Journey to Improved Quality Outcomes: Restructuring Our Leadership Model and Implementing Unit-based Practice Councils

Purpose:
Direct care nurses lacked accountability for falls and pressure ulcers. Charge nurses were overwhelmed. Unit councils lacked knowledge of how to interpret data and take action. Our goal was to restructure our leadership model, engage bedside nurses and empower them to own their practice.

Significance:
CMS and other insurers no longer pay for nosocomial complications or the occurrence of “never events.” The key to eliminating these occurrences is based on direct care nurses' ability to analyze clinical data and being empowered to take action to achieve quality patient outcomes.

Strategy and Implementation:
Leadership transition included creating nurse manager positions and eliminating managerial functions of charge nurses. Their title was changed to Clinical Leader and they are responsible for ensuring positive patient outcomes, evidence-based practice and creating a healthy work environment. We consolidated the TCAB Steering, Fall and Pressure Ulcer Committees into a Patient Excellence Team which includes unit practice council (UPC) chairs. We also formalized ongoing development of the UPCs. The Patient Excellence Team meets on the first Thursday of each month. Standing agenda items include all nurse sensitive indicators (RN vacancy and turnover, falls, pressure ulcers, and patient satisfaction). UPC chairs receive a workshop day that includes the Nursing Professional Practice Council meeting, time for follow-up activities, Patient Excellence Team meeting to report progress with action plans and outcomes, networking with peers and holding UPC meetings on their respective units.

Evaluation:
Our 2009 fall rate decreased 39% and pressure ulcers decreased 39% with no stage 3 or 4. The patient satisfaction Net Promoter Score increased from 67 to 72. Nursing Satisfaction subscales outperform the national mean and increased in all areas and the UPCs have taken ownership of nursing practice.

Implications for Practice:
Mentoring and support of nurse managers, clinical leaders and bedside nurses can sustain positive patient outcomes. Our shared leadership model empowers bedside nurses to analyze practice and take the necessary actions to achieve our vision for clinical excellence.