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Developing the Clinical Nurse Leader Developing the Clinical Nurse Leader Role in the Baptist Hospital of Miami Role in the Baptist Hospital of Miami
12 Bed Hospital Model12 Bed Hospital Model ©©
A Best Practice for Care Delivery RedesignA Best Practice for Care Delivery Redesign
CNL TeleconferenceJoan Shinkus Clark RN, MSN, CNAA, BCJanet Maloney RNC, MSM-HM, CNA, BC
Flor Aguirre RN, BSN, OCNMaria Encinas RN, BSN, OCN
March 15, 2006
March 15, 2006 CNL Teleconference 2
Baptist Hospital of MiamiBaptist Hospital of Miami
q Part of Baptist Health South Florida
q 577 Bedsq Community, Not for Profitq Magnet Hospital since 1998n First in Floridan 11th in Nationn Re-designated in 2002
March 15, 2006 CNL Teleconference 3
Framework for Practice
q Based on Dr. Jean Watson’s Theory of Transpersonal Caringn caring is central to the nursing role
and its mission as a distinct professionn caring is often the measure by which
patients evaluate their “cure-dominated” experience
n caring is transpersonal in nature, involving the one caring as well as the one being cared for
March 15, 2006 CNL Teleconference 4
Current Healthcare System
q Patients are older, sicker, and better informedq Healthcare spending, reimbursement and
advances in science and technology have pushed dramatic changes in length of stay and setting
q Physician care patterns have changedq Nursing delivery patterns have changed
YetYet……q Patients’ expectations have not changed!
Realities
March 15, 2006 CNL Teleconference 5
Why it was locally important to change (2000-2001)
q Rapid growth inpatient volumes amidst capacity constraints within the facility
q Increased responsibility for hospital to intervene to ensure physician commitment and continuity
q Increased risk with numbers of novice nursing staffq Patient satisfaction consistently validating
communication and coordination as an issueq Staff dissatisfaction with re-engineered hospital
environment of the 1990’s
March 15, 2006 CNL Teleconference 6
The Twelve Bed HospitalThe Twelve Bed Hospital©©
Care Delivery ModelCare Delivery Model
March 15, 2006 CNL Teleconference 7
TwelveTwelve Bed HospitalBed Hospital©©
q Describes a model for coordinating patient care
q Breaks a patient care unit into small, manageable segments of 12 or more beds, depending on physical layout of the patient care unit
q Places a Patient Care Facilitator in the “lead” role for all the patients in the 12 bed hospital
12 Bed 12 Bed 12 Bed
12 Bed 12 Bed
March 15, 2006 CNL Teleconference 8
Patient Care Facilitator (PCF)
q PCF functions as a clinical leader for RNs, LPNs, and other staff, not as manager
q Knows about each patient in their hospital
q Consistent figure for patient in the hospital to offset fragmentation
q Acts in the role of ‘traffic control’ in coordinating rollout of the plan for care
q Acts as the primary liaison for physicians, other disciplines, and families
q Monitors competency and mentors team members and students
March 15, 2006 CNL Teleconference 9
Twelve Bed Hospital©- 48 Bed Unit
PCF
PCF
PCF
PCF
•Patient Care Center
Manager
•Asst Patient Care Center
Manager
•Charge (Resource) RN
RNRN
RN RN
RN RN
RN
CNA
CNA
CNA
CNA
CNA
CNA
CNA
RN
12 Beds
12 Beds
12 Beds
12 Beds
CNA
March 15, 2006 CNL Teleconference 10
Twelve Bed Hospital© as Care Delivery Model
‘Twelve Bed’ care model incorporates best attributes of traditional nursing practices /delivery models
Team Nursing: Same staff work together all the time
Primary Nursing: PCF coordinates care 24/7 for all patients in group
Modular Nursing: PCF and team work in the same area of the unit on a daily basis
Case Management: PCF is a liaison between third party payors, physicians, and other disciplines in the coordination of care and payment for services
March 15, 2006 CNL Teleconference 11
Vice President Chief Nursing Officer
Nursing Director
Registered Nurse (CN I,II,III)
Assistant Patient Care Center Manager
Assistant Patient Care Center Manager
Registered Nurse (CN I, II, III)
Graduate Nurse Licensed Practical Nurse Nursing Care Technician
Other Allied Health Professional*
Registered Nurse (CN I,II,III)
Graduate Nurse Licensed Practical Nurse Nursing Care Technician
Other Allied Health Professional*
Graduate Nurse Licensed Practical Nurse Nursing Care Technician
Other Allied Health Professional*
Nurse Clinician/
Support Partner
Administrative Partner
Administrative Partner
Support Partner
Administrative Partner
7-3 3-11 11-7
Generic Table of Organization for Patient Care Centers
*Other support personnel vary depending on type of unit (ex. monitor technician - telemetry unit)
Patient Care Facilitator (PCF) /
Advanced PCF
Patient Care Center Manager Assistant Patient Care
Center Manager
March 15, 2006 CNL Teleconference 12
PCF Role and Selectionq BSN required for entry level q Full-time position (not reflected in
direct hours of care); Clinical Nurse IVq Salaried position q 24/7 accountabilityq Reports directly to Patient Care
Center Manager q Certification preferredq 3 years acute care experience with clinical maturity, team
leadership and excellent communication skillsq Provides direct care as backup for staffq Hours worked according to needs of patient, family or MD
n Expected to work one weekend shift and some off-shift hours every month
March 15, 2006 CNL Teleconference 13
Advanced PCFAdditional Responsibilities
q MSN (CNL, CNS or ARNP)q Clinical Nurse Vq Expert resource for all aspects of
patient care deliveryq Certified in clinical specialty areaq Responsible for data collection,
analysis and follow-up within service line-based collaborative performance improvement teams
q Leader in organizational initiativesq Works closely with management
team in planning clinical goals and objectives for patient unit
March 15, 2006 CNL Teleconference 14
Influence of PCF Role on Retention
Director of Nursing CNO
Patient Care Center ManagerResource Nurse
SupervisorAsst Patient Care Center Manager
Faculty (dual appointment with
School(s) of Nursing)
EducatorPerformance Consultant
Clinician (CN IV)
Adjunct Faculty
Advanced PCFsClinical Specialist (CN V)
ARNPs (CN V)Nurse Researchers (CN VI)
PCF (CN IV)
Advanced PCF(CN IV)
Clinical Nurse(CN I,II,III)
CLINICAL TRACKCLINICAL TRACK
EDUCATOR TRACKEDUCATOR TRACK
MANAGER TRACKMANAGER TRACK
March 15, 2006 CNL Teleconference 15
PCF Trainingq Selection and orientation coordinated by the Twelve Bed
Project Managerq Five week training period including:
n Two weeks with experienced PCF on their home unitn One week with experienced PCF on the new PCF’s home unitn 2-4 days with an experienced social workern Time with: ¤ Risk Management ¤ Pastoral Care¤ Utilization Review ¤ Patient and Guest Relations¤ Ethics Consultant¤ International Services
q Attends specialized leadership course tailored to implications of this role
March 15, 2006 CNL Teleconference 16
Twelve Bed Hospital©Implementation: History
Pilot begun on 51 Bed CV Unit
Research begun on pilot CV unit
Pilot extended to two 50 bed Med-Surg Units
12-Bed Hospital Project Manager appointed
12-Bed Model
presented to
Leadership Group
12-Bed Model
defined for rest of hospital
RolloutPlan
initiated
12-Bed ModelFully
Deployed
4th Qtr 2000 4th Qtr 2001 2nd Qtr 2002 2nd Qtr 2002
4th Qtr 20024th Qtr 20021st Qtr 20033rd Qtr 2004
The Clinical Nurse Leader sm
March 15, 2006 CNL Teleconference 18
Education-Practice Partnerships
q 85 academic institutions providing CNL degree with >165 practice sites piloting CNL demonstration programs
q Baptist is partnering with the Christine E. Lynn College of Nursing at Florida Atlantic University n 11 PCFs currently enrolled in CNL program
March 15, 2006 CNL Teleconference 19
PCF versus CNL
q The two roles have similarities. Exceptions related to the PCF role at Baptist Hospital include:n Entry level qualifications are at the baccalaureate level
with specialty-based certificationn Unit/Department-based versus population-based (DRG)n Does not necessarily address the full continuum of care,
although PCFs provide contact information for follow-up
n Definition into 12-16 bed units across all departmentsn 12 Bed concept and role is theory-based (i.e.
transpersonal caring)
Twelve Bed Hospital©Results
Research ~ Caring Framework
March 15, 2006 CNL Teleconference 22
Caring FrameworkThe PCF role impacts patients positively through patients experiencing increased caring. When a patient indicated they had a PCF, they experienced significantly higher (p<.000) caring means for all subscales as measured by the Cronin and Harrison Caring Behaviors Assessment Tool©, 19884.25258YES
3.82165NOExistential/Phenomenological/Spiritual
Forces
4.66274YES
4.42169NOHuman Needs Assistance
4.41268YES
4.15167NOSupportive/Protective/Corrective
Environment
4.32267YES
3.93168NOTeaching/Learning
4.21261YES
3.63164NOExpression of Positive-Negative feelings
4.26275YES
3.86171NOHelping/Trust
4.55281YES
4.18176NOHumanism/Faith-Hope/Sensitivity
MeanNHadPCF?
Carative Factors (subscales)
March 15, 2006 CNL Teleconference 23
Do you feel ready to go home?
100.0%77.7%22.3%% Had PCF
40831791CountTotal
100.0%81.3%18.7%% Had PCF
25720948CountYES
100.0%71.5%28.5%% Had PCF
15110843CountNOHad a PCF
YESNO Total
Ready to Go HomePatient Responses
Chi Square: Exact Significance p = .026
March 15, 2006 CNL Teleconference 24
Did everyone who took care of you seem to know about your care?
Chi Square: Exact Significance p = .000
100.0%82.4%17.6%% Had PCF
46638482CountTotal
100.0%89.2%10.8%% Had PCF
28825731CountYES
100.0%71.3%28.7%% Had PCF
17812751CountNOHad a PCF
YESNO Total
Everyone Knew CarePatient Responses
Quality Measures
March 15, 2006 CNL Teleconference 26
Acute MI – Core MeasuresP
erc
en
t
A M I A C E I o r A R B f o r L V S Dp char t
Temporary: UCL = 115.00, Mean = 75.88, LCL = 36.76Inspected Mean = 10.76, Counts Mean = 8.17
U C L
Mean
L C L
J C A H O T o p 1 0 %
Focused A t ten t ion by PCF
Jul 02
Aug 0
2
Sept 0
2Oct 0
2
Nov 02
Dec 02Jan
03Fe
b 03
Mar 03Ap
r 03
May 03Ju
n 03Ju
l 03Au
g 03
Sept 0
3Oct
03
Nov 03Dec
03Ja
n 04
Feb 0
4Mar
04Ap
r 04
May 04Jun
04Ju
l 04
Aug 0
4
Sept 0
4Oct 0
4
Nov 04Dec
04Ja
n 05
Feb 0
5Mar
05Ap
r 05
May 05Ju
n 05Ju
l 05
Aug 0
5
Sept 0
5Oct 0
5
Nov 05
Dec 05
0
20
40
60
80
100
120
140
Pe
rce
nt
A M I A s p i r i n a t A r r i v a lp chart
Temporary: UCL = 105.99, Mean = 94.43, LCL = 82.87Inspected Mean = 35.45, Counts Mean = 33.48
UCL
Mean
LCL
J C A H O T o p 1 0 %
Focused At tent ion by PCF
Jul 02
Aug 0
2
Sept 0
2Oct 0
2
Nov 02Dec
02Ja
n 03
Feb 0
3Mar
03Ap
r 03
May 03Ju
n 03Ju
l 03
Aug 0
3
Sept 0
3Oct 0
3
Nov 03
Dec 03Jan
04Fe
b 04
Mar 04Ap
r 04
May 04Ju
n 04Ju
l 04
Aug 0
4
Sept 0
4Oct
04
Nov 04Dec
04Ja
n 05
Feb 0
5Mar 0
5Ap
r 05
May 05Jun
05Ju
l 05
Aug 0
5
Sept 0
5Oct 0
5
Nov 05Dec
05
8 0
8 5
9 0
9 5
100
105
110
Pe
rce
nt
A M I A s p i r i n P r e s c r i b e d a t D i s c h a r g ep chart
Temporary: UCL = 105.21, Mean = 93.04, LCL = 80.87Inspected Mean = 39.33, Counts Mean = 36.60
U C L
Mean
L C L
J C A H O T o p 1 0 %
Focused A t ten t ion by PCF
Jul 02Au
g 02
Sept
02Oct
02
Nov 02Dec
02Jan
03Fe
b 03
Mar 03Ap
r 03
May 03Ju
n 03Ju
l 03
Aug 0
3
Sept 0
3Oct
03
Nov 03Dec
03Ja
n 04
Feb 0
4Mar
04Ap
r 04
May 04Jun
04Ju
l 04
Aug 0
4
Sept 0
4Oct
04
Nov 04Dec
04Ja
n 05
Feb 0
5Mar
05Ap
r 05
May 05Jun
05Ju
l 05
Aug 0
5
Sept 0
5Oct 0
5
Nov 05Dec
05
80
85
90
95
100
105
Pe
rce
nt
A M I B e t a B l o c k e r a t A r r i v a lp char t
Temporary: UCL = 107.63, Mean = 93.30, LCL = 78.97Inspected Mean = 27.38, Counts Mean = 25.55
U C L
Mean
L C L
J C A H O T o p 1 0 %
Focused A t ten t ion by PCF
Jul 02
Aug 0
2
Sept
02Oct 0
2Nov
02
Dec 02Ja
n 03
Feb 0
3Mar 0
3Ap
r 03
May 03Ju
n 03Ju
l 03Au
g 03
Sept 0
3Oct
03
Nov 03Dec
03Ja
n 04
Feb 0
4Mar 0
4Ap
r 04
May 04Ju
n 04Ju
l 04
Aug 0
4
Sept 0
4Oct 0
4Nov
04Dec
04
Jan 0
5Fe
b 05
Mar 05Ap
r 05
May 05
Jun 0
5Ju
l 05
Aug 0
5
Sept
05Oct 0
5Nov
05
Dec 05
70
75
80
85
90
95
100
105
110
Pe
rce
nt
A M I B e t a B l o c k e r P r e s c r i b e d a t D i s c h a r g ep chart
Temporary: UCL = 104.90, Mean = 91.84, LCL = 78.79Inspected Mean = 39.57, Counts Mean = 36.34
UCL
Mean
LCL
J C A H O T o p 1 0 %
Focused A t ten t ion by PCF
Jul 02
Aug 0
2
Sept 0
2Oct 0
2Nov
02Dec
02
Jan 0
3Fe
b 03
Mar 03
Apr 0
3
May 03Ju
n 03Ju
l 03
Aug 0
3
Sept 0
3Oct 0
3Nov
03Dec
03
Jan 0
4Fe
b 04
Mar 04
Apr 0
4
May 04
Jun 0
4Ju
l 04
Aug 0
4
Sept
04Oct 0
4Nov
04
Dec 04Ja
n 05
Feb 0
5Ja
n 05
Feb 0
5Mar 0
5Ap
r 05
May 05Ju
n 05Ju
l 05
Aug 0
5
Sept 0
5Oct 0
5Nov
05Dec
05
7 0
7 5
8 0
8 5
9 0
9 5
100
105
110
Pe
rce
nt
A M I S m o k i n g C e s s a t i o np chart
Temporary: UCL = 117.12, Mean = 87.90, LCL = 58.68Inspected Mean = 11.21, Counts Mean = 9.86
U C L
Mean
L C L
J C A H O T o p 1 0 %
Focused A t ten t ion by PCF
Jul 02Au
g 02
Sept
02Oct
02
Nov 02
Dec 02Ja
n 03
Feb 0
3Mar 0
3Ap
r 03
May 03Ju
n 03Ju
l 03
Aug 0
3
Sept 0
3Oct
03
Nov 03
Dec 03Ja
n 04
Feb 0
4Mar 0
4Ap
r 04
May 04Ju
n 04Ju
l 04
Aug 0
4
Sept 0
4Oct
04
Nov 04Dec
04Ja
n 05
Feb 0
5Mar 0
5Ap
r 05
May 05Ju
n 05Ju
l 05
Aug 0
5
Sept 0
5Oct 0
5Nov
05Dec
05
40
60
80
100
120
140
March 15, 2006 CNL Teleconference 27
CHF – Core MeasuresP
erc
en
t
H e a r t F a i l u r eA C E I n h i b i t o r U s e
p chart
UCL = 100 .41
Mean = 75.18
LCL = 49.95
J C A H O T o p 1 0 %
Focused Attent ion by PCF
Jul 02Au
g 02
Sept
02Oct 0
2Nov
02
Dec 02
Jan 0
3
Feb 03
Mar 03
Apr 0
3
May 03
Jun 0
3Ju
l 03Au
g 03
Sept 0
3Oct
03Nov
03Dec
03
Jan 0
4Fe
b 04Mar 0
4Ap
r 04May
04Ju
n 04Ju
l 04
Aug 0
4
Sept
04Oct 0
4Nov
04Dec
04Ja
n 05Feb
05Mar
05
Apr 05
May 05
Jun 0
5Ju
l 05
Aug 0
5Se
p 05Oct 0
5Nov
05Dec
05
4 0
5 0
6 0
7 0
8 0
9 0
100
110
Pe
rce
nt
Hear t Fa i lu reA s s e s s m e n t o f C a r d i a c F u n c t i o n
p char t
UCL = 101.74
Mean = 91.83
LCL = 81.91
J C A H O T o p 1 0 %
Focused Attention by PCF
Jul 02Au
g 02
Sept 0
2Oct
02Nov
02Dec
02Ja
n 03Fe
b 03Mar 0
3Ap
r 03May
03Ju
n 03Ju
l 03Au
g 03
Sept
03Oct 0
3Nov
03
Dec 03Ja
n 04
Feb 04
Mar 04
Apr 0
4
May 04
Jun 0
4Ju
l 04Au
g 04
Sept 0
4Oct 0
4Nov
04Dec
04
Jan 0
5Fe
b 05Mar 0
5Ap
r 05May
05Ju
n 05Ju
l 05
Aug 0
5Se
p 05Oct 0
5Nov
05Dec
05
65
70
75
80
85
90
95
100
Pe
rce
nt
H e a r t F a i l u r eD i s c h a r g e I n s t r u c t i o n s
p chart
U C L = 6 7 . 4 8
Mean = 48.26
LCL = 29.04
J C A H O T o p 1 0 %
Focused Attent ion by PCF
Jul 02
Aug 0
2
Sept
02Oct 0
2Nov
02Dec
02Ja
n 03
Feb 0
3
Mar 03Ap
r 03
May 03Ju
n 03Ju
l 03
Aug 0
3
Sept
03Oct 0
3
Nov 03Dec
03Jan
04Fe
b 04Mar 0
4Ap
r 04
May 04Ju
n 04
Jul 04
Aug 0
4
Sept 0
4Oct 0
4
Nov 04
Dec 04Ja
n 05
Feb 0
5Mar
05Ap
r 05
May 05Jun
05Jul 05
Aug 0
5Se
p 05Oct 0
5
Nov 05Dec
05
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
Pe
rce
nt
Hear t Fa i lu reS m o k i n g C e s s a t i o n
p char t
Mean = 74.48
LCL = 24.35
J C A H O T o p 1 0 %
Focused Attention by PCF
Jul 02
Aug 0
2
Sept
02Oct
02
Nov 02Dec
02Ja
n 03
Feb 0
3Mar
03Ap
r 03
May 03Ju
n 03Jul
03
Aug 0
3
Sept 03
Oct 03
Nov 03
Dec 03Ja
n 04
Feb 0
4Mar
04Ap
r 04
May 04Jun
04Jul 04
Aug 0
4
Sept
04Oct 0
4Nov
04Dec
04Ja
n 05
Feb 0
5
Mar 05Ap
r 05
May 05Ju
n 05Ju
l 05
Aug 0
5Se
p 05Oct 0
5
Nov 05Dec
05
0
10
20
30
40
50
60
70
80
90
100
110
120
March 15, 2006 CNL Teleconference 28
Pneumonia Core MeasuresP
erc
en
t
CAP Ant ib io t ic T iming w i th in 4 hours o f Ar r iva lp chart
Temporary: UCL = 73.52, Mean = 50.77, LCL = 28.01Inspected Mean = 43.44, Counts Mean = 22.06
U C L
Mean
LCL
Jul 04
Aug 0
4
Sept 0
4Oct 0
4Nov
04
Dec 04
Jan 0
5Fe
b 05
Mar 05
Apr 0
5
May 05
Jun 0
5Ju
l 05
Aug 0
5
Sept 0
5Oct 0
5Nov
05
Dec 05
10
20
30
40
50
60
70
80
Pe
rce
nt
CAP Smoking Cessat ionp chart
Temporary: UCL = 123.21, Mean = 92.90, LCL = 62.59Inspected Mean = 6.46, Counts Mean = 6.00
UCL
Mean
LCL
Focus Attention by PCF
Jan 04
Feb 04
Mar 04
Apr 0
4
May 04Ju
n 04
Jul 04
Aug 0
4
Sept 0
4Oct 0
4
Nov 04Dec
04Jan
05Feb
05Mar
05Ap
r 05
May 05
Jun 0
5Ju
l 05
Aug 0
5
Sept 0
5Oct 0
5
Nov 05Dec
05
0
20
40
60
80
100
120
140
Pe
rce
nt
CAP Blood Cul turesp chart
Temporary: UCL = 99.79, Mean = 83.47, LCL = 67.15Inspected Mean = 46.63, Counts Mean = 38.92
U C L
Mean
LCL
Focus Attention by PCF
Jan 0
4
Feb 0
4Mar 0
4Ap
r 04May
04Ju
n 04Ju
l 04
Aug 0
4
Sept
04Oct
04
Nov 04
Dec 04
Jan 0
5
Feb 0
5Mar 0
5Ap
r 05
May 05
Jun 0
5Ju
l 05
Aug 0
5
Sept
05Oct
05
Nov 05
Dec 05
65
70
75
80
85
90
95
100
105
Per
cent
CAP Ini t ia l ATB Select ion non-ICUp chart
Temporary: UCL = 103.27, Mean = 84.88, LCL = 66.49Inspected Mean = 34.17, Counts Mean = 29.00
UCL
Mean
LCL
Jul 04
Aug 0
4
Sept 0
4Oc
t 04Nov
04Dec
04Jan
05Feb
05Mar
05Ap
r 05
May 05
Jun 05
Jul 05
Aug 0
5
Sept 0
5Oct 0
5
Nov 05
Dec 05
30
40
50
60
70
80
90
100
110
Pe
rce
nt
CAP Pneumococca l Vacc ina t ionp chart
Temporary: UCL = 94.89, Mean = 69.41, LCL = 43.92Inspected Mean = 29.42, Counts Mean = 20.42
UCL
Mean
LCL
Focus Attention by PCF
Jan 0
4Fe
b 04Mar 0
4Ap
r 04May
04Ju
n 04
Jul 04
Aug 0
4
Sept
04Oct
04
Nov 04
Dec 04
Jan 0
5
Feb 0
5
Mar 05
Apr 05
May 05
Jun 0
5Ju
l 05Au
g 05
Sept 0
5Oct 0
5Nov
05
Dec 05
20
30
40
50
60
70
80
90
100
Patient Satisfaction
March 15, 2006 CNL Teleconference 30
86.2
74.2
7877.7
77.2
85.7
80.583.3
86.6
91.4
83.985.7
81.882.3
96.9
93.1
86.988.4
60
65
70
75
80
85
90
95
Percent
Jul-Sep 2002 Oct-Dec 2005
4 BCVI3 Tower3 Main4 Tower4 Main5 Main5 TowerOBWomens
12 Bed Hospital Implementation
BEFORE AFTER
Press Ganey 90th percentile
Press Ganey 90th percentile
Press-Ganey Patient Satisfaction Survey“Nurses Kept You Informed”
March 15, 2006 CNL Teleconference 31
87.5
79.781.7
77.8
77.8
85
79.7
88.7
85.3
90.8
87.387.3
80.9
84.7
95.9
94.2
87.288.8
60
65
70
75
80
85
90
95
Percent
July-Dec 2002 Oct-Dec 2005
4 BCVI3 Tower3 Main4 Tower4 Main5 Main5 TowerOBWomens
12 Bed Hospital ImplementationBEFORE
AFTER
Press Ganey 90th percentile
Press Ganey 90th percentile
Press-Ganey Patient Satisfaction Survey“Attention to Special/Personal Needs”
Nurse Satisfaction
March 15, 2006 CNL Teleconference 33
NDNQI RN Satisfaction Survey“Teamwork Between Coworkers”
(Individual Level Response)
Baptist Hospital NDNQI RN Satisfaction Survey 2003-2005
"Teamwork"(Individual Level Response)
0
10
20
30
40
50
60
70
80
2003 NDNQI2003 All Units BHM2004 NDNQI
2004 All Units BHM2005 NDNQI2005 BHM All Units
Individual Level Question:
There is a good deal of teamwork between my coworkers and me.
March 15, 2006 CNL Teleconference 34
NDNQI RN Satisfaction Survey“Sufficient Time for Patient Care”
Baptist Hospital NDNQI RN Satisfaction Survey 2003-2005
"Time for Patient Care"(Individual Level Question"
0
10
20
30
40
50
60
70
80
2003 NDNQI2003 All Units BHM2004 NDNQI2004 All Units BHM2005 NDNQI2005 BHM All Units
Individual Level Question:
I have sufficient time for direct patient care.
March 15, 2006 CNL Teleconference 35
NDNQI RN Satisfaction Survey“Job Enjoyment Score”
Baptist Hospital NDNQI RN Satisfaction Survey 2003-2005
"Job Enjoyment"
0
10
20
30
40
50
60
70
80
2003 NDNQI2003 All Units BHM2004 NDNQI2004 All Units BHM2005 NDNQI2005 BHM All Units
Individual level Question:
I am fairly well satisfied with my job.
Physician Satisfaction
March 15, 2006 CNL Teleconference 37
Physician Survey
77%
81.2%
90.1%88.5%
65.0%
74.4%
81.5%
81.8%
77%
89.7%
89.9%90%
77%
92.4%
97.5%
93%
50%
60%
70%
80%
90%
100%
Overall Nursing Care Nursing Staffresponse to MDs
Manage Emergencies D/C Coordination
BenchmarkMar-03Jun-04Mar-05
Organizational GoalsPatient Throughput
March 15, 2006 CNL Teleconference 39
Per
cen
tBaptist Hospital 11 AM Discharges-Med Surg Units
34226
38133
41846
38325
39329
37838
36650
33454
40040
35635
40649
34653
39963
40744
39849
38250
28837
41348
41876
37257
36847
37050
35060
40072
41857
34548
34858
36568
37957
BHM Med Surg totalBHM Med Surg before 11
p chartTemporary: UCL = 18.19, Mean = 12.99, LCL = 7.79
Inspected Mean = 376.66, Counts Mean = 48.93
UCL
Mean
LCL
Goal 33%
Hurr. Katrina 8/26
Hurr. Rita 9/20
Hurr. Wilma 10/24
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-7
/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-
10/7
10/10
-10/14
10/17
-10/21
10/24
-10/28
10/31
-11/04
11/07
-11/11
11/14
-11/18
11/21
-11/25
11/28
-12/02
12/05
-12/09
12/12
-12/16
12/19
-12/23
12/26
-12/30
1/02-1
/06 20
06
1/9-1/
13
1/16-1
/20
0
5
10
15
20
25
30
35
40
March 15, 2006 CNL Teleconference 40
Per
cen
tBaptist Hospital 2 PM Discharges-Med Surg Units
342106
381121
418143
383133
393131
378130
366146
334137
400146
356110
406163
346139
399170
407141
398161
382146
288101
413144
418193
372165
368151
370154
350167
400202
418188
345146
348161
365166
379170
BHM Med Surg totalBHM Med Surg before 2
p chartTemporary: UCL = 47.21, Mean = 39.65, LCL = 32.09
Inspected Mean = 376.66, Counts Mean = 149.34
UCL
Mean
LCL
Goal 66%
Hurr. Katrina 8/26 Hurr. Rita 9/20
Hurr. Wilma 10/24
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-7
/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-
10/7
10/10
-10/14
10/17
-10/21
10/24
-10/28
10/31
-11/04
11/07
-11/11
11/14
-11/18
11/21
-11/25
11/28
-12/02
12/05
-12/09
12/12
-12/16
12/19
-12/23
12/26
-12/30
1/02-1
/06 20
061/9
-1/13
1/16-1
/20
0
10
20
30
40
50
60
70
March 15, 2006 CNL Teleconference 41
11 AM Discharge Outcomes Med- Surg/Oncology Nursing Unit
Pe
rce
nt
5 T o w e r 1 1 A M D i s c h a r g e s37
444
94612
427
373
3 64
428
4 09
444
4 34
409
3 57
434
4810
405
4610
2511
5415
5215
4910
429
3010
256
3714
4 01 2
298
2 68
4415
3 51 0
5T total5 T b e f o r e 1 1
p c h a r tTemporary : UCL = 41.59, Mean = 21.89, LCL = 2.20
Inspected Mean = 39.69, Counts Mean = 8 .69
U C L
Mean
LCL
G o a l 3 3 %
Hurr . Wi lma 10/24
Hur r . R i t a 9 /20Hurr . Kat r ina 8 /26
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-7
/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-
10/7
10/10
-10/14
10/17
-10/21
10/24
-10/28
10/31
-11/04
11/07
-11/11
11/14
-11/18
11/21
-11/25
11/28
-12/02
12/05
-12/09
12/12
-12/16
12/19
-12/23
12/26
-12/30
1/2-1/
6 200
61/9
-1/13
1/16-1
-20
0
5
10
15
20
25
30
35
40
45
Pe
rce
nt
5 T o w e r 2 P M D i s c h a r g e s3712
4 42 0
4622
4 21 7
3717
3614
4 22 3
4019
4 41 5
4310
4016
3515
4315
4820
4021
4621
2519
5 43 0
5224
4 92 3
4218
3018
2516
3732
4022
2922
2615
4423
3 51 8
5T total5T before 2
p chartTempora ry : UCL = 72 .19 , Mean = 48 .39 , LCL = 24 .60
Inspec ted Mean = 39 .69 , Counts Mean = 19 .21
U C L
Mean
LCL
G o a l 6 6 %Hur r . R i t a 9 /20
Hurr . Kat r ina 8 /26
Hur r . Wi lma 10 /24
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-7
/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-
10/7
10/10
-10/14
10/17
-10/21
10/24
-10/28
10/31
-11/04
11/07
-11/11
11/14
-11/18
11/21
-11/25
11/28
-12/02
12/05
-12/09
12/12
-12/16
12/19
-12/23
12/26
-12/30
1/2-1/6
2006
1/9-1/
13
1/16-1
-20
20
30
40
50
60
70
80
5 Tower Percent Discharged by 11:00 AM
5 Tower Percent Discharged by 2:00 PM
March 15, 2006 CNL Teleconference 42
Pe
rce
nt
5TD Flor Aguirre 11 AM Discharges151
132
236
192
170
162
201
173
181
232
152
162
171
174
141
212
113
224
263
193
132
82
72
81
93
50
52
125
62
5TD total5TD before 11
p chartTemporary: UCL = 42.43, Mean = 14.81, LCL = none
Inspected Mean = 14.90, Counts Mean = 2.21
UCL
Mean
Goal 33%
Hurr. Wilma 10/24
Hurr. Rita 9/20
Hurr. Katrina 8/26
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-7
/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-
10/7
10/10
-10/14
10/17-
10/21
10/24
-10/28
10/31
-11/04
11/07
-11/11
11/14
-11/18
11/21-
11/25
11/28
-12/02
12/05-
12/09
12/12
-12/16
12/19
-12/23
12/26-
12/30
1/2-1/
6 200
6
1/9-1/1
3
1/16-1
-20
0
10
20
30
40
50
60
Pe
rce
nt
5TD Flor Aguirre 2 PM Discharges153
136
2310
197
177
167
209
176
180
236
156
162
176
176
145
218
114
229
267
194
136
84
74
87
97
54
54
125
63
5TD total5TD before 2
p chartTemporary: UCL = 75.13, Mean = 37.50, LCL = none
Inspected Mean = 14.90, Counts Mean = 5.59
U C L
Mean
LCL
Goal 66% Hurr. Rita 9/20
Hurr. Katrina 8/26
Hurr. Wilma 10/24
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-7
/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-1
0/7
10/10
-10/14
10/17-
10/21
10/24
-10/28
10/31
-11/04
11/07-
11/11
11/14
-11/18
11/21
-11/25
11/28-
12/02
12/05
-12/09
12/12
-12/16
12/19
-12/23
12/26
-12/30
1/2-1/
6 200
6
1/9-1/1
3
1/16-1
-20
0
20
40
60
80
100
Pe
rce
nt
5TA Maria Encias 11 AM Discharges91
1 15
63
71
72
62
63
94
1 02
71
1 04
83
123
1 24
102
92
41
113
137
1 11
95
95
61
1 34
1 23
1 13
93
1 45
1 54
5TA total5TA before 11
p chartTemporary: UCL = 76.70, Mean = 31.52, LCL = none
Inspected Mean = 9.52, Counts Mean = 3.00
U C L
MeanGoal 33%
Hurr. Wilma 10/24
Hurr. Rita 9/20
Hurr. Katrina 8/26
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-7
/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-
10/7
10/10
-10/14
10/17
-10/21
10/24
-10/28
10/31
-11/04
11/07
-11/11
11/14
-11/18
11/21
-11/25
11/28
-12/02
12/05
-12/09
12/12
-12/16
12/19
-12/23
12/26
-12/30
1/2-
1/6
2006
1/9-1/1
3
1/16-1
-20
2 0
4 0
6 0
8 0
100
Pe
rce
nt
5TA Maria Encias 2 PM Discharges93
1 18
64
73
72
62
64
96
1 03
71
105
87
125
125
107
94
42
1 16
1 31 0
115
97
96
64
137
1 24
1 16
96
1 48
1 58
5TA total5TA before 2
p chartTemporary: UCL = 102.12, Mean = 53.62, LCL = 5.13
Inspected Mean = 9.52, Counts Mean = 5.10
UCL
Mean
L C L
Goal 66%
Hurr. Rita 9/20
Hurr. Katrina 8/26
Hurr. Wilma 10/24
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-7
/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-
10/7
10/10
-10/14
10/17
-10/21
10/24
-10/28
10/31
-11/04
11/07-
11/11
11/14-
11/18
11/21
-11/25
11/28
-12/02
12/05
-12/09
12/12
-12/1
6
12/19
-12/23
12/26
-12/3
0
1/2-1/6
2006
1/9-1/1
3
1/16-1
-20
0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
Pe
rce
nt
5TC Jan Roy 11 AM Discharges60
162
92
82
61
80
92
112
101
60
72
41
90
132
132
113
70
142
90
80
102
70
62
102
124
91
5TC total5TC before 11
p chartTemporary: UCL = 49.82, Mean = 14.71, LCL = none
Inspected Mean = 9.15, Counts Mean = 1.35
UCL
Mean
Goal 33%
Hurr. Wilma 10/24
Hurr. Rita 9/20Hurr. Katrina 8/26
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-
7/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-1
0/7
10/10
-10/14
10/17
-10/21
10/24
-10/28
10/31
-11/04
11/07
-11/11
11/14
-11/18
11/21
-11/25
11/28
-12/02
12/05
-12/09
12/12
-12/16
12/19
-12/23
12/26
-12/30
0
10
20
30
40
50
60
70
Pe
rce
nt
5TC Jan Roy 2 PM Discharges61
163
94
84
65
82
96
116
105
60
73
42
94
135
137
115
75
148
92
84
104
73
64
108
128
95
5TC total5TC before 2
p chartTemporary: UCL = 96.99, Mean = 47.48, LCL = none
Inspected Mean = 9.15, Counts Mean = 4.35
UCL
Mean
L C L
Goal 66% Hurr. Rita 9/20
Hurr. Katrina 8/26Hurr. Wilma 10/24
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-7
/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-
10/7
10/10
-10/14
10/17-
10/21
10/24
-10/28
10/31
-11/04
11/07-
11/11
11/14
-11/18
11/21
-11/25
11/28
-12/02
12/05
-12/09
12/12
-12/16
12/19
-12/23
12/26
-12/30
0
20
40
60
80
100
120
11AM Outcomes by PCFP
erc
en
t
5TB Susan Howard 11 AM Discharges72
40
81
82
70
60
72
30
60
71
81
71
50
60
30
53
32
72
43
1 12
1 00
60
61
63
72
41
62
62
72
5TB total5TB before 11
p chartTemporary: UCL = 67.10, Mean = 19.44, LCL = none
Inspected Mean = 6.21, Counts Mean = 1.21
UCL
Mean
G o a l 3 3 %
Hurr. Wilma 10/24
Hurr. Rita 9/20
Hurr. Katrina 8/26
7/04-7
/08
7/11-7
/15
7/18
-7/2
2
7/25-7
/29
8/01-8
/05
8/08
-8/1
2
8/15-8
/19
8/22-
8/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-
9/30
10/3-
10/7
10/10
-10/14
10/17
-10/21
10/24-
10/28
10/31
-11/04
11/07-
11/11
11/14
-11/18
11/21-
11/25
11/28-
12/02
12/05-
12/09
12/12
-12/16
12/19
-12/23
12/26-
12/30
1/2-1/
6 200
6
1/9-1/1
3
1/16-1
-20
0
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
Pe
rce
nt
5TB Susan Howard 2 PM Discharges75
43
84
83
73
63
74
31
61
73
82
74
50
64
32
54
33
73
43
1 16
1 01
62
64
66
73
44
63
64
73
5TB total5TB before 2
p chartTemporary: UCL = 110.76, Mean = 50.56, LCL = none
Inspected Mean = 6.21, Counts Mean = 3.14
U C L
Mean
LCL
Goal 66%
Hurr. Rita 9/20Hurr. Katrina 8/26
Hurr. Wilma 10/24
7/04-7
/08
7/11-7
/15
7/18-7
/22
7/25-7
/29
8/01-8
/05
8/08-8
/12
8/15-8
/19
8/22-8
/26
8/29-9
/02
9/05-9
/09
9/12-9
/16
9/19-9
/23
9/26-9
/30
10/3-1
0/7
10/10
-10/14
10/17
-10/21
10/24
-10/28
10/31
-11/04
11/07
-11/11
11/14
-11/18
11/21
-11/25
11/28
-12/02
12/05
-12/09
12/12
-12/16
12/19
-12/23
12/26
-12/30
1/2-1/
6 200
6
1/9-1/1
3
1/16-1
-20
0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
PCF #1 PCF #2
PCF #3 PCF #4
March 15, 2006 CNL Teleconference 43
Nursing Statistics
0%
5%
10%
15%
20%
2001 2002 2003 2004 2005
Turnover Rates 2001-2005
Baptist HospitalFlorida
0%
5%
10%
15%
20%
2001 2002 2003 2004 2005
Nurse Vacancy Rate 2001-2005
Baptist HospitalFlorida
March 15, 2006 CNL Teleconference 44
Next Steps
q Improve standardization among PCFsq Extend 12 bed concept to other disciplinesq Measurement on all key outcomes by PCF q Integration with a “care manager” roleq Evaluate as a system-wide deliveryq Formal cost-benefit analysis and further
research
March 15, 2006 CNL Teleconference 45
Contact Information:
Joan Shinkus Clark RN, MSN, CNAA, BCBaptist Hospital of [email protected]
Janet Maloney RN, BC, MSMBaptist Hospital of [email protected]