a data driven approach to nurse engagement · introducing our national employee engagement database...
TRANSCRIPT
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Nursing Executive Center
Survey Solutions
A Data Driven Approach to
Nurse Engagement
Today's Presenters:
Sarah Strumwasser
Senior Director
Research and Insights
Key Insights and Best Practices from the Experts
Kendall Adler
Consultant
Research and Insights
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
2
The Nursing Executive Center in Brief The Comprehensive Resource for Executing Health System Strategy
Performance
Assessments
• Competency diagnostics
• Benchmarking reports
• Customized quality
assessments
• Red flag audits
Executive-Level
Insights
• National meetings
• Executive briefings
• Strategic frameworks
Team
Education
• Onsite presentations
• Private webconferences
• Facilitated working
sessions
• Nursing Insights
• Journal Review
On-Call
Support
• Tactical solutions to unique
challenges
• On-demand phone
consultation with
senior advisors
• Facilitated networking
Setting Strategy Translating Strategy into Action
Percentage
Magnet Hospitals
62% Years supporting
nurse executives
13 Nurse leaders attending
Center sessions each year
15,500+ Institutions holding
membership
1,900+ Renewal
rate
>90%
Trusted Partner for Leading Nurse Executives
Best Practice
Recommendations
• Executive strategies
• Replicable, pressure-tested
best practices
• Manager toolkits
• Customizable templates
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Introducing Advisory Board Survey Solutions
3
Comprehensive Portfolio of Services for Executives
Creating the High-Performance Workforce
ABSS - Physician
Engagement (PE)
• Best-in-class survey platform
with Dedicated Advisor support
• Targeted survey questions for
employed, affiliated, and
independent physicians
ABSS - Employee
Engagement (EE)
• Real-time data query to
prescriptive results platform
• User-friendly change
management tools, expert
consultations, networking
ABSS - Culture of
Safety (CoS)
• AHRQ culture of safety survey
setup and administration
• Best-practice and action
planning support
ABSS - Nursing
Engagement (NE)
• Magnet-compliant survey
instrument with department and
unit-level drill-downs
• Hands-on nurse-leader training
and expert consultations
Strategic Action
Planning Tool
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Why Are We Here?
4
Source: Advisory Board Survey Solutions’ Employee Engagement National Database, 2013.
27.9 28.7
31.4 32.6
2010 2011 2012 2013
Percentage of RNs Engaged Nationally
27.9% 28.7%
31.4% 32.6%
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Introducing Our National Employee
Engagement Database
5
Source: Advisory Board Survey Solutions’ Employee Engagement National Database, 2013.
1) Includes psychology, children’s, and heart institute.
2) Includes research and corporate services.
8%
18% 73% Non-
Teaching
69% 31% 89% 11%
Magnet
Designation
Teaching Status
System
Participation
Magnet Non-
Magnet
Teaching
Academic
Medical
Center
Hospital Health
System
34%
5%
10%
29%
7%
10%
5%
Facility Type
Short-Term
Acute
Critical
Access
Non-
Clinical2
Outpatient
Post-Acute Care
Physician
Practice/ Clinic
Children’s and
Specialty1
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
The Advisory Board’s Engagement Index
6
Source: Advisory Board’s Employee Engagement Survey
Setting a High Bar
To be considered "engaged" respondents must answer "Strongly Agree" to at least two
of the four items listed above, and no less than "Agree" to any item.
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
A Deeply Disturbing Comparison
7
RN Engagement Lagging Behind Everyone Else
Source: Advisory Board Survey Solutions’
Employee Engagement National Database, 2013.
1) Includes administrative/executive assistant, associate/professional, social worker, and support services personnel.
2) Includes advanced practice nurse (NP, CNL, CNS, DNP), dietician, medical technologist, occupational therapist, pharmacist,
phlebotomist, physical therapist, radiologic technologist, respiratory therapist, speech pathologist, support services personnel.
Percent Engaged by Job Role
Percent
Disengaged
OtherFrontline
Non-Clinical¹
PCAs LPNs MDs OtherFrontlineClinical²
RNs
42.9% 42.3%
38.4%
32.6%
37.8% 37.4%
5.5% 5.8% 4.8% 6.1% 7.4% 6.3%
n=180,384
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Not Closing the Gap
8
Source: Advisory Board Survey Solutions’ Employee Engagement National Database, 2013.
Percentage of Staff Engaged Nationally
RNs Versus All Other Frontline Roles
27.9 28.7
31.4 32.6
37.7 38.9
41.5 42.8
2010 2011 2012 2013
RNs All Other Frontline Roles
37.7% 38.9%
41.5% 42.8%
27.9% 28.7%
31.4% 32.6%
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
What’s Possible?
9
Source: Advisory Board Survey Solutions’ Employee Engagement National Database, 2013.
26.3
31.4
36.5
43.6
25thpercentile
50thpercentile
75thpercentile
90thpercentile
RN Engagement Level Within an Organization by Quartile
Percentage of RNs Engaged
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Still Searching for the Ceiling
10
Considering the Benefits of a More Targeted Approach
Source: The Advisory Board Survey Solutions’ Employee Engagement National Database, 2013. 1) Preliminary analysis.
Average Percentage of Staff Engaged per Facility1
39.3%
43.2%
44.0%
36.7%
41.3%
47.2%
2011 2012 2013
First-Time Partners Multi-Year Partners
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Plotting a Principled Path Forward
11
Source: Nursing Executive Center interviews and analysis.
1 What are my best enterprise-wide opportunities?
2
What best practices should I implement to act on
those opportunities?
Are there critical “hotspots” where I need to do more?
3
Three Key Questions for Improving Engagement
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
42 Proven Drivers
12
Source: Advisory Board Survey Solutions interviews and analysis.
Communication and Input
1. I am kept informed of the organization's future plans and direction
2. My ideas and suggestions are valued by my organization
3. My manager communicates messages that my coworkers need to hear, even when the information is unpleasant
4. My manager is open and responsive to staff input
5. My manager stands up for the interests of my unit/department
Employee Support
6. My manager helps me balance my job and personal life
7. My organization does a good job of selecting and implementing new technologies to support my work
8. My organization helps me deal with stress and burnout
9. My organization supplies me with the equipment I need
10. My unit/department has enough staff
Feedback and Recognition
11. Executives at my organization respect the contributions of my unit/department
12. I have helpful discussion with my manager about my career
13. I know what is required to perform well in my job
14. I receive regular feedback from my manager on my performance
15. My organization recognized employees for excellent work
Professional Growth
16. I am interested in promotion opportunities in my unit/department
17. I have the right amount of independence in my work
18. I receive effective on the job training
19. My current job is a good match for my skills
20. My manager helps me explore other jobs within my organization
21. My manager helps me learn new skills
22. My most recent performance review helped me to improve
23. Training and development opportunities within my organization have helped me to improve
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
42 Proven Drivers
13
31. Abusive behavior is not tolerated at my organization
32. Conflicts are resolved fairly in my unit/department
33. I have good personal relationships with coworkers in my unit/department
34. I receive the necessary support from employees in my unit/department to help me succeed in my work
35. I receive the necessary support from employees in other units/departments to help me succeed in my work
36. My coworkers do a good job
37. I have job security
38. I have a manageable workload
39. My organization pays me fairly for my job
40. My organization supports employee safety
41. My organization understands and respects differences among employees
42. The benefits provided by my organization meet my needs
Mission and Values
24. I believe in my organization’s mission
25. I understand how my daily work contributes to the organization’s mission
26. My organization gives back to the community
27. My organization provides excellent care to patients
28. My organization provides excellent customer service to patients
29. Over the past year I have never been asked to do something that compromises my values
30. The actions of executives in my organization reflect our mission and values
Baseline Satisfiers
Teamwork
Source: Advisory Board Survey Solutions interviews and analysis.
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Narrowing Our Focus
14
Source: Advisory Board Survey Solutions’ Employee Engagement
National Database, 2013; Nursing Executive Center analysis.
Relative Impact on Engagement
Running Room
Baseline Performance Sufficient
Outsized Investment Required
42 Proven Drivers
7 Most Promising Drivers
1
2
3
4
Filters
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Some Drivers Have More Impact Than Others
15
Source: Advisory Board Survey Solutions’ Employee Engagement
National Database, 2013; Nursing Executive Center analysis.
Filter #1: Relative Impact on Engagement
1) 2013 model contains 19 out of 42 drivers with an R2 of 0.65. All
drivers correlate with the engagement index in individual regressions.
Results from National Multivariate Regression1
Rank Driver
1 I believe in my organization’s mission.
2 My organization provides excellent care to patients.
3 My ideas and suggestions are valued by my organization.
4 The actions of executives in my organization reflect our mission and values.
5 My organization helps me deal with stress and burnout.
6 I am interested in promotion opportunities in my unit/department.
7 My current job is a good match for my skills.
8 My organization pays me fairly for my job.
9 My manager stands up for the interests of my unit/department.
10 Training and development opportunities offered by my organization have helped me to improve.
11 I understand how my daily work contributes to the organization’s mission.
12 My most recent performance review helped me to improve.
13 My organization recognizes employees for excellent work.
14 My organization supports employee safety.
15 I have job security.
16 Executives at my organization respect the contributions of my unit/department.
17 My organization provides excellent customer service to patients.
18 I have a manageable workload.
19 Over the past year I have never been asked to do something that compromises my values.
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Set Aside Areas of High Performance
16
Source: Nursing Executive Center analysis.
Filter #2: Running Room
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sample Box and Whisker Plot
Box bottom and top
represent 25th and 75th
percentile
High performing drivers have small, high boxes with relatively short tails.
Filter Out the High Boxes with Short Tails
!
Top and bottom of tails
represent maximum and
minimum performance
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Highlighting the Running Room
17 Filter #2: Running Room
Percentage of RNs Agreeing or Strongly Agreeing per Organization
I believe in
mission
Organization
provides
excellent care
Ideas and
suggestions
valued
Executive
actions
reflect mission
and values
Organization
addresses
stress and
burnout
Interested
in promotion
opportunities
Job good
match
for skills
Organization
pays fairly
Manager
stands up
for unit
1 3 2 4 5 6 7 8 9
Source: Advisory Board Survey Solutions’ Employee Engagement
National Database, 2013; Nursing Executive Center analysis.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Highlighting the Running Room (cont.)
18
Source: Advisory Board Survey Solutions’ Employee Engagement
National Database, 2013; Nursing Executive Center analysis.
Filter #2: Running Room
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Training and
development
helpful
My work
contributes
to mission
Performance
review
helped me
improve
Organization
recognizes
employees
Organization
supports
employee
safety
I have
job security
Executives
respect unit
contributions
Organization
has good
customer
service
Workload
manageable
Didn’t
compromise
values
10 11 12 13 14 15 16 17 18 19
Percentage of RNs Agreeing or Strongly Agreeing per Organization
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Identifying the Baseline Drivers
19
Source: Nursing Executive Center analysis.
Filter #3: Baseline Performance Sufficient
Attributes of Baseline Drivers
Reflect Basic
Employee Needs
Achieving Average
Performance Sufficient
Less Opportunity
for Improvement
To reflect the fact that baseline drivers require a different bar, analysis of baseline drivers
should include staff who respond “tend to agree” in addition to “agree” and “strongly agree.”
! Including “Tend to Agree”
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Applying a Different Bar for Baseline Drivers
20
Source: Advisory Board Survey Solutions’ Employee Engagement
National Database, 2013; Nursing Executive Center analysis.
Filter #3: Baseline Performance Sufficient
Driver Agree,
Strongly Agree
Tend to Agree,
Agree,
Strongly Agree
“My organization pays me fairly for my job.” 46.8% 72.8%
“I have job security.” 54.7% 82.8%
“I have a manageable workload.” 52.1% 76.9%
National Performance on Baseline Drivers
70% threshold used
to assess baseline
driver performance
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Set Aside Drivers Requiring Outsized Investment
21
Source: Engaging the Nurse Workforce, 2007; Advisory Board
Talent Development; HR Investment Center, The Performance
Management Playbook, 2008; Nursing Executive Center analysis.
Filter #4: Outsized Investment Required
Driver Rationale Available Resource
“My manager stands up
for the interests of my
unit/department.”
Low-hanging fruit for managers
covered in Engaging the Nursing
Workforce; further improvement
likely requires heavy investment in
manager competency training
• Engaging the Nursing
Workforce
• Advisory Board Talent
Development
“My most recent
performance review
helped me to improve.”
Poor performance signals need for
comprehensive performance
management system overhaul
• The Performance
Management
Playbook1
Available Resources for Drivers Requiring Disproportionate Investment
1) Resources available through the HR Investment Center.
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Best National Opportunities to Improve Engagement
22
Source: Nursing Executive Center analysis.
• “My ideas and suggestions are valued by
my organization.”
• “The actions of executives in my organization
reflect our mission and values.”
• “My organization helps me deal with stress
and burnout.”
• “I am interested in promotion opportunities in
my unit/department.”
• “Training and development opportunities offered
by my organization have helped me to improve.”
• “My organization recognizes employees for
excellent work.”
• “Executives at my organization respect the
contributions of my unit/department.”
42 Drivers of
Employee
Engagement
Seven Drivers with Greatest
Opportunity for Improvement
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Translating Drivers into Pointed Action
23
Source: Nursing Executive Center interviews and analysis. 1) Based on 42 proven engagement drivers.
Developing a National Prescription for Nurse Engagement, 2014
Dimension Top Improvement
Opportunity1
Potential
Root Causes
Solvable
Challenge
Executive
Strategy
Recommended
Practices
I. Executive
Actions
Executive Actions Reflect
Mission and Values
II. Stress and
Burnout
Organization Addresses
Stress and Burnout
III. Staff Input Ideas and
Suggestions Valued
IV. Recognition
Organization
Recognizes Employees
Executives Respect
Unit Contributions
V. Training and
Development
Training and
Development Helped
Me Improve
Interested in Promotion
Opportunities
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
All the Places We Looked
24
Sub-Groups Analyzed for Identifying Potential Hotspots
Source: Advisory Board Survey Solutions’ Employee Engagement
National Database, 2013.; Nursing Executive Center analysis.
• Unit type/care setting
• Tenure
• Age
• Shift
• Region
• Employment status
(full time, part time, PRN)
• Union status
• System
• Standalone facility
• Academic Medical Center
RN Attributes Analyzed During Hotspot Analysis
Organizational Attributes
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Unit Type/
Care Setting Tenure Age Shift Region
Employment
Status
• < 1 Year
• 1-3 Years
• 4-6 Years
• 7-15 Years
• > 15 Years
• < 25
• 25-35
• 36-45
• 46-55
• > 55
• Day
• Evening
• Night
• Midwest
• Northeast
• South
• West
• Full-time
• Part-time
• Per Diem
The Two that Fell Below the Bottom Quartile
25
Source: Advisory Board Survey Solutions’ Employee Engagement
National Database, 2013.; Nursing Executive Center analysis.
RN Attributes
RN Sub-Groups Below the 25th Percentile for RN Engagement
• Cardiology
• Critical Care
• ED
• Float
Pool/PRN
• General
Telemetry
• Labor and
Delivery
• Med/Surg
• Nursery/NICU
• Nursing
Administration
• OB/GYN
• Oncology
• OR/
Perioperative
• Other Nursing
• Outpatient
• Peds/PICU
• Psychiatric
• Rehab
• Stepdown Unit
RN subgroups with engagement
levels lower than 25th percentile for
overall RN engagement automatically
categorized as hotspots
26
I. Executive Actions
Dimension
Top
Improvement
Opportunity1
Potential
Root Causes
Solvable
Challenge
Executive
Strategy
Recommended
Practices
I. Executive
Actions
Executive Actions
Reflect Mission
and Values
• Staff uncertain on
mission and value
• Executive actions
don’t reflect mission
and values
• Staff not aware of
executive actions
• Linkage between
executive actions
and mission
unclear
Staff don’t
fully appreciate
market rationale
for executive
actions
Translate Market
Forces into
Frontline Terms
#1 Mobile Town
Hall Forums
#2 Peer-to-Peer
Strategy
Liaisons
#3 Nurse Manager
“Doomsday”
Exercise
#4 Staff-Surfaced
Rumor Control
1) Based on analysis of 42 proven engagement drivers.
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Homing In on Potential Root Causes
27
Source: Nursing Executive Center interviews and analysis.
Executive Actions
One-Level Root Cause Tree
“The actions of executives within my organization reflect
our mission and values.”
Linkage between executive actions
and mission unclear
Executive actions don’t reflect mission
and values
Staff uncertain of mission and values
Staff not aware of
executive actions
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
The Solvable Challenge
28
Source: Nursing Executive Center interviews and analysis.
Sending Frontline Staff a Mixed Message
“They keep saying patient safety is a top priority and we’re working with a smaller budget, but all
I see are staffing cuts and a new patient care facility being built. It doesn’t make any sense.”
Frontline Nurse
”
Executive Actions
Staff Don’t Fully Appreciate Market Rationale for Executive Actions
Representative Newsletter
Announcement
Nurse Perspective
Executive Perspective
“This is just another item on my already long to-do
list. Executives must not know how much I juggle.”
“Implementing bedside rounding will allow us
to maximize reimbursement by improving
performance on metrics tied to payment.”
Representative Perspectives
on Hourly Rounding
Nursing Buzz December 9, 2013
Hourly Rounding Update: Starting
January 1st, 2014, all nurses are required
to begin hourly rounding. Mandatory
training will be held across the week of
December 16th. If you have any questions,
please contact Edie Anderson at 123-456-
7890 or [email protected].
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Not Speaking Their Language
29
Source: CMS, available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-
Instruments/hospital-value-based-purchasing/Downloads/FY-2013-Program-Frequently-Asked-Questions-about-
Hospital-VBP-3-9-12.pdf, accessed November 1st, 2013; Nursing Executive Center interviews and analysis.
Executive Actions
Sample Talking Points
Topic Talking Points
Value-Based
Purchasing
Overview
• The Hospital Value-Based Purchasing (VBP) Program is a Centers
for Medicare & Medicaid Services (CMS) initiative that rewards
acute-care hospitals with incentive payments for the quality of care
they provide to people with Medicare.
Measuring
Hospital
Performance
• CMS bases hospital performance on an approved set of measures
and dimensions, grouped into specific quality domains. Different
domains apply depending on the FY 2013 – 2015.
• In 2013, CMS bases performance on clinical process and patient
experience; in 2014, clinical process, patient experience, and
outcomes, and in 2014, clinical process, patient experience,
outcomes, and efficiency.
• CMS assesses each hospital’s performance by reviewing its
achievement and improvement scores for each applicable Hospital
VBP measure.
Reimbursement
• Reimbursement calculated by hospital’s base operating DRG during
that fiscal year and hospital’s value-based incentive payment
percentage during that fiscal year.
Staff may not
understand acronyms
or complex terms
Explanations assume
underlying knowledge
of market forces
Dense text; difficult
to pull out important
information
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Focusing on the Intended Audience
30
Source: Nursing Executive Center interviews and analysis.
Executive Actions
Key Characteristics of Effective Frontline Education Materials
Interactive
Format
Live, two-way
dialogue allows
staff to get real-
time answers
to questions
Captures Frontline
Perspective
Helps staff understand
how broad, organizational
changes impact their
daily work
Readily
Scannable
Ensures messaging
is clear, not
overwhelming
Brief
Makes complex
concepts easier
to digest
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Introducing Our Toolkit on Translating Market
Forces into
31
Sample Toolkit Resources
Customizable
Presentations
PowerPoint slides
and scripting for
leaders to brief
staff on tough
messages
Ready-to-
Use Videos
Short, easy-to-
digest videos for
frontline staff on
current market
forces
Manager
“Cheat sheets”
One-page primers
on market forces
impacting
organizational
strategy
Interactive
Exercises
Games for frontline
staff and managers
aimed at conveying
budget constraints
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Three Channels for Translating Market Forces
32
Source: Nursing Executive Center interviews and analysis.
Communication Channels
Executive
Best positioned to discuss
organization-wide changes
Peer
Most relatable; staff may feel
more comfortable asking
questions when discussing
change with a peer
Manager
Can provide context for
how organizational changes
will impact the unit
Executive Actions
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Failing to Train the Trainers
33
Source: Baptist Health Lexington, Lexington, KY; Nursing Executive Center interviews and analysis.
Practice #3: Nurse Manager “Doomsday” Exercise
An Unrealistic Expectation
“We put people into leadership positions and assume they know
how to lead change. Most of the time, managers don’t really
understand the steps or process themselves. How can we expect
them to teach frontline staff when we don’t teach them first?”
Executive Director, Administrative Services
Baptist Health Lexington
”
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Demonstrating the Financial Impact of Adverse Events
34
Source: MedStar Montgomery Medical Center, Olney, MD; Nursing Executive Center interviews and analysis.
Practice #3: Nurse Manager “Doomsday” Exercise
Overview of MedStar Montgomery’s Hypothetical “Doomsday” Exercise
Admitted to
observation unit
Central line
precautions missed;
develops 103º fever
Urinary catheter kept
in place longer than
necessary resulting in UTI
Develops pressure
ulcer after placed
on wrong surface
in OR and PACU
No bed alarm
used despite fall
risk; falls and
fractures femur
Clostridium difficile
spread to Mrs. Jones
after clinician forgets
to wash hands
$3,000 $10,000 $54,000 $3,000 $44,000 $7,000
Avoidable
Event:
Cost:
Observation
Unit
Admission
Patient
Fall
14 Day Hospital Stay
Central
Line
Infection
Pressure
Ulcer
Urinary
Tract
Infection
Clostridium
Difficile
Infection
Mrs. Jones
Arrives at
Emergency
Department
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Helping Managers Internalize Impact of Market Forces
35
Source: MedStar Montgomery Medical Center, Olney, MD; Nursing Executive Center interviews and analysis.
Practice #3: Nurse Manager “Doomsday” Exercise
1) Budget cuts include cuts from sequestration and Value-Based
Purchasing; calculated using publicly available data.
Overview of MedStar Montgomery’s Nurse Manager Budget Exercise
“Doomsday” Event Calculator
For complete “Doomsday” Event Calculator Tool, see Appendix.
Managers
Bring Their
Unit Budgets
Apply Across
the Board
Budget Cuts1 to
Unit Budgets
Deduct Impact
of “Doomsday”
Events
17% of
Managers Learn
Their Units
Would Close
Total Number of Patient
Falls, FY2013
Total Patient
Fall Cost
Average Cost per
Patient Fall
Number of Units
Total Patient
Fall Cost
Cost of Patient
Falls per Unit
=
=
X
÷
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
What Would You Cut?
36
Bringing the “Doomsday” Scenario to the Front Line
Source: MedStar Montgomery Medical Center, Olney, MD; Nursing Executive Center interviews and analysis.
Practice #3: Nurse Manager “Doomsday” Exercise
For complete “Doomsday” Exercise Item Cost List, see Appendix.
“Doomsday” Exercise Item Cost List for Frontline Staff
Medical Surgical Division Item Cost List
Item
Foot/ankle pumps
Small copier
Office chairs
Wait room furniture
Nurses station computers
Bedside computers
Stretchers
IV pumps
Cost
$10,000
$3,500
$540
$6,000
$1,000
$5,000
$6,000
$3,000
Staff use cost list to
select items to cut
from representative
unit budget at each
avoidable event in
“doomsday” scenario
Staff receive list
of estimated costs of
commonly budgeted
unit items
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Visualizing the Impact of Avoidable Budget Cuts
37
Source: MedStar Montgomery Medical Center, Olney, MD; Nursing Executive Center interviews and analysis.
Practice #3: Nurse Manager “Doomsday” Exercise
“Doomsday” Magnetic Board Exercise for Frontline Staff
Magnetic board with
moveable, magnetic
pieces placed at front of
room during “Doomsday”
exercise for frontline staff
Staff asked to remove
items from board as they
cut them from
hypothetical unit budget
Board created in-house
using a camera, color
printer, laminator, and
magnetic tape
IMA
GE
CR
ED
IT: M
ED
ST
AR
MO
NT
GO
ME
RY
ME
DIC
AL C
EN
TE
R.
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
Reducing Ad-Hoc Budget Requests
38
Source: MedStar Montgomery Medical Center, Olney, MD; Nursing Executive Center interviews and analysis.
Practice #3: Nurse Manager “Doomsday” Exercise
0 0 0 0
April May June July August September October November
Ad-Hoc Manager Requests for Unbudgeted Items
Nurse Manager
“Doomsday” Exercise
2013
©2014 T
he A
dvis
ory
Board
Com
pany •
27813D
39
Building a High-Value Care Team that Thrives
Our Newest National Meeting: Energizing the
Nursing Workforce
From Patient to Partner
Forces Shaping Provider Strategy in the New Health Care Economy
• Shifting market dynamics with most critical implications for nurse leaders
• Expanding access at all points along the continuum
• Redefining care delivery models within and beyond acute care
Building the High-Value Care Team
Strategies for Delivering Cost-Effective, Coordinated Care
• Unifying caregiver roles around shared goals
• Mobilizing the right staffing complement based on patient needs
• Comparison of highly effective care teams in different settings
Data-Driven Prescription for Advancing Frontline Engagement
How to Translate Survey Results into Meaningful Improvement
• Key trends and findings from The Advisory Board’s Employee Engagement
Database
• Identifying “hot spots” of staff with low engagement
• Targeting highest-impact engagement drivers
The Nurse Executive’s Role in Building a Highly Committed Workforce
Enfranchising Frontline Caregivers in Organizational Transformation
• Effectively communicating priorities to the front line
• Developing workforce resiliency in a changing environment
• Profiles of high-impact nurse executives
The Unit Manager’s Engagement Toolkit
Best Practices and Tools for Building Teams that Thrive
• Preempting key causes of staff burnout
• Integrating staff feedback into unit-level decisions
• Generating excitement about changing care delivery models
2013-2014 National Meeting Agenda
12 Meetings in 10 Cities
December 9-10
Washington, DC
January 16-17
Chicago, IL
February 10-11
San Francisco, CA
February 27-28
Atlanta, GA
March 6-7
New York, NY
April 24-25
Dallas, TX
CNO Roundtables
Leadership Team Summits
Two-day meeting in a small group setting
Audience: Senior nurse executives
Two-day meeting with an expanded agenda
Audience: Senior nurse executives and members of their nursing
leadership teams
February 18-19
Washington, DC
March 31-April 1
Chicago, IL
April 7-8
Laguna, CA
Regional Sessions
March 24
Denver, CO
May 9
Dearborn, MI
June 2
Seattle, WA
One-day meeting with a condensed agenda
Audience: Senior nurse executives and senior members of their
nursing leadership teams
2445 M Street NW I Washington DC 20037
P 202.266.5600 I F 202.266.5700 advisory.com
©2014 The Advisory Board Company advisory.com 1
Source: MedStar Montgomery Medical Center, Olney, MD.
MedStar Montgomery’s “Doomsday” Event Calculator
“Doomsday” Event Calculator
Observation Unit Admission:
Instructions: Use the equation below to calculate the impact of hypothetical adverse events on
nursing unit budgets.
Patient Fall:
Central Line Infection:
Pressure Ulcer:
Total Number of
Observation Unit
Admissions, FY2013
Total Observation
Unit Cost
Average Cost per
Observation Unit
Admission
Number of Units
Total Observation
Unit Cost
Cost of Observation
Admissions per Unit
=
=
$3,000 X
÷
Total Number of Patient
Falls, FY2013
Total Patient
Fall Cost
Average Cost per
Patient Fall
Number of Units
Total Patient
Fall Cost
Cost of Patient
Falls per Unit
=
=
$10,000 X
÷
Total Number of Central
Line Infections, FY2013
Total Central Line
Infection Cost
Average Cost per
Central Line Infection
Number of Units
Total Central Line
Infection Cost
Cost of Central Line
Infections per Unit
=
=
$54,000 X
÷
Total Number of
Pressure Ulcers, FY2013
Total Pressure
Ulcer Cost
Average Cost per
Pressure Ulcer
Number of Units
Total Pressure
Ulcer Cost
Cost of Pressure
Ulcers per Unit
=
=
$3,000 X
÷
©2014 The Advisory Board Company advisory.com 2
Source: MedStar Montgomery Medical Center, Olney, MD.
MedStar Montgomery’s “Doomsday” Event Calculator
Urinary Tract Infection
Clostridium Difficile Infection:
Hypothetical “Doomsday” Scenario Unit Budget:
Total Number of Urinary
Tract Infections, FY2013
Total Urinary Tract
Infection Cost
Average Cost per
Urinary Tract Infection
Number of Units
Total Urinary Tract
Infection Cost
Cost of Urinary Tract
Infections per Unit
=
=
$44,000 X
÷
Total Number of
Clostridium Difficile
Infections, FY2013
Total Clostridium
Difficile Infection Cost
Average Cost
per Clostridium
Difficile Infection
Number of Units
Total Clostridium
Difficile Infection Cost
Cost of Clostridium
Difficile Infections per Unit
=
=
$7,000 X
÷
- 2014 Unit Budget Cost of Observation
Admissions per Unit
Cost of Patient
Falls per Unit
- -
Cost of Central Line
Infections per Unit
- Cost of Pressure
Ulcers per Unit
- Cost of Urinary Tract
Infections per Unit
-
Cost of Clostridium
Difficile Infections per Unit
= Hypothetical “Doomsday”
Scenario Unit Budget
©2014 The Advisory Board Company advisory.com 3
Source: MedStar Montgomery Medical Center, Olney, MD. 1) Enables seat-to-seat transfers
MedStar Montgomery’s “Doomsday” Exercise Item Cost List
Medical Surgical Unit Cost List
Item Estimated Cost/ Each
Foot/ankle pumps $10,000
Small copier $3,500
Office chairs $540
Wait room furniture $6,000
Nurses station
computers $1,000
Bedside computers $5,000
Stretchers $6,000
IV pumps $3,000
Large printer $1,500+ $1,000
per year maintenance
Large copier $6,000
Cold therapy machines $3,800
Bedside commodes $100
Vital signs monitor $3,500
Steady1 $4,100
Recliners $1,800
Bladder scanner $17,000
Line cart $1,400
Isolation cart $100
Fax machine $250
Doppler $600
Thermometer $650
Vocera accessories
(replacing 1 per day) $525