Katherine Howell, MBA, BSN, RN, NEA-BC, Senior Vice President and Chief Nurse Executive, Saint Luke's Health System - Presentation delivered at the marcus evans National Healthcare CNO Summit 2016 held in Las Vegas, NV

1. Developing a Clinically Integrated Health System
A System Chief Nurse Executive Perspective
March 7 and 8, 2016

3. 10 Hospitals
>10,000
Employees
1,061 Staffed
Beds
147,910 ER
Visits
$168 million
Charity
7,422 Home
Health
Admissions
45,884
Hospital
Admissions
1,200
Physicians

4. 4

5. Vision 2020
Patient Centered, High Value
System of Care

6. 6

7. 7
SLHS Professional Nursing and Clinical Structure

8. Structural Framework *Saint Luke’s Hospital Designation
2

9. Level of Care Nurse Executives
Critical
Care Medicine Surgery
Maternity/
NICU
Emergency

10. System Directors Allied Health Professions
Pharmacy Laboratory Radiology

11. Director of Professional Practice
• Magnet Coordinator
• Pathways to Excellence
Consultation
• Shared Governance
• Clinical Advancement
Program

12. System Chief Nurse
Executive
System Coordinating Council
System Level of
Care Practice
Councils
Surgical
Medicine
Critical Care
Ambulatory
Behavioral
Post-Acute
Emergency
Neonatal
Peri-Natal
Cardiac Rehab
Specialty Councils
Falls
Value Analysis Team
SVAN
Wound Care
Saint Luke’s Care
Connection with
System Level of Care
Practice Councils
System Clinical
Advancement
Council
System Nursing
Research Council
System Chief
Nursing Officer
Council
Clinical Leadership
Council Connection
with CNO/CNEs
System Clinical
Quality Connection
with CNO/CNEs
System Advanced
Practice Provider
Council
Clinical nurse
representation at
these Councils.
SLHS Professional Practice Model

13. 13
Entity Shared Governance Executives

14. • System level outcomes with two measureable system outcomes
• BSN Requirement by 2020 for existing RN’s
• All new promotions must have BSN
• Certification required
Level 4
• Outcomes involving more than one unit through informal and formal leadership.
• BSN Requirement by 2020 for existing RN’s
• All new promotions must have BSN
Level 3
• Unit based outcomes through informal and formal leadership
Level 2
• Novice Registered Nurse
Level 1
System Clinical Advancement Program (CAP)

15. CAP Key Changes
Clinical Advancement and maintenance now have the same requirements
Level IV promotions all reviewed and approved at System CAP Council
4% increase between each level of promotion and $0.50/hour differential
for certification

16. Strategic Plan Linkage
Individual Goals/Clinical Advancement Program
Department Goals
Entity Strategic Plan
Saint Luke’s Health System Nursing Strategic Plan
Saint Luke’s Health System Strategic plan

17. Integrated Electronic Medical Record
Chief Nursing Informatics Officer
EMR

18. System Education Department
- 18 -
System Director of
Education Services
Jamie Luark
Program Coordinator
Jessica Walker
Med Surg
Kristin Carlson
Makenzie Stuck
OR
Cheryl Fisher
SLH
Amy Adkison
Meagan Randle
Robinson
SLN & Smithville
1.0 FTEEntity
Director of Research
Jacque Carpenter
SLHS CNE
Kathy Howell
SLHS Patient Care Services Clinical Education Specialists
ER
1.0 FTE
Intermediate
Alisa Barker
Colleen Lad
Critical Care
Kristin Sollars
Marci Ebberts
Women’s /
Children’s
Julie Mitchell
Kim Dishman
Program Coordinator
Nancy McEntee
Administrative
Assistant
Anna Hawthorne
Level of
Care
SLEH
Michelle Rennolds
1.0 FTE
SLS & Anderson
County
Kathleen Bennett
SLCH
Brenda Potter
HMC & WMH
Jewell Harris
Jenni Kennebeck
CES at SLCH, HMC, WMH and ACH are responsible for all staff education
CES at SLN, SLEH, SLS and SLH are responsible for nursing education
Neuroscience
Productline –
Grant Funded
Donna Hunt
Education Solutions
Specialist
Christina Carlos-Moke

19. Productive Hours
Specialty Unit Registered Nurse Ratios Nursing Assistant Ratios
Medical Surgical
Day Shift: 5:1
Night Shift: 6:1
Day Shift: 8:1
Night Shift: 10:1
Intermediate
Day Shift: 4:1
Night Shift: 5:1
Day Shift: 8:1
Night Shift: 10:1
High Acuity Intermediate
(Located in SLH)
Day and Night Shifts: 3:1 Day Shift: 8:1
Night Shift: 10:1
Intensive Care Unit & NICU Day and Night Shifts: 2:1 Day and Night Shifts: 1 per Unit
Mother and Baby
(Varies slightly by facility based on
AWHONN Standards)
Day Shift: 1:1 (Land D); 3:1 (Couplet)
Night Shift: 1:1 (Land D); 4:1 (Couplet)
Day and Night Shifts: 1 OB Tech
Standardized: Productive and Other Productive Hours
Established both productive and other productive hours standards across all facilities by levels of care
Other Productive Hours
Medical
Surgical
Intermediate Intensive Care
Unit
Mother and
Baby
Labor and
Delivery
NICU
Education
(per FTE)
24 hours 24 hours 24 hours 24 hours 24 hours 24 hours
Meetings (RN) 8 hours 8 hours 8 hours 8 hours 8 hours 8 hours
Orientation 220 hours 292 hours 436 hours 220 hours 724 hours 580 hours

20. Workflow Redesign – Central Staffing Office
Decentralized
Model
Variability of staffing
functions and structure
Inability to share staff
resources
Competition for available
float and/or agency staff
Sub-optimal
understanding of nursing
demand & capacity
Central Staffing
Office Model
Standardization of staffing
function and structures
Ability to share staff across
System entities
Resources dedicated to
staffing projections and
analytics
System-view of demand
and capacity
Key Staffing Functions
Self-Scheduling
Schedule Leveling
Assign PRNs, Float staff
and Agency
Predictive Analytics
Daily Staffing
JIT Needs Management
Assign Agency
Assign Float Staff
Track & Back-Fill Call-Ins
Future Needs Projections
Open Shift – Post/Approve
Long Term Needs – FMLA
Agency Competencies/Files

21. Centralized Float Pool Tiered Pay Structure
Tier 1* Tier 2* Tier 3*
Registered Nurse
 Staff will only be required to work at
one entity
 Pay differential is $2.00 above base
salary
 It is estimated 60% of staff will be
allocated to this Tier
 Staff will be assigned to work at two
entities
 Pay differential is $4.00 above base
salary
 It is estimated 25% of staff will be
allocated to this Tier
 Staff will be assigned to work all four
entities
 Pay differential is $6.00 above base
salary
 It is estimated 15% of staff will be
allocated to this Tier
Nursing Assistant and Information Associate
 Staff will only be required to work at
one entity
 No pay differential
 It is estimated 70% of NA staff will be
allocated to this Tier
 Staff will be assigned to work at two
entities
 Pay differential is $1.25 above base
salary
 It is estimated 20% of NA staff will be
allocated to this Tier
 Staff will be assigned to work at all four
entities
 Pay differential is $2.00 above base
salary
 It is estimated 10% of NA staff will be
allocated to this Tier
Additional Pay Differentials
 All other pay differential will continue per system policies:
- Evening shift differential
- Night shift differential
- Weekend pay differential
- Holiday pay differential *Only applies to full-time and part-time staff. PRN staff will remain at current rates
All float staff will start in Tier 1 on 11and 4

22. System Float Pool Management Structure
Director of Central
Staffing & Float Pool
Entity Nursing House
Supervisors *
Central Staffing
Office
Manager
Float Pool Clinical
Nurse Managers
System Float Pool
* House Supervisors will still report to their specific entity
Sr. VP and CNE
Central Staffing
Office Coordinators
Clinical Analysts

23. Manual to Automated Analytics

24. Manual to Automated Analytics

25. System Policies and Procedures

26. Care Progression – Overview of Model
26
Care Integration
Case Management
Hybrid approach consisting
of utilization review and
discharge planning
Social Work
Identify barriers to
transition and facilitate
placement into
appropriate care setting
Care
Coordination
• Unit based Care
Coordinators
• Overcoming obstacles to
delivery of care and
ensuring care progression
Utilization
Review
• Centralized Utilization
Review RNs
• Utilization review, referral
authorization, and denials
management.
Social Work
• Identify barriers to
transition and facilitate
placement into appropriate
care setting
Care
Progression
New ModelFormer Model

27. System Care Progression

28. Chief Nursing Officer, Ambulatory Nursing and
Advanced Practice Providers
Ensure all APP’s are
practicing to the full extent
of their licensure
Executive Sponsor of the
System APP Council and
Ambulatory Nursing Council
Ensure consistent standards
of care throughout all
ambulatory clinics.

29. Quality Outcomes
0.00
0.20
0.40
0.60
0.80
1.00
1.20
2014-01
2014-02
2014-03
2014-04
2014-05
2014-06
2014-07
2014-08
2014-09
2014-10
2014-11
2014-12
2015-01
2015-02
2015-03
2015-04
2015-05
2015-06
2015-07
2015-08
2015-09
SLHS Sepsis Mortality O/E Ratio
(SLE, SLH, SLN, SLS)

30. Financial & Productivity Results
2013 2014
Patient Care Services 15.17 14.87
Laboratory 0.09 0.09
Pharmacy 0.04 0.04
Radiology 1.24 1.29
Respiratory Therapy 0.63 0.70
0.56 0.66
Emergency Services 2.76 2.77
Savings by Year $ 21,096,980 $ 17,996,028

31. • APP Fellowship
• New Graduate Residency and Preceptor Enhancements
• Central Logistics Center
• Ambulatory Float Pool
• System wide Nursing Peer Review
• Quality – Zero Patient Harm
Clinical Integration 2016 Strategic Priorities

32. • Katherine Howell, MBA, BSN, RN, NEA-BC
Sr. Vice President, Chief Nurse Executive
khowell@saint-lukes.org
Phone: 816-932-1585
901 E 104th Street, Mailstop 900 N
Kansas City, MO 64131
saintlukeshealthsystem.org
Contact Information