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Allegheny General Hospital and SEIU Healthcare PA RNs. APPROACH TO PARTNERING FOR A QUALITY IMPROVEMENT PROCESS. Outline for Discussion. Background on Quality Improvement Structures at Unit and Hospital Level Successful Work Projects Nurse Collaboration Council (NCC) Approach and Outcomes

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allegheny general hospital and seiu healthcare pa rns
Allegheny General Hospital and SEIU Healthcare PA RNs


outline for discussion
Outline for Discussion
  • Background on Quality Improvement Structures at Unit and Hospital Level
  • Successful Work Projects
  • Nurse Collaboration Council (NCC)
  • Approach and Outcomes
  • Collaboration Project – Length of Stay (LOS)
  • Lessons Learned
  • Next Steps


Allegheny General Hospital

  • Level 1 Trauma Center
  • Academic Medical Center
  • Flagship of West Penn Allegheny Health System
  • 1,500 RNs represented by SEIU Healthcare PA

7 years “hospital level” and “unit level” structures in contract

  • Patient Care Committees (PCC)
  • Nurse Collaboration Council (NCC)
patient care committees
Patient Care Committees
  • Unit Level Structure
  • Structure can vary but includes staff RNs and nurse manager and Division Director
  • Monthly meetings for 1 hour on unit
  • Shared Goals for Effective PCC
    • Led by staff RNs
    • Collaboration on agenda with manager and staff RN
    • Communication of process and outcomes
balancing unit and hospital work previous theory
Balancing Unit and Hospital Work:Previous “Theory”
  • Union’s focus was on expanding unit level committees
    • Way to engage nurses and build union—focusing on “RN concerns”
    • Way to “respond to issues”
    • Have “problems” filter up from PCCs to NCC
  • Start with a few successful PCCs and then expand outward
  • Train RNs in a basic “evidenced based approach” around the issues that nurses wanted to address
early results
  • Handful of units with strong and sustainable PCCs
  • Several other units with PCCs that started and then faded
  • Lack of collaboration and sustainability for the PCCs
  • Frustration between Union and Management– Mistrust
examples of pcc work
Examples of PCC work
  • 9A
    • Evidence Based Project on Remote Telemetry Patients
  • Neuro ICU
    • Building a new ICU design
  • 8C
    • Grab n Go Respiratory Bags
nurse collaboration council
Nurse Collaboration Council
  • 7 staff RNs and 7 nurse managers and union staff representatives
  • Monthly Meeting
    • 4 hours (used to be 1 hour before most recent contract)
  • Purpose:

The parties acknowledge and agree that the Nurse Collaboration Council (NCC) shall oversee the work of the PCCs in the following relevant strategic initiatives as described below:

    • 1) Achieving excellence in patient care and service
    • 2) Nursing retention and recruitment
    • 3) Workplace Health and Safety
    • 4) Operational and Quality Initiatives and Patient Flow
    • 5) Professional Education and Training
    • 6) Advancement of the art and science of nursing
    • 7) Pursuing relevant grants or examining important developments in industry standards (e.g. Health Information Technology)
    • 8) Helping achieve organizational goals and directives
balancing unit level and hospital level challenges
Easier to get started and get some results

Easier to innovate pilots

Good way for RNs to see the “action”

Takes time and energy to make sustainable

Need time and energy to share results Across Hospitals

Several “unique” goals make it harder to get “hospital” focus

Solutions may lie at Hospital Level

Balancing Unit Level and Hospital Level: Challenges

Challenges for Unit Level

Arguments for Focus on Unit Level

nursing as strategic partners
Nursing as Strategic Partners
  • Contract Negotiations
    • More explicit discussion of goals and theory
    • Less focus on specific structures or answers but did make some changes (longer meetings, budget time and resources for “sharing” and training)
  • Retreat
    • Continued to share independent and common goals and vision
    • Identified a joint “umbrella” project that both sides have a strong stake in
implementing new strategies for success
Implementing New Strategies for Success
  • Choosing Joint Project for Organizational Success
    • Length of Stay
  • Don’t Rush the Unit Level
    • Develop clearer, collaborative strategy on PCC sustainability
    • Maintain focus on evidenced based nursing and also balance with Hospital level strategic goals
  • Engage RNs at Unit Level

– “Walk Around” Process

walk around process
Walk Around Process
  • Manager and Staff RN from NCC visit all units in day and engage in structured discussion/data collection with RNs and Manager
  • Initial Walk Around to gather initial data from RNs on
    • What barriers do nurses encounter that impact patient flow?
    • What impacts LOS on your unit?
    • Well received
walk around assessment
Walk Around Assessment

Initial Data led to Action Plan for NCC at Hospital Level

  • Nurse Aide Consistency project
  • Pilot on monitor tech team devoted to transport for testing procedures
  • Case Management simple process improvements—paperwork, ancillary support
  • Another Walk Around to continue to Build RN Engagement around our NCC Initiatives
    • “LOS target” in computer charting system
walk around part 2
“Walk Around” Part 2

Continue to Engage RNs at Unit Level

  • Update RNs on NCC work
  • Educate RNs on importance of Length of Stay
  • Verbal Survey
  • Analysis of Feedback
summary of lessons learned
Summary of Lessons Learned
  • Need to have both unit level and hospital level activity happening
    • Can’t be one or the other
    • Explicitly collaborate between Union and Management on the strategy for that balance
  • Best if they complement one another
  • At some point hospital level work can help to drive the unit level work
  • Fostering unit level engagement around issues such as we heard today
next steps
Next Steps
  • Implement ideas from “Walk-Arounds”
  • Refine and Develop PCC strategy
  • Enhanced coordination of the PCC and NCC
  • Unit level RN engagement/education while building PCCs
    • “Walk arounds” and all other trainings that we have identified that will sustain our work and attain our vision