420Change Burke 19 - Proposed Change assignment with Peer Review and PDF

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Proposed Change assignment with Peer Review and Literature Table ...

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I. DESCRIPTION OF THE ISSUE/PROBLEM/PROPOSED CHANGE INCLUDING BACKGROUND The Womancare Birth Center is designed to be a comfortable, intimate, family-centered environment where women can labor, deliver, and recover in one place, and family members can be close at hand to support mom and welcome their new arrival or arrivals. Nearly 10,000 babies are born at Magee each year, accounting for 45 percent of all births in Allegheny County In June of 2019, UPMC reached an agreement with Highmark to enter into a long-term contract to provide Highmark members with the in-network access to the UPMC physicians and facilities. For the first time since 2014 Highmark customer could utilize UMPC services resulting in an increase of patient population creating staffing shortages, stretched resources and inadequate workflow from unit to unit. The arrival of patients from the Highmark system though anticipated created an increased workload on existing staff twofold. More patients meant staff shortages along with a flux of new hires. Obstetrics is a nursing specialty that requires a longer training time this puts existing staff at risk for fatigue and burnout as they continue the double duty of training and increased workload as they await the new staff to come off of orientation and reduce the workload. The new leadership at The Women Care Birth Center at the UPMC Magee Women’s Hospital is committed to acting as an instrument of change by providing stewardship focused on delivering not only the UPMC experience of providing outstanding patient care but the moving forward to achieve the Magnet environment.

II. SYSTEMATIC INVESTIGATION (LITERATURE SEARCH AND ANALYSIS To lead effectively through change, Lal (2019) encourages Nurse Leaders to organize staff around an accepted, shared purpose that propels the organization to realize its goals. Traits that these leaders have in common include the following: 

Communicating with full transparency;

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being visible-getting out from behind their desks and interacting with staff

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modeling the behavior, they expect-they don't just tell their employees to do something, they show them how to do it. An analyses of open-ended survey responses by Press Ganey. (12AD, April 2018)

showed that for new and experienced nurses, the majority of the suggested retention targets involved organizational characteristics, followed by work characteristics, manager characteristics, and affective or cognitive responses to work. From the perspective of nurse managers of high-intent-to-stay units specifically, top priorities for retaining new and experienced nurses include workforce cohesion, staffing and scheduling. In addition, education and mentorship emerged as priority considerations for newly licensed nurses, while value/respect and shared decision making were perceived to be priorities for experienced nurses. (Press Ganey 2018) Press Ganey 2018 found responses from the subsequent in-depth interviews mirrored and extended these observations. The most prevalent retention priorities that emerged from these interviews focused on collaboration and leadership. For example, work group cohesion and positive unit culture were cited as key retention drivers by nearly all the nurses interviewed. Teamwork, a supportive culture, and strong relationships and bonds between coworkers were also repeatedly mentioned as highly important factors influencing nurses’ desire to stay on their

unit, as were nurse manager support and strong leader relationships, described as support from direct supervisors, managers who had their nurses’ backs, and trust in senior leadership. Research has shown that patients’ experience with hospital care is significantly related to whether hospitals are well-resourced with respect to nursing, for example, nurse staffing, supportive work environments, and reasonable nurse work hours (Kutney-Lee et al. 2009; Aiken et al. 2012; Stimpfel, Sloane, and Aiken 2012). With adequate numbers of well-trained nurses in an environment that promotes professional practice, nurses are able to provide critical surveillance of their patients and intervene when appropriate, educate patients on medications, give discharge instructions and perform other important bedside care. (Stimpfel et al. 2012) Unit directors at The Women Care Birth Center at the UPMC Magee Women’s Hospital currently round on the patients within their unit with a focus on the patient experience. The Patient experience involves the series of interactions that patients have with the health care system, including their care from health plans, and from doctors, nurses, staff in hospitals, and other health care facilities. (Patient Experience = Interactions Perceptions. March 2019). Unit Directors chart the patient experience in ParlaiQ, a web-based application created by UPMC that simplifies patient engagement with customizable interviews and real-time feedback. ParlaiQ provides a digital, qualitative and quantitative data-collection solution. hospital leaders and nurses can address non-clinical, patient-related issues in real-time to ultimately increase patient satisfaction, which has a direct impact on the patient’s experience. Hospital employees can quickly resolve questions or concerns by talking with patients about their care. (Patient 2019)

III. OUTLINE PLAN/MANNER OF IMPLEMENTATION It all starts by just acknowledging and telling staff “You’re Special” by utilizing ParlaiQ to promote employee teamwork, moral and fellowship. -

While rounding with ParlaiQ the nurse manager will utilize patient feedback to provide real time feedback to bedside staff

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“You’re Special” notes will have the staff’s name on the note and a brief written communication acknowledge the employee contribution to the patient's positive experience (Appendix 2)

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The notes can be placed/taped on the staff worksite, locker, mailbox or unit bulletin board with the intent that not only the nurse getting the note, but other unit staff members will see the note as well.

Why a written note-

The prosocial gesture of expressing gratitude in a handwritten note boosts positive emotions and well-being for both the letter-writing “expresser” and the recipient of the stated appreciation. (Kumar, Epley 2018)

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“Thank you” from a supervisor boosts self-worth and self-efficacy.

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According to the U.S. Department of Labor, the number one reason why people leave their jobs is because they don’t feel appreciated. (Simon-Thomas & Smith)

Create the Buzz and Build Anticipation. -

The first week that the You’re Special notes are given there will be no explanation as their meaning or source.

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By utilizing secrecy, the objective is to engage the staff into wondering why the notes are being given.

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The goal is for the notes generate a positive response to the feedback and grow an interest in the “You’re Special” initiative.

You’re Special goes Live! -

With staff interested and intrigued it’s time to go life and reveal the goals and purpose of the You’re Special initiative.

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Utilizing Unit Bulletin Boards, Flyers and a You’re Special email bliss all will be revealed

You’re Special is about acknowledging and recognizing staff by showing and telling them their Special-

As stated earlier, Obstetrics is a nursing specialty that requires a longer training time by emphasizing and quantifying the additional time needed to prepare nurses to practice alone You’re Special will encourage new staff through positive feedback

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You’re Special will acknowledge the dedicated work of the existing staff by acknowledging their dedication.

Recognize how Special the staff is – -

Create a positive unit culture that encourages teamwork, work group cohesion and collaborative leadership.

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Show leadership engagement and respect for the employees through acknowledgement of their contribution to the creating the UPMC experience for their patient.

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Create a culture of trust fostered by Leadership engagement on all levels of care with a focused on empowering and encouraging the nursing staff

IV. MEANS OF EVALUATION -

Biweekly meeting with Charge Nurses, Clinicians and Educators with a focus on staff feedback, team building and staff confidence embracing the theme of being special.

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Utilize Press Ganey’s Nursing Excellence Solution (NES) capabilities to create an openended RN Retention Survey

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Reduction in perceived staff negativity through higher Press Ganey survey scores

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Track Individual and team success by creating an excel spreadsheet to track the quantity of “You’re Special” notes given and acknowledge staff privately to ensure team building continues

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Share qualitative and quantitative data-collection from ParlaiQ with nursing staff to address non-clinical, patient-related issues in real-time to ultimately increase patient satisfaction.

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Reduction in staff call offs

References Fischer S .A. (2016) Transformational leadership in nursing: a concept analysis. Journal of Advanced Nursing 72(11), 2644–2653. doi: 10.1111/jan.13049 Kutney-Lee, A., Wu, E. S., Sloane, D. M., & Aiken, L. H. (2013). Changes in hospital nurse work environments and nurse job outcomes: an analysis of panel data. International journal of nursing studies, 50(2), 195–201. doi:10.1016/j.ijnurstu.2012.07.014 Kumar, A., & Epley, N. (2018). Undervaluing gratitude: Expressers misunderstand the consequences of showing appreciation. Psychological Science, 29(9), 1423–1435. Lal, M. M. (2019). Leading Effectively Through Change. The Journal Of Nursing Administration, 49(12), 575–576. https://doi.org/10.1097/NNA.0000000000000816 Patient Experience = Interactions Perceptions. (2019, March 29). Retrieved November 24, 2019, from https://enterprises.upmc.com/blog/patient-experience/. Press Ganey Associates, Inc. (2013). Every voice matters: The bottom line on employee and physician engagement. South Bend, IN: Author. Retrieved from: http://healthcare.pressganey.com/2013-PI-Every_Voice_Matters Press Ganey. (12AD, April 2018). Press Ganey Nursing Special Report Identifies Key Drivers of Intent to Stay Across Multiple Nursing Segments. Business Wire (English). Simon-Thomas, E. R., & Smith, J. A. (n.d.). How Grateful are Americans? Retrieved from https://greatergood.berkeley.edu/article/item/how_grateful_are_americans Suratno, K., Ariyanti, S., & Kadar, K. S. (2018). The Relationship between Transformational Leadership and Quality of Nursing Work Life in Hospital. International Journal of Caring Sciences, 11(3), 1416–1422

Witkoski Stimpfel, A., Sloane, D. M., McHugh, M. D., & Aiken, L. H. (2019). Hospitals Known for Nursing Excellence Associated with Better Hospital Experience for Patients. Journal of Nursing Administration, S25.

Appendix

Name of Article

Authors Type of Purpose Article

Design

Sample/ Method

Setting

Findings/Outcomes

Transformationa Fischer S .A Concept l leadership in Analysis nursing: a concept analysis

Tasked with Concept This report Transformational leadership in improving analysis draws on extant nursing has been associated with Literature/Academ patient using Walker literature on high-performing teams and ia outcomes while and Avant's transformational improved patient care, but rarely decreasing the (2005) leadership, has it been considered as a set of cost of care concept management, competencies that can be taught. provision, analysis and nursing to nurses need method effectively strategies for analyze the implementing concept of reform in health transformational care and one leadership in the promising nursing context. strategy is transformationa l leadership.

Kutney-Lee, Survey Changes in hospital nurse A., Wu, E. data S., Sloane, work environments D. M., & and nurse job Aiken, L. H. (2013). outcomes: an analysis of panel data.

A retrospective, 137 Pennsylvania To demonstrate A retrospective, two-stage panel hospitals in 1999 how rates of design was and 2006 two-stage burnout, panel design chosen for this intention to leave, and job was chosen study. Survey dissatisfaction for this study data collected from large changed in a random samples panel of of registered hospitals over nurses employed time, and to in Pennsylvania explore whether hospitals in 1999 these outcomes and 2006 999 were associated and 2006 in 137 with changes in hospitals. nurse work environments.

In general, nurse outcomes improved between 1999 and 2006, with fewer nurses reporting burnout, intentions to leave, and job dissatisfaction in 2006 as compared to 1999. Our difference models showed that improvements in work environment had a strong negative association with changes in rates of burnout

Lal, M. M. Journal Leading (2019 Index Effectively Through Change

essential elements that contribute to successful change management

Drawn from Magnet Hospitals Magnet literatureand Credentialing and Peer reviewed articles

the Magnet Model component of transformational leadership and examine its impact on creating and sustaining an environment where change flourishes and nurses thrive.

Suratno, K., Survey The Ariyanti, S., Data Relationship between & Kadar, K. Transformationa S. (2018). l Leadership and Quality of Nursing Work Life in Hospital.

The research crosshypothesis was sectional that quantitative transformationa study. l leadership styles would have positive influence on the quality of nurses’ working lives

A total of 807 12-item General participants wereHealth contacted and Questionnaire 651 questionnaires were fully completed (response rate 80.7 %).

This study focused on revealing the relationships between the key variables including transformational leadership, job content, job satisfaction, organisational commitment and general health well-being.

Journal editorial

Hospitals Known for Nursing Excellence Associated with Better Hospital Experience for Patients

Witkoski crossStimpfel, A.,sectional Sloane, D. data from M., the 2010 McHugh, M.HCAHPS D., & Aiken,survey L. H. (2019).

To examine the retrospective Using common Magnet hospitals relationship observational hospital and non-Magnet between study. identifiers,create hospitals. Magnet d a matched set recognition, an of 212 Magnet indicator of hospitals and nursing 212 non-Magnet excellence, and hospitals patients' experience with their hospitalization.

Magnet recognition is associated with better patient care experiences, which may positively enhance reimbursement for hospitals

Appendix 2...