Allegheny General Hospital and SEIU Healthcare PA RNs

1. Allegheny General Hospital and SEIU Healthcare PA RNs APPROACH TO PARTNERING FOR A QUALITY IMPROVEMENT PROCESS

2. 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

3. Background Background 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

4. Background 7 years “hospital level” and “unit level” structures in contract • Patient Care Committees (PCC) • Nurse Collaboration Council (NCC)

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. “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

16. LOS Walk Around Findings

17. 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

18. 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