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AORN

CORE Award

Application Template

Introduction

Congratulations on choosing to apply for the CORE Award!Like many other perioperative services departments,you are on a journey to distinguish yourselves by improving every facet of patient care.This applicationtemplate, along with the CORE Award Program Handbook and other resources available at,will support you in completing the CORE Award application process.

Instructions for Use

Before using this template, it is recommended that you read and familiarize yourselves with the CORE Award Handbook.It contains detailed information about the CORE Award and application process.Whether you are applying for designation or redesignation the application and submission process is the same.

Afteryou are prepared to write your application, you will use this form to write your CORE Award Application.Please be sure to follow these instructions:

  • For your application submission, you will need to download and save this CORE Award Application Template.You will enter your responses in the appropriate “Response” box under each criteria question. After you have completed it, you will upload your saved document during the online submission process.
  • Pay special attention to font size and length restrictions:
  • The minimum font for the application is 10. The template is formatted for this font size.
  • Including the pages of the application template, the maximum length is 50 pages. If the application exceeds 50 pages, only the first 50 pages will be reviewed.
  • Ensure all graphics, particularly in the Outcome Measurement section, are appropriately labeled.
  • Avoid using acronyms and abbreviations. They can have more than one meaning, which detracts from an application's clarity. If it is essential to use an abbreviation or acronym, it must be spelled out the first time it is used.
  • Do not include patient- or employee-specific information. If confidential information is included in the application, all identifying details must be removed.

When your application has been written and proofread, you are ready to begin the online submission process.Click “Application Process” on the CORE Award home page (). Then click “Online Submission Process,” and log in with your member or customer ID number. The person who logs in and submits the application will become the primary contact associated with the application.

Afteryou log in, you will be guided through a series of steps to submit your application and payment.If you have additional questions about the CORE Award or the Application Template, please contact us at .

Unit Profile

The Unit Profile describes the framework within which your perioperative services functions. The Unit Profile should identify the key characteristics of your perioperative services,including the environment of care and relationships with other departments, patients, families, and stakeholders. Information from the Unit Profile helps reviewers better understand the composition and structure of your perioperative servicesand facility. You do not need to include detailed information about your processes or outcomes in the Unit Profile. You will have an opportunity to provide that information when answering the criteria questions in categories 1-6. The Unit Profile is not scored.

Criteria Questions
1 / Describe the facility designation in which perioperative services functions.
Notes: The facility designation describes the overall structure within which perioperative services functions (eg, teaching, nonteaching, trauma designation, rural, urban, critical access, government)The focus is on the inpatient perioperative services.
Response
2 / If part of a multi-organizational system, describe the structure of the system, including the number of facilities.
Notes:A multi-organizational system describes the organizational structure of multiple facilities in one organization creating a complex health system.Each site must qualify individually for the award.
Response
3 / What surgical services are excluded within the facility(eg, transplants)?
Notes:The scope of surgical service is the surgical classification of the scheduled procedures as defined by the surgeon’s area of expertise or health care organization’s medical by-laws.
Response
4 / How does perioperative services contribute to the mission, valuesand vision of its hospital/system?
Notes: Each unit in the hospital contributes to the hospital’s overall mission and vision. Articulate perioperative services role in achieving that mission, value,and vision.
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5 / What are the major cultural populations cared for by perioperative services? How does perioperative services meet the cultural/spiritual needs of the patient and family for each major group?
Notes:Describe the demographics of the patient population including major diagnoses and procedures, age and cultural or ethnic groups.
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6 / How many ORs are there in the surgical suites (by site if appropriate)?
Notes:Describe the number of rooms within perioperative services in which operative or other invasive procedures are performed. Include any specialty rooms (eg, cystoscopy rooms, endovascular suites).
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7 / How many cases are performed per year?
Notes: Describe the number of individual patients having surgery or a procedure performed each year. Multiple procedures performed on one patient at the same time are counted as one case.
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8 / Describe the multi-professional staff members that provide hands-on patient care within perioperative services. Include the number and type of nurses, surgical technicians, RN first assistants, ancillary assistants/transport, advanced practice nurses in the OR, physicians, anesthesia providers, pharmacists, and so on. Include education levels, skill mix, and bargaining units. (See leadership section for managers, leaders in the Handbook).
Notes:Skill mix describes how many of each type of care provider is generally available for each patient care shift. Identify the titles and roles of each type of provider (eg, unlicensed assistive personnel, RN). If staff includes unionized workers, identify the union and its effecton the nursing structure.
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9 / How many perioperative services staff members are members of AORN?
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10 / Describe other key stakeholders who collaborate with the perioperative services team to provide services/consultation to the patient.
Notes: Other key stakeholders could include social workers and representatives from the pathology, laboratory, radiology, biomedical engineering, purchasing, or respiratory therapy departments, as well as others.
Response
11 / Describe the perioperative services structure (eg, councils, leadership team, shared governance). How do leadership relationships and accountabilities for perioperative operations function between surgeons and the anesthesia, nursing, administration, and central processing teams?
Notes: Describe how physicians, nursing administrators, and central processing department members think and feel about perioperative services. Example of key factors include physician, nursing administration, and central processing involvement; communication from administration; quality of nursing care; medical staff governance; and other specific organizational issues. The governance structure should describe how decision-affecting operations are made within perioperative services. Two examples are top-down leadership and unit-based councils.
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12 / Describe the key challenges for perioperative services. How are these challenges addressed to ensure optimal patient care?
Notes: Challenges might related to technology, people, or other resources or regulatory requirements.
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13 / How does perioperative services access organizational resources? How does it remove organizational barriers?
Notes: Organizational resources should include resources needed to provide optimal patient care. They could include personnel, equipment, or financial support. Organizational barriers should include system-related processes and policies that affectefficient and timely delivery of patient care and affect patient care outcomes. Barriers may include inadequate personnel, barriers within the physical environment, ineffective decision-making structures or lack of equipment.
Response

Category 1: Leadership Structures and Systems—150 Points

Perioperative leaders are integral to ensuring a healthy work environment that focuses on the delivery of the best care for patients and families. In perioperative services, the best care may be reflected in a commitment to systematically develop and train nurse leaders; ensure accountability; advocate and participate in decision making; and provide meaningful recognition to staff. Creating a sustainable healthy work environment can improve the care delivery environment, thereby improving clinical outcomes, patient and family satisfaction, and staff member satisfaction and retention.

The criteria questions in this category are aimed at soliciting information about how your perioperative leaders support and maintain a healthy work environment. For each question, reviewers will evaluate the comprehensiveness of your approach; application and integration across staff and key stakeholders; and evidence of continued evaluation, shared learning, and process improvement.

Criteria Questions
1 / Who are the perioperative leaders in your facility and describe the structure. How are the perioperative leaders educationally prepared, trained and supported to meet the responsibilities of their jobs? How are they held accountable by the team including surgeons and anesthesia providers?
Notes:A perioperative leader is anyone who has daily responsibility for departmental function and may include managers, supervisors, charge nurses, educators or directors. They may be held accountable through formal processes such as peer review, performance evaluation, and/or performance against measurements and goals. They may also be held accountable through formal or informal feedback mechanisms or surveys. Attach organization chart.
Response
2 / How do the perioperative leaders guarantee joint accountability between medical, nursing and other key leaders?
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3 / How do the perioperative leaders interact with staff through a shared governance model to build relationships, provide timely feedback and ensure patient-centered care? How do they encourage/ensure frank, two-way communication throughout perioperative services? How do they communicate key hospital decisions and information to staff?
Notes:Include frequency of interactions and models of communication, both formal and informal. Also include accountability structures and daily supervision. One example would be a Perioperative Executive Committee which would include all key nursing and medical staff stakeholder representatives.
Response
4 / How do the perioperative leaders hold staff members accountable for practicing within their individual scope of practice? How do they evaluate staff member professional practice and promote evidence based and professional development?
Notes: Scope of practice defines the boundaries/limits of practice for individual care providers (ie, the ability to do a particular activity based on education, license or training). Professional practice is defined by the standards of practice and standards of care set by the profession and provides a framework for evaluating how a particular group meets the expected outcomes.
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5 / Describe the structure of the professional development program and how it is evaluated.
Notes: The professional development program evaluation may include use of surveys, evidence of staff mentorship and subsequent promotions, and others. Reward programs may include opportunities for advancement, salary considerations for certification programs, career ladders, and succession planning.
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6 / How is professional development recognized? What active role does the perioperative leaders take in recognizing professional development?
Notes: Professional staff members can be recognized through understanding what the staff members believe is important to them, which may include a self-governance model with the ability to have direct input into schedules, time off, and career ladders. Other considerations for recognition include membership and active engagement in professional associations, participation in academic programs to enhance knowledge, and certification programs.
Response
7 / How is the culture of safety evaluated? How is this information usedto make improvements to the culture of safety within perioperative services?
Notes: Culture of safety can be evaluated through the use of a tool such as a valid culture of safety attitude questionnaire (eg, AHRQ).
Response
8 / How do the perioperative leaders empower the nursing staff to participate in evaluation/selection of equipment/supplies?
Notes: Demonstrate evidence the institution is providing nurse sensitive value based purchasing through balancing costs with quality in the decision making process. Demonstrate evidence of efforts towards standardization to support quality outcomes through reduction in variability.
Response
9 / How is physician satisfaction monitored within perioperative services? What are the key factors that affect physician satisfaction? How are they physician satisfaction scores communicated and how are the scores used to make improvements within perioperative services?
Notes: Describe how physicians think and feel about perioperative services. Example of key factors include physician involvement in decision making and purchasing of technology, communication from administration, quality of nursing care, medical staff governance and other specific organizational issues.
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10 / How is patient/family satisfaction monitored within perioperative services? What are the key factors that affect patient/family satisfaction? How are the patient/family satisfaction scores communicated and how are the scores used to make improvements within perioperative services?
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11 / Describe the programs or actions implemented to address patient safety risk areas.
Notes: Responses may include performance improvement programs and patient safety programs (eg, falls, use of pneumatic tourniquets, workforce fatigue, aspiration).
Response

Category 2: Appropriate Staffing and Staff Engagement—100 Points

Appropriate staffing is key to ensuring the provision of safe, quality, patient-centered care; it also ensures the safety, satisfaction and retention of competent staff. Although staffing can be complex, ensuring an effective staffing plan can positively affect the measurable outcomes on the unit.

The criteria questions in this category are aimed at soliciting information about how perioperative servicesengages, manages and develops staff. For each question, reviewers will evaluate the comprehensiveness of your approach; application and integration across staff and key stakeholders; and evidence of continued evaluation, shared learning and process improvement.

Criteria Questions
1 / Describe the levels of education and certification held by each perioperative services staff member by percentages (eg, AD, BSN, MSN, CNOR, CST).
Notes:The IOM report on nursing education recommendations include: “Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.” “Increase the proportion of nurses with baccalaureate degree to 80% and double the number of nurses with a doctorate by 2020.”
Response
2 / How are staffing needs determined for perioperative services including required skills, competencies, staffing levels and skill mix (RN vs ST)? How does your perioperative services account for seasonal variances? What key measures does perioperative services use to evaluate the effectiveness of staffing decisions? How do these measures assess staffing and adjust to changing staffing needs after a plan is established? What creative ways do you use to staff based on patient acuity in the OR?
Notes: Describe the staffing plan for your patient population including skill mix and the use of equipment specialists, biomedical technicians, NP, CRNFA, CCS,and similar staff members assigned to perioperative services.You may use skill mix in perioperative units per National Database for Nursing Quality Indicators (NDNQI) to describe skill mix.
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3 / Describe how you useadvance practice RNs.
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4 / Do you have specialty teams? If yes, how is staffing determined between specialty teams? Between skill mixes?
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5 / How is the staff mix in perioperative services managed to ensure an effective match between patient needs and nurse competencies? How is the role and related skill competencies of the care team aligned with the specific clinical, spiritual and cultural needs of patients?
Notes: Describe what processes are in place to ensure an effective match between patient needs and nurse competencies, including formal and informal acuity-based systems, technical equipment needs, creative staffing plans, call-converted to work, overtime, hospital time off.
Response
6 / How does perioperative services recruit, hire, place and retain new staff? How do staff nurses and other key stakeholders participate in staffing decisions, including planning, hiring, orientation, education, and evaluation?
Notes:Examples of staff participation in staffing decisions might include peer reviews, preceptor or mentor programs, group interviews or nurse shadowing.
Response
7 / How does perioperative services maintain a safe, secure and supportive work environment? What are the key measures and results for staff safety?
Notes:Measurements of staff safety might include employee health services reports, employee incident reports and the subsequent education, teaching, and corrective action plans involved to make perioperative services area a safer place to work.
Response
8 / What formal and/or informal methods are used to determine staff satisfaction? What are the measures and results for staff satisfaction within perioperative services?How do perioperative services results compare with perioperative services goals and other appropriate comparisons?
Notes:Methods to determine staff satisfaction could include formal surveys, absenteeism rates, turnover, list of applicants waiting to transfer to the unit, or informal feedback. Describe the level of satisfaction that employees within perioperative services have thatindicates their level of engagement within the work environment.Comparisons might include other units, overall facility, regulatory requirements, external benchmarks, employee satisfaction committee and theunit’s mission.
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9 / What are the key factors that affect staff satisfaction? How are the staff satisfaction scores communicated and how are the scores used to make improvements within perioperative services?
Notes:Examples of key factors include treating employees with respect, employee recognition, empowering employees, benefits and compensation, and positive leadership. Attach the most recent employee survey scores for perioperative servicesin the Outcome Measurement section.
Response

Category 3: Effective Communication—50 Points