ORGANIZATIONAL OVERVIEW (REQUEST QUESTION NUMBER 2) MISSION VISION AND

ORGANIZATIONAL STRATEGIC PLANNING SUMMARY THREE OPTIONS OPTION
1 OBSERVATION GROUP VISITS (NGOS) ORGANIZATIONAL GROUP VISIT IS
26 A PROCESS FOR CHANGING ORGANIZATIONAL CULTURE KIM CAMERON

297 CHAPTER 15 ORGANIZATIONAL DESIGN AND STRUCTURE 15 ORGANIZATIONAL
3 FUNCTIONS AND ORGANIZATIONAL RESPONSIBILITIES IN THE MINISTRY OF
33 ORGANIZATIONAL COMMITMENTS AND TEACHING APPROACHES DO ORGANIZATIONAL COMMITMENTS

Organizational Overview

Organizational Overview

(Request Question Number 2)

Mission, vision, and goals of organization included. The strategic and performance improvement plans lacked substance. The content included was superficial and did not provide clear description of how the important components are operationalized. Please provide clear and complete information on the strategic plan/priorities and performance improvement plans for the organization and the nursing division.

Introduction:

Since 2004 the Elevate process has guided our organizational performance agenda. The organizational pillar goals were and are set by the Elevate Steering Committee. This committee is chaired by the Vice-Chancellor for Health Affairs and membership includes: the CEOs of Vanderbilt University Hospital (VUH) and the Vanderbilt Children’s Hospital (VCH); COO of the Vanderbilt Medical Group (VMG); Dean of the School of Nursing; Dean of he Medical School; Chief Nursing Officer; Chief Human Resource Officer, Vanderbilt University; Associate Vice-Chancellor, Research; Associate Vice-Chancellor, VUMC Communication; Chief Medical Officer and the Vice President for Clinical Affairs. This executive group set the initial long term goals for the organization related to the pillars and annually sets goals for the respective entities to be used for performance plans and for executive and leadership compensation.

The pillar goals are set at an organizational level and then cascaded to appropriate entities and disciplines within the organization. Specific goals exist for nursing related to turnover and retention, financial and growth performance of respective areas, service standards for each area of responsibility, and the publicly reported quality metrics. The quality metrics are inclusive of the NDNQI metrics which were chosen for nursing sensitive quality indicators. These are translated throughout the nursing organization by the Chief Nursing Officer through the Administrative Directors, the management structure and the unit and clinic boards.

. Goal performance against all pillars guides the work of the organization and is reviewed at a variety of meetings and widely disseminated throughout the organization. In a formal fashion the organizational finance and growth pillar results are reviewed by the Clinical Enterprise Group (CEG) on a monthly basis. A quarterly session is held for a full financial and growth review plus a review of the quality, service and people results, which do not change on a rapid cycle. The specific strategic goals for nursing are also addressed in the Nursing Administrative Board (NAB) and the Nursing Leadership Board (NLB). The achievement of these goals is dependent upon a well-functioning multidiscipline and collaborative organization; however, optimal performance also requires strength in each component and discipline of the organization. This approach has allowed both organizational alignment and optimal tracking of performance.

At a more local level, these cascading goals and metrics are tracked respectfully by the entities, patient care centers, units and clinics. At this level, patient care and nursing goals are reviewed on a monthly basis at the patient care center meetings and in the one on one meetings with the Directors and the Chief Nursing Officer. Agendas for these meetings are formatted by pillar to reflect topics and goals, as well as issues and concerns that are addressed using that format. This provides an opportunity for review of dashboards, trends in performance and areas that require intervention.

People

The People Goal is to be the Employer of Choice.

This goal has led to focus on efforts at staff selection, satisfaction and retention. Additionally, retention research indicates the importance of management strength as a key driver for staff retention and satisfaction; this supported efforts at Leadership Development for both the Administrative Directors and Managers leading to regular learning sessions for all nursing leadership throughout the year. These were facilitated by the Nursing Executive Center of the Health Care Advisory Board and strategically linked to initiatives that we were involved with at the time, i.e. patient throughput, strategic planning, etc.

In 2004-05, a planned organizational initiative was launched to educate managers and hiring individuals for targeted selection. This tactic has led to better selection of candidates and optimized placement of those candidates throughout the organization. The Recruitment and First Year Task Force continually focuses on efforts that support the choice of candidates and the optimal on boarding of those individuals hired. Nurse residencies have been used to assist the transition of new graduates in the organization. The Pediatric Nurse Residency is based upon the work of the LA Children’s Hospital and is evaluated in an ongoing fashion. Participation in the University Healthcare Consortium (UHC) Nurse Residency as a beta site has offered an additional tactic to support new graduates and the goal of retention. This partnership allows national benchmarking with other academic health centers and ongoing learning related to orientation and retention. Specific unit and clinic turnover results are summarized each quarter, reviewed with the Nursing Administrative Board (NAB) and then disseminated by the Administrative Directors to their respective mangers and unit/clinic boards. This discussion allows celebration of successes and learning and also identification of issues that require intervention.

An important aspect of becoming the Employer of Choice is related to staff satisfaction. This parameter is monitored in several ways for the organization and nursing. A University and Medical Center survey is completed on a regular basis. The survey was done in 2004 and 2006, with plans to move toward an annual survey process. This survey identifies trended performance for the organization and aggregated work group and individual results for units and clinics. It also identifies key drivers for employee satisfaction and the employee plan to continue working at VUMC. The survey results are reviewed at the organizational level and distributed throughout the organization for action planning by the respective clinical areas and by task forces and committees within the nursing organization. As an example, the Service Improvement Task Force was originally established following survey results indicating the need for better support of nurses and patient care by the support departments within the Medical Center.

The NDNQI nurse satisfaction survey has been utilized to provide deeper understanding of RN satisfaction throughout the organization. These results were reviewed by the Nursing Administrative Board (NAB) and then shared with the managers and staff in the clinical areas. Active and robust focus group work is ongoing with staff to determine feedback and to seek input regarding selected topics, i.e. orientation, critical care training, service standards, etc. These group sessions feed the work with staff input and suggestions. The monthly CNO breakfasts and staff rounding provide rich feedback to leadership and hence the efforts that are initiated or modified. These tactics, tied to the organizational goal have produced extremely positive RN satisfaction results, including the award to Vanderbilt University Medical Center nursing by the Tennessee Nurses’ Association as the Employer of Choice for Nursing in 2004.

Service

The Service Pillar goal is to be the provider of choice for our patients and their families.

The baseline metrics of patient satisfaction were established and are tracked on a monthly basis for each clinical area. The aspects of service satisfaction, nursing care, medical care, plans to recommend and intent to return to Vanderbilt University Medical Center (VUMC) as a patient are trended for each inpatient admission and randomly for the ambulatory visits. The achievement of excellence in these metrics at the 90-95^th percentile is the goal organizationally and is reported and reviewed regularly. Service excellence is core to excellent nursing practice and resonates with an excellent environment for patient care. The key drivers of satisfaction are available by unit or clinic and hence may be reinforced or addressed as needed. Our tactic of understanding those we serve so that we are able to meet their expectations is essential to success in this area. Over 2,600 staff, nursing and other clinical staff have been trained in skills that support communication, acknowledgement, reinforcement and problem-solving. These approaches, (e.g. AIDET, HEART, etc) have helped to standardize the ways in which patient interactions are undertaken. Local tactics have included the use of in-room whiteboards for patient/family and care team communication and expectation cards in several clinics to identify what the patient hopes to achieve through his or her visit that day. The evolving results reflect more individualization of patient care, enhanced pain management and improved team work and communication.

Quality

The Quality Pillar goal is to be the safest hospital in the United States.

Clinical quality is at the center of all we do at Vanderbilt University Medical Center. Our collaborative model of care acknowledges the importance of each team member to achieving the best outcome for our patients. The myriad of publicly reported quality metrics are a major component of the framework for quality. Nursing and Medicine are partnered against each of the quality metrics and the work to achieve the best result takes in to account the team that will be required to do so. Creation of evidenced based pathways, protocols for care, patient and family- centered rounds, and the use of crew resource management for teams providing care drive our efforts for safety. Nursing provides leadership and partnership for these efforts. Specific nursing quality goals related to falls, restraint use, and pressure ulcers, etc. are supported through task forces that are multi-disciplinary and evidenced- based. The initiation of an automated clinical documentation system is in support of both ease in documentation, standardization of reporting, and enhanced communication between providers at all levels of care. This system is also the first piece of a closed loop medication process that will be launched in calendar year 2006. The creation of a Rapid Response Team in both the Vanderbilt University Hospital and the Vanderbilt Children’s Hospital has led to decreased codes being called and enhanced learning and mentoring of clinical nursing staff. Each of these clinical process enhancements is targeted to the achievement of being the safest hospital in the United States.

Growth

The Growth Pillar goal is to be able to support the patient services that will be required if VUMC is the provider of choice for the region.

Exceeding our targeted patient volumes, in admission, ambulatory visits, emergency visits and surgical operations is critical to the growth goal. For Nursing leadership and staff, organizational growth is dependent upon our stewardship of many resources. Each clinical area has a projected volume target; the ability to achieve that target rests upon collaboration with other colleagues, stable staffing, and innovation in patient throughput. These goals are established annually through the budget process and are tracked and monitored for execution. The ability to provides services to patents is dependent the presence of qualified, capable staff in the right numbers at the right time and at the right place. This goal has required active planning and problem-solving with nursing leadership and staff for innovations in the delivery of patient care. Nursing has led initiatives related to Bed Management, Elective Scheduling of Patients, and Use of Observation Beds, in addition to the ongoing efforts focused on use of days, bed turn around, OR room turn around and resource utilization. These efforts have targeted the movement of patients for care and service. Other tactics targeted the use and availability of nursing staff for care provision. To that end, the Staffing Task Force has sponsored pilots that used nurses to facilitate care initiation, made changes in staffing templates that support fluctuations in patient volume demand, and modified staffing polices and procedures to provide more consistent and safe staffing approaches.

Finance

The Finance Pillar goal is to be financially solvent in a way that will support our continuing service to the patients we serve.

The ability to achieve this goal is tied to strong stewardship of nursing resources throughout the organization. Financial performance in nursing is complicated in times of workforce shortages and requires long-range planning and meticulous monitoring of metrics and parameters related to recruitment, retention, safety and utilization of resources. Since 2004, VUMC has opened the Children’s Hospital; back-filled the space vacated by that move by opening greater than 80 adult acute care and critical care beds, and opened new ambulatory sites. The hiring, orienting, placement and retention of nursing staff are the most expensive labor variable for the Medical Center. The use of staffing templates has been extremely successful for this work and has supported workforce planning not only for current operational units but also those areas that are in the planning for implementation. The Nursing Administrative Board, along with the Nursing Leadership Board has partnered with colleagues in Medicine, Finance and Informatics to achieve the best innovations possible to define staffing patterns, monitor those for accuracy and accountability and to create stems that will allow improved approaches to this work in the future. The Staffing Task Force has led the implementation of an automated web-based scheduling system that will be implemented in 2006 and will create a new level of data and understanding of labor use. These efforts are widely recognized in the Medical Center as being best of class and are bring implemented in all hospital, clinics, and in other departments, i.e. Radiology, etc.

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