Ache jack rowe_tamiminnier_3-14-12b

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American College of Healthcare Executives March 21, 2012 John W. Rowe, MD Professor, Mailman School of Public Health Department of Health Policy and Management Columbia University, New York Tamra E. Minnier, RN, MSN, FACHE Chief Quality Officer University of Pittsburgh Medical Center

Transcript of Ache jack rowe_tamiminnier_3-14-12b

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American College of Healthcare ExecutivesMarch 21, 2012

John W. Rowe, MDProfessor, Mailman School of Public HealthDepartment of Health Policy and ManagementColumbia University, New York

Tamra E. Minnier, RN, MSN, FACHEChief Quality OfficerUniversity of Pittsburgh Medical Center

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Agenda

• Review key Institute of Medicine Future of Nursing recommendations

• Describe the Future of Nursing: Campaign for Action’s efforts

• Discuss the business case of supporting higher levels of nurse education

• Share an example of how it all comes together in a new model of care delivery

• Q&A

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IOM REPORT & FUTURE OF NURSING: CAMPAIGN FOR ACTION

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Health Care System Challenges

Aging and sicker population

High costs

Primary care shortage

Fragmentation

Healthcare disparities

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IOM Committee Task

Producing an action-oriented blueprint to transform health and healthcare by using nurses more effectively

Developing evidence-based recommendations to address:

Delivery of nursing services Nursing education system capacity limitations

Examining nursing workforce supply and demand

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Institute of Medicine Report

High-quality, patient-centered healthcare for all will require a transformation of the healthcare delivery system

One of the most-viewed online reports in IOM

history

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IOM Report Recommendations

Remove scope-of-practice barriers

Expand opportunities for

nurses to lead and diffuse collaborative improvement efforts

Implement nurse residency programs

Increase the proportion of nurses with a baccalaureate degree to 80 percent

by 2020

Double the number of nurses with a

doctorate by 2020

Ensure that nurses engage in lifelong

learning

Prepare and enable nurses to lead change

to advance health

Build an infrastructure for the collection and

analysis of interprofessional

healthcare workforce data

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Future of Nursing: Campaign for Action

Campaign Vision

All Americans have access to high-quality, patient-centered care in a healthcare system where

nurses contribute as essential partners in achieving success

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Campaign for Action Pillars

Advancing Education Transformation

Removing Barriers to Practice and Care Nursing Leadership

Interprofessional Collaboration

Diversity

DATA

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Campaign Strategies

Diverse Stakeholders

Policy-makers

Communications

Field Strategy

Research, Monitoring, Evaluation

Grantmaking

RWJFAARP

Advisory Committee

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Campaign for Action State Involvement

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THE CASE FOR MORE HIGHLY EDUCATED NURSES

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The Need for More Highly Educated Nurses

Payment Models

Readmission rates

Quality measures

Care coordination

Leadership & Interprofessional

Collaboration

Executive leadership

Teamwork

Primary Care & Faculty

Worsening primary care

shortage

Nursing schools turn

students away

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IOM Recommendations

Implement nurse residency programs

Increase the number of nurses with doctorates

Promote lifelong learning

Increase the proportion of nurses with BSN and higher degrees to 80

percent by 2020

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Evidence

Some association between educational level and patient outcomes

Twenty percent of BSN graduates get advanced degrees

Six percent of associate-degree graduates get advanced degrees

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Here’s the Point

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WHY CHANGE? AND HOW?

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The Real Question for CEOs

What plans do you have anyway to solve the cost and quality problems in healthcare?

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There are No Silver Bullets Anymore

Less than ideal outcomes No more time

No more money Have to do more with less in growing complexity

Clinical outcomes will drive financial bottom line in our

lifetime—the 1-3 percent margin will become the

difference

Innovative nurse-driven models of care are needed as the

primary care shortage looms

When we fix nursing…we really will fix healthcare

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The Facts

Every 10% increase in the proportion of BSN staff

reduces risk of death by 4%

Nursing staff models with a higher BSN/MSN staff ratio achieve higher productivity

Better clinical outcomes are achieved with a higher

BSN/MSN staff ratio

Cases with infections cost 3x more those without

We will no longer be paid for hospital acquired conditions,

mortality scores and readmissions

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FY 2013 2014 2015 2016 2017

VBP 1.0% 1.25% 1.5% 1.75% 2.0%HAI Reporting Reporting 1.0% 1.0% 1.0%Readmissions 1.0% 2.0% 3.0% 3.0% 3.0%TOTAL 2.0% 3.25% 5.5% 5.75% 6.0%

1% = $7 million*Total at risk for CMS = $42 million at UPMC

What is the impact in your organization?

Progressive Financial Impact of Poor Outcomes

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*Includes the overall impact on Medicare managed care revenues

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There is a Big Difference Between Vision and Reality

THE VISION:

The right patient gets the right care at the right time… every time

THE REALITY:

The right patient…gets some of the care they need…some of the time…when we have time

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Critical Design Theme: RELIABILITY

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• Build reliability into the design• Ability of a process to perform the same function in routine

circumstances over and over again• Same process Same outcome• Every time When I have time • A good outcome can be due to…

– Chance (i.e., “dumb luck”)– Heroic efforts of hardworking diligent staff– The DESIGN of a process (this is Reliability)

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Tug of War

• Predictable work:– Predictable tasks at predictable

times– Tasks that can be scheduled– Tasks that should happen at

repetitive intervals– Reliable (consistent) work– The work everyone intends to

get to– No surprises

New Role: RELIABLE ROUNDER

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• Unpredictable work:− Tasks at unpredictable times− Things you know will come up – you just don’t know

when – happens at variable times− The things that get in the way of the work everyone

intends to do

Tug of War

New Role: VARIABLE ROUNDER

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Some Outcomes to Ponder

Implementation Jan 2011

Implementation Jan 2011

Implementation Jan 2011

Implementation Jan 2011

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What can you do now, in your position as healthcare executives, to be supportive of

advancing nurse education ?

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Do you know your own BSN mix?

Do you pay a BSN differential?

With equal candidates, do you hire the BSN first?

Are you setting a goal for your nursing staff to achieve BSNs in 5 years?

Are you looking at nursing time as the most valuable asset you have to assure quality outcomes?

Do you know how much you have at risk in Medicare dollars with your nurse sensitive outcomes?

Call to Action

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Have you analyzed where an advanced practice nurse could extend the productivity of a doc in your area?

Are you providing scholarships/tuition for nurses to get those advanced degrees if you can?

Have you offered your nursing leadership a chance to be innovative and creative on care delivery models?

Have you looked at your nursing resources as dollars spent/outcome?

Does your state have an Action Coalition you can support?

Call to Action

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Benefits to Employers

Workforce Deployment

Point-of-care decision-making

System-wide changes

Turnover & Employee Retention

Sensitivity to human resources policies

Cost of nurse turnover and

vacancies as high as $64,000 per position

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Organizations with Preferential Hiring for BSNs (AONE Survey)

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Barriers to Preferential Hiring for BSNs (AONE Survey)

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Organizations with Other BSN-supportive Policies

Organizations with BSN Pay Differential

32%

68%

Pay differen-tialNo pay dif-ferential

Organizations with Time Limit for BSN

27%

73%

Time limitNo BSN require-ment

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Some Employers that Favor BSN-prepared Nurses

John’s Hopkins• Preference for BSN• 80 percent BSN or

higher

Veteran’s Health Administration• Pay differential• Career ladder

U.S. Public Health Service, Army, Navy, Air Force• BSN requirement

Tenet Healthcare Corporation• Prefers BSN• Career ladder

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IN SUMMARY

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Summary

• IOM Report: – Future of our healthcare system – Role of nurses in helping to meet patient needs

• The Future of Nursing: Campaign for Action is focused on key pillars that correspond to the IOM report’s recommendations:– Advancing education transformation– Removing barriers to practice and care– Nursing leadership

• Understand the challenges faced by nursing today• Agree that role of nursing is changing and needs to change

in order to transform healthcare

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Campaign Resources

Visit us on the web:http://thefutureofnursing.orghttp://championnursing.org

Follow us on twitter:www.twitter.com/futureofnursing

http://twitter.com/#!/championnursing

Join us on Facebook:http://facebook.com/futureofnursing

http://www.facebook.com/championnursing

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QUESTIONS?