SCONL / GONL Nurse Leadership Institute Highlights

At the recent Nurse Leadership Institute meeting—a collaborative effort between the Georgia Hospital Association and the South Carolina Organization of Nurse Leaders—South Carolina speakers represented our state well by presenting some of the best quality initiatives underway in our hospitals. Here’s a brief summary of those presentations. 


Jill Benns, Director of Nursing Education at Palmetto Health, presented two project boards that outlined new programs aimed at reducing turnovers for both new and experienced nurses in the system.


Nurse Leaders


The first board, Developing Nurse Leaders, showcased Palmetto Health’s Nurse Leader Academy, a collaboration with the Leadership & Learning Section of the hospital’s Organizational Development department. The academy allows nurses to devote one half day per work week to taking various courses that develop hard skills, soft skills, and project management techniques. By providing career growth opportunities for nurses that develop leaders from within and promote retention while minimizing the effect on operations, the hospital increases nurse job satisfaction while improving succession planning and preparing new leaders. The program has already seen a dramatic drop in turnovers among both nurse managers and assistant nurse managers since it was implemented two years ago. 


Nurse Residency


Benns’ second board tackled the problem of nurse retention at the beginning of their careers with Palmetto Health’s Nurse Residency program. Using the residency model as an orientation for graduate nurses entering the workforce, the program is designed to create a ready-trained RN pool and reduce turnover while also encouraging more attention to decreasing critical events and harm.


Using an evidenced-based accrediting curriculum from national nursing organizations and blended learning opportunities in classrooms, simulations, and on-hand training sessions, these nurses will be far better equipped to assume full-time duties than they would otherwise. Given that Palmetto Health has a 17.8% turnover rate for new graduate nurses, and an open position takes an average of 56.8 days to fill once approved, retaining a single additional graduate nurse a year can fund a major portion of the residency program’s budget, Benn explained.


Jody Spence, Manager of Case Management at Baptist Easley Hospital, presented a board on the Care Transitions Community Collaboration project, which works to improve communication between acute care facilities and community partners and establish continuity of care to maximize patient’s health outcomes. The project is funded through a generous grant from The Duke Endowment.  


Care Transitions


The hospital began the process of inpatient case management with risk stratification years ago, and they developed a tool to identify the highest-risk patients and implemented a clinically-focused follow-up program. In 2015 they expanded this approach, using a new tool to make the program more structured and data- and outcome-driven. Now a call is made to high-risk patients within 24 hours of discharge to review treatment information and begin the assessment process. A home visit follows within 72 hours of discharge, with weekly telephone follow-ups through the next month. Each call requires collection of health confidence scores that gauge how capable the patient seems in managing their own care.


The program also seeks to eliminate gaps in care by working with primary care providers, specialists, pharmacists, home health providers, and other organizations. As the hospital expands the program, Case Management should be embedded in physician practices by the end of 2016 and the hospital will begin identifying at-risk patients prior to admission to continue eliminating gaps in care.  


AnMed Health’s Jody Phillips, Director of Clinical Quality & Patient Safety, and Susan Roos, Senior Director of Nursing at Beaufort Memorial, each gave a presentation on the value of daily organizational huddles for hospital systems. Both hospitals instituted these safety huddles as part of the South Carolina Safe Care Commitment, an effort to make all of the state’s hospitals highly reliable organizations that provide exceptionally safe care and consistently high levels of quality. 


Phillips and Roos


Phillips’ presentation detailed the way their safety huddle worked in a large hospital system. At AnMed each day at 8:30 a.m., a huddle command consisting of the executive team and key staff gathers with huddle facilitators who make sure every staff person is in a reporting area. There’s a standard reporting roster, with 64 daily reports delivered (there’s also a separate weekend roster). Following the huddle, the command group has a 15-minute debrief to discuss the issues reported, with issue resolution discussed at the next day’s debriefing.


These daily meetings are designed to improve system-wide situational awareness and communication. It also encourages occurrence reporting, especially near misses, and helps identify systemic issues for process improvement. Stakeholder buy-in is crucial, and AnMed has instituted to their Good Catch program to reward individuals reporting. And because of the standardized report rosters, the hospital has data that verifies the huddles are working, with an uptick in both errors and near misses being reported across the system.  


Roos’ presentation dovetailed nicely with Phillips as an account of how safety huddles work effectively in small hospital systems like Beaufort Memorial. The hospital actually used AnMed as a model, although they elected to make a few changes, like making the meeting a conference call each day. The huddle moves quickly, with department-specific scripting and closing with the Risk Manager/Patient Safety Office to summarize and identify follow-up issues. Roos says that, like AnMed, this has allowed good catches to increase and to diminish siloed thinking across the system. It’s also been a great way to increase Senior Leaders’ awareness of what happening on the frontline—the leaders rotate who “leads” the call each day.


Kinneil Coltman, Chief Diversity Officer for Greenville Health System, presented on the prevalence of unconscious biases and how to overcome them in medical care. The Institute of Medicine published a study called Unequal Treatments: Confronting Racial and Ethnic Disparities in Healthcare in 2003 that found significant variation in rates of medical procedures based on race even when controlling for insurance status, income, age, and severity of the injury. Coltman pointed out other studies that support this understanding, along with a brief primer on how implicit biases work generally and in healthcare specifically. 




In the second half of her presentation Coltman noted there are classes and strategies that help minimize the impact of implicit bias in patient/provider interactions, provider decision-making, and health outcomes and then reviewed some of the techniques and approaches that are appropriate for the clinical setting and beyond. Practicing mindfulness is key, as is creating accountability based on outcomes rather than intentions. Most decisions affected by bias tend to have time pressures or source constraints associated with them, so it’s important to recognize those moments and ensure providers really know the patient before moving on. Coltman also recommends having larger groups, like a quality committee, look at patient satisfaction data broken out by race, ethnicity, and language to address systemic problems.   


Caroline DeLongchamps, Manager of Patient and Family Centered Care (PFCC) at MUSC Health, explains the values and benefits of strengthening partnerships with patients, families, and staff in her presentation. Her program is premised on the fact that each of the stakeholders plays a vital role in ensuring the health and well-being of a patient, so emphasizing respect and garnering participation from families in a collaborative effort can be instrumental to improving the quality of care. This extends to not only the delivery of individual care, but also policy, program development, and professional education. MUSC Health has already seen the benefits of this focus. DeLongchamps cites improved clinical outcomes, a reduction in readmissions, and patient and family satisfaction, but also a more supportive workplace environment that encourages recruitment and retention among staff and a more effective learning environment.




PFCC has a variety of initiatives aimed at fostering this culture, with everything from revisions of hospital brochures and documents to changes in the family lounge and waiting area. The program works with their six Patient and Family Advisory Councils, members of which serve on hospital committees and provide a valuable perspective and voice to ensure high reliability standards in all facets of hospital services.


Morgan Rackley, a project specialist at the South Carolina Hospital Association, presented her work on the Plain Language Toolkit. A high-level quality effort designed promote safety and reduce harm, the toolkit helps hospitals is implement plain language emergency codes. Historically, hospital emergency codes were assigned a color. The use of color codes was intended to convey essential information quickly with minimal misunderstanding to staff, while preventing stress and panic among visitors to the hospital. Unfortunately, the risks of using color codes now outweigh the benefits. There is significant variation of color codes across organizations, which leads to confusion of health care providers and, in some instances, harm to health care providers. Hospitals have also received feedback from consumers stating that color codes increased their stress level. Consumers want to be informed and have asked hospitals for transparency.




In collaboration with SCHA’s Strategic Issues Council and a Plain Language Workgroup made up of hospital CEOs, CNOs, CMOs, Emergency Managers, Risk Managers, and other experts, a set of plain language codes is being rolled out and adopted across the state. This code adopts a simple system of announcing emergencies by category (facility, security, or medical) followed by the type (e.g., evacuation, civil disturbance, medical emergency), location, and directions.


All photos by Lorri Gibbons.

06-20-2016 10:41 (EDT)