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!