Kim Hitchings

Work Flow Analysis: Eliminating Non-Value-Added Work

Objective: To evaluate the impact of implemented work environment changes on nursing and support staff roles. Background: In 1999, the authors identified key drivers of unnecessary work associated with the day-to-day delivery of patient care in their institution and implemented changes based on their results. Methods: Both quantitative and qualitative methods were used. Work sampling and focus groups were used to evaluate work flow. Activity categories were identified and clearly defined by advanced practice nurses. All compiled data were subsequently synthesized and cross-checked with the information acquired through independent, multidisciplinary validation studies. Results: There were significant changes (P <.0001) noted in overall distribution of observed activities for nurses and all support staff. Conclusions: The significant changes noted in overall distribution of observed activities reflect the important adjustments made in both job descriptions and the environment to eliminate key drivers of unnecessary work in the delivery of patient care.

Use of a Validated Model to Evaluate the Impact of the Work Environment on Outcomes at a Magnet Hospital

Abstract: Using a structural model, we evaluated the impact of leadership, staff stability, resources, workload, work environment, and staff expertise on nurse-sensitive patient outcomes to determine elements that can be modified.

Preceptors promote competence and retention: strategies to achieve success.

When considering factors that affect nurse recruitment and retention, an appropriate response to the nursing shortage may be to either implement a preceptor model or refine an existing preceptor program. This article describes the evolution of a comprehensive preceptor model including the following: strategies to gain staff, administrative, and educational support and involvement; a preceptorship policy and procedure; a formal program to prepare preceptors; the need for identified orientation, learning expectations, and documentation of the same; evaluation methods of a preceptor model; and rewards for the preceptor. The viability and strength of this preceptor program may be attributed to the inclusion of all levels of nursing staff in its development and implementation.

Peer case review sharpens event analysis.

This manuscript describes a scholarly approach to peer case review that identifies and analyzes quality-of-care issues in response to a question about nursing care of a specific patient. The comprehensive method provides a structured format that critically examines untoward patient events, generates an awareness of gaps in care from a systems perspective, ensures action planning focused on legitimate root causes, stimulates performance improvement initiatives, and provides a forum to share learning throughout the organization.

Lehigh Valley Hospital: Engaging Patients and Families

BACKGROUND Lehigh Valley Hospital (LVH), a 623-bed tertiary care referral center, is one of two hospitals of the Lehigh Valley Hospital and Health Network. PATIENT AND FAMILY INVOLVEMENT Improving patient safety requires active engagement. Many units have collaborative rounds, which family members may join. Family meetings often include multimedia sources to review patient conditions, results, and plans of care. LVHs advanced intensive care unit program allows virtual meetings with an off-site intensivist. USE OF INFORMATION TO SET AND EVALUATE QUALITY GOALS AND PRIORITIZE INITIATIVES The Institute of Medicine (IOM) aims of care are addressed in terms of Donabedians clinical outcomes (safety, effectiveness, and timeliness), financial outcomes (efficiency), and service outcomes (patient-centeredness and equity). APPROACH TO ADDRESSING THE SIX IOM AIMS Two strategies to address the IOMs six aims have been employed--patient engagement and an emphasis on technology. More than

Nurses Leading the Transformation of Patient Care Through Telehealth.

30 million has been invested, thereby creating a digital hospital, which, in combination with evidence-based practice, uses advanced computerized and wireless systems to improve patient care and safety. CHALLENGES AND LESSONS LEARNED New problems evident once process improvements are made are quickly addressed. Technology cannot fix bad processes; rather, process improvements should come first, with technology then added to enhance those improvements.

Development of a Reliable and Valid Organization-Specific Professional Practice Assessment Tool

The essential role of nurses in leading, developing, and improving Lehigh Valley Health Network (LVHN) telehealth services and programs was a key reason the organization was selected to receive the American Nurses Credentialing Center 2013 Magnet® Prize. This article describes the application of telehealth as a nurse-led technology. The innovations within LVHN telehealth services are presented as well as essential success factors of design, implementation, and evaluation.

The Professional Excellence Council: Implications for All Forces of Magnetism

PurposeThis article describes a study to devise an organization-specific professional practice model (PPM) assessment that reflects actual unit involvement. A secondary study goal is the development of a unit-based index that can be used to conduct comparative analyses in an efficient way. DesignEach of the 5 elements of the organizations PPM was represented by 1 or more items on an author-developed instrument. The tool was structured so that item scores could be summed to achieve a single subscale for each PPM element and further aggregated into a total score. MethodsThe instrument was administered to a 40% random sample of all regularly scheduled, full- and part-time registered nurses in an academic, community Magnet hospital in 2003 and 2005. Descriptive statistics were calculated for items, subscales, and summary scores for each patient care unit and overall. A weighted, unit-based index was developed to reflect each units score on a scale of 100. FindingsThe 2003 assessment response rate was 51% (n = 200); the 2005 response rate was 48% (n = 193). Subscale scores and a total PPM score were calculated by summing the values of each individual item. Submissions enabled calculations of total scores by unit, mean scores by item, and the development of a unit-specific PPM index of performance. ConclusionsBeyond shared principles of empowerment, the specifics of each organizations PPM may differ in those key components of care delivery nurses are empowered to effect. Thus, fidelity to the organization-specific PPM is not well tested with generic decisional-involvement instruments. An organization-specific assessment such as this one can provide evidence of not only organizational PPM fidelity but a quantitative method to ensure that staff nurse decisional involvement is continuously evolving to an ever higher state.

Respiratory Nursing Diagnoses: Practicing Nurses' Selection of Defining Characteristics

LEHIGH VALLEY HOSPITAL is an 850-bed academic, community hospital in Allentown, Pennsylvania. Part of the Lehigh Valley Hospital and Health Network (LVHHN), it was originally designated a Magnet hospital in 2002 and redesignated in 2006. This column describes the Professional Excellence Council (PEC) and shares how associated activities and outcomes sustain the momentum to continuously embed designated Forces of Magnetism1 within the LVHHN culture. Lehigh Valley Hospital Patient Care Services has employed a shared governance professional practice model (PPM) for more than 20 years. The conceptual framework of the PPM is based upon core values and beliefs that are consistent with the Forces of Magnetism.