Unifying organizational approaches to measuring and managing patient outcomes

Information about patient outcomes is increasingly available to guide consumers in their selection of healthcare. By unifying the traditionally separate programs of performance improvement, case management, and research, nurse executives can take control of care processes and outcomes. This article provides four case examples of patient care improvements achieved using performance improvement, case management, and research approaches. The use of the technologies outlined in the Johnson and Nolan article in this issue, "A Guide to Choosing Technology to Support the Measurement of Patient Outcomes", also is described.     

Total quality management. Applications to nursing service

Total quality management (TQM) can offer nursing practical solutions to the "best for less" dilemma when specifically adapted to the needs of the nursing profession and individual nursing service departments. The author explains the TQM philosophy and its principles, presents strategies that may be used by nurse executives interested in integrating TQM into their nursing management systems, and discusses specific guidelines for successful implementation of TQM within any nursing department.     

Evaluating clinical information systems

As members of organizational committees to evaluate and select clinical information systems, nurse executives must identify a system that not only has the core functionality to support necessary changes in workflow and optimize nurse productivity and patient safety but that also is embraced by the nursing staff. There are specific features that nurse executives must demand to help nurses at the bedside reap the greatest benefit from the technology.     

Nurse executives champion change in integrated health systems

When facilities join integrated health systems, nurse executives must increase their focus on governance, staff education, financial analysis, mentorship, and planning to maintain strong patient advocacy across a continuum of care.     

The American Organization of Nurse Executives System CNE Task Force: A Work in Progress

Health care is a complex industry, consequently requiring a diverse group of health care executives leading initiatives for efficiency and effectiveness in patient care delivery. Value-based purchasing and pay for performance are at the top of the list for indicators of success, and many hospitals are merging into health care systems. The role of the system chief nurse executive is an evolving role to lead health care systems in clinical, operational, patient safety, and patient satisfaction processes and outcomes. The American Organization of Nurse Executives, being the voice for nursing leadership, convened a group of system chief nurse executives to address the role, function, and competencies needed for this significant and emerging role in health care. This article describes the role statement and system chief nurse executive competencies needed for success in the role. In addition, the next steps for addressing the needs of this group will be outlined in this article.     

A ten-step process to develop case management plans

The use of case management plans has contained cost and improved quality of care successfully. However, the process of developing these plans remains a great challenge for healthcare executives, in this article, the author presents the answer to this challenge by discussing a 10-step formal process that administrators of patient care services and case managers can adapt to their institutions. It also can be used by interdisciplinary team members as a practical guide to develop a specific case management plan. This process is applicable to any care setting (acute, ambulatory, long term, and home care), diagnosis, or procedure. It is particularly important for those organizations that currently do not have a deliberate and systematic process to develop case management plans and are struggling with how to improve the efficiency and productivity of interdisciplinary teams charged with developing case management plans.     

Managing a new medication administration process

The national focus on medication errors has stimulated rapid adoption of medication administration technologies with bar code verification. The effectiveness of these technologies in preventing errors is directly related to how consistently practitioners use the technology to verify both patient identity and drug identity with each administration. The authors discuss management strategies that have proven effective at increasing staff compliance with using bar code-enabled medication systems.     

Change readiness assessment for conversion to electronic medical records

Nurse executives are challenged to translate the mission of their healthcare organizations into desired outcomes that accomplish what is best for patients. Moving from paper to an electronic clinical documentation system can be a key tool in meeting this challenge; thus, nurse executives must lead a workforce that understands and embraces technology. The authors describe the change management approach that began the organizational culture transformation from paper to an electronic clinical documentation system.     

Professional behavior in collaborative practice

Cost containment, increased severity of illness, earlier patient discharge, and high staff turnover are causing nurse executives to implement new systems of health care delivery. One such delivery system, collaborative practice, strives to maximize efficient and effective use of staff, to improve nurse retention, and to enhance patient care. The authors present one approach to implementing collaborative practice and the empirical findings related to the system's impact on physician-nurse professionalism.     

The system chief nurse executive role: sign of the changing times?

As the health care system landscape continues to evolve toward more integrated care, a trend toward consolidation of hospitals into larger systems continues. The systems are more than the traditional hospital-centric structures, as acute care becomes just one component to a larger system that includes ambulatory care, acute and post-acute care, chronic disease and end-of-life management, and all structures in between. To provide leadership in these new models, there have been an increasing number of system chief nurse executives hired both to facilitate the integration of care and to align and standardize nursing practice across the continuum. By definition, the role of the system chief nurse executive differs from that of the entity chief nursing officer. A crosswalk is presented that describes the differences between the roles and reflects on the implication for system chief nurse executives during our changing times.     

Demand management: another marketing tool or a way to quality care?

Demand management tools are population-based strategies used to control costs and improve utilization of services by assisting health consumers in maintaining their health and seeking appropriate health care. These tools are increasingly used by health care delivery systems and, in the US, by fiscal intermediaries, such as insurance companies. If these tools are not properly applied, there is a clear possibility that their use may lead a reduction of health care services with no improvement in clinical, humanistic, or economic outcomes. Demand management effectiveness has not been rigorously examined by the medical industry or academia. Before adopting or purchasing demand management technologies, health care systems should examine them carefully to determine how the tools were developed and who they were intended to serve. Once implemented, careful tracking of population outcomes is as necessary with these technologies as with any other technologies that can affect health care.     

Nurse executive and staff nurse perceptions of the effects of reorganization in Veterans Health Administration hospitals

OBJECTIVE: To examine nurse executive perceptions of effects of service line reorganization on nurse executive roles, nursing staff and patient care, and compare nurse executive responses to staff nurse reports of job satisfaction and quality of care in the same types of Veterans Health Administration facilities. BACKGROUND: Although a growing body of research focuses on the association between nurse staffing structures, nurse satisfaction, and patient outcomes, relatively little attention has been paid to the effects of hospital restructuring on nursing management and nursing staff. METHODS: Data on hospital and nursing service organization and nurse executive perceptions were collected through structured interviews with 125 nurse executives conducted from December 2002 through May 2003. Staff nurse data were derived from a survey of Veterans Health Administration nursing staff conducted from February through June 2003 at the same facilities. RESULTS: Nurse executives in Veterans Health Administration described significant changes in the nurse executive role, and new challenges for managing nursing practice and achieving consistent quality of nursing care. Although nursing management perceived differences in the overall effects of restructuring on nursing staff depending on the type of reorganization, staff nurses reported significant differences in perceived quality of patient care across organization types.     

A model to facilitate interactive planning

The IPEM has helped stakeholders in a very complex tertiary medical center to understand the importance of interactive planning. The need to do so was highlighted by nursing demand and shortage issues. Deliberate efforts to refine and to restructure patient care within a hospital necessitates multidisciplinary planning and problem solving, collaborative nurse/physician relationships, and sound recruitment/retention policies. The experience at one hospital shows how nurse executives can take ownership of issues that help to reduce nursing supply and demand problems. Restructuring of patient care is one method of addressing demand; supply can be addressed locally by collaborative relationships with schools of nursing to increase students' access to education. Enhancing professional nursing practice is the responsibility of nursing service executives as well as educators. Yet, ultimately, it is the hospital's professional environment and reward system that influences nurses' choice of practice setting.     

Contract management. Filling the void created by CNE vacancies.

Contract management can provide interim chief nurse executives (CNEs) during the search process for a permanent executive. Experienced and effective, interim nursing executives can communicate to all audiences, prepare the organization for the next permanent nursing executive, and their presence avoids problems that arise during a long recruitment period. Typically, interim nursing executives find that working through contract management is a rewarding and challenging experience.     

Preparing nurses to use microcomputers for the work of management

Communications and information systems are expanding rapidly in health care organizations today. That nurses must not only be computer literate but also consumers of information technologies emerges as a professional imperative. This is especially true for nurses in management and administration. Therefore, exposing them to current technologies becomes crucial in their academic experience. Educating students to use business software applications and to understand their output will yield a leading edge to those preparing for management decision-making.     

Planning alternative delivery systems. An organizational assessment

The tendency to react to circumstance rather than to initiate on its own agenda has been a prevalent response of the nursing profession, in particular, and the health care industry, in general. With retrospective reimbursement, hospitals were reimbursed for what they spent, one of the factors that fostered a reactive mode of analysis and management. With the advent of the prospective reimbursement system--a system that implies the need for forecasting--the mandate for nurse executives to take a proactive stance in managing their product line is clear. The resulting economically constrained environment has challenged nurse executives to devise strategies for efficient patient care delivery without sacrificing commitment to quality. These strategies must be planned to respond to the current changing environment and adapted to meet future changes.     

Case management: a bottom-line care delivery model. Part 1: The concept

Nurse executives have been challenged to "reinvent" hospital-based nursing through alternative care delivery models. These models also help eliminate a major barrier to quality: the lack of understanding and ability to control the care delivery process. The authors discuss a collaborative and multidisciplinary case management model which promises to positively affect the institution's total bottom-line patient, staff, and system, including financial, outcomes.