OnSomble OMNE Final Handout 10182012[1].pptx (Read-Only)

5th Annual OMNE Nurse Leaders of Maine Today’s Nurses, Tomorrow’s Leaders: Role Based PracAce Accountability Presented by Maria W. O’Rourke RN PhD FAAN FAAHC

11/5/2012

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Today’s Nurses, Tomorrow’s Leaders: Role Based Practice Accountability

Presented by

Maria W. O’Rourke RN, PhD, FAAN, FAAHC

5th Annual Conference - Organization of Maine Nurse Executives

Objectives •  Describe the value of professional role clarity and its

relevance to Nursing leadership and the 2008 Future of Nursing Report

•  Explain how professional role clarity relates to accountability, responsibility and authority of a professional and serves as the basis for nurse leader development and practice

•  Link professional role clarity to the development and sustainability of a professional model of practice for care delivery

The Future of Nursing Leading Change, Advancing Health

•  In 2008 –  Robert Wood Johnson Foundation (RWJF) and the

IOM launched a two-year initiative

•  Respond to –  need to assess and transform the nursing profession

•  Produce a report –  recommendations for an action-oriented blueprint

for the future of nursing

Four Key Messages

•  Nurses should-MUST practice

–  to the full extent of their education and training

•  Nurses should-MUST be full partners

–  with physicians and other health care professionals in redesigning health care in the United States

•  Nurses should-MUST achieve higher levels of education and training

–  through an improved education system that promotes seamless academic progression

•  Effective workforce planning and policy making

–  through better data collection and information infrastructure

Opportunity to Transform Health Care System

•  Nurses can and should-MUST play a fundamental role in this transformation

•  Nurses have the opportunity to- MUST ensure health care system provides seamless, affordable, quality care that is accessible to all and leads to improved health outcomes

8 Recommendations


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Recommendations 1 & 2

•  Remove scope-of-practice barriers –  Advanced practice registered nurses should be able to

practice to the full extent of their education and training

•  Expand opportunities for nurses to lead and diffuse collaborative improvement efforts

–  Expand opportunities for nurses to lead and manage collaborative efforts with physicians and other members of the health care team to conduct research

–  Redesign and improve practice environments and health systems. These entities should also provide opportunities for nurses to diffuse successful practices

Recommendations 6 & 7

•  Ensure that nurses engage in lifelong learning –  Nurses, nursing students and faculty continue their

education and engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan

•  Expand opportunities for nurses to lead and diffuse collaborative improvement efforts

–  Prepare the nursing workforce to assume leadership positions across all levels

–  Ensure that leadership positions are available to and filled by nurses

What does this have to do with Role Based Practice Accountability?

Everything

Role Clarity Equation™

ROLE PRACTICE OUTCOMES

Role Clarity Defined

•  A state of Clearness & Certainty regarding

– Structural & behavioral expectations

– Responsibility, authority, autonomy, competency, accountability, ethics, standards of practice

– Knowledge, abilities, & skill required to function in this “role based manner”

Role Clarity Ensures Role Capacity

•  Applies to all roles – professional, technical & assistive

•  Interdisciplinary Practice is an obligation not an option

•  Full capacity in all roles based on role authority

•  Maximizes workforce capacity –  Achieve practice excellence

–  All members of the interdisciplinary team

–  Achieved through role relationships based on appropriate role authority


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Role Clarity – High Priority Issues

•  Clarifies Expectations –  Professional Role vs. Task Orientation

– Decision-Making Practice: Nursing & Medical Condition

–  Personal vs. Professional Practice

– Use of Evidence-Based Practice

•  Enhances Communication & Collaboration – Role Delineation & Relationships within the Team

is based on Role Authority

Role Clarity – High Priority Issues

•  Ensures Staffing Excellence – RN to Patient Match based on Professional

Role Competence not only skills

– Appropriate skill mix

– Patient assignments

•  Optimizes High Quality Performance – Workload – Beyond “how many” to “how competent”

Why Focus on Professional Role Clarity?

Why Focus on Professional Role Clarity?

Too much variation

•  Professional role -

•  Discipline specific role - RN

•  Functional role – clinicians, managers, educators, researchers, consultants

Obligation

Ownership

Oversight

Outcomes

Opportunity

1.  Obligation – –  lead our practice –  use decision making authority in best interest of those

served –  be accountable for our decisions and actions

2.  Ownership – Models to guide practice

3.  Oversight – Tools to monitor practice-oversee the work

4.  Outcomes – Link role and practice to results

5.  Opportunity – See the power and beauty of the professional role applied to practice i.e. nursing, pharmacy, medical practice


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Accountability and Competency are based on Role Clarity

We Promise To Work In the Patient’s Best Interest

Obligation not Option

Our Promise

Work in best interest of the public It is in their best interest for us to:

– Use our role to its full capacity

– Use ethics to guide our decisions

– Be role competent

– Be excellent in our practice

– Be vigilant

– Keep them safe

Professional Role Obligation- To Lead in a Transformational Manner

Individual who leads in a manner that communicates vision and values and asks for the involvement of the work group to achieve the vision

Modified from The Magnet Model Components and Sources of Evidence, American Nurses Credentialing Center/ Magnet Recognition Program©

Why Interdisciplinary Professional Practice

•  Obligation not an option

•  Essential to ensuring safe passage for the patient –  brings to bear full power of the individual roles

through overlapping skills and knowledge of each discipline in the situation

–  results in synergistic effects that improves outcomes

–  effect is more comprehensive than the simple aggregation of any individual’s efforts.

Own What We Promised

We are given powerful decision authority over the health and welfare of others based on the belief that … we use a substantial amount of scientific knowledge & technical skill to guide our practice … and we uphold our commitment to monitor & evaluate our practice to a set of standards.

Maria W. O’Rourke, 1976

Ownership - Empowerment

•  We are already empowered – authorized, sanctioned permitted to act by

virtue of our role authority

•  We are enabled to act with and on behalf of those served


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Structure to Make Our “Obligations”

Real & Operational

Own our responsibility to develop and sustain a PPM?

Role-Based Practice TM Framework

Role Clarity Practice Outcomes

Role Clarity Practice Outcomes™

Pa$ent Safety &

Quality

O’Rourke Model of the Professional Role™

Measure & Monitor Prac$ce -‐ The Basis of Autonomy

Prac%ce

O’Rourke Pa$ent Care Model™

Leader

• Decision Maker

• Self-‐Directed Autonomy • Ethical Prac:ce

Scien$st

• Popula:on Based Thinking

• Evidence-‐Based Thinking

Prac$$oner

• Results Oriented Decision-‐Making

• Introduce Best Evidence & New Learning

Transferor Communica:on -‐ Therapeu:c Interpersonal Rela:onships -‐Collabora:on

Results

Role Based Professional Practice Competency is an Obligation and the Basis for

Nurse Leader Development

1.  EXERCISE Decision Making Authority that ensures role and standards based practice

2.  CONTROL the Recovery Process from a discipline specific perspective

3.  CONTROL Care Coordination from a discipline specific perspective

Core Professional Role Competency – Leader

4.  MONITOR & EVALUATE role and standards based practice

5.  MEASURE professional role expertise & role-based practice excellence

6.  LINK professional role competency with clinical, service and financial outcomes

Core Professional Role Competency – Scientist


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7.  ACT in a manner that promotes dialogue, open communication & positive interdisciplinary working relationships

8.  ENSURE coordination, integration & management of pertinent information

9.  PREVENT any interference with the transfer of information

Core Professional Role Competency – Transferor

11.  DIRECT and MANAGE all situations in a THERAPEUTIC manner

12.  INSPIRE others to transform care/service through appropriate use of their role

13.  TRANSFORM the practice culture through application of discipline specific work that ensures best practice is used in the provision of care/service

Core Professional Role Competency – Practitioner

Complementary vs. Competing Models

Role-Based Caring Practice™

Leader

•  Decision Maker •  Self-‐Directed •  Autonomy •  Ethical Prac:ce •  Caring Science

Mindset

Scien$st

•  Popula:on-‐Based Thinking

•  Evidence-‐Based Thinking •  Caring Science Research

& Knowledge Development

Prac$$oner

• Results-‐Oriented Decision–Making • Introduce Best Evidence & New Learning • Caring Science & Processes Applied

Transferor Communica:on –Therapeu:c Interpersonal Rela:onships –Collabora:on

Caring Science and Rela:onship Based Care Context

O’Rourke Model of the Professional Role™

Measure & Monitor PracAce

Role-‐Based Caring Prac:ce

Caring Science

Human CondiAon

Human Caring Processes

Role-Based Caring Practice™ Outcomes

Results

Pa$ent Safety Quality from a

Caring Science Perspec$ve

O’Rourke Model of the Professional Role™ within the context of Caring Science and

RelaAonship Based Care

Measure & Monitor PracAce – The Basis of Autonomy

Role-‐Based Rela:onships & Caring Prac:ce™

O’Rourke Pa$ent Care Model™

Oversight

Professional Role as Decision Maker Impact on Error Reduction and Outcomes


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We Promise to Keep the Patient Safe! Looking for Quality in all the Right Places!

•  Error depends on “two kinds of failure” – Failure of execution …The correct action

does not proceed as intended – Failure of planning… The original intended

action is not correct

•  Error can occur throughout the care process

Oversight Monitoring and Measuring

Role Based Professional Practice Competency

Professional Role Clarity Impact on Professional Role vs. Task Orientation

Organization Measurement N=670 Overall Score = 3.09

Professional Role Decision Making Impact on Error Reduction and Outcomes

We Promise to Keep the Patient Safe! Looking for Quality in all the Right Places!

•  Error depends on “two kinds of failure” – Failure of execution …The correct action

does not proceed as intended – Failure of planning… The original intended

action is not correct

•  Error can occur throughout the care process

Handover Data - Metric


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Analysis of the Patient Handover Observation

89% 90%

72% 76% 77%

64%

92%

74%

37%

84%

62%

41%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Stated stability level related to medical/

nursing condition. Stated medical diagnosis realted

to medical condition.

Reported data that supports the medical/

nursing condition stability level and, if applicable, change in stability level.

Identified change(s) in plan of care and

subsequent change(s) in interventions related to

medical/nursing condition stability.

Changes were reported to relevant interdisciplinary

team members.

Recommended observation cycle to monitor and evaluate

changes in condition and patient progress toward

goals.

Reported patient/family teaching related to

medical/nursing condition.

Total Facility Aggregate (n=574)

Medical Condition

Nursing Condition

m

Role Clarity EquationTM

ROLE

PRACTICE

OUTCOMES

HCAHPS

Engagement & Satisfaction

Errors

Nurse Sensitive Indicators

METRIC

Influence

Role + Practice = Outcomes

Professional Role Competency Survey

METRIC

Handover Audit

Knowledge Assessment

METRIC

Oversight Leaders are Stewards of Our Resources

Role + Practice + Outcomes = ROI

$ Decrease

RN Turnover $80,000 per hire

Patient Falls $11,000 per fall

HAPUs $43,500 per event

HCAHPS 1% CMS reimbursement is at risk of loss

Nur

se S

ensi

tive

Indi

cato

rs

Example Approximately 475 RNs 5% unplanned turnover / 24 new hires/yr. - Cost = $1.9M 4% unplanned turnover / 19 new hires/yr. – Cost = $1.52M 1% Decreased Turnover = $380,000/yr. savings

Opportunity Empowerment Requires Engagement

•  All work has meaning

•  Meaningfulness comes from a positive emotional connection to their work

•  When engaged there is palpable vigor, dedication, and absorption

•  A fully engaged team makes full use of all the talents of team members based their role authority

Opportunity

It is in the best interest of the patient and the organization to actualize the full “power, beauty and influence” of the professional role at the point of care.

– Dr. Maria O’Rourke


11/5/2012


Role and System Clarity – The Organization

Breakout Session

Maria W. O’Rourke, RN, PhD, FAAN, FAAHC Chief Strategy Officer & Chief Nurse Executive OnSomble [email protected] www.onsomble.com

Thank You

References

O’Rourke, M.W. , Davidson, P. (2004). Governance of practice and leadership: Implications for nursing leadership. Chapter 14, 327-343 in Nursing Leadership. Daly, J., Speedy, S., and Jackson. D. (Eds.) Elsevier, Australia.

O’Rourke, M. W. (2006, June). Beyond rhetoric to role accountability: A practical and professional model of practice. Nurse Leader, 26-44.

Kramer, et al., (2007, January). Excellence through evidence: Structures enabling clinical autonomy. Journal of Nursing Administration, 37(1), 41-52.

O’Rourke, M.W. (2007). Role-Based Nurse Managers: Linchpin to Practice Excellence. Nurse Leader August, 44-53.

Schmalenberg, C., & Kramer, M. (2008). Essentials of a productive nurse work environment. Nursing Research, 57(1), 2-13.

Cornett, P, O’Rourke, M (2009). Building Organizational Capacity for a Healthy Work Environment through Role-based Professional Practice. Critical Care Nurse Quarterly, 32(3), 208–220.

Searle Leach, L., Mayo, A., O’Rourke, M.W. (2010). How RNs rescue patients: A qualitative study of RN’s perceived involvement in rapid response teams. Quality Safety HealthCare 2010 19: 1-4.

O’Rourke, M.W., White, A., Professional Role Clarity and Competency in HealthCare Staffing – The Missing Pieces. Nursing Economics July/August 2011 Volume 29 Number 4

Loos ,N., O’Rourke, M.W. (2012) Autonomy, Job Satisfaction and Quality of Care: Barriers and Facilitators of a Role Based Approach to Practice Within the Context of the Essentials of Magnetism. Sigma Theta Tau International Conference, Brisbane, Australia

Role and System Clarity – The Organization

Breakout Session

Presented by Maria W. O’Rourke RN PhD FAAN FAAHC

When is an Organization Role Competent?

•  Implements structures and processes that – Organize & support the delivery of quality, cost

effective care –  Based on a professional role based approach to

•  role authority •  role relationships •  scope of practice-regulations •  interdisciplinary dialogue & collaboration •  delegation and supervision

When is an Organization Role Competent?

•  Creates work environments which –  Empower those responsible for the production of

the product or service to – Accomplish their work in an effective and

efficient manner –  Support professional role and practice model

•  Ensures relentless and focused attention on – Core business of producing quality patient care – Development of systems and processes to

support the work within a clinical enterprise


11/5/2012


Organizational Competence 3 kinds of “practice” leads to a competent organization capable of quality performance

O’Rourke PaAent Care Model™

The Integrated Models Professional Role-Based Practice

Foundation for Organizational Performance

OnSomble OMNE Final Handout 10182012[1].pptx (Read-Only)

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