Registered Nursing Manager

  1. OUTCOME MEASURES

Outcome measures evaluate the health status of a patient that results from the received care. Some of the typical and traditional outcome measures include health-related quality of life issues, the incidence of disease (morbidity), and survival (mortality). In the facility that I am working in, there are a variety of outcome measures that range from changes in blood pressure in hypertension patients to PROMs (patient-reported outcome measures). The standard outcome measures include safety of care, readmissions, mortality (life expectancy), effectiveness of care, patients’ experience, efficient use of medical imaging and timeliness of care. 

One of the necessary population health outcome measures is mortality. The indicator that is commonly used in analyzing mortality is life expectancy at birth. According to UN (2007), life expectancy at birth is the average number of years that an individual expects to live at birth when subjected to existing mortality conditions in someone’s life. Data on mortality is collected by recording the number of deaths after their occurrece. This includes deaths of infants and late fetal deaths.

 The total number of deaths is influenced by mortality rates and population size of cohorts (age groups) reaching the end of their lifecycle. The number of deaths in the facility is registered using various demographic data, including sex, year of birth, age and educational attainment. A series of various mortality indicators are generated that derives a range of information on life expectancy or crude death rates by sex, age, and level of education.  

Increasing Quality Outcomes

As mentioned earlier, mortality is a crucial population health outcome measure. Findings derived from this measure assists in improving the health outcomes. The statistics assist in drawing measures and interventions that reduce the incidences and mortality rates. For example, the health facility may improve patient care, health cost, and pneumonia patients experience to reduce the number of deaths. 

Benchmarking Performance in Healthcare Facilities

All health professionals are under a duty of care which ensures the consistent provision of high and quality health services. According to Lovaglio (2012) benchmarks are generated from similar practices in one area or comparison of the practice with a bigger group across the country. Another source is standards that are laid by authoritative body. One of the groups is local quality collaborative where similar performance data is collected by several practices where they later compare themselves. 

Community clinic association often hosts this type of effort through the management of multi-organization quality improvement projects like asthma. The group as part of their activities may then benchmark across the participating sites. Other potential sources of benchmarking include National Committee and National Association on Quality Assurance as well as public health, and local and state health agencies. Another emerging source of benchmark is health information technology vendor which allows organizations comparisons by use of their systems. 

Assessing Facilities for Blame

After the occurrence of an error, a health facility should be assessed. During this assessment, it is essential to first identify the cause of the error or the factors that facilitated its occurrence. This will assist in identifying if the error would have been prevented. Errors may either affect or not affect patients and to track these errors an error reporting system is used. The system assists in identifying the cause of errors and its impacts. This assists in identifying the blame of the said error. 

Role of Nurse Manager With Regards To Standards, Outcomes, Benchmarking, and Errors

In reducing errors, nurse managers have the responsibility for ensuring delivery of a customer focused care. They ensure quality and safety of patients by applying their experience, knowledge, and skills in caring for the needs of patients. They shoulder the responsibility when care falls short of standards due to inappropriate standards and policies or due to resource allocation (like lack of needed medical equipment and workforce shortages). In benchmarking, nurse managers support all interventions and goals in the process by monitoring the progress towards these goals. 

They are also involved in measuring the compliance of the plan as they audit the practice of nurses in ensuring achievement of required measurable outcomes. A nurse manager is responsible for comparing, reporting and measuring health outcomes as a way of achieving the Triple Aim of healthcare: reduction of per capita healthcare cost, improving the health of the population and improving patient care experience. 

2. EMPLOYEE EVALUATION

Planning

As a nursing manager, the first step in planning for the annual employee evaluation is determining the reasons why the outpatient wants to evaluate its employees. The organization intends to use the results to improve the performance of nurses in the outpatient department. The RN Manager will identify cultural and environmental factors that affect the outpatient department. In the planning process, it is important to identify who will observe the performance of the employees by incorporating supervisors, peers, support staff or customers. The manager should develop an evaluation form, identification of performance measures, set feedback guidelines, creation of termination and disciplinary measures and prepare an evaluation schedule.

Component of Performance

The evaluation tool evaluates the nursing practice in each of their nursing roles to promote their individual development and growth in nursing. The nurse can self-reflect their practice and is evaluated by peers and supervisors in the identification of performance goals that improve nursing practice. Another nursing component is training where the nurses are required to complete annual training on their specific roles so as to assist in improving care towards patients. Some of the training include HIPAA training, emergency preparedness, hazard communication and general safety, electrical safety and fire and safety training. 

Another nursing component to review is competency as commanded by Competency Assessment Taskforce. The assessment identifies and recommends competencies for all roles in nursing for a coming year. According to MGH (2007), the members of the task force include Management Systems Advisory Committee, PCS Office of Quality and Safety Representatives, Staff Specialists, Staff Nurse Chairs of the Nursing Practice Committee and Quality Committee, Operations Coordinators, Clinical Nurse Specialists, Nursing Directors, and the Associate Chief Nurses. Every nurse will hence complete a self-directed learning packet that is pre- and post-test related to the needed competency and training materials.

Positive Forces in an Evaluation

Feedback is one positive force in an evaluation process. The supervisors should give balanced feedbacks by avoiding errors of glossing on the deficiencies of employees but focusing on their strengths only. Another positive force is rewarding the performance of employees by pay. This is a motivational task that ensures that employees strive towards quality care. 

Innovative Ways for Creating Improvements

The best creative thing to do during an evaluation process is waking from the traditional procedure of supervisors carrying the process alone. The study illustrates that a supervisor is only able to observe 30% of an employee’s performance, the rest is observed by support staff, clients, and peers (PSIE, 2010). Therefore, all the groups will be incorporated in evaluating the performance of nurses in the outpatient department. 

Negative Forces in an Evaluation

Cultural and environmental factors affect the evaluation system. For example, highly overworked supervisors will lead to disastrous time-consuming performance evaluating employee performance appraisal system. The environmental also negatively affects evaluation process where if the facility lacks finances for merit pay can lead to the frustrating numerical complex system. 

Terminating the Session

The reason for termination should be objectively and briefly explained. The employee should be validated in person maybe by use of positive slant in their potentials in nursing. The employee should be allowed to ask a question and assisted to leave with all possible dignity. 

Employee Responsibilities

Employees are expected to understand their nursing practice assignments and the expected results. They are also required to improve their performance in the provision of care. They should have excellent communication on performance requirements and expectations. All nursing employees are required to fill an employee evaluation form annually. 

3. DEMING’S 14 PRINCIPLES FOR TOTAL QUALITY MANAGEMENT

The Deming’s 14 principles for lowering cost and achieving quality include: 

1. Steadily improving products and services

2. Adoption of total quality philosophy 

3. Correction of defects as they occur

4. Awarding business for more than just price

5. Constant improvement of production and service system

6. Instituting training

7. Establishing leadership

8. Elimination of fear

9. Breaking down barriers among staff areas

10. Elimination of superficial goals and slogans

11. Eliminating standard quotas

12. Removing pride workmanship barriers

13. Instituting rigorous education 

14. Everybody should work toward transformation accomplishments

Healthcare systems should build quality in their services, products, and outcomes while benefiting financially. Not all the Deming’s principles were used in the health facility. Some of the principles used are: instituting rigorous education, correction of defects as they occur, instituting leadership, instituting training, adoption of total quality philosophy, breaking barriers among staff areas and improvement of production and service system. 

Personally, I think that each Deming principle is important. However, in our field, (healthcare) some principles are stronger than others. For example, the majority of government bodies campaign for affordable health care. Not all patients are willing to pay more for health services for providers with high cost and quality. The target of government in health care is quality care for all patients which are one of the important principles in TQC. 

Organizations can be successful even in the implementation of a few Deming’s principles. In health care, Deming’s principles are a new model and are still in adoption in the sector. However, the majority of health facilities that are utilizing all the principles are highly successful. It should be every facility’s desire to adapt the principles in their daily practices. The 14 principles are all relevant and applicable in every health center. 

Quality Management Project

One of the quality management projects I have been involved in is developing a quality model for the facility’s chain. There was a need for paradigm alteration in the facility that required an insightful commitment to the customers. Supervisors were chosen, and they underwent a workshop on team skills, process improvement and Deming philosophy which was followed by on-site training. A quality policy was later formulated that included the meaning of quality in the facility, mission statement, and the type of principles to be used. Frequent meetings were set when the participants would share experiences as well as learning new skills. 

References

Lovaglio, P. (2012). Benchmarking Strategies for Measuring the Quality of Healthcare: Problems and Prospects. The Scientific World Journal, 2012, 1-13. http://dx.doi.org/10.1100/2012/606154

MGH. (2007). Magnet Evidence – Patient Care Services & Nursing (pp. 228-230). Retrieved from http://www.mghpcs.org/pcs/magnet/documents/evidence/Volume_3/Force_4/4_18_perform_appraise.pdf

PSIE. (2010). Chapter 7: Evaluating Employee Performance (p. 241). Retrieved from http://www.psiedu.ubbcluj.ro/data/uploads/doc/licenta/muncii-aamodt.pdf

UN. (2007). HEALTHY LIFE EXPECTANCY AT BIRTH. Retrieved from http://www.un.org/esa/sustdev/natlinfo/indicators/methodology_sheets/health/health_life_expectancy.pdf

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