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Nursing Department improves quality and patient satisfaction with culture change


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In 1998, The University of Kansas Hospital in Kansas City, KS, was faced with a patient satisfaction rate in the fifth percentile, turnover rates that were through the roof, and the reality of an organization that was losing market share.

As part of the organization's strategy to turn the hospital around, nursing set out to change the culture of the department. A renewed commitment to quality improvement, nursing excellence, and staff engagement—along with a six-part strategic plan—effected culture change that transformed the organization. Since 1998, the hospital has seen a 60% decrease in turnover, a 65% increase in inpatient admissions, and more than 200% increase in revenue.

"We were losing volume, but even now in this economy, we've still seen an 8% increase in inpatient visits this fiscal year over last fiscal year," says Tammy Peterman, executive vice president, chief operating officer, and chief nursing officer. "We believe that one of our critical success factors in staff engagement is this strategic plan. You can get where you're going without a plan, but you don't always get where you want to be. We put very specific action items, linked to the strategies, into the plan."

The nursing department's plan focused on six key strategies:

  • Excellence

  • Caring

  • Professionalism

  • Communication

  • Stewardship

  • Quality

Peterman says the department wanted to raise the overall level of professionalism of nursing in the facility, so they examined tactical ways to raise the bar and increase quality. They did this by methods such as encouraging nurses to pursue specialty certification and initiating professional portfolios.

To incentivize nurses to obtain specialty certification, the organization compensates nurses for certifications and provides a bonus each year they maintain their certification.

Nursing portfolios are an innovative way to focus on nurse professionalism. All nurses at the hospital create their own portfolio, which is a mechanism for them to monitor and track their professional activities throughout the year, including continuing education participation, committee involvement, research activities, or presentations they have conducted. The portfolios are a part of the annual review process and are also used by nurses when they interview for other positions within the hospital.

"We all have them," says Peterman. "And it's good to do that because you find if you look back on a five-year time period you can't remember all the things you have done to help promote the profession of nursing. But this way you can."

One tactic used to engage nurses was having staff decide the department's vision statement. "We had a small team that went out and held brainstorming sessions about our vision," says Chris Ruder, vice president, patient care services. "These sessions were held during day, evening, and night shifts to really capture what the staff throughout the organization thought it should be."

The team collated all the statements, which encompassed hundreds of ideas and areas that nurses felt strongly about, and the results were voted on by the whole department. The result was a vision statement that Ruder says is truly about all of nursing at the hospital.

Once the departmentwide statement was decided upon, each unit crafted a personal vision statement that encapsulated the unit's ethos.

The sixth part of the department's strategic plan related to quality. The hospital was an early adopter of the rapid response team concept and it has tracked data for more than 3,000 rapid responses since its inception. The RRT is staffed by the medical intensive care unit, and it has played a significant role in the hospitalwide low mortality rate.

One of the most nurse-friendly initiatives the hospital undertook as part of the commitment to quality improvement was to create a nursing resource center. Now nurses have somewhere they can go when they need a quiet space to study for professional certification, a computer to research the latest evidence-based practices, or a conference table to bring people together. The nursing resource center is a room dedicated solely to nurses' use and equipped with comfortable chairs, audiovisual equipment, professional journals, and computer access.

"It is funded through an endowment that nurses and others donate to," says Peterman. "[We] have money taken out of our checks each month to support the nursing resource center. So it's really a nursing resource center supported by nurses."

This center is an example of the commitment to nursing excellence that turned the culture around. The plan helped the organization achieve patient satisfaction rates in the 91st percentile, an impressive turnover rate of around 10%, and a committed and engaged staff.

"On almost all the metrics that you would consider important, we as an organization are doing well and we righted the ship in terms of where we started and where we are today," says Peterman.

For more tips on patient satisfaction , conflict resolution and recruitment, check out the following articles from our Strategies for Nurse Managers site  and the Leaders' Lounge Blog!