Future Patient Care Delivery Committee: Innovation and Future Trends

Do you publish most everything electronically instead of on paper, have a Facebook presence within your practice setting, know the latest apps for enabling efficient workflow at the bedside or communicate real time via SharePoint and twitter with your nurses? Despite the protests, barriers and challenges to each of those innovations in practice, they are rapidly moving from innovative ideas to assumed practices by our millennial nursing workforce.

How can you discover what is needed to cope, plan and deal effectively with the rapid changes in care delivery models, reimbursement value engineering, the volume and speed of leadership transitions and the need to completely reinvent how we provide care? To start, every nurse executive must have critical knowledge of emerging trends and learn to navigate changes real-time. Moving from dealing with the rapid changes that are faced regularly to incorporating complex and fast changing trends into strategy is quickly becoming a core competency.

In April, Dr. James Canton, CEO, Institute for Global Futures posted the four futures that will shape medicine: prediction, personalization, prevention and promotion. These futures are already influencing the practice of nurse executives, requiring infrastructure creation in the practice environment to produce innovations and rapid change. Several references in the AONE Future Care Delivery Toolkit describe the context in which Chief Nurse Executives must create innovation in practice to support the futures of healthcare.

The toolkit provides a thorough and efficient framework for gaining critical knowledge of important TRENDS:
T – Technology-enabled innovations are driving the game changing disruption that is producing the solutions to reinventing healthcare delivery.
R – Re-inventing health care will require rapid dissemination of successful exemplars and, in turn, rapid cycle change in all practice areas.
E – Ensuring quality and safety are at the core of care delivery is imperative.
N – Nurse executives must be transformational leaders to produce organizational innovation.
D – Disruptive innovation will produce new products of medical care at much lower cost.
S – Skills are required for managing innovation and ensuring the presence of high-level innovation within all practice areas.

Stay closely tuned to this blog, the Future Care Delivery Toolkit and AONE, because it won’t be long that the answer to your question about innovation and future trends for the nurse executive will come with one simple answer: There’s an app for that!


Lamont M. Yoder, MSN, RN, MBA, NEA-BC, FACHE

Future Patient Care Delivery Committee: Patient and Family-Centered Care

In its recent landmark report, the Institute of Medicine (IOM, 2010) envisioned the future of care delivery as patient-centered. They also indicated that healthcare should be “seamless, affordable, quality care that is accessible to all and leads to improved health.” This certainly seems to be in direct agreement with AONE’s Guiding Principles for Future Care Delivery.

Not only are healthcare providers to base care on a safe environment, but also we must individualize that care to the needs and circumstances of the patient and family (AONE, 2010). The Guidelines call upon us to recognize ourselves as “guests” in that environment, whether this is in the hospital or in the home. One might wonder how care givers will shift their views from that of “hosts” to that of “guests”. This idea calls to mind the image of a bow in those cultures where it is customary to bow when greeting. The late philosopher, Joseph Campbell, indicated that the bow is to acknowledge the deity within the greeted individual.

Inherent in care based on a patient and/or family focus, one might immediately think of the concept of Relationship-Based Care. Delivery of this type of care is obtainable only when we are able to understand what patients and families see as the most important aspects of their care (Person, 2004). Indeed we see that the development of a therapeutic and trusting relationship with the professional caregiver results in better patient satisfaction. Furthermore, nurse satisfaction and quality outcomes have shown improvement in this model.

As we look to the future (and does it not seem like the future is now?), we must consider the transition from acute care to home as not only seamless but also coordinated. Even more importantly our primary care model must shift to one of integrated from home and throughout the system (Birk, 2011). Birk points out that having fewer patients per PCP allows more time on the front end for care management. Think about our trends on the nursing floors. Are not many of our institutions trying to move to an increased patient assignment for the nurses? Does an increase in the number of patients for whom a professional nurse must develop a plan of care not reduce the amount of time that nurse has to provide for the management of care and to develop those trusting relationships? What IS that magic number? How will we support and institute changes to our care delivery models in this challenging financial climate?

Please consider using the resources and exemplars in the Future Care Delivery Toolkit as you navigate in the coming months. While the questions above are meant to be rhetorical, it does seem pertinent for leaders who have the opportunity to move towards effective, integrated, and coordinated care that keeps the patient and family at the center of all decisions.

Annelle Beall, MSN, RN, CNN, NE-BC

Future Patient Care Delivery Committee: Transparency

Today we hear a lot about transparency. In health care this often refers to public awareness: patients and our communities being aware of stats related to specific quality bundles or core measures.

As we consider the guiding principles for Future Patient Care Delivery around coordination of care and patient safety, it becomes apparent that sharing real-time information among care team members is crucial. Transparency of current status of care could affect the provision of evidence-based best practice care and care coordination within the health team to improve patient outcomes. Think about it – today reports are available to us retrospectively, telling us what we did not do. We need to request and expect that our clinical information systems give us current information so that we can change patient outcomes, driving safety and coordinated care into our practice, in real time.

Bringing real-time transparency into care activities that are yet to be delivered could ensure better compliance to protocols or clinical paths by allowing other care team members to have insight into what still needs to be accomplished on a given patient. As an example, take the stroke core measure around giving an antithrombotic by 48 hours for a patient with a documented history of atrial fib. Leveraging our IT systems to show the care team, not just the staff nurse, that the medication is not yet given and the time window in which to do it is narrowing could change practice. This could drive care prior to ‘non-compliance’ in a situation where that patient’s RN is consumed with care of another patient. And research has shown that following the evidence yields better patient outcomes.

The work environment of the care team in acute care settings today needs the support of innovative technology to help ease the burden of ever increasing quality metrics and tasks to perform. Linda Q. Everett, PhD, RN, in the March ’11 Voice, “Leveraging Technology for the Future of Nursing Care Delivery” discusses the complex environments of acute care settings in which a high number of tasks are performed and interruptions are common.

The next step for care delivery is transparency into real time status of key care measures so that patient care can be directed in the moment and there is less reliance on human nature to remember every detail in a complex and interruptive workflow.

1. Define the data that is needed, and
2. Work with IT to provide real-time transparency into this information.

This information could change patient outcomes and actually help the clinician provide care the way it should be: the best care known by the evidence, for all our patients, all the time.

Catherine Whelchel, BSN, RN, MHSA NEA-BC

AONE TCAB Meeting May 16-18, 2011

The city of Minneapolis welcomed 28 AONE TCAB hospital teams last week with sunshine and weather in the mid-60’s – lovely! It was the fourth and final face-to-face meeting for the AONE TCAB hospital teams, who have been on the TCAB journey with us since August 2009. Two hospitals from this AONE TCAB cohort, Abbott Northwestern and Gillette Children’s Specialty Healthcare, opened their doors to us and hosted wonderful site visits for the group on Monday afternoon, the 16th. Both of the TCAB units at these hospitals welcomed us and gave us some behind-the-scenes opportunities to see some newly opened and even some soon-to-be-opened areas. It was a great afternoon for everyone. Thank you to Abbott and Gillette for being such gracious hosts!

At this meeting, we had an array of phenomenal presenters who shared their expertise with the teams. Claudia Perez from the Seton Family of Hospitals in Austin spoke about spread and sustainability of TCAB. Maureen White, Chief Nurse and Senior VP at North Shore-Long Island Jewish Health System in New York, offered an excellent perspective about connecting the work of TCAB with the future of health care and the IOM Report on the Future of Nursing. Rosemary Gibson, author and consultant from Arlington, VA spoke about linking the work of TCAB with the concepts of patient safety and just culture. The nurse managers, who met as a small group on May 18, heard from Deborah Washington, director of patient care and diversity at Massachusetts General Hospital, about the critical importance of diversity and TCAB leadership.

They also participated in a session with Debra Gerardi, RN, JD, MPH, on resolving conflict using engagement and self-nurturing. AONE is truly fortunate to have such a cadre of experts who challenged the teams to think beyond their TCAB unit to some of the larger issues confronting all health care professionals.

Not only was this the final meeting of this AONE TCAB cohort that began in August of 2009, but it was the last meeting where AONE would be using the “TCAB” name. As many of you know, AONE has developed its own program, based on the principles and processes of TCAB, called the Center for Care Innovation and Transformation or C-C-I-T for short, and we have 47 new hospitals enrolled. Applications for the 2012 cohorts will be available Fall 2011 at http://www.aone.org/.

Future Patient Care Delivery Committee: Care Complexity

Concerned about increased patient care safety issues in your workplace? Have you seen a rise in medication errors without an obvious cause? Wondering how you’ll improve productivity and patient outcomes in your newly formed ACO? Have you thought about the science behind that all-too-familiar term “multitasking”?

Complexity Science is a current attempt to understand and explain the behavior and dynamics of systems composed of many interacting elements. Complexity Science studies adaptive systems that contain components in a constant state of change with outcomes that are not totally predictable. This is in contrast to linear methods where change can be measured and predicted. Our nursing practice is both predictable and unpredictable. Dr. Atul Gawande gives a very generalized analogy in his book, The Checklist Manifesto. He says a simple process equates to a recipe. A complicated process, he states, would be one with many linear processes or recipes or checklists added together, like sending a rocket to the moon. A complex process, he describes, is like raising a child -- no recipe is the same for each child!

This is sounding more and more like nursing’s work as our staff are faced with competing goals and priorities, stressful demands, technical challenges, facility design flaws, operational failures, etc. In what ways can we, as nurse leaders, understand the work and design environments of care, respectful of the complex work nurses perform? Many of you have “interruption-free zones” that outline when and where distractions and interruptions are not acceptable. Other examples I’ve heard are: decreasing non-value added services; increasing visual scanning capabilities; and increasing access to timely information. These are all great examples of practice complexity acknowledgement and change at the point of service. What else is happening out there to stimulate innovation and creativity for others related to nursing’s cognitive work and complex practice?

At the AONE 44th Annual Meeting and Exposition last month, Patricia Ebright and Mary C. Sitterding presented their analysis on complexity and how they are studying it through a Cognitive Practice of Nursing model. They would benefit from descriptive feedback on their methodology. Also, the AONE Future Patient Care Delivery Committee encourages you to give us feedback on activities presently occurring in the field.

If you’re looking for additional resources, check out AONE’s 2011 Toolkit for Future Care Delivery with examples to get you and your staff involved in future change.

Future Care Delivery

Welcome to the AONE Future Care Delivery Blog! Starting in May, members of AONE’s Future Patient Care Delivery Committee will be blogging about issues that face nurse leaders as we continue to confront challenges to providing safe and reliable patient care now and into the future. The bloggers will be highlighting topics included in the AONE Guiding Principles for Future Care Delivery and Toolkit for Future Care Delivery.

I invite you to read these blogs and use them to stir up discussion among your colleagues and fellow AONE members about how we can begin today to impact and prepare for the future. I’m looking forward to participating in some great discussions and connecting with many of you via this blog site in the months to come!

Blog for Gail Latimer, Siemens CNO

AONE 2011 is off to a terrific start! As the current President-elect of the Pennsylvania Organization of Nurse Leaders, yesterday I participated in the AONE Chapter Leaders meeting. I enjoyed the opportunity to learn about the wide-range of nursing efforts underway across the country and hope to bring back some new and innovative ideas for my local nurse leader colleagues. We at Siemens were very proud to sponsor this morning's amazing and inspiring keynote presentation featuring Roger Nierenberg and The Music Paradigm. It certainly challenged us to look at things differently and provided a new perspective as we consider how to model leadership styles for success. And lastly, many of you may know that my sister Patty has joined me this year for AONE. She is a true "shopper" and yesterday "scored big" with a beautiful piece of jewelry from one of the local boutiques here in San Diego! For those of you that love a little retail therapy the opportunities in San Diego are endless!

Unparalleled Opening Session

From Joan Shinkus Clark: At the opening session of the AONE Annual Meeting in San Diego, California, attendees were invited into a room with a seating arrangement in the round, interwoven with symphonic instruments in sections throughout the room. Soon, the orchestra conductor, Roger Nierenberg stepped up to the podium and began conducting beautiful symphonic music, and while he put all attendees under the spell, he began to teach us lessons about leadership in organization, using the analogy of the orchestra and the role of the conductor. We learned about the importance of listening, being a coach and a mentor, thinking a half beat ahead but being present in the moment, and how every single person's role adds to the synergy that occurs when we all hear beautiful music. The lessons learned were invaluable and helped to remind us of the important role of the leader in bringing out the potential of staff in our organizations. Everyone I spoke with absolutely loved the session and the Maestro's book immediately sold out in the Leader Book Store on site. When asked how he came to making these presentations to organizational leaders, the Maestro said that he felt that the love of classical music was being lost. He simply wanted to have more people experience the symphony. I for one, will have new energy and appreciation of the symphony and I know we all want to thank the Maestro for a fantastic opening session.

Exhibit Hall - Donna Poduska and Rob Rose

The ribbon cutting ceremony was off to a great start with Cheryl Hoying cutting the ribbon. The newly designed Passport to Prizes charted the way to a successful exhibit hall. Our partners were excited to demonstrate their products and services and we were excited to get our books stamped. Check out the Passport Prizes in the center of the exhibit hall, you will surely be motivated to complete the book. Don't forget that passports have to be turned in by 1:30 on Friday and you need to be present to win! We would like to thank our exhibitors who have generously supported the Passport to Prizes and all our exhibitors who participate in our annual meeting. We appreciate their support.

free fallin' into apps

I am a huge “i” fan. I love iPods and iPhones – and covet anyone with an iPad. When AONE first decided to create an app for the annual meeting I was very excited.

My favorite section of Mobile Meeting is the “My Schedule.” From the general “Schedule” section of the app, you can browse the different sessions and then click the + sign at the top right corner. It is then magically added to “My Schedule.” When you are walking from session to session, you have everything you wanted to go to in one spot. It links to the time, room and speakers.

It was also a lot of fun to develop the app. I got to work with Apple and learned the true (and complex) process of creating an app. I was multi-tasking on my way home during the testing period. I had my iPhone, cup of tea and book all in my hands. As I stepped onto the train my phone fell over 50 feet (from the top of the ‘el train platform, through the tracks and all the way to the middle of the street)! But, amazingly enough, the screen wasn’t cracked, the battery wasn’t smashed and I was still able to continue testing the app on my way home. The sad part is, the next day the antenna died…

But do not worry, I got a replacement and the app has been fully testing and is ready to go. I hope you like the app as much as I do. Shoot me an email (akittner@aha.org) with any feedback you have or visit me at the AONE booth in the exhibit hall or LeaderShop.

And, if you have any questions about the app, we have a help desk right outside the LeaderShop. Jay will be able to help you download it and troubleshoot any problems you may have.

Happy app-ing!

--Alyse Kittner AONE membership manager

Sunny San Diego

To all you AONE annual meeting attendees get ready for a wonderful location! The convention center is located right near the bay and the views are wonderful. Lots of great restaurants and shopping so bring your credit cards. I hope to see many of you at the pre-conference session on Wednesday, there are some great topics and for those that want to brush up their resume and interview skills there is a session for that too. First time attendees on behalf of the Board of Directors we welcome you and invite you to the New Member and First time Attendee Reception Wed night. Safe travels and see you soon!! Rob Rose, Region 1

Charting My Course - Rob Rose Region 1 BOD

Cannot believe the AONE annual meeting is almost here, it seems like yesterday I was blogging from Indiana. I am sure by now your travel arrangements have been made, and like me you are trying to to clear your desk before you leave. This year's annual meeting looks to be even more exciting than last year, if that can be possible. I cannot wait to hear our opening keynote speaker: The Music Paradigm with Roger Nierenberg! The breakout session will also have such pertinent and timely subjects, it will be hard to choose which ones to go to. Our exhibit hall and passport to prize program is a must and every year I get excited to see if I win one of the great prizes... and never do... but this year is my year, I can feel it!! As most of you know, I am the Board of Directors networking expert and look forward to dancing with all of you at our President's Welcome Reception. See you in Sunny San Diego :) - Rob Rose

AONE launches new Mobile App for Annual Meeting and Exposition

Are you addicted to your mobile app? So are we!

New this year, you can download the new AONE Mobile Meeting app for iPhone, Droid and Blackberry and stay connected and informed on all that's happening at the AONE Annual Meeting!

With Mobile Meeting, you can:

• Create your own custom schedule
• View the entire meeting schedule
• Receive real-time updates from AONE staff on changes and news

Stay tuned for more details in the coming weeks on how to participate. AONE Mobile Meeting apps are sponsored by PatientSafe Solutions, Inc.

From the hospital side of things...

Skillful. Efficient. Compassionate. That's how I see nurses.

As the marketing communications manager of AONE, my life is played out in an office environment and not in a clinical setting. However, I recently had an outpatient surgical procedure that put me on the hospital side of things. That's right ladies and gents, I had a bunionectomy!

Those who know me know I am squeamish and a big baby when it comes to anything medical-related - just ask my colleagues! Having worked at AONE in the company of strong and formidable nurse leaders, I thought... OK, now I will see the front line of nurses in action... and I can report back my experience.

My foot surgeon and anesthesiologist were assisted by a scrub nurse and rotating nurse, both of whom ROCKED! From the moment I arrived, they were totes compassionate and calmed my nerves. I watched Nina, my scrub nurse, prepping my foot with efficiency and careful attention- not one movement was superfluous! Stephanie, my rotating nurse, also moved with precision, and at one point tricked me into a conversation as the anesthesiologist inserted the IV into my hand. Ah, the power of diversion!

All in all, through prep, surgery and recovery, I knew I was in capable and expert hands because of these awesome nurses!

I know this blog isn't groundbreaking or anything you didn't know, but I wanted to share my experience and take the opportunity to say thanks to all the nurses in my life- for all that you do.

So... how do YOU see nurses? If you have a similar story of appreciation you would like to share, please send my way to efrancque@aha.org and I'd love to pass along to the AONE membership.

Have a great day! Eric

Cuts to Title VIII Nursing Programs

The House of Representatives is currently finalizing the FY 2011 appropriations process. Under consideration is a Continuing Resolution (CR), H.R. 1, which the House Appropriations Committee introduced on February 11, 2011. As the largest cut to discretionary funding for the federal government in history, this CR would reduce spending by over $100 billion from the President’s FY 2011 budget request.

Of importance to you, the CR cuts the Nursing Workforce Development Programs and Health Professions Programs (Title VII, Public Health Service Act) by $145.1 million, a 29% decrease in funding over FY 2010 levels. Additionally, the CR proposes a reduction of nearly $1 billion for the National Institutes of Health, which includes the National Institute of Nursing Research (NINR).

Members of Congress must hear from the Nurse Executive Community and aspiring nurse leaders that they must protect funding for Title VIII and NINR given their unique benefits to America’s healthcare system.The vote on H.R. 1 will set the stage for future budget debates. If proposed cuts to FY 2011 are enacted, nursing education and research will be jeopardized and it will take years to recover.

Please take a few moments between now and Thursday, February 17, 2011 to send a message to your Representative asking them to preserve the federal investment in health, and in particular nursing. Most importantly, personalizing the message with mention of the hospital, system or place of employment and how cuts to the workforce programs could affect you. As an example (Did your hospital receive money through the Title VIII programs for nurse retention, grants or scholarships or loan forgiveness, did you or someone on your staff finish a Masters, or APRN training because of federal dollars?

Click the link below to log in and send your message:
http://www.votervoice.net/core.aspx?aid=1309&issueid=23810&atid=18355&siteid=0&app=GAC&isvisited=false

"Oh what a beautiful mornin'..."

"Oh what a beautiful day! I've got a beautiful feelin', ev'rything's goin' my way."

I'm not sure why, but ever since I was about ten this is the song that always pops into my head when the weather is nice and I'm feeling excited about something. Perhaps it's the inner "ham" inside me who was always willing to belt out show tunes to annoy my older sister in front of her friends, or the vivid technicolor genius that is the set design of Oklahoma. Well, whatever it is, the weather has been chilly here in DC this winter, and while we haven't had the snow we did last year, I've been feeling the winter blues a little more than normal.

Today changed all that. It was sunny this afternoon and 50 degrees. I'm not getting my hopes up about spring yet, but it was just enough sunshine and warmth to pull me out of my slump a bit and put an added spring in my step. And, while that spring was fresh and bouncy I decided to channel it into working on our plans for AONE's 44th Annual Meeting and Exposition coming up in just two short months. I headed into the office on this sunny Sunday afternoon to put the finishing touches on some items including our menu selections for the meeting, the onsite program that has to go to the printer soon, and rounding up all the stray questions I've received about registration, housing, speaking, sponsorships and more. I made it through a ton of emails and my desk is looking more organized than it has in about six months.

Though part of me can't believe it is only two months away and is begging for just a little more time, the other part is bursting with excitement to see all of our plans laid out for you - the AONE membership. I think you'll really enjoy some of the surprises we have planned for you in San Diego! But, you'll have to be there to know what they are, so register now if you haven't already. You don't want to miss it.

www.aone.org/annualmeeting

"There's a bright golden haze on the meadow..."

-Jessi
Director of Education