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 2015 0
Brief Summary of Project 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 outpacing experienced nurses for the float pool. 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 The Academy 1
Project Goals, Scope, and Objectives GOALS OBJECTIVES Develop a single evidenced based infrastructure that is Integrate the following areas into a single structure: innovative. § Centralized Staffing and Scheduling Department Review and redesign where appropriate, structures and § Nursing Business Office processes that will support an efficient, cost effective, reliable operation to ensure that the right patient § Daily Operations Pool receives the: Conduct overall assessment and identify short-term – Best Staff and long-term goals – Best Time Identify current gaps – Best Cost Develop flexible workforce Identify appropriate technological applications/systems to support infrastructure Create a pipeline for new grads Develop reporting tools and information to ensure Reduce vacancies in the pool outcomes. 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 Oct 2015 System Pool The Academy 2 2
Nursing Resources Operations Center Scope of Service Business Functions Data Management/ KAS implementation and Reporting maintenance Innovation in Technology Unit Scheduling Onboarding of staff Resource Management Budget builds, CVP Functions Efficient, results, Licensure monitoring Competent clinicians timely updates to KAS, Vacancy, LOA and unit schedules Flex tiered nurse Engaged staff Scheduling Assistants Productivity deployment Ongoing development staffing Associates Leadership Development SWAT Nurses Traveler Recruitment Response to Oversight RRT, Trauma, Stroke, Tracking and monitoring and other emergencies Contract review Supporting Unit recruitment Traveler competency Deployment of Resources to Patient Care Areas Nursing CN PCA/CT Resource BA/UC IV Team - SRC Operations Constant Companion Observation Associates Center Patient Care Assistants 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 3/25/16 The Academy 3 areas. 3
Scope- Resource Center Design Focus Areas • Define Scope & Service • Define Roles Concept of • Develop Comm. Plan Service • Change • Refine current language from roles and Pools to responsibilities Communities Unit Structural Scheduling • Review Resource Design • Determine Process scheduling and staffing Center staffing standards, Design policies policies, and Focus practices Areas • Implement new nurse cohort • Complete KAS program Hiring and Data implementation and Retention • Develop recruitment Analytics develop reporting Strategy strategy for center tools • Evaluate strategies for flexible staff The Academy 4
Methods & Milestones 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 600 580 560 HVC, Medicine, MICU's & OBS 540 Units SRC & YSC Budgeted ADC 520 500 HVC, Medicine, MICU's & OBS Units SRC & YSC InpaQent + OBS 480 Actual Days 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 The Academy 5
Project Planning Tools/ Methods Sub-team Charters & Design Model Template Project Timeline/Dashboard Updated as of 9.19.2014 Nursing Resource Center Project Plan Project Sponsors: Sue Fitzsimons, Jim Staten 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 Project Chairs: Ena William, Janet Marseglia patient care areas. shaded cells indicate the week is over Green= Complete Yellow cells=at risk of not completing as scheduled red cells = project off schedule purple cells = extension needed to get on schedule WK11 WK12 WK13 IMPL ACTIVITY Members Role Team # Activity 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 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 12/15 12/22 12/29 DATE Nursing Resource Center Project Plan XX WEEKS 1 Concept of Service Ena William Chair/Team Leader Frame Work a Define Scope of Service Janet Marseglia Chair/Team Leader Design b Operational Functions Details c Delineate user Expectation Implement Ensure the design supports the change the changing d healthcare delivery environment 2 Structural Redesign Down Dowd Chair/Team Leader Frame Work a Create a single department Rochelle Mikolinski Chair/Team Leader Design b Change Language from Pools to Communities Trina Boyce Chair/Team Leader Details c Evaluate Deployment Process Implement Define: Customer/Job d Descriptions/Roles/Reponsibilities Define: Job e Descriptions/Roles/Reponsibilities/Compensation f Geographical Location g Technology 3 Data Analytics Joanne Reilly Chair/Team Leader Frame Work a Complete KAS Implementation Dave Annunziata Chair/Team Leader Design b Identify and Define Appropriate Metrics Details c Develop Dashboard Implement d Develop Dynamic Tracking Tools and Reports e Open Shift Bid Communication 4 Hiring Strategy Sheila Coonan Chair/Team Leader Frame Work a Create a New Nurse Cohort Program Laura Jansen Chair/Team Leader Design b Develop Marketing Strategy Details c Evaluate Tiered Program Implement d Compensation Review e Define traits for Highly Mobile, Flexible and Friendly 5 Unit Scheduling Process Joanne Reilly Chair/Team Leader Frame Work a Clarify Roles and Responsibilities of Scheduler Pat Byrne Chair/Team Leader Design b Review Scheduling and Staffing Policy and Procedures Details Reevaluate Scheduler Workload and Service line c Alignment Implement d Develop Performance Metric on Scheduling Processes Methods/Processes • Use of a Staffing Effectiveness Model • Use of an Implementation Design framework • Project planning processes and techniques • Charter designs • Standard templates • Brainstorming/voice of customer • Data analytics • Communication framework 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 (2 nd Ed). Sewell, New Jersey. Nursing Economics, The Journal for Healthcare Leaders. Jannett Publications The Academy Inc.. 6
Methods - Organizational Design Framework Determining Designing the Implementing Developing the Design Resource the New the Details Workflow Center Design Mar Apr June Sept Oct 2014 2014 2014 2014 2014 The Academy 7
Early Successes Interdisciplinary Planning: -Weekly meetings to design program YNHH Resource Center Medical/Surgical -considered input from literature/evidence and key GN Orientation Program stakeholders -performed needs assessment to ensure end product of GNs would meet needs of organization Recruitment: - Partnered with HR to design “open house” for pre- screened candidates - Held in September 2014, 15 GNs attended with 3 additional post-event Selection: - Performed interdisciplinary interviews and provided clinical shadow experience - PSMs and nurses collaboratively chose 12 candidates to extend offers to Development: - 12 weeks of programed orientation - Integrated multigenerational workforce needs - With 3 rotations in 9 participating Med/surg units. The Academy 8
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