Organizational Strategic Plan Part 1

ORGANIZATIONAL STRATEGIC PLAN PART 1

Tamara Putney

Jessica Rochefort

Terri Sand

Jennifer Sarns

Jennifer Stewart

Ferris State University

Abstract

The healthcare system in the United States is changing rapidly, mainly due to the economy and technology advancement. Bedside nurses feel the impact of these changes in the form of workflow inefficiencies. This can have a negative result on patient outcomes as evidenced by pressure ulcers, falls, and hospital acquired infections (Delucia, Ott, & Palmieri, 2009). A clinical support system called Nursing Organizational Support (NOS) is needed in hospitals to help prevent negative occurrences that take place due to increasing demands faced by nurses. The vision of NOS is to increase workflow efficiency and free the bedside nurse from most non-nursing and inefficient tasks. This department will be implemented in a small 350 bed rural Michigan hospital. NOS will work directly with nurses and information systems to promote workflow efficiency as well as support clinical questions with regard to system process. Implementation of the NOS department in the hospital will promote safety, increase the effectiveness of the workforce and generate revenue otherwise missed due to unfavorable patient outcomes.

Keywords: Nursing, clinical support, workflow, effective beside care, promote patient outcomes

Organizational Strategic Plan Part 1

The project presented was developed by a group of nurses with various nursing clinical experiences. These nurses are students of Ferris State University. In order to satisfy an assignment in their Nursing Leadership class, and familiarize themselves with the workings of an organization, they have created an Organizational Strategic Plan (OSP) project. The project is aimed toward assisting the delivery of healthcare within a hospital setting. As the world evolves, so does our healthcare environment. The evidence can be seen in every sector of society and within every class of people. How people interact with their environment is critical to everyday coping and success in life. Disruptions in the surrounding environment can have cascading effects. Nationally and locally, today’s environment is fraught with crisis in many forms. The bedside nurse is not immune. Disruptions in the healthcare environment can affect both care deliver and the patient receiving the care.

The current economic climate and condition of the healthcare system is demanding change. The major change in regard to healthcare is coming in the form of initiatives to increase patient outcomes and decrease cost of care delivered. There are many avenues being pursued to ensure these demands are met. Many avenues involve hospitals and bedside nurses.

The evolution of our healthcare environment and technology has been proven to have a direct impact on bedside nursing care. Direct correlations have been made between patient outcomes and quality of nursing care (Delucia, OttPalmieri, 2009). Occurrences of nursing sensitive quality indicators (NSQI) such as pressure ulcers, falls, medication errors, and hospital-acquired infections can be correlated to quality of nursing care (2009). There have been several tedious studies conducted to determine percentages of time spent by nurses in different categories of care delivery, such as direct, non-direct and non-nursing care. Studies from 1998-2009 reveal the percentage of time the RN is directly at the bedside is anywhere from 26-37% during a shift (2009). A 2009 review of literature by Delucia, Ott and Palmieri, shows indirect care (tasks such as charting, retrieving and setting up medications, or coordinating care) can account for 39-48% of a nurses time, while anywhere from 5-25% of a typical 8hour shift can be spent performing non nursing tasks such as answering phones, walking, gathering supplies, or searching for people to assist with tasks or technology. Non-nursing task percentages can vary widely and are very dependent upon factors such as experience, unit and institutional system design, and workflow efficiencies (2009). Studies show that direct bedside patient care time can have drastic impacts on patient outcomes (Agency for Healthcare Research and Quality [AHRQ], 2009). Nurses spending time on non-nursing tasks or indirect care tasks is directly linked to such things as low job satisfaction, burnout, and frustration; all of which can have a direct effect on the quality of care delivered (Hendren, 2010). Again, quality of care has a direct link to patient outcomes, which has a direct link to profits seen by health care institutions.

Today, more than ever, advancing technology plays a large role in nursing workflow efficiency. As more tools of the trade are introduced in an attempt to increase quality and ensure documentation of healthcare services, nurses are feeling the impact (AHRQ, 2009). One thing is for sure, nurses need to stay at the bedside as much as possible and care for the patient. The mix of new technology and process changes to accommodate systems or reimbursement requirements is placing more responsibility on the bedside nurse.

This evidence supports the need for a clinical support system for the bedside, direct care nurse. Development of this support system will include the creation of a new hospital department called Nursing Organizational Support (NOS). The focus of NOS is to support and improve clinical efficiency of the bedside clinical nurse. The vision for this department is to increase workflow efficiency and free the bedside nurse from most time consuming non-nursing or inefficient tasks. This will be achieved by empowering the nurse with increased knowledge, more efficient workflow, and the utilization of nursing participation in process redesign. NOS will work directly with nurses and information systems and also provide immediate, in hospital support, to answer clinical questions with regard to system process utilizing during a nurses shift. This in turn will increase hospital profits and promote optimal outcomes because nurses can focus on delivering safe, efficient quality care, with every patient, every time. The care the nurse delivers at the bedside is critical and has an enormous impact on all hospital processes, as well as the financial bottom line.

This organizational strategic plan will present focused internal and external assessments of the current environment, provide a mission statement and philosophy, as well as lay out goals, and objectives, describe structure, outline job descriptions, define hiring strategies and a budget plan. This department will be implemented in a general hospital with a maximum bed capacity of 350 patients.

External Environment Assessment

Today’s economic climate is being directly impacted by personal health status and healthcare. Nationwide, many factors are impacting our environment and changing the face of health care. Health care costs in all arenas are spiraling, the national debt is rising, and the government healthcare fund is dwindling. More people are enrolling in Medicare due to longer life spans, Medicaid enrollees are increasing due to changes in eligibility and more chronic health conditions exist which demands more care (Kaiser Commission, 2011). Nationwide, health care delivery and payment structures are changing. Many organizations are now directing the control of healthcare and demanding higher quality, more efficient care outcomes, as well as a better patient experience. Quality and efficiency are now being stressed. Organizations like The Joint Commission, and The Centers for Medicare and Medicaid Services (CMS) are setting mandatory safety and quality goals, measures and outcomes that care delivery organizations must meet in order to receive payments for services and accreditation (Quality Net, 2012). Government Health Care Reform, the HITECH Act and the Affordable Care Act are also having major impacts on the environment by mandating such things as the implementation and use of electronic health records for ordering, documenting and reporting care delivered (Federal Register, 2010). Goals are to reduce cost, increase quality and increase access for all health care consumers. The hope is that by demanding more responsible and quality care that the hospital experience will improve for the patient, the cost of healthcare will decrease, preventative care access will increase, populations will get more healthy, less chronic disease will exist which will trend toward healthy, engaged communities. This, in turn, could result in positive effects on the economy and increase opportunity for all citizens in many communities.

Current trends being seen in hospitals are a rapid change in the demand for services, as well as organizational mergers and acquisitions in order to economically survive (Yoder-Wise, 2011). Volumes in patient admits are changing, some traditional inpatient procedures are now being done on an outpatient basis, mandates such as pay for performance measures are impacting Medicaid and Medicare reimbursements. General hospitals are also being forced to implement millions of dollars worth of electronic equipment. The trend nationwide is pushing quality of care to extend cost savings to the everyday health care consumer. Hospitals are being forced to go from getting money for services rendered in the here and now, focusing on that patient, to a performance and value based payment system where the continuum of care matters and the community becomes the focus. Better, higher quality care institutions will receive more money.

Nationwide, nursing care trends indicate that patients are sicker and have longer lengths of stay, as well as new and rapidly changing technology tools are being implemented with insufficient support and clinical maintenance, and some of the systems are not end user friendly. There are many technical jobs that have been developed over recent years to help this dilemma; such as hospital information technicians, biomedical information technicians, health information technician, and registered health information technician. But these technicians are not usually on the hospital unit floor. The hospitals allow a short period to teach these systems to their personal and often assign ‘super users’ or sometimes called ‘operations teams’ (Carpenter, 2012). Unfortunately, most super user support models fail because these individuals must also take patient loads, leaving little time to assist other users.

Nurses are being asked to do more with less and many hospitals are even demanding advanced degrees. The overall trend for nursing means the profession will need to refine the care delivered. The care will need to become safer and of higher quality than ever before, and it will need to be done more efficiently.

An external assessment does not reveal a department like this that combines the roles of ensuring quality and supporting clinical bedside workflow. Many other departments exist such as support services for clinical areas like cancer care, nutrition, medications, and a variety of other support systems, but they are mainly centered around the patient and usually do not interact directly with the patient, rather they dictate the care the nurse will deliver. There are also very isolated and specialized support structures such as technical support and staff education departments. None of which can offer any clinical help, support or consistent ongoing input and knowledge to the bedside nurse.

Opportunities for success are many, both for the organization as a whole and the advancement of the nursing profession. Nursing and healthcare organizations have an amazing opportunity to not only impact their local and national environment, but global health and economics could be impacted as well.

The major threat to healthcare organizations overall, and to a department like this, is bankruptcy from the inability to keep up with the challenging healthcare restructuring demands. Millions of dollars will need to be spent to comply with all standards to promote quality and optimal outcomes and avoid fines.

Internal Environmental Assessment

The healthcare organization chosen to implement this new department is a small 350 bed rural northern Michigan hospital. This hospital is on the forefront of innovation and leads the area in many specialties of care. Many computer implementations have already taken place, but the environment lacks ongoing clinical support for staff using the systems implemented to document and deliver bedside care. The interactions between ancillary, technical and technology staff and nursing is very reactive instead of proactive. The atmosphere is one where processes are not normally changed or evaluated unless some type of problem arises. The overall moral as reported by many bedside nurses is that of frustration for being asked to do more with less. Informal surveys have revealed many nurses are unaware of most quality mandates, and they do not entirely understand the Medicare or Medicaid reimbursement structure.

This institution is in the thralls of implementing many systems and new processes back to back over the next five years to comply with Meaningful Use, CMS, and The Joint Commission mandates. The preceding assessment of the external environment directly affects the internal structure and function of this institution. There are many departments that manually monitor and data mine information and documentation in an attempt to comply with quality measures. If measures are missed, rarely is feedback given to the bedside nurse directly responsible for the care, nor is the process routinely and rapidly assessed and changed to ensure quality care and documentation for the future.

The major strength of this hospital organization is that ensuring quality is directly inline with the stated mission, vision and philosophy. This organization appears to be very fiscally responsible and engaged in doing what it takes to ensure quality of care and optimal patient outcomes. Administration is completely committed to working with staff and listening to all new ideas. The organization can support this endeavor. This new department could potentially eliminate existing FTE’s, increase the talent of the workforce and ensure quality and core measures are met every time, with every patient. The strengths of this department are that it has the potential to save millions of dollars every year.

Weaknesses noted are the uncertain and fluctuating economy, both local and national. While financial resources are a strength, they are also considered a weakness. Any given quarter could prove to be stressful on the budget. Budgets and available financial resources fluctuate with the environment and economy.

Feasibility and viability of this department is directly linked to improvement of patient outcomes and cost savings generated. Return on investment will be shown in metric comparisons in such areas as fall prevention, decrease in pressures ulcers occurrences, fewer medication errors, and an increase in staff moral and job performance. All of these indicators equate to millions of dollars.

Overall, the main threats to the development of this department are funding, staffing and resource allocation from Information systems, as well as the ability to recruit the very specialized nurses needed to staff this unique department.

Healthcare is ever changing and demands for a higher quality of care are increasing with time. However, patients suffer negative outcomes as an effect on growing requirements for nurses giving direct bedside care. Requirements for expanding technology including electronic charting and non-clinical duties such as answering phones and gathering supplies all decrease patient-to-nurse interaction time as well as decreasing job satisfaction and burnout; both of which can result in negative patient outcomes (Hendren, 2010). By implementing the NOS department in a small northern Michigan hospital negative patient outcomes will decrease. Additionally, the hospital will save money by providing quality patient care and decreasing expenses that result from hospital acquired infections and falls and unmet regulations.

Mission Statement

The mission statement of the Nursing Organizational Support (NOS) department is intended to provide nurses with support for nursing clinical practice and technology. The NOS department will assist in the provision of efficient nursing care, patient safety, and the promotion of cost containment in healthcare. It is the goal of the NOS to improve patient care quality, satisfy regulatory requirements, and promote optimal patient outcomes for healthcare reimbursements.

Philosophy

A philosophy of an organization “expresses the values and beliefs that members of the organization hold about the nature of their work, about the people to whom they provide service, and about themselves and others providing the services” (Yoder-wise, 2011, p. 138). The philosophy of this department is based on the American Nurses Association code of ethics. These values are integrated in the beliefs of the Nursing Organizational Support (NOS) team.

We believe clinical practice support for nurses will enhance the quality of care for patients.
We believe that nursing staff support will positively contribute to the nursing process, core and quality measures, and the effects of healthcare reform in the future.
We believe that a nursing support unit will promote quality assurance for patient care and contribute to optimal patient outcomes.
We believe that the NOS will contribute to the efficiency of direct patient care nursing and enhance the delivery of high quality, cost effective, and competent care.
We believe that the NOS will contribute to the empowerment of nursing autonomy and efficiency.
We believe that providing support for nursing staff will promote a clinical care setting which will deliver a positive patient experience, provide respect for patient dignity, and rights.
We believe that implementing a nursing clinical support department will make a direct impact on the local and national economy.

Organizational Goals