Running head: LEADERSHIP STRATEGY ANALYSIS

Leadership Strategy Analysis Amy Johns, RN, ONC Ferris State University

LEADERSHIP STRATEGY ANALYSIS Abstract

Students pursuing a Bachelor of Science in Nursing degree at Ferris State University were assigned a Leadership Strategy Analysis Paper as a requirement of a Leadership in Nursing class. Concepts of the quality management, quality improvement, evidence-based practice and its importance, leadership theory, and the role of nursing leadership were explored. A clinical quality issue in need of improvement was determined to be the focus of the leadership strategy. An interdisciplinary team was assembled. Data collection methods were determined. Strategy implementation methods were specified. discussed. Methods for evaluation of effectiveness were

LEADERSHIP STRATEGY ANALYSIS Leadership Strategy Analysis Quality management (QM) and quality improvement (QI) are crucial concepts in the nursing profession and for nurse leaders and managers. QM and QI operations are evolving processes that are driven by competition between healthcare entities for improved patient outcomes (Yoder-Wise, 2014). They also are imperative for fostering efficient patient care processes which directly contribute to the financial health of institutions that rely on reimbursement from the Centers for Medicare and Medicaid Services (CMS) (Yoder-Wise, 2014).

The purpose of this assignment is to explore the concepts of nursing quality management in the context of a Leadership in Nursing class; a requirement for the Bachelor of Science in Nursing at Ferris State University. For the purposes of this paper, a clinical area in need of quality improvement will be determined, an interdisciplinary team will be assembled, data collection methods will be chosen, desired outcomes specified, implementation strategies described, and the methods to evaluate the effectiveness of the leadership strategy will be discussed. Quality improvement steps will be supported with research and theory. Clinical Need Quality management and quality improvement focus on several patient-outcome areas. Nursing-sensitive indicators are those outcome areas that most specifically measure nursing performance (Yoder-Wise, 2014). Indicators often focused upon at the unit level include, but are not limited to, rates of nosocomial infections, patient falls, and hospital acquired pressure ulcers (American Nurses Association, 2014). The maintenance of skin integrity is an area of QI which demands a great deal of attention in the acute-care hospital setting. Ensuring positive patient outcomes related to skin integrity requires creativity, diligence, knowledge of evidence-based

LEADERSHIP STRATEGY ANALYSIS techniques, team building and staff motivation skills, strategic planning ability, and data gathering and analysis skills. For the purposes of this paper, management and prevention of hospital acquired pressure ulcers (HAPU) on the orthopedic unit of Munson Medical Center (MMC) will be the topic of this leadership strategy analysis. The patient population of the orthopedic unit at MMC is composed of many groups at high risk for loss of skin integrity and the development of a HAPU. Immobility, advanced age, decreased nutrition status, comorbidities, decreased mentation, and preexisting skin fragility all contribute to increased risk. Research has shown that implementation of a HAPU bundle decreased the occurrence of HAPUs from 12.4% to 6.1% in a study of critically ill, very high risk patients (Carino, Ricci, Bartula, Manzo, and Sargent, 2012). The HAPU bundle consists of

daily skin assessment, regular repositioning, nutrition assessment, calorie intake, glucose control, and redistribution surfaces (Carino et al., 2012). These interventions are in place at MMC but periodic re-education is needed to refresh the staff and remind them of the crucial and wide-ranging importance of continued diligence. The leadership strategy of reinforcement of education, policies and procedures for HAPU prevention at MMC is supported by a concept called Expectancy Theory, a leadership theory whose central concept is that behavior compliance is increased when staff can see a direct correlation in the behavior with positive results. Compliance is also increased when the employees role in the positive results is recognized and valued by leadership and management (Yoder-Wise, 2014) HAPU data for the orthopedic unit at MMC is acquired by the unit manager through many sources. Data related to pressure ulcer assessment which is entered into the hospital incident reporting software, called Voice, is analyzed to determine if, indeed, the ulcer was

LEADERSHIP STRATEGY ANALYSIS

acquired during the current admission. A department called Decision Support helps provide unit managers with data and analyses. Data is also reported to the National Database of Nursing Quality Indicators (NDNQI) for use in nationwide data collection, analysis, and benchmark establishment (ANA, 2014). Recent analysis of data on the orthopedic floor at MMC indicates a slight increase in rates of HAPUs (Stagman-Tyrer, D., personal communication, April 15, 2014). A leadership strategy analysis will be useful to address this issue. Interdisciplinary Team An interdisciplinary team will be assembled, consisting of the following: Unit manager Rationale: The unit manager has access to data from Decision Support and NDNQI, has broad scale knowledge of the process and performance of the unit, and has decisionmaking capability. Unit resource clinician Rationale: The unit resource clinician has access to and is proficient in research techniques and current evidence-based practices. Unit Skin Champion Rationale: The unit Skin Champion is the designated specialist in monitoring and communicating HAPU issues to staff and unit management. Chair of the Unit Action Council Rationale: The Unit Action Council Chair developes the agenda for Unit Action Council meetings and can communicate the project to staff. Can be a source to implement concepts of Expectancy Theory.

LEADERSHIP STRATEGY ANALYSIS

Two staff nurses: one from afternoon-shift, one from midnight-shift. Rationale: They are care providers and will provide relevant process input and to relay communication from project to staff on off-shifts. They will be a focus of Expectancy Theory concepts. Two nurse assistants: one from afternoon shift, one from midnight shift. Rationale: They are direct care providers. They will provide relevant process input and relay communication from project to staff on off-shifts. They will be a focus of Expectancy Theory concepts. Data Collection Methods Data collection and analysis will be important to provide an illustration to the staff of the occurrence of the increase in HAPU incidents since often these can be invisible to those not directly involved. Correlation with benchmark data from NDNQI to illustrate unit performance will provide information and rationale to employees who do not see statistical quality-measure data as a routine part of their job. Data from Decision Support and NDNQI will be acquired by the unit manager which will encompass the most recent time frame of measurement. Line graphs will be used to form trend charts (Yoder-Wise, 2014) to provide visualization of the increase, the desired outcome and progress made. Chart audits will be performed by the Skin Champion to determine performance with regard to compliance with specific aspects of the HAPU Bundle. This will include data regarding regular repositioning, presence of pressure redistribution beds for high-risk patients, and daily skin assessment. Trends in compliance will be used, as per Expectancy Theory, for reinforcement of the staffs contribution to quality. Trends in non-compliance will be used to

LEADERSHIP STRATEGY ANALYSIS determine opportunities for improvement. Benchmark data will also be collected from the NDNQI and displayed in bar graph form to illustrate comparison (Yoder-Wise, 2014) to other units similar in scope. Desired Outcomes After data is collected that illustrates the units baseline, the current increase in HAPUs, and the benchmark data, outcomes will be determined that correlate with high quality measures as determined by NDNQI and also are consistent with prior unit baseline. A timeline of three months will be established. The data collection and visualization graphs will be created to accommodate the new data, which will be entered at the end of the project time period, so progress will be apparent to the staff. Implementation Strategies A planning session will be scheduled with all members of the interdisciplinary team

during which the problem will be presented using data provided by the unit manager. Discussion of the leadership strategy will occur and will focus on NDNQI benchmark data, current unit trend, desired outcomes, the evidence-based HAPU bundle, and Expectancy Theory. Action assignments will be distributed to the Skin Champion, the unit manager for data collection and display. The Unit Action Council Chair will be given the action assignment of working the HAPU leadership strategy into the meeting agenda. Action assignments will be given to the interdisciplinary team staff nurses and nurse assistants to communicate between the floor and the team. Continual reinforcement of the implementation of the evidence-based proven HAPU bundle will be demonstrated to the staff through education by the unit resource clinician. Positive reinforcement of the efforts of staff and their contribution to positive results will be

LEADERSHIP STRATEGY ANALYSIS continually demonstrated to the staff, as per Expectancy Theory, at Unit Action Council meetings and mandatory staff meetings. Evaluation Comparative data will be collected by the unit manager and the unit Skin Champion and integrated into the illustrative data charts for evaluation of statistical compliance with baseline

and benchmark data. Informal interviews with staff by the interdisciplinary team will determine the effectiveness of Expectancy Theory interventions. Conclusion For the purposes of exploration and study of quality management and quality improvement concepts, a leadership strategy analysis project was planned to address a clinical quality management need. An increase in HAPU occurrences was determined to be the clinical need used for study. An interdisciplinary team was assembled, and data collection methods and implementation strategies were described, including research-based rationale and evidence-based practices. Methods for evaluation were determined. Leadership theory was researched for guidance of the interdisciplinary team behavior and staff interaction. Expectancy Theory was determined to be very supportive of the project and provided a structure to help the team support the staff. The assignment was valuable in providing a tool for understanding of these leadership concepts. ,

LEADERSHIP STRATEGY ANALYSIS References American Nurses Association, (2014). Nursing Sensitive Indicators [Webpage]. Retrieved from

http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/P atientSafetyQuality/Research-Measurement/The-National-Database/Nursing-SensitiveIndicators_1 Carino, G., Ricci, D., Bartula, D., Manzo, E., & Sargent, J. (2012). The HAPU Bundle: A Tool to Reduce the Incidence of Hospital-Acquired Pressure Ulcers in the Intensive Care Unit. International Journal of Nursing Science, 2(4), 34-37. doi: 10.5923/j.nursing.20120204.02 Yoder-Wise, P.S., (2014). Leading and Managing in Nursing (5th ed.). St. Louis, MO: Elsevier