Search Results

Upping Our Game

from Jerry Spicer, DNP, RN, NEA-BC, FACHE
Vice President
Regional Patient Care Services
Southern California

The Affordable Care Act expanded the opportunity for millions of people throughout our nation to access health care insurance and ultimately to achieve better health. Our recent record-breaking membership growth and the increase in work performed by our frontline providers are proof of the impact this greater access to health care coverage has had on Kaiser Permanente. Through it all, it’s been the willingness of our nurses to put the care of our members, patients, and their families at the center of what they do, that has helped us meet the access and care challenges faced by our delivery system.

We know our more than 20,000 Southern California nurses and the other members of the Patient Care Services team will respond to pressures caused by continuing membership growth with dedication, compassion, and professionalism. At the same time, we also must decide how we meet three challenges that affect the role of our nurses in transforming health care to meet 21st century needs. These challenges concern how we should:

  • Maintain the resiliency of Regional Patient Care Services.
  • Identify, implement, and spread best practices throughout the Region.
  • Advance patient safety and quality while improving KP’s affordability.

Reshaping nursing’s role

For 13 years running, nurses have been named the most trusted profession in America according to an annual Gallup poll that rates professions for their ethical standards and honesty. In addition to ethical standards and honesty, this trust is based on several other factors, among them competence, professionalism, compassion, drivers for innovation, inspiring hope, being patient advocates, and serving as valued members of our patients’ health care team.

Competence, trust, and the potential for making significant contributions to improve care outcomes are the reasons nurses should have key roles in redesigning health care in the United States. Nurses can become significant contributors to health care transformation by helping to create a work environment that promotes the opportunity for nurses to practice to the full extent of their education and training. This includes encouraging and supporting nurses to achieve higher levels of professional education and training through an improved education system that promotes seamless academic advancement.

Much of this is outlined in the Institute of Medicine’s Report on the Future of Nursing. Among its recommendations are:

  • Removing scope of practice barriers.
  • Expanding opportunities for nurses to lead and diffuse collaboration.
  • Implementing nurse residency programs.
  • Increasing the proportion of nurses with baccalaureate degrees to 80 percent by 2020.
  • Doubling the number of nurses with a doctorate by 2020.
  • Ensuring that nurses engage in lifelong learning.
  • Preparing and enable nurses to lead change to advance health.
  • Building an infrastructure for the collection and analysis of inter-professional health care workforce data.

As we think about the Institute’s recommendations, we also need to look at how nurses might reshape their identity. Nursing historically has held on to some responsibilities that could be delegated to other positions that possess the training to assume them—for example, medication administration and other task-oriented work that nurses perform because it’s seen as part of a nurse’s “identity.” But health care today is not business as usual and one of the ways Patient Care Services is responding is by breaking down traditional silos and seeking to work more interdependently to support Kaiser Permanente’s strategy to “Perform, Grow, and Lead” to improve patient outcomes and care affordability.

Our future as more effective health care team members may be based on how well we’re able to move away from task-based roles to a process coordination and collaboration focus in which our professional competency and knowledge to navigate patients throughout the entire care continuum is leveraged. This would allow nurses to serve as more significant contributors and members of our care team. This suggested step is similar to the ongoing transformation of the role of pharmacists who are no longer seen primarily as “pill dispensers.” Pharmacists’ knowledge and skills have them embedded as respected members of the care team who create care recommendations that produce higher quality care outcomes.

Spreading best practices

Our system has expansive pockets of excellence because of the innovative work of our nurses. Our mission is to deliver high-quality, affordable health care through Extraordinary Nursing Care - Every Patient, Every Time. To do that we need to provide the same excellent care experience everywhere, every time—and develop and spread successful practices that improve access, quality, safety, and affordability. Let me offer two examples of how this is being accomplished:

  • The Anaheim Medical Center’s Maternal Child Health Unit-Based Team scored above the 90th percentile on the HCAHPS overall rating hospital score and sustained those results for more than 12 months. More than 81 percent of the members who visit this unit give it a 9 or 10 rating on a scale of 1 to 10. This level 5 UBT is a high performing team and an example of interdisciplinary teamwork yielding outstanding results.
  • Our nurses also contributed to the success of the Total Joint Replacement UBT at Fontana Medical Center. The goal of that program was to reduce the length of stay from 48 hours to 24 hour for 10 percent of all total joint replacement patients without diminishing the quality of care. From February through December 2014, 997 total joint surgeries were completed at the Fontana and Ontario Medical Centers. Fifty one percent of those patients were discharged within 23 hours of the surgery. The UBT is now working on improving these numbers even further.

Both of these successes, as well as several others in which our nurses have been involved, have been forwarded to our region’s SPREAD Committee which was formed to identify and review effective practices and then—if they are found to be appropriate for spreading—plan for their expansion and use across Southern California. Our nurses have suggested literally hundreds of ideas as part of our effort to improve our care processes or to create the transformative changes that will take Kaiser Permanente to the next level. We hope the ideas and innovations keep coming because we know the people who are directly responsible for delivering care to our members and patients have the best experience and thinking to recommend more effective ways to make lives better for the people we serve.

Building engagement

It’s our obligation as professionals to dare ourselves and to speak up and challenge our organization to constantly strive to be better. Nurses are the largest portion of our workforce at Kaiser Permanente. We have approximately 50,000 nurses Programwide who represent about one-third of our workforce. We have great influence over the quality of work provided by Kaiser Permanente. Ask yourselves: “Are we leveraging this huge community of practice to its fullest extent to achieve better outcomes for our members and patients?”

Often we see a fundamental need for change in something, but we may not know how to get it done. However, continuing to do what we’ve always done when we know there is a need for a different outcome is not a solution. We have to work with each other to find answers to these problems. This engagement begins with making a personal commitment to have the courage to speak up and raise issues and questions about how to get higher quality results in a more affordable way to make life better for our members and patients. The next step is to talk with each other to share ideas and begin seeking solutions.

Kaiser Permanente Southern California Region has successfully built productive relationships with our partner unions through the Labor Management Partnership. One of the things our labor partners ask – and it’s a reasonable expectation – is: “Bring us into the conversation early. Involve us upfront so we can partner with you and work this together and then go to our membership and say that we fully support this direction and we think you need to get on board with it.” We need to expand our engagement with our labor partners. Such a step has the potential to produce even better outcomes for our members and help us become the greatest place to work in health care.

Change won’t happen overnight

The creation of a more effective operating paradigm in which our nurses’ current and potential value is fully realized and applied will take time and much work. Decisions about how we transform our care to produce greater value to the entire patient care experience and our nurses’ role in that work must begin with conversations among ourselves and with our physician colleagues.

There is an opportunity for Regional Patient Care Services to work more closely with SCPMG, our labor partners, and Hospitals and Health Plan leadership to develop tests of change – both on a regional and medical center level. It may take only one small test of change to serve as a proof of concept. That would be a step in the right direction to establish greater openness to new ideas, and better ways to work together for the ultimate benefit of our members and patients.