A 180 Degree Turn from Illness to Wellness

I have been a critical care nurse for over 14 years, and a nurse leader for the past 7 years.  In that time, I have watched nursing evolve from caring for the patient at the bedside to doing whatever we can to prevent that patient from ever entering our hospital.  We have done a 180-degree turn from illness to wellness.

In this new world, how do we measure our success?

The question remains:  How do we know if our efforts are successful?  In any profession, outcomes and success stories are driven by data.  But in healthcare, sometimes we struggle to put a numeric value on our performance.

To effectively measure performance and drive change, you need accurate and complete data, a clear standard against which to work, and clear assignment of and accountability for responsibilities.

As nurses, we work in a complex, layered environment that can make measuring performance a challenge.  It starts with the fact that not everything we do is captured by and integrated into the computer systems that we all have grown to love (and hate).  Then, we have multiple governing bodies that tell us what we can and cannot do – sometimes inconsistently.  And finally, we have multiple professionals who work autonomously from one another, but still have to function as a team.  So how do we move forward, turning toward wellness?

First, figure out what to measure

Health systems that really understand how to close these gaps and measure performance know that it all starts with data.   But which data?

As a nurse leader, you must first decide what goals your area or department needs to work on to improve your direct processes – and you’ll want to make sure these departmental goals are well aligned with the overall goals of your organization.   You will probably need data to figure this out.

For example, a health system might have a goal of reducing visits to the emergency department (ED).  A nurse leader in that system might want to analyze ED visit data to understand how many of those visits are driven by patients with poorly-managed chronic conditions – these are patients whose ED department use could be minimized with nursing interventions. Perhaps the nurse leader proposes an expanded complex care management function – or looks more closely at the performance of care management nurses, and sets patient engagement goals intended to drive down ED visits.

In this example, the nurse leader uses data to analyze a problem and then to measure the effectiveness of a solution to that problem:

  • Claims for ED visits
  • Clinical (EHR) data about the patient’s diagnoses and ongoing chronic condition
  • Operational data about how nurses are engaging patients

Generally speaking, to improve wellness nurse leaders need comprehensive information about all the different types of care their patients receive (even care rendered outside the nurse leader’s organization, and detailed clinical information about each patient’s health. The first type of data can come from claims, and the second type of data can come from EHR systems. Bringing claims and EHR data together helps a nurse leader fully understand the needs of a population.

Second, explain the data to your team

In my experience as a nursing director, to improve performance you must first and foremost get the buy-in of the people whose work you are measuring and trying to change.  There are too many times when we just tell people to change their processes, without taking the time to explain why we are making a change, and to explain how much of an impact each task has on a bigger scale.

For example, a nurse might give a patient’s pain medication late. To the nurse, this may seem like a minor error. But in aggregate, multiple instances of late medication administration cause the healthcare organization to do poorly on quality measures relating to pain management. Not only does this translate into a perception that the healthcare organization does not care about patient pain, but it could also result in a loss of quality-based reimbursement monies.  This would then makes it more difficult to invest in adding resources to fix quality issues.

By explaining the bigger picture, nurse leaders can get better performance and engagement from their teams.  And similarly, explaining the data that is used to measure performance encourages teams to capture it more accurately.

A nurse leader needs many different skills

As described in a Hospitals & Health Networks article, nurse leaders need many different skills in their arsenals to be successful at improving outcomes.   Advanced education, proficiency in technology, and performance-driven business smarts are a few that I would highlight from the article – I feel these three are the key to success in this arena.

As a nurse leader, you must understand how to take a process and come up with a reasonable goal and outcome that aids in that bigger picture for your organization.  You cannot fix the world overnight, so you should start with small gains, change the culture of your department, and work to foster a performance-oriented organizational culture in order to truly make an impact in your outcomes.

Over my next few blogs, I will lay out a game plan for how we as nurse leaders can be successful at using data to cure, with specific examples of success stories from organizations that have begun to master this approach.

December 8, 2016

Client Spotlight: Caleb Ledford, ARNP

In our Autumn Client Spotlight, a medical leader on the front lines of value based care explains how he uses data to drive better patient care, provider satisfaction, and practice performance in south central Washington. Learn more about Caleb Ledford, ARNP in our interview.

Read the interview