Stijn Slootmans – Change manager Danny Van heusden – Magnet program director

Journey to nursing excellence at UZA

Antwerp University Hospital (UZA)

• Academic hospital founded in 1979

• 573 beds

• 400 physicians and 38 medical fields

• Over 3000 employees – 1200 nurses

• 650,000 patients treated yearly

UZA Lean & accreditation journey

S2 2010 –S1 2011 Mrch 2011 Sept-Dec 2011 Sept 2011 Nov 2013

Preparation Site visits & implementation planning UZALean

Communication Roadshow: 25 information sessions + magazine, intranet,…

Jan-Febr 2014 Juli 2014 Jan 2015 April 2015 Aug 2015

Training PW

OR

ER

Productive

Ward

Pharmacy

Outpatient ICT

Oct 2015 Febr 2016 Oct 2016 Aug 2017

Poli 2020

Application Written

documentation

Site visit

Model of Lean in healthcare

Transformational leadership

• Strong connection with Lean leadership

→ Shingo model for enterprise excellence

Ideal results require

ideal behaviour

Leadership development

• Training:

• Lean leadership (2012-2013)

• Inspirational and Coaching Leadership (2015-2017)

• End-to-End thinking of the patient journey (2017)

Management by walking around

• Regular Gemba-visits by CEO and C-suite

• Creates improvement dynamic & sustainability

• Concern & support very much appreciated by nursing teams

Strategy deployment

Excellentie

Kennis - Kwaliteit

Missie en visieAls universitair centrum willen wij een vooraanstaande positie innemen in patiëntenzorg, wetenschappelijk onderzoek en opleiding. Wij willen erkend worden als een innovatieve

kwaliteitsorganisatie met een uitstekende reputatie, een krachtig netwerk en enthousiaste medewerkers.

UZA Lean Leadership & Mindset

· Verbeteren van de

patiëntervaring:

bejegening

educatie

pijnbeleid

patiënt oproep

· Verbeteren van patiënt

betrokkenheid door verdere

uitbouw bedside briefing

· Standaardiseren van normen

t.a.v. patiënt educatie

(waaronder teach back)*

· Zorg afstemmen op

professioneel praktijkmodel

· Verbeteren van Nurse

Sensitive Outcomes:

HAPU 2

CAUTI

CLABSI

VAL met letsel

ð invoeren van bundels

· Pijnbeleid (NRS >7)

· Compliance behouden met JCI

standaarden, inclusief

uitvoeren van SIP

· Ontwikkeling van procedures/

processen o.b.v. EBP*

· Implementatie van trainingen

en vormingsbeleid in kader

van accreditatie*

· Alignering van strategie tot

team en medewerkersniveau

· Evaluatie van medewerkers

inclusief opstart peer review,

vastleggen

opleidingsbehoeften,

persoonlijke doelstellingen

· Aanpassen

governancestructuur i.f.v.

Magnet accreditatie

· Leiderschapsvorming*

· Focus op UZA als

aantrekkelijke stageplaats

(WPL sites ↑)

· Monitoren en verbeteren van

engagement/tevredenheid van

medewerkers en studenten

· Borging Lean PW methode

· Doelmatige inzet van de

mobiele equipe*

· Staffingsbeleid in functie van

budget*

· Objectiveren van processen en

capaciteit a.d.h.v. BI

toepassing*

· Dossiervoering met oog op

voorbereiding EPD*

· Herbepalen van workflows

i.f.v. doelmatiger aanwenden

van middelen

Kwaliteit en veiligheidPatientWerkomgeving

MedewerkersKosten Efficiëntie

Productive Ward – Releasing Time to Care

• Lean approach designed by the NHS (UK)

• Evidence based change management in healthcare

• Based on Lean & Prince 2

• Specific for nursing wards

• Focus on eliminating waste & adding more value for patients & nurses

• Goal:

• Visualization of performance at ward level

• Regular team meeting

• Discussion of results

• Define and monitor action items

• Content:

• Indicators and results

• Nurse sensitive clinical outcomes

• Other quality and patient safety indicators

• HR indicators (e.g. employee engagement)

• Department indicators → choice based on patient population

• Improvement suggestions

• Safety incidents

Improvement Boards and Team Meetings

Providing Data on KPI’s

Development of a comprehensive B.I.-system

Developing PDCA Thinking

Model of Nurse Second-Order Problem-Solving

Adapted from Tucker and Edmondson

A3 Training Sessions

• Regular Training Sessions open to all staff

• Integration of A3 in Project Management Methodology

Projectmanagement @ UZA - Projectgrootte

Criteria met omschrijving

Score

Ja Ne

e Kost (i.e. investeringskost, werkingskost, personeelskost

(zowel externe als interne, …) ≥ 150.000 € 7 0

Mensdagen ≥ 50 dagen 2 0 Actief meewerkende partijen [intern: diensten; extern:

aanspreekpunten (geen onderaannemers)] ≥ 5 2 0

Doorlooptijd ≥ 1 jaar 2 0 Projectteam (projecteigenaar, -coördinator, -

deelverantwoordelijken, -medewerkers incl. externen) ≥

10 2 0

Betrokken directies(leden van het directiecomité) ≥ 3 1 0

Totaal

A3 problem solving

Bedside Nursing Handover

Patient Satisfaction

8,3 / 10

Nurse Satisfaction

6,6 / 10

Shift handover → Value for the patients?

Team of “reference nurses Q&PS” Brainstorming on concept, designing future state,

coaching team & ward leader

Expected results (evidence-based) Patient empowerment, better care plan follow-up,

improvement of care safety and quality, overtime

reduction, handover efficiency,…

Time spent on Direct Patient Care

Increase of Direct Patient Care 10%

Results Productive Ward

Active PW versus passive PW

Employees of active PW

report significantly

less workload

“Enthousiasm for Lean”

grows with time

Results organization context

• Overall increase of positive perception

of nurse-physican relation

• Higher mean active PW

• Strong increase of positive perception of nursing

management (active & passive PW)

• Higher mean active PW

→ Lean implementation & leadership development

• Increase of positive perception organization support but

significant lower scores

• Higher mean active PW

Magnet Worldwide

Background and aim

• To transform the hospital organization guided by a

research programme to improve organizational

context of nursing practice and patient quality and

safety outcomes (2007)

• Transformation process inspired on the principles of

the ANCC Magnet Recognition Program™ to create a

healthy nurse practice environments that stimulate

nurse professionalism, retention, productivity,

satisfaction, and safe quality patient care.

Background and aim

• Three of the original 14 forces of magnet guided a

transformation process from an organisation form that

was classic hierarchical and departmental to one that

was flat and interdisciplinary:

• (1) flat organizational structures, where unit-based

decision making prevailed, with sufficient nurse

representation in the organizational committee structure;

• (2) a participative management style incorporating

sufficient feedback from staff nurses and the presence of

visible and accessible nursing leaders; and

• (3) positive interdisciplinary relations with mutual respect

amongst all disciplines.

Breathe Magnet ®…

“Magnet is not something you can start

and stop; you have to live and breathe it

every day, and if you don't get that

concept, you have to step back and

reevaluate your journey.”

Stephan Davis

DNP, MHSA, NEA-BC, CPHQ, FACHE

Director, Nursing Excellence and Utilization Management

Metropolitan Hospital Center

New York, NY

The new Magnet ® model

• Transition in 2008:

• 14 forces of magnetism 5 component Magnet ® model

• Focus on outcomes/results

Magnet model

Strategic Planning

Advocacy and Influence

Visibility, Accessibility, and

Communication

Professional Engagement

Commitment to Professional

Development

Teaching and Role Development

Commitment to Community

Involvement

Recognition of Nursing

Professional Practice Model

Care Delivery System(s)

Staffing, Scheduling, and Budgeting

Processes

Interdisciplinary Care

Accountability, Competence, and

Autonomy

Ethics, Privacy, and Confidentiality

Diversity and Workplace Advocacy

Culture of Safety

Quality Care Monitoring and

Improvement

Research

Evidence-based Practice

Innovation

Magnet Hospital Components

Magnet®

@

Magnet@ UZA - Cornerstones

Nursing Councils

UZA Professional Practice Model

01

02

03

04

05

Organizational Mission From organization to nursing fit

Nursing Professional Roles, responsibilities, and relationships. Mostly

derived from nursing theory

Patient Care Delivery System

Governance & Decision making Practice of nursing

Recognition & Rewards Meaningfull recognition

Professional Practice Model (’13 – 14)

Shared governance structure

• Mentor/coach

• Champions nursing care excellence

• Champions pain, palliative care and ethics

• Champions patient safety and hygiene

• Nurse managers

• Council structure

council structure

Continuous focus on outcomes

Continuous focus on outcomes

x 34

Transforming process

• Transformational leadership

• Nursing mission, vision, values and strategic (2007)

• Leadership program for nurse managers and nurse leaders

(2008)

• Structural empowerment

• Support for clinical units

• Quarterly unit meetings; agenda based on team member

consultation; setting unit goals per year; meetings between staff

nurses and physicians about dedicated unit level topics (2009)

• Nursing councils

• Nurse preceptors (2008)

• Patient safety and infection prevention & control (2010)

Transforming process

• Professional practice

• Interdisciplinary improvement projects

• Patient safety incident reporting system (2008)

• Unit level registration of pressure ulcers, falls with injuries and

physical restrains (2008)

• Introduction of EWS and SBAR (2010)

• Dedicated clinical projects

• Palliative care program (2011)

• Assessment and treatment of delirium (2011)

Following steps

Magnet Gap Analysis

Submit Magnet Application

Implement Magnet Standards and

Sources of Evidence

Submit Written Documentation

Site Visit

COM Vote

Magnet documentation website

You don’t do all of the great

things you do, to be Magnet®…

You are Magnet® because of

all the great things you do.

UZA magnet journey

Improve nursing practice and outcomes

References

• Van Bogaert P., Van heusden, D., Somers, A., Tegenbos, M., Wouters, K., Van der Straeten, J., Van Aken, P., & Havens D. (2014). Impact of

the Productive Ward program™ within a Hospital Transformation Process: A Longitudinal Multilevel Study of Nurse Perceived

Practice Environment, Burnout and Nurse Reported Quality of Care and Job Outcomes. Journal of Nursing Administration, 44, 452-461.

• Van Bogaert Peter, Van heusden Danny, Verspuy Martijn, Wouters Kristien, Slootmans Stijn, Van der Straeten Johnny, Van Aken Paul, White

Mark (2017) The productive ward program TM : a two-year implementation impact review using a longitudinal multilevel study

Canadian journal of nursing research - ISSN 0844-5621 - 1705-7051

• Van Bogaert Peter, Peremans Lieve, Van heusden Danny, Verspuy Martijn, Kureckova Veronika, Van de Cruys Zoë, Franck Erik (2017)

Predictors of burnout, work engagement and nurse reported job outcomes and quality of care : a mixed method study BMC nursing -

ISSN 1472-6955 - 16:5, p. 1-14

• Van Bogaert Peter, Peremans Lieve, Diltour Nadine, Van heusden Danny, Dilles Tinne, Van Rompaey Bart, Havens Donna Sullivan Staff

nurses' perceptions and experiences about structural empowerment : a qualitative phenomenological study PLoS ONE - ISSN 1932-

6203 - 11:4(2016), e0152654

• Gregory et al. (2014), Bedside Shift Reports What Does the Evidence Say? Journal of Nursing Administration, 44 (10), 541-545..

• Holden R.J., (2011) Lean Thinking in Emergency Departments: A Critical Review. Annals of Emergency Medicine, 57 (3), 265-278.