OnSomble OMNE Final Handout 10182012[1].pptx (Read-Only)
Transcript of 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
. ©Copyright 2012 OnSomble. All Rights Reserved This program contains licensed & propriety models /materials/data and may not be used without permission 1
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
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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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
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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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
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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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
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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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$$oner
• Results Oriented Decision-‐Making
• Introduce Best Evidence & New Learning
Transferor Communica:on -‐ Therapeu:c Interpersonal Rela:onships -‐Collabora:on
Results
Role Based Professional Practice Competency is an Obligation and the Basis for
Nurse Leader Development
1. EXERCISE Decision Making Authority that ensures role and standards based practice
2. CONTROL the Recovery Process from a discipline specific perspective
3. CONTROL Care Coordination from a discipline specific perspective
Core Professional Role Competency – Leader
4. MONITOR & EVALUATE role and standards based practice
5. MEASURE professional role expertise & role-based practice excellence
6. LINK professional role competency with clinical, service and financial outcomes
Core Professional Role Competency – Scientist
5th Annual OMNE Nurse Leaders of Maine Today’s Nurses, Tomorrow’s Leaders: Role Based PracAce Accountability Presented by Maria W. O’Rourke RN PhD FAAN FAAHC
11/5/2012
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7. ACT in a manner that promotes dialogue, open communication & positive interdisciplinary working relationships
8. ENSURE coordination, integration & management of pertinent information
9. PREVENT any interference with the transfer of information
Core Professional Role Competency – Transferor
11. DIRECT and MANAGE all situations in a THERAPEUTIC manner
12. INSPIRE others to transform care/service through appropriate use of their role
13. TRANSFORM the practice culture through application of discipline specific work that ensures best practice is used in the provision of care/service
Core Professional Role Competency – Practitioner
Complementary vs. Competing Models
Role-Based Caring Practice™
Leader
• Decision Maker • Self-‐Directed • Autonomy • Ethical Prac:ce • Caring Science
Mindset
Scien$st
• Popula:on-‐Based Thinking
• Evidence-‐Based Thinking • Caring Science Research
& Knowledge Development
Prac$$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
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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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
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
. ©Copyright 2012 OnSomble. All Rights Reserved This program contains licensed & propriety models /materials/data and may not be used without permission 8
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
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
. ©Copyright 2012 OnSomble. All Rights Reserved This program contains licensed & propriety models /materials/data and may not be used without permission 9
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
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
. ©Copyright 2012 OnSomble. All Rights Reserved This program contains licensed & propriety models /materials/data and may not be used without permission 10
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