John W. Rowe, MD Tamra E. Minnier, RN, MSN, FACHEProfessor, Mailman School of Public Chief Quality OfficerHealth University of Pittsburgh Medical CenterDepartment of Health Policy andManagementColumbia University, New York
• 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 OFNURSING: CAMPAIGN FOR ACTION
Fragmentation High costs Healthcare disparitiesPrimary care shortage Aging and sicker population
Examining nursing workforce supply and demand Developing evidence-based recommendations to address: Nursing education systemDelivery of nursing services capacity limitations Producing an action-oriented blueprint to transformhealth and healthcare by using nurses more effectively
High-quality, patient-centered healthcare for allwill require atransformation of thehealthcare delivery systemOne of the most-viewed online reports in IOM history
Expand opportunities for Remove scope-of- Implement nurse nurses to lead and practice barriers residency programs diffuse collaborative improvement efforts Increase theproportion of nurses Double the number Ensure that nurseswith a baccalaureate of nurses with a engage in lifelongdegree to 80 percent doctorate by 2020 learning by 2020 Build an infrastructure for the collection and Prepare and enable analysis of nurses to lead change interprofessional to advance health healthcare workforce data
Campaign VisionAll Americans have access to high-quality, patient- centered care in a healthcare system where nurses contribute as essential partners in achieving success
Advancing Education Removing Barriers to Nursing Leadership Transformation Practice and Care Interprofessional Collaboration Diversity DATA
What plans do you have anyway to solve the cost and quality problems in healthcare?
Less than ideal outcomes No more time No more money Clinical outcomes will drive financial bottom Innovative nurse-Have to do more with driven models of care line in our lifetime— less in growing are needed as the the 1-3 percent margin complexity primary care shortage will become the difference looms When we fix nursing…we really will fix healthcare
Nursing staff models Better clinicalEvery 10% increase in with a higher outcomes arethe proportion of BSN BSN/MSN staff ratio achieved with a staff reduces risk of achieve higher higher BSN/MSN staff death by 4% productivity ratio We will no longer be paid for hospital Cases with infections acquired cost 3x more those conditions, mortality without scores and readmissions
FY 2013 2014 2015 2016 2017VBP 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?*Includes the overall impact on Medicare managed care revenues21
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• 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)23
• 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 surprisesNew 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 New Role: VARIABLE ROUNDER
Implementation Implementation Jan 2011 Jan 2011 Implementation Jan 2011Implementation Jan 2011
What can you do now, in your position ashealthcare 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 toassure quality outcomes?Do you know how much you have at risk in Medicare dollars with yournurse sensitive outcomes?
Have you analyzed where an advanced practice nurse couldextend the productivity of a doc in your area?Are you providing scholarships/tuition for nurses to get thoseadvanced degrees if you can?Have you offered your nursing leadership a chance to beinnovative and creative on care delivery models?Have you looked at your nursing resources as dollarsspent/outcome?Does your state have an Action Coalition you can support?
Workforce Turnover & EmployeeDeployment Retention Point-of-care Sensitivity to humandecision-making resources policies Cost of nurse System-wide turnover and changes vacancies as high as $64,000 per position
Organizations with OtherBSN-supportive Policies Organizations with BSN Pay Organizations with Time Limit Differential for BSN 32% Pay 27% Time limit differential No pay No BSN 68% differential 73% requirement
John’s Hopkins Veteran’s Health• Preference for BSN Administration• 80 percent BSN or • Pay differential higher • Career ladderU.S. Public Health Tenet HealthcareService, Army, Navy, Air CorporationForce • Prefers BSN• BSN requirement • Career ladder
• 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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