C158 Final Paper.docx - Running head ORGANIZATIONAL LEADERSHIP Organizational Leadership and the Impact on Patient and Family Centered Care Margaret

C158 Final Paper.docx - Running head ORGANIZATIONAL...

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Unformatted text preview: Running head: ORGANIZATIONAL LEADERSHIP Organizational Leadership and the Impact on Patient and Family Centered Care Margaret Nichols Western Governors University 1 ORGANIZATIONAL LEADERSHIP 2 Organizational leadership can have a significant impact on the patient experience at an acute care hospital. Through evaluating the current patient and family-centered practices, opportunities can be identified. A multidisciplinary team can be formed to address opportunities and implement strategies to improve the patient experience. Sensitivity to cultural diversity, team skill assessments, and specific methods to evaluate the effectiveness of the improvement strategies will be important components of success. Effects on Patient-Centered Care Patient-Centered Care in an acute care hospital is affected by business practices, regulatory requirements and reimbursements laws. Some of the business practices affecting patient and family-centered care are visiting hours in the facility. The visiting policy is open on all inpatient units except for the intensive care units. This allows for families to visit patients more often as the time is not limited. In addition, serenity time occurs from 2:00pm-3:00pm. During this time, the visitors are asked to step out or leave so that patients have an uninterrupted time to rest and puts the focus on the patient's needs. Regulatory requirements such as quality measures required by the Centers for Medicare and Medicaid also have an impact on family and patient-centered care. Measures such as hospital-acquired infections and fall rates are closely monitored and this information is reported for the public to see. This reporting holds the hospital and staff accountable for the care provided to patients and gives feedback so that the nursing leadership can support continuous process improvements. Finally, reimbursement also affects family and patient-centered care. Value-based purchasing is a pay for performance incentive that is offered to hospitals for the quality care that is provided. Hospitals receive more reimbursement when there are better patient outcomes. Therefore there is a great focus on ORGANIZATIONAL LEADERSHIP 3 achieving quality care on a regular basis. All of these measures increase information sharing, participation, and collaboration in nursing driven councils throughout the hospital. Patient and Family Centered Care Tool (PFCC) Please see separately attached document for completed PFCC Tool. Setting Description The healthcare setting used for the PFCC is a full service 513-bed acute care hospital in Texas. This hospital is the only Level 1 trauma facility in Collin County. It includes a burn center, hyperbaric treatment center and has been accredited as a Comprehensive Stroke Center. The hospital is in Plano, TX, and serves the Dallas-Fort Worth area as well as rural areas to the North. According to U.S. News and World Report, Collin County has over 782,000 people. Approximately 13% of the population has no insurance and the life expectancy is 82 years (2018). Information from Data USA shows Colling County as culturally diverse with over 25% of the population speaking a language other than English. The racial diversity is divided as “58.3% White, 15.1% Hispanic, and 14.1% Asian (n.d.). Patients served at the hospital include severely injured trauma patients, burn patients, patients with general medical-surgical issues, and transferred patients requiring a specialty surgeon or physician. ORGANIZATIONAL LEADERSHIP 4 Strengths and Weaknesses of the Organization Domain Strength Weakness Leadership/Operations Family members attend board No weakness identified meetings and share stories. Accountability is a key value to the facility and the safety and satisfaction of patients are shared in all leadership meetings. Mission, Vision, Values Mission, Vision, and Values and Patient Bill of Rights reflect patient and familycentered care. No weakness identified Advisors Patient and family participate in quality and safety rounds There are no family/patient advisory councils. Family and patients do not serve on hospital committees Quality Improvement Patient and family are part of walking rounds. Patient and family do not participate in quality improvement meetings or give input towards quality aims and goals. Personnel Staff and physicians are prepared for and supported in patient and family-centered practice. Patient and family do not participate in the interview process or help with job descriptions or policies. Occasionally patients or family will attend employee orientation. Environment & Design The environment supports collaboration with family and patients through consult rooms and meeting spaces. Patient and family do not participate in clinical design projects. Information/Education Web portals provide resources Patient and family do not ORGANIZATIONAL LEADERSHIP 5 for patient and families and clinical staff can email patients and family safely. serve as educators, and there are no resource rooms for patient and family. Diversity & Disparities Patient and family diversity is carefully measured, patient and family are provided timely access to translation services, nurse navigators are designated for special populations, and educational materials provided at appropriate literacy levels. No weakness identified. Charting & Documentation Patient and family have full access to the medical record. Patient and family have no access to charting. Care Support Family members have open visiting hours, can participate in rounds and report, will find support and disclosure with errors, can activate rapid response and stay during rescue events, and receive an updated medication history each visit. No weakness identified. Care Patient and family are listened No weakness identified. to and respected, collaborate with goal setting, partner in pain management, and are involved in care management and transitions. Area of Improvement One area of improvement identified from the PFCC tool is in the domain of personnel. Currently, this facility does not involve patients or family members in the interview process or allow for collaboration in recruitment search committees. This element of the personnel domain ORGANIZATIONAL LEADERSHIP 6 if improved could help decrease turnover rates and procure valuable knowledge on patient and family preferences for staff. By focusing on how family and patient can participate more actively in the domain of personnel, this facility can increase patient and family centeredness. Improvement Strategy By focusing on one element of weakness in the personnel domain on the PFCC tool, the facility can improve patient and family-centered care. Specifically, patient-centeredness could be improved by increasing the amount of family and patient input in the hiring process. By recruiting family and former patients to become active partners in helping select new staff members for the hospital, the facility can gain valuable insight into what is important to family and patients when selecting staff. As a result, the patients and family will feel more valued and involved in the hospital and potential staff will see the facilities commitment to patient and family-centered care during the interview process. System or Change Theory Kotter's change theory will be applied to address the weakness of no family or patient involvement in the employee interview process. According to Sullivan, Kotter's change theory is an eight-step process that helps ensure the success of change in healthcare organizations (2017). The first two steps will involve creating a sense of urgency and forming a powerful coalition. Identifying the issue of increasing turnover rates will create a sense of urgency. Involving nursing, human resources, and leadership will help form a powerful coalition. Next will be the creation of a vision and the communication of that vision to the organization. The vision will include forming a team of patient and family ambassadors that are including in the interview process. This action will help reduce turnover and give family and patients a sense of inclusion ORGANIZATIONAL LEADERSHIP 7 and that their voice is being heard. The intended results of the change and the change itself will be communicated to the leadership team and staff. Additionally, employees will be empowered to act and the facility will plan for and create short term wins. The employees will be apprised of the process in which family and patients are recruited and will be involved in committees where the process is discussed so that there is employee ownership. As the first test interviews are conducted the facility will celebrate the short term wins of this new collaboration. After reviewing the short term wins, the facility will consolidate improvement by continuing the progress with the new change and keeping the momentum going. As the change becomes successful, the final step will be to institutionalize the new change process. Financial Implications The financial implications of the new process to increase family and patient centeredness are salary costs to the team involved in the change process and office supply costs. Meetings of staff members from multidisciplinary departments and time to oversee the training of the family and patients will impose additional working hours to the facility and must be considered. Ongoing efforts to organize interview times and provide support to family and patient interview ambassadors must also be included in the financial implications. Office supply financial implications will include coffee, light refreshments, copy paper, and printing expenses. No additional capital costs are expected due to pre-existing meeting space and no need for specialized equipment. Methods ORGANIZATIONAL LEADERSHIP 8 Prior to the implementation of this change, baseline data will be collected on existing employee turnover rates. In addition, a pre-survey will be given to the management teams to assess the current views on the existing interview process. During the implementation, a postsurvey will be given to the management team to assess the satisfaction on the new process and if there are any suggestions for improvement. This survey process will allow for feedback on the process to allow for changes or discontinuation if necessary. Once the process has been in place over 3 months, turnover data will be reviewed to see if the change has been successful by showing a decrease in the turnover. Multidisciplinary Team Team Member VP of Human Resources Role on the Team Sponsor of team Manager of Human Identify best practices and help guide the legal aspects of the Resources change process. Provides support to the leader of the project. Nurse Manager of Pilot Unit The leader of the change project. Change agent and participant in the process. Frontline Nurse from Pilot Help provide feedback and participate in the interview process as Unit Director of Clinical Innovation peer interviewer. Support on evidence-based practice, and ongoing process improvement for improvement strategy. Patent and Former Patient Three former patient or family members will be recruited to help Interview Ambassadors participate in the interview process and will also help develop ORGANIZATIONAL LEADERSHIP 9 interview questions. Team Diversity Patient-centered care is supported by culturally competent care. To address cultural diversity the multidisciplinary team will be diverse as well. As discussed previously, a good majority of patients that come to this acute care hospital are of Asian and Hispanic culture. To fully appreciate the cultural diversity of the patients, some team members will represent these Asian and Hispanic cultures as well as Muslim and Hindu religions. Every attempt will be made to recruit patient and family ambassadors that represent cultural diversity. By representing cultural diversity on the multidisciplinary team, patient preferences and the attitudes and beliefs of patients can be represented in hiring decisions which will support culturally competent care. Leadership Theories Transformational leadership will be used in developing the team. According to Rousell, transformational leadership includes having a vision and inspiring others to feel confident and maintain higher expectations for results. In addition, transformational leaders allow team members to discuss ideas, value creativity, and help to maintain the vision and goals of a project (2017). As the transformational leader creates and sustains trust with the team members, a shared vision is created and the team is more likely to be successful. Implementation of Strategy To implement the improvement strategy the Plan-Do-Study-Act (PDSA) cycle will be used. In the planning phase, the Director of Clinical Innovation, the frontline staff nurse, and the nurse manager will retrieve evidence-based practice research on the patient and family member ORGANIZATIONAL LEADERSHIP 10 interview process. These 3 team members then will discuss the best practices from research and then meet with the Manager of Human Resources to discuss any legal implications of the process. At this time one medical-surgical unit will be used as the pilot and the Nurse Manager of that floor will lead the team. The frontline staff nurse will retrieve patient and family member contact information from the electronic health database to identify candidates. The Manager of Human resources will help the frontline staff nurse to draft a letter to potential patient and family member ambassadors with a deadline to respond. At this time the Manager of Human Resources will collect the baseline data on turnover. The Nurse Manager and other managers in the hospital will take a pre-survey to rate satisfaction with the current interview process. In the next phase of PDSA, the entire team will help to mail letters to ambassador candidates. When 10 or more responses are collected, a date will be set by the team to meet the candidates and discuss the level of participation in the team. At this time, ambassador interview questions will also be discussed and the questionnaire will be developed. Each team member will be at this meeting. Light refreshments will be served to help incentivize attendance. Ambassadors will be selected by team member agreement, and cultural diversity will be considered during selection. The Nurse Manager will work with the Human Resources Manager to identify upcoming staff interviews and will contact ambassadors for attendance. At this time, the process will also be reviewed by the Vice President of Human Resources and the Director of Clinical Innovation for any changes or issues. After the first 10 interviews, surveys will be sent to interview candidates to collect data on satisfaction with the interview process versus previous interview experiences. Any management staff that participated in the pre-survey will now take the post-survey. At this time, the team will enter the next phase and study the results of survey responses from interview candidates, review the results of pre and post surveys, and speak to the Ambassadors about the ORGANIZATIONAL LEADERSHIP 11 process. The team will decide if the pilot was successful and if changes need to be made. The next step will be to announce the change to all hiring managers and expand the improvement project hospital-wide. At this time, the PDSA cycle will start again. After 3 months of implementing this strategy, the Human resources manager will gather employee turnover rates and compare them to the baseline data. In addition, the Nurse Manager will re-evaluate the patient and the family-centered tool to assess for improvement. Communication to Organization To communicate this improvement strategy to the organization it will be important to include the major stakeholders. During the monthly leadership meeting, a PowerPoint presentation will be given to addressing all aspects of the strategy. The audience in this monthly meeting includes the major stakeholders of CEO, CNO, COO, CFO, ACNO, and all hiring managers in the hospital. The intended outcomes covered in the presentation will be a reduction in turnover which will represent significant cost savings and an increase in patient and familycentered care. Tools for the Team The multidisciplinary team will be using the Keirsey temperament sorter tool to help the team develop self-assessment skills. This tool was chosen as it helps team members understand more about their own personality and how they communicate with others. In fact according to Keirsey, the temperament sorter tool measures “communication, patterns of action, and sets of characteristic attitudes, values, and talents” (n.d.). When team members are more aware of their ORGANIZATIONAL LEADERSHIP 12 communication styles and values it improves communication. The results from the tool will also work well with the transformational leadership style of the Nurse Manager. The Nurse Manager can use results to inspire, motivate, and choose which members should work closely together. Conclusion In summary, one way that healthcare facilities can increase patient satisfaction is through the improvement of family and patient-centered care. To assess the level of patient and family centeredness, the PFCC tool can be used. One weakness from the tool can be identified and a strategy to improve that weakness created. It is important to use a culturally diverse team to implement the strategy and to have methods to measure success. ORGANIZATIONAL LEADERSHIP 13 References Data USA. (n.d.). Collin County, TX. Retrieved from Kiersey. (n.d.). Temperament overview. Retrieved from Roussel, A., L., Harris, L., J., Thomas, Tricia. (2016). Management and Leadership for Nurse Administrators. [Vitalsource learning resource]. Available from Sullivan, E.J. (2017). Effective Leadership and Management in Nursing. [Vitalsource learning resource]. Available from ...
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  • Spring '16
  • Nursing, Nurse Manager, Multidisciplinary Team

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