nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 1 Accelerating NICHE through Systemness Purpose Objectives

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1 Accelerating NICHE through Systemness The Influence of a HealthSystem Steering Committee on NICHE Implementation Presenter: Karen Mack, MS, MBA, CCNS, ACNPC, CHFN 1 Purpose The purpose of this activity is for the learner to: Recognize the value of a HealthSystem Steering Committee in implementing NICHE, including the required resources, planning, and activities; and Evaluate the benefits and fit of this type of governance for his/her system. 2 Objectives The learner will: Describe the structure and resources required to develop a system-level NICHE Steering Committee; Define processes utilized in a system-level NICHE Steering Committee; and Identify outcomes derived from implementation of a system-level NICHE Steering Committee. 3 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 1

2 Introduction: MedStar Health A distributed care delivery network in central Maryland and Washington, DC Region MedStar associates: 30,000 including 8,400 nurses 10 Hospitals MedStar Visiting Nurse Associations of DC & MD Large Ambulatory Network 4 NICHE initiated in 2010 at MedStar Washington Hospital Center. Remaining 9 hospitals designated in NICHE is a MedStar Nursing Signature Program under the leadership of Dr. Maureen McCausland, MedStar Senior Vice President and Chief Nursing Officer NICHE and MedStar 5 Top 10 NICHE HealthSystems* Health System Rank NICHE Hospitals CHI Health Nebraska 1 16 Baylor Scott & White Health 2 10 MedStar Health 2 10 ProMedica 2 10 OSF HealthCare 4 9 University Hospitals Health System 4 9 Cape Breton District Health Authority 6 8 Aurora Health Care 7 7 Bon Secours Virginia Health System 7 7 NYC Health and Hospitals Corporation 7 7 *As of January 27, nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 2

3 Systemness MedStar Health as a whole is much stronger than the sum of its parts. The advantages of being a system are significant, and we must leverage those advantages to full effect each and every day if we are to accomplish our vision. Our challenge is to look at all areas of our organization, find ways we can streamline and replicate successful processes, share knowledge and best practices, and more effectively align all aspects of our system. (MedStar Health, n.d.) 7 Problem How can systemness accelerate implementation of NICHE? 8 Structure: Methods Establish a MedStar NICHE Steering Committee (MNSC) comprised of NICHE Coordinators at each hospital Create a committee charter. Develop and implement a 2-year action plan with goals, objectives and outcomes. Hold quarterly meetings. Utilize a SharePoint MedStar NICHE intranet website for committee information sharing. 9 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 3

4 Structure: MedStar NICHE Steering Committee Mission To develop a system-wide approach to planning, implementing, and evaluating the MedStar NICHE Program. Activities: Design program measures. Implement shared initiatives. Provide mechanisms for knowledge and resource sharing. 10 Structure: MedStar NICHE Steering Committee Development Timeline September 2010: First MedStar Hospital NICHE- Designated November November 2013: Remaining 9 Hospitals NICHE- Designated June 2013: Monthly conference calls began December 2013: SharePoint MedStar NICHE intranet site created September 2014: Committee Chartered & Quarterly On-Site Meetings Initiated January 2016: Onsite Meetings increased to every other month 11 Resources Chief Nursing Officer support NICHE at the system and hospital level. NICHE implementation is an annual operating plan objective. System-level coordinator facilitates MNSC meetings. Conference room availability and catering are provided by MedStar Corporate Nursing. Teleconferencing services allow flexibility. Intranet support services provide resource access. 12 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 4

5 Processes: NICHE Coordinator Education & Roundtable Discussions NICHE hospital committee & Geriatric Resource Nurse (GRN) structure Recognition of GRNs & Geriatric Patient Care Associates (GPCA) and internal marketing Unit quality measures NICHE education requirements NICHE Knowledge Center resources Geriatric care environment improvements NICHE Webinar Utilization 13 Processes: Collaborative Initiatives Geriatric documentation design for assessment, care planning, and data presentation with integration of the SPICES framework (in development). 14 Processes: Collaborative Initiatives January 2016 MedStar Nursing Professional Development Council Conference: Nurses Leading Care for the Older Adult: A MedStar Health NICHE Initiative 15 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 5

6 Outcomes: Geriatric-specific Clinical Data First year of data has been collected for: HAPU Falls HCAHPS Pain Satisfaction Scores 16 Outcomes: Pilot Projects Implemented Mobility Protocol SPICES Implementation 17 Outcomes: Associate Education NICHE Courses Total GRN GPCA Introduction to Gerontology Nursing Care for the Older Adult N/A with Cancer Total Yearly Course Completions nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 6

7 Outcomes: 2014 Professional Practice Development NICHE 2014 Conference Presentations Hospital/Entity Title Type MedStar Georgetown University Hospital MedStar Montgomery Medical Center Impact of the NICHE Curriculum on the Nurses Perceptions of Care for Our Elderly Innovations: Collaboration Engaging the Community in a Community Hospital s NICHE Program Poster Poster MedStar Washington Hospital Center Dementia Communication Skills: An Iowa Model Evidence-Based Practice (EBP) Project Poster 19 Outcomes: 2015 Professional Practice Development NICHE 2015 Conference Presentations Hospital/Entity Title Type MedStar Georgetown University Hospital MedStar Franklin Square Medical Center MedStar Montgomery Medical Center MedStar Corporate Nursing Harmonizing the mood: Music Therapy as an Intervention to Reduce Anxiety and Agitation in Elderly Patients with Dementia Geriatric Standardized Patients: An Essential Strategy in Geriatric Education for Interdisciplinary Teams Poster Podium Delirium as a Medical Emergency: Podium Leading the Community into Action Developing a Gap Analysis Podium Methodology to Guide and Improve NICHE Implementation in a Ten Hospital System 20 Results: September 2014 MedStar Levels of NICHE Implementation* (Start of MNSC) *Includes results of September Annual Program Evaluation submissions Exemplar 1 21 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 7

8 Results: September 2015 MedStar Levels of NICHE Implementation* (Post MNSC Year 1) *Includes results of September Annual Program Evaluation submissions Exemplar 3 22 Discussion What are some lessons learned in the first year of implementation of the MedStar Nursing Steering Committee? Sharing of NICHE implementation stories provides energy, vision, and efficiencies. Time away from the clinical setting to devote to NICHE implementation accelerates progress. The 2-year action plan is a helpful guide. System-level geriatric-specific data collection requires development of a network, time, and resources. 23 Conclusion A system-level NICHE steering committee provides a structure and forum that accelerates care improvement and program implementation strategy adoption. 24 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 8

9 References Boltz, M., Capezuti, E., Fulmer, T., Zwicker, D., & O Meara, A. (Eds.). (2012). Evidence-based geriatric nursing protocols for best practice (4th ed.). New York, NY: Springer. Boltz, M., Capezuti, E., Shuluk, J., Brouwer, J., Carolan, D., Conway, S.,... Galvin, J. E. (2013). Implementation of geriatric acute care best practices: Initial results of the NICHE SITE self-evaluation. Nursing & Health Sciences, 15, doi: /nhs Boltz, M., & Shabbat, N. (2010). Building a framework for a geriatric acute care model. Leadership in Health Services, 23, 4. doi: / Capezuti, E., Boltz, M., Cline, D., Dickson, V. V., Rosenberg, M., Wagner, L.,... Nigolian, C. (2012). Nurses Improving Care for HealthSystem Elders- A model for optimising the geriatric nursing practice environment. Journal of Clinical Nursing, 21, doi: /j x MedStar Health. (n.d.). Achieving greatness at MedStar Health: FY 09- FY11 strategic plan. Columbia, MD: MedStar Health. 25 Karen Mack, MS, MBA, CCNS, ACNPC, CHFN Karen.M.Mack@medstar.net nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 9