffing and one of the initiatives was to integrate and begin the process of redesigning an evidenced based data driven nursing pool. Significant vacancies existed and the recruitment of new grads was
It was necessary to develop new initiatives to reduce the vacancy (40%) and begin to reduce the use of agency staff and increase flexibility across the service lines and campuses
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Develop a single evidenced based infrastructure that is innovative. Review and redesign where appropriate, structures and processes that will support an efficient, cost effective, reliable operation to ensure that the right patient receives the: – Best Staff – Best Time – Best Cost Identify appropriate technological applications/systems to support infrastructure Develop reporting tools and information to ensure
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Integrate the following areas into a single structure:
§ Centralized Staffing and Scheduling
Department
§ Nursing Business Office § Daily Operations Pool
Conduct overall assessment and identify short-term and long-term goals Identify current gaps Develop flexible workforce Create a pipeline for new grads Reduce vacancies in the pool
Phases Scope Proposed Dates
Phase I In Patient Units Oct 2014-June 2015 Phase II Ambulatory Specialty June - December 2015 Phase III Complete Business Plan for System Pool Oct 2015
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Nursing Resource Operations Center
Deployment of Resources to Patient Care Areas CN PCA/CT BA/UC Constant Companion Observation Associates Patient Care Assistants SWAT Nurses Response to RRT, Trauma, Stroke, and other emergencies Unit Scheduling Functions Efficient, timely updates to KAS, unit schedules Scheduling Assistants staffing Associates Data Management/ Reporting Innovation in Technology Budget builds, CVP results, Vacancy, LOA and Productivity Business Functions KAS implementation and maintenance Onboarding of staff Licensure monitoring Flex tiered nurse deployment Resource Management Competent clinicians Engaged staff Ongoing development Leadership Development Traveler Recruitment Oversight Tracking and monitoring Contract review Supporting Unit recruitment Traveler competency IV Team - SRC
All staff working in this unit will be fully engaged in the hospital and nursing strategic plans and will provide the highest customer service to the patient care areas.
3/25/16 3
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Resource Center Design Focus Areas
Concept of Service Structural Design Data Analytics Hiring and Retention Strategy Unit Scheduling Process
Service
language from Pools to Communities
staffing standards, policies, and practices
roles and responsibilities
scheduling and staffing policies
nurse cohort program
strategy for center
for flexible staff
implementation and develop reporting tools
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Developed a multidisciplinary steering committee with CNO and CFO as executive sponsors The project was organized using an organizational design framework Focus areas were identified and sub-teams further developed Tools such as process mapping, data analytics, brainstorming, evidence review, networking and timelines chart to monitor and track progress. The sub-team reported monthly using a standardized template. Dashboards for tracking overall performance Graph : Sample Data Analytics – Census Trends
480 500 520 540 560 580 600 October-13 November-13 December-13 January-14 February-14 March-14 April-14 May-14 June-14 July-14 August-14 September-14 October-14 November-14 December-14 January-15 February-15 HVC, Medicine, MICU's & OBS Units SRC & YSC Budgeted ADC HVC, Medicine, MICU's & OBS Units SRC & YSC InpaQent + OBS Actual Days
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Project Timeline/Dashboard Sub-team Charters & Design Model Template
Updated as of 9.19.2014 shaded cells indicate the week is over Team # Activity ACTIVITY Members Role WK1 10/6 WK2 10/13 WK3 10/20 WK4 10/27 WK5 11/3 WK6 11/10 WK7 11/17 WK8 11/24 WK9 12/1 WK10 12/8 WK11 12/15 WK12 12/22 WK13 12/29 WK14 1/5 WK15 1/12 WK16 1/19 WK17 1/26 WK18 2/2 WK19 2/9 WK20 2/16 WK21 2/23 WK22 3/2 WK23 3/9 WK24 3/16 WK25 3/23 WK26 3/30 WK27 4/6 WK28 4/13 WK29 4/20 WK30 4/27 IMPL DATE Nursing Resource Center Project Plan 1 Concept of Service Ena William Chair/Team Leader a Define Scope of Service Janet Marseglia Chair/Team Leader b Operational Functions c Delineate user Expectation d Ensure the design supports the change the changing healthcare delivery environment 2 Structural Redesign Down Dowd Chair/Team Leader a Create a single department Rochelle Mikolinski Chair/Team Leader b Change Language from Pools to Communities Trina Boyce Chair/Team Leader c Evaluate Deployment Process d Define: Customer/Job Descriptions/Roles/Reponsibilities e Define: Job Descriptions/Roles/Reponsibilities/Compensation f Geographical Location g Technology 3 Data Analytics Joanne Reilly Chair/Team Leader a Complete KAS Implementation Dave Annunziata Chair/Team Leader b Identify and Define Appropriate Metrics c Develop Dashboard d Develop Dynamic Tracking Tools and Reports e Open Shift Bid Communication 4 Hiring Strategy Sheila Coonan Chair/Team Leader a Create a New Nurse Cohort Program Laura Jansen Chair/Team Leader b Develop Marketing Strategy c Evaluate Tiered Program d Compensation Review e Define traits for Highly Mobile, Flexible and Friendly 5 Unit Scheduling Process Joanne Reilly Chair/Team Leader a Clarify Roles and Responsibilities of Scheduler Pat Byrne Chair/Team Leader b Review Scheduling and Staffing Policy and Procedures c Reevaluate Scheduler Workload and Service line Alignment d Develop Performance Metric on Scheduling Processes Details Implement Design Details Implement Frame Work Design Frame Work Design Details Implement Frame Work Frame Work Design Implement Details XX WEEKS Frame Work Design Details Implement red cells = project off schedule purple cells = extension needed to get on schedule Green= Complete Yellow cells=at risk of not completing as scheduled Nursing Resource Center Project Plan Project Sponsors: Sue Fitzsimons, Jim Staten Project Chairs: Ena William, Janet Marseglia Purpose: To develop a single evidence based infrastructure of nursing resource management for the purpose of ensuring the efficient use and deployment of resources to the patient care areas.Methods/Processes
framework
techniques
Anderson, R., Ellerbe, S., Haas, S., Kerfoot, K., Kirby, K., and Nickitas; K. Excellence and Evidence in Staffing: A Data-Driven Model for Excellence In Staffing (2nd Ed). Sewell, New Jersey. Nursing Economics, The Journal for Healthcare Leaders. Jannett Publications Inc..
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Determining the Design Workflow Designing the Resource Center Developing the Details Implementing the New Design
Mar 2014 Oct 2014 Apr 2014 June 2014 Sept 2014
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The Academy Early Successes
Interdisciplinary Planning:
stakeholders
Recruitment:
screened candidates
additional post-event
Selection:
clinical shadow experience
to extend offers to
Development:
YNHH Resource Center Medical/Surgical GN Orientation Program
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Initial Outcomes ü Recruitment of 39.6 100% BSN new grads in pool ü 100 BSN (supports 80% BSN by 2020) strategy ü Hiring of 35 flex (non-benefited) RNs
§ Cross campus orientation and
assignments ü Early adoption in other service lines ü Reduce vacancy in pools – from 40% to 12% ü Identified additional resources with no added budget (17 CN non-hirable positions) ü Standardized staffing technology systems across campuses
§ Provide resources to units in a
timely manner
§ Provide a pipeline of oriented and
more experienced staff to institution
§ Create health system pool. § Employee satisfaction with
“adequate staffing”.
§ Ambulatory Model § Reduce agency use and cost.
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Budgeted Employed Vacant Vacancy rate Jan-15 146 129.9 16.1 11% Feb-15 146 134 12 8% Sep-15 160.6 142 18.6 12% 20 40 60 80 100 120 140 160 180 # Hirable FTE
ü Additional Clinical Nurses added to the resource center ü Recruitment efforts will result in even lower vacancy rates by end of December ü Current vacancies are supplemented by agency and per-diem staff * Higher vacancies in ICU and experienced nurses
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Gap in perception and understanding of services Gap in an overall evidenced based staffing strategy for YNHH An overall strategy can provide a framework and answers to why and perhaps why we do what we do. May need to go slower earlier to go faster later
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Network Knowledge Base Change Management and Leadership
Expanded my network and built relationships both within and outside of the organization and system Increased my knowledge of the very broad
the nursing pool to the patient care areas. How to more effectively bring together a very broad multidisciplinary team to drive an organizational change. This is a dynamic project which requires consensus building, stakeholder buy in Working closely with a senior finance leader Learning to present information in a concise manner OK to go slow to go fast
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This project has moved me out of my comfort zone of leading a service line change to
relationships, learned to integrate data, utilize numerous change management and project management tools.