First appeared in PSQH Magazine.
Five years ago, PSQH spoke with Jeanette Ives Erickson, RN, DNP, FAAN, about a new and exciting innovation in her hospital, Massachusetts General Hospital (MGH). Dr. Ives Erickson, the senior vice president for patient care and chief nurse at MGH, spearheaded an initiative that designated 12 Innovation Units, where a philosophy of relationship-based care and 13 evidence-based interventions could be safely tested. This March, we checked in to see how the initiative has fared.
Putting nurses front and center
The major goal of the innovation units at MGH were to emphasize the Patient’s Journey: helping the patient before, during, and after hospitalization. This emphasis hinged on a new role created specifically for these units: the attending nurse (ARN). As Dr. Ives Erickson explained five years ago, “The ARNs function as clinical leaders, working with staff nurses, interdisciplinary team members, patients, and family members to manage the care of patients on a single unit from admission to discharge. Essentially, the ARN role is designed to manage between the spaces and coordinate the delivery of the care of patients on a single unit from admission to discharge, working with the entire healthcare team and the patient and family" (Ives Erickson, 2013).
As the appointed navigator of the Patient’s Journey, the ARN is responsible for making the patient and family members part of the team. This process starts at admission. The ARN begins by giving the patient and family business cards that establish an open line of communication, then reviewing a specially developed “welcome packet” with the patient and family. The packet includes a patient and family notebook, a patient compact, ab overview of the care team, and space to write questions to review with caregivers. The ARN consistently connects with caregivers and the patient, reviewing the health plan and posting a “Goal for the Day” in the patient’s room. The ARN’s responsibilities continue even after the patient leaves the hospital; the ARN makes post-discharge follow-up calls with the patient to ensure the care plan is being followed and to answer any questions.
The ARN is part navigator, advocate, educator, and discharge nurse, and gives patients and families a consistent presence throughout their hospitalization and after discharge. Having eight-hour shifts allows the ARN to establish relationships with the care team and the patient and family, providing a familiar face that ensures continuity of care and a steady presence. As Dr. Ives Erickson notes, “Because the ARNs are staff nurses, they are better able to support the team in closing any gaps that may arise in this fast-paced world of healthcare.”
In addition to designating innovation units, MGH also made a concerted effort to track the results and quickly identify trends and adapt their protocols on the fly. They developed an evaluation schema in all of their units, collecting data before the innovation units launched, and at specific intervals to measure their successes or failures. They gathered qualitative feedback from focus groups, surveys, observations, and interviews with both patients and staff.
Almost immediately, they saw positive results. More than 95% of patients surveyed felt included as part of the care team, a stated goal of the Innovation Unit. Patients also reported that calls were answered promptly 88% of the time. By the end of the first year, MGH found that units using ARNs saw a 5% decrease in length of stay and a 3% drop in readmissions in the first year. Patient satisfaction scores for these units doubled those from the rest of the hospital.
The staff reported an increase in satisfaction as well. In a 2013 survey, 86% of the staff reported that they were satisfied or very satisfied with their work environment. Many reported that they were proud of their contributions to patient care, and clinicians stated they wanted to increase the standardization of innovation strategies and were satisfied with their professional development.
The results of the Innovation Units were so impressive that in May 2013, the American Nurses Credentialing Center (ANCC) redesignated MGH as a Magnet® hospital. By the end of 2013, all inpatient units at MGH had transitioned to the innovation/ARN model (Jones et al., 2013).
Looking back, looking forward
In March 2017, five years after the Innovation Unit model was introduced at MGH, I had the chance to ask Dr. Ives Erickson to reflect on how the model has impacted the hospital's practice. The conversation has been edited for clarity.
PSQH: Now that the Innovation Unit program at MGH is five years old, what do you think are the unit’s biggest successes?
Jeanette Ives Erickson: I think the Innovation in Care Delivery at MGH was a success in every measure. We’ve seen improvements in all aspects of the patient experience, from length of stay reduction to a decrease in patient falls and pressure ulcers. Beyond the improved outcomes, the interprofessional collaboration that the units inspired might be the greatest success. It is heart-warming to see clinical staff working together to create and implement ideas to improve their unit.
PSQH: How has the attending nurse program changed over the last five years?
Ives Erickson: The group has truly emerged as institutional leaders. In fact, one of the ARNs has just been promoted to a nursing director! All of the ARNs are highly regarded clinical nurses who provide consistent patient and family and care team contact that supports all clinicians. The follow-up phone program has been especially successful, as it has helped to reduce readmissions and enhance patient satisfaction.
PSQH: Is there anything you would do differently if you were just starting out?
Ives Erickson: Yes, I would have had more patient involvement from the beginning. I did meet with patient and family advisory committees, but I think I should have hosted them at our staff retreats as we developed the Innovation Units. Their input has been crucial in understanding the need to streamline some of our care processes.
PSQH: Do you have any advice for other hospitals that hope to implement Innovation Units?
Ives Erickson: We were successful precisely because we were open to widespread change from the beginning. No ideas were dismissed, big or small. Innovation Units require buy-in from all levels of an organization, and I highly recommend that organizations bring large numbers of staff together to think, create, and implement ideas.
Ives Erickson, J. (2013). Innovation Units and the 'attending nurse' at MGH. Patient Safety & Quality Healthcare, January/February 2013.
Jones, D., Adams, J., Giuliano, A., & Ditomassi, M. (2013). Evaluation. Caring Headlines: Patient Care Services at Massachusetts General Hospital, December 19, 2013.