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Transcript of Ache jack rowe_tamiminnier_3-14-12b
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
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
IOM REPORT & FUTURE OF NURSING: CAMPAIGN FOR ACTION
Health Care System Challenges
Aging and sicker population
High costs
Primary care shortage
Fragmentation
Healthcare disparities
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
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
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
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
Campaign for Action Pillars
Advancing Education Transformation
Removing Barriers to Practice and Care Nursing Leadership
Interprofessional Collaboration
Diversity
DATA
Campaign Strategies
Diverse Stakeholders
Policy-makers
Communications
Field Strategy
Research, Monitoring, Evaluation
Grantmaking
RWJFAARP
Advisory Committee
Campaign for Action State Involvement
THE CASE FOR MORE HIGHLY EDUCATED NURSES
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
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
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
Here’s the Point
WHY CHANGE? AND HOW?
The Real Question for CEOs
What plans do you have anyway to solve the cost and quality problems in healthcare?
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
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
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
21
*Includes the overall impact on Medicare managed care revenues
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
Critical Design Theme: RELIABILITY
23
• 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)
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
• 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
Some Outcomes to Ponder
Implementation Jan 2011
Implementation Jan 2011
Implementation Jan 2011
Implementation Jan 2011
What can you do now, in your position as healthcare executives, to be supportive of
advancing nurse education ?
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
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
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
Organizations with Preferential Hiring for BSNs (AONE Survey)
Barriers to Preferential Hiring for BSNs (AONE Survey)
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
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
IN SUMMARY
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
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
QUESTIONS?