By Jennifer Thew, RN
Nurse leaders are responsible for a vast array of metrics related to processes, clinical outcomes, and everything in between.
"Our CNOs are held accountable for readmissions, mortality rates, [and] hospital-acquired conditions, and for the financial bottom line in their particular hospital," says Maggie Hansen, RN, BSN, MHSc, senior vice president and chief nurse executive at the South Florida–based Memorial Healthcare System.
"Nurses have to worry about almost every touch point on the continuum of care.”
That’s a big job. And with the immense amount of information generated in today’s healthcare environment, knowing exactly how data should be measured to create meaningful metrics is a challenge.
But nurse leaders are up for it.
“We’re counted on to produce great and enviable metrics,” Hansen says. “We’re the ones that can make it happen, because healthcare is about the patient care that nurses provide."
Patient Experience on the Radar
To help CNOs get their arms around the myriad metrics they need to collect, Sean Lynch, RN, MSN, SCRN, assistant administrator for patient services and nurse executive Baptist Medical Center Beaches in Jacksonville Beach, Florida—part of Northeast Florida’s five-hospital Baptist Health system—suggests looking at data through four "pillars:”
- Patient experience
- Team engagement
Throughout the Baptist system, all meetings in every department begin with a review of quality metrics. And while quality is important, Lynch says the pillar of team engagement should not be underestimated.
"Your team is what makes the other three pillars happen," he says.
To measure employee engagement, Baptist Medical Center Beaches administers a Willis Towers Watson team engagement survey every two years.
"Each department identifies their strengths and their weakness, and they build action plans based on their opportunities," he says.
Hospitals and health systems may also want to consider collecting metrics in real-time, Lynch says.
Baptist Medical Center Beaches is piloting a program called Rounding and Driving Awesome Results (RADAR), which one of the organization’s administrators created to help leaders respond to patient issues as they occur.
During a RADAR survey, nurse managers ask patients five questions, including "Are we meeting all your expectations?" and "Are the staff responsive to you?" The patients’ answers are entered into a tablet, and each day at 7 AM a report is printed.
Depending on the patients’ responses, the program issues a red light (dissatisfied) or a green light (satisfied or very satisfied).
The organization’s leadership can also review patient comments entered into the survey. The color-coded system makes it easy to identify opportunities for service recovery before a patient leaves the hospital.
"If there are opportunities, we want to intervene as a leadership team," Lynch says.
Reduction in Harm
At Mission Health, a nonprofit, independent community health system in Asheville, North Carolina, the organization is improving care by collecting metrics across the board related to harm.
"We benchmark that," says Jill Hoggard Green, PhD, RN, Mission Health System’s chief operating officer and president of Mission Hospital, the system’s 763-bed flagship hospital.
"Over the last three years, we have had a substantial reduction in harm across the board. For us, that’s everyone’s goal. We do it at the system level and then we look at it on individual units, usually with specific measures, where we can see we have opportunities."
At Mission Hospital, the facility is creating team-based care units where a physician provider, care manager, and nurse leader co-lead a unit that focuses on a specific patient population.
"We work on having standard work with outcomes, and we have huddle boards where we assess our metrics and how well we’re moving forward," says Karen Olsen, MBA, BSN, RN, NE-BC, vice president and chief nurse executive at Mission Hospital.
Length of stay, readmissions, leader rounding, and patient experience are all evaluated and used to improve unit processes.
For example, if the goal is to discharge patients earlier in the day, metrics are assessed to help identify barriers to reaching that goal. If the unit-based leadership team notices there is a delay in a specific department, they work together to find solutions to the hurdle.
Unit-based safety issues are also reviewed.
"We do root cause analysis and partner with our safety and quality leaders to [develop] action plans," she says. "We have a strategic committee, and we are very transparent with our metrics. Those units that are excelling and doing well—we want to transfer that knowledge and that experience so we can have gains across all of our units as well."