Running head: SELF-REFLECTION PAPER

Self-Reflection Paper
Clinical Systems Leadership Immersion
Melissa Ritchey
The University of Arizona

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Introduction

Over the last thirteen weeks I have been able to integrate all of the knowledge I have
acquired in this program to a Systems Leadership Immersion Project. I have been able to reflect
on my journey over the last year and half. This program has exceeded the expectations I had of
an online Masters program focused on Leadership.
Overview of Clinical Systems Leadership Education Process
When I first began this program, my initial goal was to obtain a Masters degree to meet
the position requirements in my current role as a Director. My personal goal was to obtain a
degree to continue growing in the healthcare field in leadership positions. I was not prepared for
the experience I have had in this program. The educational journey that I have experienced has
been stellar. I read an article about clinical leadership which discussed the changes in healthcare
and the complex systems in healthcare. The article stated that an effective clinician needs to
understand the different pathways and systems of care to function effectively for the benefit of
the patients. Engaging in leading systems of health care is a professional obligation of any
clinician (Swanwich & McKimm, 2011). I believe this program encompasses innovation and
integrates the opportunities available in todays healthcare. It was imperative to learn about the
Electronic Health Record and the importance of being able to extract data for Meaningful Use
for the Centers for Medicare and Medicaid Services (CMS). I found it beneficial for the program
to introduce us to the Institute of Healthcare Improvement (IHI) in which we were privileged to
complete modules to increase our knowledge related to quality and safety. All of the courses
were beneficial in my educational journey, but one that stands out to me was the Integrative
Nursing course. As a nurse it is important for us to be able to care for ourselves before we can
care for others. I believe in leadership, this is a key initiative that we must implement in our
work settings to take care of our staff. I also believe that with experience we also gain emotional

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intelligence, which helps us understand where we are in our lives, what our needs are and how to
manage them. Finally the Clinical Systems Leadership Immersion course facilitated the ability
to tie everything together and create a proposal for a business plan taking into consideration the
financial component, but also creating a strategic plan for developing a program that would help
provide better care to our patients in the most efficient manner. I believe that this course has
prepared us for the dramatic change in healthcare in which the efforts of nurses are directed to
the development of the profession (OGrady, Clark, & Wiggins, 2010).
Program Outcomes
As a nurse leader in todays healthcare environment, I have learned that innovation is
what sets us apart from others in providing the best care for patients. One of the most recent
projects I have been involved with consists of accessing a different organizations medical record
to provide better care to our patients. When a patient presents to the Emergency Department
(ED) and is registered, the patients primary care physician (PCP) is captured in the electronic
health record (EHR). If the patient belongs to the group we are working with, which is its own
Accountable Care Organization (ACO), the EHR is flagged and notifies our unit associate that
the patients belongs to this ACO. The unit associate then enters the ACOs EHR and accesses a
summary including a medication list. This is given to our physicians to take into consideration
when developing a plan of care for the patient. It has helped us eliminate unnecessary or
duplicate testing in the ED and leads to efficient, quality care for the patient. The ACO is then
able to benefit from the care because they eliminate possible penalties from CMS and benefits
from the pay for performance metrics that CMS has developed.
I have learned that developing interprofessional relationships with other teams is an
integral part in delivering evidenced based patient care. One example is the Clinical Practice
Team meeting that we hold once a month for the Pediatric Emergency Department. We have

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always had staff and physicians from the hospital participated, but after writing a paper on
childhood asthma for one of the courses, I learned the importance of involving our community
pediatricians. I have since then built a relationship with one of our community pediatricians who
is dedicated and engaged in our team. She blocks time at her practice to join us once a month for
a lunch meeting. She has been a valuable asset and we have been able to streamline the reports
that we provide the pediatrician offices after a childs ED visit.
Evidenced based practice is key in delivering quality care to our patients. One of the
teams that I have become more engaged with is our sepsis mortality team. It was a meeting that
our Medical Director attended. I began attending the meetings and have put electronic processes
in place with the help of our Informatics team to identify a patient at risk for sepsis mortality
once a nurse triages a patient. We began standing orders immediately and have been successful
in decreasing our overall mortality rate. We also worked closely with hospice and palliative care
to identify the right time to speak to the families regarding their loved ones condition to provide
them with different options. It has created a change in the culture of our emergency department.
One of my favorite courses was the Integrative Nursing course. I know it was definitely
a weak area for me as a nurse and as a nurse leader. I am very proud of the changes I have made
in the department to help ease the patients anxiety, but also improve the ambience for the staff.
In the Adult ED we started playing classical music over the intercom system. I have received
comments from the staff and patients when rounding about how calm the department feels even
when we know its chaotic. In the Pediatric ED, I worked with our foundation to find art for the
walls. It was a surprise to the staff that I chose paintings with nature scenes that were calming,
they expected something bright and related to children. I explained to them that children usually
sense their parents anxiety and there is evidenced based literature that these type of paintings
ease anxiety at all ages. The staff, the physicians and our families love them.

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At our organization we are very lucky to have an informatics team that has built a
business model to become an integral part of each department. I have been working closely with
our team on methods to decrease the staff workload and improve the patients quality of care.
We have learned that visual alerts are very helpful for staff to look at the electronic health record
at a glance and know what orders are outstanding. Two orders we were struggling with were the
time the oral contrast was given and electrocardiograms that were not completed in a timely
manner. We have added visual alerts to the board so that our staff can quickly look for any
overdue items. Its a great tool for our Navigators that float in the department to assist the staff
with time sensitive orders which helps decrease delays in patient care.
When completing the Leadership Immersion Project for this course I formed a
relationship with a Coordinator at Arizona Connected Care (ACC) which is an ACO. We
discussed patients with chronic illnesses which were frequenting the ED because they did not
have the appropriate follow up after discharge to manage their care. We worked with our case
managers (CM) and IT department to create a flag in our EHR to identify patients who had been
discharged from our hospital in the last thirty days. We of course did the right thing for the
patient and admitted them if it was medically necessary, but we made the initial referral to ACC.
Our inpatient CMs worked with the ACC coordinators to transition the patient from the hospital
to home with the appropriate resources and follow up with the goal of preventing a second
readmission. This has driven our readmission rate down at the hospital and we are meeting the
metric that CMS has deemed acceptable.
When completing the IHI courses I was exposed to theory and evidenced based practice
in several topics related to patient safety, patient and family centered care, leadership, quality
care, cost of care and efficiency. I was able to utilize this knowledge to accent the improvements
I was working on especially related to Lean methodology. Lean has provided a framework for

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me to gather data to identify the issues, drill down to the root cause by using a fishbone diagram
and creating countermeasures to implement improvements in the department which have led to
safe and efficient care of our patients. Using the Plan Do Check Act process we learned about
has also reminded me of the importance of checking periodically to assure the changes are still
serving their purpose.
Conclusion
I have gained so much more knowledge than I had imagined by completing this program.
I believe the program was tailored to prepare me as a nurse leader in our current healthcare
system and in the changes that we will face in the future. I know that I am a better nurse, a better
leader and a better person because of this program. I also learned a lot about myself through this
program. I have learned that my drive to succeed has given me the strength to beat all odds in
the past fifteen months. I have sacrificed a lot to be able to complete this program, both in my
personal and professional life. I know that I can do anything I set my mind to as long as I
continue to have the support from my family and friends.
I have truly grown as a person through this program and gained strengths and skills that I
did not have before. As a future leader in healthcare I am prepared to adapt to the changes in
healthcare. I rely on evidenced based practice to guide my decisions to assure I am always doing
what is best for our patients. I also believe I am a better role model for my staff and more
understanding to their personal needs when balancing work and life. I hope that the strengths I
have obtained through this program have prepared me for my goal as a Chief Nursing Officer of
a Childrens Hospital. I have a wealth of knowledge that I have been able to integrate into my
nursing practice that has proven to decrease bad outcomes in our patients and improve not only
the care they receive, but their overall patient experience.

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References

OGrady, T.P., Clark, J.S., & Wiggins, M.S. (2010). The case for clinical nurse leaders: Guiding
nursing practice into the 21st century. Nurse Leader, 8(1), 37-41. Doi:
10.1016/j.mnl.2009.11.002
Swanwich, T., & McKimm, J. (2011). What is clinical leadershipand why is it important. The
Clinical Teacher, 8(1), 22-26. Doi: 10.1111/j.1743-498X.2010.00423.x