The System of Care

1. The System of Care CareTouch

2. Facility Ambassador LTC Ludi MSG Hester Care Teams Leader CPT Thompson SSG Lee “Optimizing Performance” Leader LTC Gerepka Peer Feedback Leader Nancy Ortiz “Creating a Foundation” Leader Lynnette Munoz SSG Smith Design Team • Care Teams • Peer Feedback • Core Values • Shared Governance • Optimized Performance • Skill Building

3. Facility Roll-Out • Everyone matters! • Wave 1-02 May 2011 • ED, QCC, ICU, 9E, 7E • Wave 2-30 May 2011 • LDRP, OR, PACU/SDS, 11Psych • Wave 3-27 June 2011 • WBAMC clinics, SFMC, SFCC

4. DRAFT as of 31 Mar 2011 Peer Feedback Standardized Documentation Care Teams Talent Management Enhanced Communication Skill Building Core Values Leader Development Patient Advocacy Capability Building Optimized Performance Healthy Work Environments Evidence- Based Centers for Nursing Science and Clinical Inquiry Shared Accountability

5. Core Values • Places our patients at the center of care; guides our daily nursing practice and our interactions with our patients, their families, and our colleagues • Nursing Creed posted in all units • Celebrations • Facility Wide: ANSOC-Hop Friday 06 May 2011 • Unit Dedications by UPCs

6. Shared Accountability • Gives nursing team members a voice in their practice and the innovation of that practice through elected nursing practice councils at unit, facility, region, and ANC levels • 100% elected representatives • 20% of staff to serve on UPCs • Meets at regular, protected, paid meeting times • Meetings will be 1-2 hours once or twice weekly during implementation process, but decrease to 1-2 hours monthly. • DMRSi codes: • FALB-For classroom learning off unit/ward • WorkCenter Task-.03 for staff implementation on the unit and committee time

7. Optimized Performance • Includes the consistent collection and reporting of cascading metrics that track quality outcomes, business practices, satisfaction of the nursing team, and patient satisfaction with their care • Ten matrix will be followed and entered into a dashboard database • Tracking and reporting data at the unit level, creating ownership over performance • 1-2 nurses elected on UPC will collect and report data to ensure consistency • Ten Matrix include: • Falls Rate • Falls rate with injury • Absentee rates • Total nursing care hours per patient day • Nursing satisfaction, practice environment, and intent to leave • Patient perception of nursing care • Voluntary Turnover • Pain reassessment rate • Medication administration errors and rate • Medication administration errors resulting in harm and rate

8. Care Teams • Consists of a Lead RN that directs nursing care and a supporting nursing team that cares for a patient throughout the length of stay, increasing consistency of care and enhancing communication • Lead RNs to oversee care • Design will be unit specific • Expect re-alignment of scope of practice for LPNs • Enhanced Communication Tools: • Collaborative, multi-disciplinary rounds • Hourly nursing rounds • Bedside huddles • Safety Huddles • Patient whiteboards • Established forms of communication (e.g., SBAR, TeamSTEPPs)

9. Peer Feedback • Allows licensed nursing team members to reflect on their practice and develop professionally through feedback from colleagues on strengths and opportunities for growth • All licensed members of the nursing team RNs and LPNs provide and receive feedback • RNs to RNs and LPNs to LPNs • Anonymous reviews are conducted at least quarterly using the ANA scope and Standards of Nursing Practice • Should be informative and primarily used as a tool for self reflection • Only used on evaluations after validated • Pending electronic version to ease implementation

10. Skill Building • Provides consistent, relevant opportunities for nursing team members to refresh their knowledge and patient care abilities • Skill building leader on each UPC • Provide regular, relevant skill building sessions to include at least 1-2 in-services, and provider talks per month • Nursing Grand Rounds

11. Prep the battlefield “Go live” Refine & sustain 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Activity Week Responsible Party Facility-level roll-out ANSOC introduction Creating a Foundation Leader Core Values celebration/reflection Creating a Foundation Leader Shared Gov/facility roll-out design Creating a Foundation Leader Optimized Performance baselining Optimizing Perf. Leader Unit-level implementation Wave 1 • 02 May Core Values celebration Creating a Foundation Leader • 30 May Shared Governance (UPCs) Creating a Foundation Leader • 13 June Optimized Performance Optimizing Perf. Leader • 25 July Care Teams Care Teams Leader • 08 Aug Peer Feedback Peer Feedback Leader • 22 Aug Skill Building Optimizing Perf. Leader Wave 2 • 30 May Core Values celebration Creating a Foundation Leader • 27 June Shared Governance (UPCs) Creating a Foundation Leader • 11 July Optimized Performance Optimizing Perf. Leader • 22 Aug Care Teams Care Teams Leader • 06 Sept Peer Feedback Peer Feedback Leader • 19 Sept Skill Building Optimizing Perf. Leader Wave 3 • 27 June Core Values celebration Creating a Foundation Leader • 25 July Shared Governance (UPCs) Creating a Foundation Leader • 08 Aug Optimized Performance Optimizing Perf. Leader • 19 Sept Care Teams Care Teams Leader • 03 Oct Peer Feedback Peer Feedback Leader • 17 Oct Skill Building Optimizing Perf. Leader