Metro Health HospitalCardiac Champion Program

Organizational Strategic Plan

Ferris State UniversityNURS 440 Leadership in Nursing

Kaitlyn BaldwinWilliam BerlinKelly JonesOksana Marchenko

Rebekkah McConnellBrandi MillerTracie Strand

Program Background• The Cardiac Champion Program (CCP) is a newly developed

cardiac education program at Metro Health Hospital (Metro) in Wyoming, Michigan

Provide: Education,

Medical Care,

Skilled Nursing

Population: patients

with newly diagnosed and poorly controlled

cardiac diseases

►This cardiac education program

will improve the quality of care for

patients and decrease

readmissions◄

• 208-bed general acute-care osteopathic teaching hospital

• Serves approximately 130,000 residents within the area

Environmental Assessment• Cardiovascular Disease (MDCH, 2009)• Leading cause of death since 1919• Responsible for 36.1% of Michigan deaths in 2006

• Cardiac Education Programs• Early rehabilitation is essential to successful outcomes and

program compliance (Mampuya, 2012)• Noncompliance increases the chance of disease recurrence and

hospital readmission (Yohannes, Yalfani, Doherty, & Bundy, 2007)• One-on-one education prior to discharge decreases readmission

rates by 40% or more (Krumholz et al., 2002; Paul, 2008)• A one-hour nurse educator delivered teaching session prior to

discharge results in improved clinical outcomes, increased self-care measures, and reduced cost of care (Koelling, Johnson, Cody, & Aaronson, 2005)

Environmental Assessment• Forces Against Cardiac Education Program• Nursing shortages and financial constraints limit implementation of

cardiac education programs (Rothberg, Abraham, Lindenauer, & Rose, 2005)

• Regional competition• To compete with Spectrum Health System and Mercy Health Saint

Mary’s Hospital, Metro must continue to develop its reputation as a provider of high-quality, patient-centered cardiac care

• Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program• Imposes penalties for excess acute myocardial infarction and heart

failure readmissions (CMS, n.d.)

Mission

In collaboration with our community partners, the mission of the Cardiac Champion Program

at Metro Health Hospital is to provide education, medical management, skilled

nursing care, and rehabilitation services to community members diagnosed with cardiac

disease and to serve as a resource for coordinating specialized, multidisciplinary

care.

Philosophy• Responsiveness• Nursing professionals provide patients with the educational

tools necessary for successful self-care activities and are responsive to patient questions both during and after discharge.

• Patient Centered Education• While the quality of education is uniform, teaching methods

may be customized according to patient needs and values.

• Communication• Nurses and all other members of the healthcare team work

diligently to fulfill the organization’s commitment to sharing knowledge and information with patients.

• Collaborative Care• Nurses will work with other members of the healthcare team

to ensure quality patient care.

Philosophy• Safety• Safety is a top priority at all times and will be enhanced by

ensuring patient needs are met during and after discharge and through peer review of nursing practice.

• Service • Patient needs should be anticipated whenever possible. • Actively listening to patients and coworkers is essential.

• Efficiency• Information should be delivered accurately and in a timely

manner.

• Teamwork• Nurses will work with other members of the healthcare

team to exchange needed information and enhance patient education.

Goals• Provide comprehensive education to patients with newly

diagnosed or poorly managed cardiac diseases during their hospital admission and after discharge.

• Develop standardized patient care pathways for patients diagnosed with cardiac diseases focusing on activities of daily living, lifestyle modifications, diet, medications, safety, and pain management.

• Promote and utilize a multidisciplinary approach to patient care by coordinating between physicians, staff nurses, social workers, home care, and other specialties to facilitate optimal outpatient cardiac disease management.

• Improve and promote community support for patients diagnosed with cardiac disease.

• Effectively market the services available through the CCP to the community.

Objectives• To enroll all patients with newly diagnosed heart disease into the CCP prior to discharge. • To provide fundamental, basic cardiac education to CCP participants during each home visit.• To assess the home environment of CCP participants, evaluate and reinforce inpatient teaching at first home visit and thereafter, if needed.• To develop individualized, multidisciplinary patient care plans based on standardized patient care pathways by second home visit. • To educate inpatient and home care nurses annually.

Objectives• To develop comprehensive, web-based resources including an educational database, online support groups, and discussion forums within 90 days of program kick-off. • To facilitate program improvement by soliciting input from CCP participants, healthcare professionals, and community members monthly. • To coordinate CCP activities with ongoing research initiatives monthly. • To develop marketing plans targeting both healthcare professionals and community members within one year of program kick-off.

Organizational Chart

Cardiac Champion Program Manager

Inpatient Clinical Nurse Educator

Outpatient Clinical Nurse Educator Nurse Research Liaison Nurse Informatics

Specialist

Cardiac Champion Committee

Job Descriptions• Developing job descriptions

to define role functions contributes to an organization’s formalization (Mancini, 2011)

• To clarify the role of each position within the CCP, detailed job descriptions were written for each position, including:

• Program Manager

• Inpatient Clinical Nurse Educator

• Outpatient Clinical Nurse Educator

• Nurse Research Liaison

• Nurse Informatics Specialist

• As a sample, the job description for Program Manager is included on the next slide

Job Descriptions 

Cardiac Champion Program ManagerSummary  

Oversees the entire program Develops a budget and marketing strategy Chairs the Cardiac Champion Committee (CCC)

Relationships 

Reports to the Chief Nursing Officer Collaborates with the CCC Supervises all CCP staff

Knowledge, Skills, & Abilities 

BSN or MSN degree Competence in basic cardiac dysrhythmia interpretation 3 years cardiac clinical nursing experience Proficient in computer use Quality leadership ability to develop and maintain good working relationships Strong conceptual skills, with skill in problem-solving, decision-making, & critical-

thinking Understanding of performance improvement tools Project management experience

Behavioral Expectations 

Supports the mission, vision, & values of the CCP Treats others with respect Fosters a collegial environment Applies ethical codes Attends CCC meetings

Protected Information  

No direct contact with patients Intermittent access to protected health information of patients

Maintaining Competency 

State of Michigan licensure as an RN BLS & ACLS certifications Completion of annual employee training Maintaining certification in cardiac field 

Cardiac Champion Committee• Represents a collaboration of experts directly involved in the

development and assessment of positive patient outcomes.

• Develops standardized patient care pathways while working to improve program elements and hospital readmission statistics by educating the multidisciplinary team to assure best practice.

• Uses role specific knowledge to facilitate comprehensive patient education both during hospital admission and after discharge.

Functions and Responsibilities:Engages and promotes ideas to communityCollaborates with clinicians to ensure best practiceChaired by the Cardiac Champion Program ManagerEducates staff and implements changes within departmentAttends at least 10 monthly meetings within the fiscal year

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Budget Proposal• An initial budget was proposed and then cost conscious

strategies were implemented to develop a final one year budget for the CCP.

• Total expenses are projected at $248,740 and total project funding is estimated to be $339,610.

• Costs include salaries, benefits, supplies, and operating expenses.

• Project funding will be generated from insurance revenue and other operating revenues produced by penalty and readmission savings.• By reducing readmissions, the program will save an estimated

$74,000 in CMS penalties and $220,000 in costs to treat readmitted patients.

• Profit is necessary to replace broken and outdated facilities and equipment, expand services, and pay for inflation costs (Stafford, 2011).

Cost Conscious Strategies• Consolidated program roles using hospital resources, reducing salary

costs by $14,020.

• Researched specific costs of office supplies, educational materials, and operating expenses, cutting program expenses by $49,400.

• Salary budgets for each position are:• Program manager (0.5 FTE) - $29,690

• Inpatient clinical nurse educator (1.0 FTE) - $66,980

• Outpatient clinical nurse educator (1.0 FTE) - $66,980

• Nurse research liaison (0.25 FTE) - $14,590

• Nurse informatics specialist (0.25 FTE) - $14,900

• In addition to these salaries, the budget for benefits was calculated to be $24,000 based on a total of three FTEs at a cost of $8,000 per FTE (Adeyanju, 2013). • While not all positions will be full-time, they will likely be filled by full-time

employees who are job-sharing with other roles and thus will include benefits.

Budget Proposal ComparisonFirst budget proposal yielded a

profit of $27,450Final budget proposal yielded a

profit of $90,870

Program Costs

Salary $193,140

Benefits $24,000

Supplies and operating expenses $31,600

Total Program Costs $248,740

Program Funding

Other operating revenue $294,000

Insurance revenue $45,610

Total Program Funding $339,610

Program Costs

Salary $205,160

Benefits $26,000

Supplies and operating expenses $81,000

Total Program Costs $312,160

Program Funding

Other operating revenue $294,000

Insurance revenue $45,610

Total Program Funding $339,610

ReferencesAdeyanju, R. O. (2013). Syllabus for NURS 440 leadership in nursing. (Available from the

Ferris State University School of Nursing, 200 Ferris Drive, Big Rapids, MI 49307)

Centers for Medicare & Medicaid Services [CMS]. (n.d.). Readmission reduction program. Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html

Koelling, T. M., Johnson, M. L., Cody, R. J., & Aaronson, K. D. (2005). Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation, 111, 179-185. doi:10.1161/01.CIR.0000151811.53450.B8

Krumholz, H. M., Amatruda, J., Smith, G.L., Mattera, J. A., Roumanis, S. A., Radford, M. J.,...Vaccarino, V. (2002). Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. Journal of the American College of Cardiology, 39, 83-89. doi:10.1016/S0735-1097(01)01699-0

Mampuya, W. M. (2012). Cardiac rehabilitation past, present, and future: an overview. Cardiovascular Diagnosis and Therapy, 2, 38-49. doi:10.3978/j.issn.2223-3652.2012.01.02

Mancini, M. E. (2011). Understanding and designing organizational structures. In P. S. Yoder-Wise (Ed.), Leading and managing in nursing (5th ed., pp. 137-156). St. Louis, MO: Elsevier Mosby.

ReferencesMichigan Department of Community Health [MDCH]. (2009). A vision for Michigan: A

strategic plan for heart disease and stroke – 2009-2014. Retrieved from http://www.michigan.gov/documents/mdch/HDS_Strategic_Plan_9_09_333778_7.pdf

Paul, S. (2008). Hospital discharge education for patients with heart failure: What really works and what is the evidence? Critical Care Nurse, 28(2), 66-82.

Rothberg, M. B., Abraham, I., Lindenauer, P. K., & Rose, D. N. (2005). Improving nurse-to-patient staffing ratios as a cost-effective safety intervention. Medical Care, 43, 785-791.

Stafford, T. B. (2011). Managing costs and budgets. In P. S. Yoder-Wise (Ed.), Leading and managing in nursing (5th ed., pp. 228-248). St. Louis, MO: Elsevier Mosby.

Yohannes, A. M., Yalfani, A., Doherty, P., & Bundy, C. (2007). Predictors of drop-out from an outpatient cardiac rehabilitation programme. Clinical Rehabilitation, 21, 222-229. doi:10.1177/0269215506070771