A Glimpse into the Care Innovation and Transformation Journey

CIT Cohort 1 Nurse Managers with Barbara Mackoff, EdD

The first cohort of AONE’s Care Innovation and Transformation (CIT) initiative met for the third time in late January in New Orleans.  Tackling complex issues like physician-nurse communication and acuity-based nursing, this group of process improvement professionals proved they are no longer the neophytes who first met in Chicago – an evolution part of the CIT journey.  While this first CIT cohort will leave the formal program later this year, they will take with them tools to improve patient care and maintain a healthy work environment.

Ring of Knowledge Example - Click on image for larger view

This learning community of hospitals is closer and more comfortable sharing with one another.  The CIT face-to-face meetings and monthly conference calls provide them with an opportunity to learn from and interact with their peers in different parts of the country.  To each meeting, attendees bring a poster highlighting a successful innovation.  At the conference, attendees are able to circulate from poster-to-poster discussing a particular unit’s test of change and collect a knowledge card from each one. For those who have not had the pleasure to attend a CIT meeting, a ring of knowledge provides an invaluable glimpse of the cohort’s process improvement work.  Knowledge cards are typically a 4 by 6-inch card describing an innovation.  These cards are collected on a small ring and shared at the meeting like baseball cards or valentines.

Barbara Mackoff, EdD, joined our group in New Orleans, addressing the nurse managers on the first day, and the CIT teams on day two.  Many of you may be familiar with Dr. Mackoff’s research and her book, Nurse Manager Engagement: Strategies for Excellence and Commitment.  Dr. Mackoff opened the nurse manager session by sharing the research question she used for her book.  Instead of asking why nurse managers leave their positions, Dr. Mackoff’s research focused on identifying reasons nurse managers stay in their roles, exploring the positive connections, strengths, and values associated with the nurse manager role.  In turn, many of the CIT nurse manager attendees shared their inspirational stories of empathy and compassion.

During the final day of the meeting, the group was addressed by Rebecca Pomrenke, RN, MSN, CNL; Jeaniffr Snide, BSN, RN-BC; Amy Lussier, RN, BSN; Jennifer O’Neill, DNP, APN; and the Director of the CIT initiative, Amanda Stefancyk, RN, MSN, MBA, CNML.  Each presenter wove in their CIT successes and lessons learned, sharing in the spirit of the meeting and contributing to the group’s collective wisdom.

AONE’s Care Innovation and Transformation initiative will accept applications again in the Fall, 2012.  Check back here frequently for further updates on the progress of these leaders in health care innovation.

 

CIT Poster Presentation

Live from New Orleans… it’s the AONE Nurse Manager Fellows!

This week, the 2012 class of AONE Nurse Manager Fellows kicked off their year-long journey of experiential learning in New Orleans, LA. This mighty group, comprised of 33 nurse managers from around the country, comes from diverse practice settings and facilities. The one thing they have in common is a passion for nursing and an even stronger desire to grow as leaders.

I had the pleasure of joining the Fellows on their kick off session this past Sunday night. Aside from my role as marketing communications manager at AONE, my other passion is improvisation. My background is in studying and performing with Chicago’s infamous Second City comedy group, and I still love playing all of the improv games I learned at that time.

On Sunday night, MT Meadows, AONE director of professional practice and Pam Thompson, AONE chief executive officer, welcomed the group and provided them with an overview of the coming week’s activities and the robust learning opportunities for 2012 (this week, the group is hearing from nationally renowned faculty on topics like shared governance, diversity, conflict resolution and managing budgets.)

“Yes, and….” improvisation! After MT and Pam were done, it was my turn to conduct an ice-breaker and fun learning activity for the group. I asked for a show of hands of who had improvised before. Without skipping a beat, one of the Fellows immediately said, “I feel like I improvise every day of my life.” Everyone nodded in unison!　

I shared my understanding of a few basic tenets of improv which are, in no particular order:

• Concept of “yes and”. In improv, we initiate a character choice, statement, action. As scene partners, we say “yes and” to further both the initiation and ultimately the scene. This is truly collaboration at its finest.　
   
• Thinking on your feet. Remember- improv is made up on the spot! We don’t have the luxury of thinking and planning what we’ll say an hour (or even a minute) before the scene. We often draw on our intuition to create character and scenes.
   
• Getting out of your comfort zone. Can you do a cheerleading routine with complete strangers? The Fellows sure could! Improv is based on play and creating imaginary environments, often based on simple audience suggestions. We dance, we sing, we juggle imaginary chainsaws! We do silly things and we realize that it’s kind of fun to get out of your comfort zone!

For the next two hours, I led the Fellows through a series of physical and vocal warm ups, classic improv games, and character work in imaginary locations such as: a biohazard room, a prison cell, a restaurant (that served alligator toe-nails- don’t ask), and a psych unit. (You can imagine the array of characters and humor that ensued.) We ended our time with basic role plays on topic areas that resonated strongly with the group: staffing, just-announced facility inspections, interview sessions, chronic tardiness to name a few.

I was truly blown away by the Fellows’ willingness to try new things, put themselves out there, and really support each other in the process. I might add that there were definitely a few ringers in the group who I’m sure are TOTAL HAMS in their daily life… if you’re reading this, I think you know who you are…

Congratulations to the 2012 AONE Nurse Manager Fellows. It was an honor to meet you and share my passion of improvisation. I wish you all success during your fellowship as well as this exciting next stage in your career as nurse leaders!

Eric Francque
AONE Marketing Communications Manager

A new leader for the Center for Care Innovation and Transformation

As the newly installed Director of the Center for Care Innovation and Transformation (CCIT) at AONE, Amanda Stefancyk, RN, MSN, MBA, CNML understands what it takes for nurse leaders to initiate change. Before coming to AONE, Stefancyk spent six years as a nurse leader where she participated in several AONE initiatives. Stefancyk says making the transition from working in a hospital to running the CCIT for AONE has been a challenge, but one she’s eager to take on. In addition to her job at AONE, she’s also pursing her doctorate in Health Services Research from Vanderbilt University.

How long have you been with AONE and what is your nursing background?

I’ve been a part of AONE for about two months. Before being hired by the organization, I was a nursing director at Massachusetts General Hospital for six years where I managed a 20-bed general medical unit. During that time, the unit participated in the AONE/RWJF TCAB initiative, a frontline-focused improvement program, which empowered staff and unit leadership to generate and test ideas for change. In a two-year period the unit tested more than 30 innovations, of which, 11 became part of our culture on a daily basis. This, in turn, improved patient care, the work environment, and patient safety.

How else were you involved in AONE as a nurse leader?

Prior to working for the organization, I was fortunate to be selected as one of 30 nurse leaders from across the country to participate in AONE’s nurse manager fellow program in 2008. I also have served on AONE’s Strategic Planning, Future Patient Care Delivery, and Health Care Reform committees.

What is the Center for Care Innovation and Transformation and how does what you do benefit nurse leaders?

The center is responsible for two key areas – quality and the Care Innovation and Transformation (CIT) initiative. The CIT initiative will replace the AONE TCAB initiative, but is closely related. The basic tenets of TCAB remain, but further support and tools are provided to the nurse leader to ensure their success as change agents, especially as we enter the era of healthcare reform.

You were a member of AONE for six years before becoming employed by the organization. How did you benefit from AONE as a nurse leader?

For me, as a nurse leader, membership in AONE was as valuable as a library card is to an avid reader. AONE was my national resource – a window to ideas, best practices, and peers who faced similar challenges, were under similar pressure, and were in search of better, smarter ways to lead our hospitals and nursing units and serve our patients. I feel AONE is the go-to organization for nurse leaders dedicated to keeping up to date on policy changes, best practices in leadership, and education in the industry. It’s been an invaluable resource in my own professional development, and I’m thrilled to be a part of the great service AONE provides.

How did you know you wanted to become a nurse leader?

As a bedside nurse I was passionate about providing patient and family-centered care, but I also wanted to learn about the management and leadership side of nursing. I returned to graduate school and studied health care administration. I then went on to be a nurse manager. The six years I spent managing a nursing unit were very fulfilling. I enjoyed partnering with nurses and supporting them to provide the best patient care experience possible. As the manager I also was focused on providing a healthy work environment for the nurses and fostering their career development.

Who inspired you to become a nurse?

My mother was a nurse and growing up I would listen to her stories — I knew I wanted to be a nurse. It has been special to share this profession with her and have that bond. I have also been very fortunate to find a few inspiring mentors. For instance, while at Mass General the associate chief nurse that I reported to became a significant mentor and was instrumental to my success in my first formal nurse leadership role. She was extremely supportive and knowledgeable, and encouraged me to take risks and role modeled the many leadership qualities I continually strive to achieve.

What gives you passion?

My curiosity probably helps, and I tend to be a pretty driven person who thrives on having many irons in the fire. I’m always looking for new challenges and learning opportunities.

What do you like to do in their spare time?

As the new Director of the CCIT for AONE and student, I tend to not find myself with a lot of spare time. I work, study, and cherish any family and exercise time. My golf game has probably suffered a bit!

What is your favorite memory as a nurse?

So many memories come to mind – the patients I’ve had the privilege to care for, the incredible people I’ve been fortunate to work with. Overall, it’s very gratifying to have chosen a career in nursing and discovered it fit me so well — especially helping to care for patients and their families during stressful times in their lives. And as mentioned before I truly enjoyed the years spent working as a nurse manager. The nurses inspired me on a daily basis and work never felt like work.

Care Innovation and Transformation

Last week, AONE hosted the second cohort of the Care Innovation and Transformation (CIT) initiative in Orlando, Florida. The cohort consists of 29 hospitals that met for the first time in Philadelphia this past June. They came together more seasoned and experienced in the transformation process. Since the last meeting, the hospital teams have been busy developing and testing rapid cycles of improvement. During the three-day meeting in Orlando, each hospital shared their innovations with their learning community via poster or podium presentation.  The innovations varied greatly and included interdisciplinary rounding, decreasing transport time from the emergency room, partnerships for clinical advancement, and team admissions.

While CIT is a bottom-up, staff-driven initiative, the nurse manager plays a key role in facilitating innovation and change on the unit.  On the first day, nurse managers from each of the participating hospitals attended an all-day meeting with Debra Gerardi, RN, MPH, JD to explore  organizational culture, adaptive challenges and conflict engagement in the healthcare setting.  On day two, Debra led the larger group in role playing exercises and a discussion of mediation strategies.  Transparency was one of the simple tools she encouraged the group to try upon their return home.  Communicate your own feelings when frustrated with a conflict, but at the same time, offer your support and assistance to resolve the issue.  Ask questions to clarify someone’s thought process or actions, instead of making assumptions or taking any sides.  When asked about her presentation, one attendee replied, “I enjoyed the session, Debra is an effective presenter because she is able to engage the audience and use their real examples to apply to the topic.”

A man who needs little introduction in the field of nursing, Tim Porter O’Grady, DM, EdD, ScD(h), FAAN, kicked off the last day of the meeting with an interactive presentation on the future of nursing practice.  He contrasted the world in which we live to the world towards which we are moving.  His paradigm encapsulated both the efficiency of technology and new patient care delivery models. Tim referred to patient discharge education programs, where how-to videos are available online, and the drastic changes in length-of-stay and care delivery over the past 20 years as examples of this metamorphosis.  His charismatic personality softened the realization that health care reform will accelerate sweeping change on nursing units that may already feel overwhelmed with the current workload and complexity.

The hospitals are one year into their CIT journey and making great strides.  We are anxious to hear more about nurse-led innovation fostering collaboration and improving patient care when they come back together for their third meeting in June of 2012.

AONE looks forward to welcoming a new CIT cohort in 2012 and is currently accepting applications.  The deadline for applications is December 15, 2011.

Saying goodbye to Cuba

The AONE delegates say goodbye to Cuba.

Hola,

Heading back home to the U.S.A. What a great group of travel companions! Everyone enjoyed learning about the Cuban health care system, the culture and the food. Hasta luego.

¡Adiós!

Cheryl Hoying, PhD, RN, NEA-BC, FACHE
AONE President

 

Future Patient Care Delivery Committee: The Time Has Come! Partnering

The old adage, ”he who has the gold makes the rule” continues to drive our economy; health care is no exception. When the government changes the payment system for Medicare and other payers follow suit, the current method of delivering care will be totally obsolete. We, as nurses, have taught, tried and sometimes implemented a seamless continuum of care. Today as ACOs develop, regardless of what they are called, bundling of payments across an episode of care will become a reality. All providers will have to share in the reimbursement: a scary thought if we are not working well together.  Hospitals will convert and become totally critical care and step down units. Obviously, new systems must be organized and implemented. Hierarchies for delivery of patient care will not work.   Success will only come about for the patient and providers through developing true partnerships. Partners will exist at all levels across the continuum and the patient and family partnership will be critical for accomplishing the desired outcomes. This partnership between providers, vendors, payers and patients must be a tightly woven, formalized structure with supportive processes that facilitate agreed upon outcomes. Some organizations have implemented this with their own employees in pilot programs achieving initial success.

The real test will come about when we address the chronically ill across this continuum. True success will be about quality medical and health outcomes at lower costs. It seems like a no-brainer: Identify your largest chronic care user in the system, assure the right person delivering care in the right venue and establish formalized relationships from primary care through hospice if necessary. Staff will have varying levels of expertise as well as responsibility, yet they need to be partners in the delivery of care.  Information for excellent functioning will be key. Maybe we will finally implement a smart card with all the patient’s information on it!  Amazing we are not universally using this  technology now.  The challenge is in front of us and nurse leaders are in the best position to design and implement these systems: let’s do it!

Roxane Spitzer, PhD, PhD, MBA, RN, FAAN
Editor-in-Chief of Nurse Leader; Professor at Texas Tech University

Healthcare in Cuba

Hello,

Today we had an overview of the Cuban healthcare system and the structure of nurses in leadership, including education. This was followed by a presentation from The Cuban Society of Nursing. We ended the evening with a very delightful dinner at a “family restaurant.”

Thanks,
Yvonne Kirk

AONE learned about the healthcare system in Cuba from Cuban nurses.

The AONE delegates enjoyed a dinner at a family restaurant.

AONE Delegation Trip to Cuba

¡Buenos Días!

We arrived in Cuba! There are 11 of us on the trip to learn about Cuba and its healthcare system.

• Deborah Carver
• James Fischer
• Colleen Goode
• Aline Holmes
• Cheryl Hoying
• Yvonne Kirk
• Susan Kosman
• Kristin Sims
• Margaret Smith
• Katherine Walsh
• Carol Watson

Cheryl Hoying, AONE President
PhD, RN, NEA-BC, FACHE

 

Future Patient Care Delivery Committee: Disruptive Innovation

Have you ever heard or thought about the business concept of Disruptive Innovation? This concept was developed by Clayton Christensen, a professor at Harvard Business School. A disruptive innovation is a product or service that is created before the public knows that they need it or want it. Usually when the innovation is first developed it is so new that it may cost more or be inconvenient for many consumers. Eventually, improvements to the innovation are made and the demand for it increases. It becomes more accessible and less expensive, therefore, displacing the previous methods or competition. The innovation becomes “disruptive” because of the dramatic changes that it makes to an entire population of customers and the way business is done.

Some of the most important innovations disrupted entire industries by creating less costly alternatives in more convenient settings. An example is the use of the personal computer as opposed to a mainframe computer. Cell phones are disruptive to land line technology. Diabetic glucose monitors are a less expensive and more convenient form of tracking blood sugars than a physician’s office visit.

Nurse leaders are well situated to drive and implement disruptive innovation. Creating an environment to generate and implement new innovative ideas, supporting education in informatics and other innovative practices, creating new nursing roles, and eliminating barriers to piloting new ways of caring for patients are skills that nurse leaders possess to improve healthcare. Nurses have been extensively involved and have led the implementation of more recent disruptive innovations such as the advent of retail clinics, the medical home model of care management, and home tele-health. These all allow patients access to care, with more convenience, and at less cost.

There is a belief that the field of healthcare needs more disruptive innovation to address the expense and inaccessibility of healthcare. For example, more technology should be utilized to allow patients to do for themselves what professionals do. Increasing innovations in diagnostic testing could allow nurse practitioners the ability to diagnose and treat more uncomplicated illnesses.

How can we continue to develop new disruptive innovations? Are resources funding technology that can help patients care for themselves or are we funding more of the same technology? One belief is that we are investing in outdated organization structures. Should investments be made in new organizational structures with the main intent to create healthcare innovations? Are there political factors and resistance that hold back innovation?
Nurse leaders have the skills and an opportunity to respond to the need for disruptive innovation and participate in transforming the current healthcare delivery system. The future is now!

Eileen Kingston RN, BSN, MPA
Associate Director Patient Care
VA Nebraska Western Iowa Healthcare System

“Bok” to Croatia

Arrivederci to Italy and Bok to Croatia!

In Zagreb, Croatia I met up with Pam Thompson, Pam Rudisill and Pat Conway-Morana. We presented today at the Third International Nursing Conference on quality and patient safety sponsored by the Croatian Nurses Association and AONE. The president of the Nurses Association and many nurse leaders involved with quality were in the audience.

I believe I have gained 5 pounds with all the pasta and now štrukli that I have eaten. So many good cooks.

Cheryl Hoying, AONE President
PhD, RN, NEA-BC, FACHE