NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) The Voice of Nursing Community of Practice Forums (CoP) Forums Northwest Ambulatory Care Nursing November 20, 2014 Patricia Rojas, Director, Ambulatory Nursing and Optimization Chris Sawyer, Professional Development Consultant, Onboarding, Ambulatory Nursing and Optimization

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) KPNW Ambulatory Care Voice of Nursing, April 2014 Nurse Leaders from Across Ambulatory Care Beth Christensen, Senior Administrator, Specialty Care Nancy Turner, Dept. Administrator, Specialty Care Ebony Sage, Asst. Dept. Administrator, Specialty Care Janie Lewis, Dept. Administrator, Specialty Care Kelly Bice, Dept. Administrator, Specialty Care Martina Fetter, Senior Administrator, Primary Care Mynell Harper, Dept. Administrator, Primary Care Dana Nguyen, Dept. Administrator, Primary Care Dennis Rouse, Dept. Administrator, Primary Care Jan Weaver-Shelby, Dept. Administrator, Primary Care Kara Wills, Dept. Administrator, Primary Care Ann Casterlin, Director, Continuing Care Services (CCS) Anna Scott, Manager, Palliative Care, CCS Anne Mooney, Clinical Supervisor, Home Infusion, CCS Susan Chauvie, Manager, Geriatrics/LongTerm Care, CCS Susan Mulligan, Prog. Dir., Hospice/Palliative Care, CCS Suzanne Symons, Care Coordination, CCS Kris Anderson, Mgr, Clinical Quality Support Services (CQSS) Nancy Craig, Clinical Quality Support Services (CQSS) Judy Lewis, Clinical Quality Support Services (CQSS) Barbara Kyler, Mgr, Regional Quality Resource Management Twila Cain Pierce, RN, Medicaid and Charitable Programs Lynn Barker, Director, Medicaid and Charitable Programs Natasha McLeron, RN Mgr, Regional Call Center / Advice David Henrichsen, OFNHP Primary Care Labor Partner Toren Brolutti, OFNHP Specialty Care Labor Partner 2 Nurse Leaders from Ambulatory Nursing and Optimization Trish Rojas, Director Lori Hill, Dir of Professional Development Jennifer Houten, Dir of Professional Practice Anja Peersen, Dir of Quality Systems & Sustainability Meagan Mangus, Informatics Manager RN Professional Development Consultants: Chris Sawyer Elizabeth Cronk Mary Johnson Heather Fisher Katie Johansen Ansley Beshere Sandy Heresa Lisa Alvarado

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) KPNW Ambulatory Nursing Aligned with KP Nursing Vision 3 Kaiser Permanente Nurses advance the art and science of nursing in a patient- centered healing environment through our professional practice and leadership. Extraordinary nursing care. Every patient. Every time. Mission: The purpose of the KPNW Ambulatory Nursing Leadership Council is to unite and align our 1,100 plus nurses under a single vision, set of values and nursing model across all ambulatory care sites and, through collaboration with our Hospital nursing colleagues across the full continuum of care. Kaiser Permanente Northwest members will know they were being cared for by a Kaiser Permanente nurse, regardless of where they entered the system. The Ambulatory Nursing Leadership Council will lead standardization of nursing where there is evidence, and elevate nursing to accomplish KPNW strategic goals.

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) KPNW Ambulatory Nursing Voice of Nursing Action Plan Objectives. 4 INSPIRE ambulatory care nurses at all levels to advance the art and science of nursing in a patient- centered healing environment through our professional practice and leadership. Implement EDUCATION to advance to top-of-scope nursing practice and competency and ensure quality of patient outcomes. Adopt EVALUATION metrics to ensure nursing practice is improving health outcomes Establish nursing leadership INFRASTRUCTURE to develop and deliver high quality, affordable, health care services to improve the health of our members and community

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) Inspiration Embedding KP Nursing Vision, Values and Professional Practice throughout Ambulatory Nursing Onboarding for all ambulatory care nursing.  Developed KPNW Ambulatory Nursing Orientation  Collaboration in Action Regional nursing recognition program  Increased March of Dimes nominations; 4 KPNW winners  Implemented Daisy Award for KPNW Ambulatory Care  Pinning Program Implementation in process Regional RNTL orientation  Revised and aligned with KPNW Ambulatory Nursing Orientation; Roll-out in January

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) Infrastructure Leadership Collaboration Across the Continuum Northwest Nursing Leadership Council  Nursing Leaders from Ambulatory Nursing, Continuing Care Services, Kaiser Westside Medical Center and Kaiser Sunnyside Medical Center.  Shared progress on vision and professional practice in nursing  Shared planning to view nursing across all care transitions  Opportunity to present nursing vision and strategies to senior leadership team  Shared concerns about RN Recruiting (first step to improved hiring and workforce planning) Ambulatory Nursing Leadership Council  Leveraged Voice of Nursing, first action item from VON was to form ANLC  Expanding in December to include all frontline RN Managers Professional Development Collaborative  Formed July 2014: All Ambulatory and Inpatient Nursing Professional Development Consultants  Nursing orientation across the continuum  New product implementation 6

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) Education Preparing Nurses for Current and Future Roles Onboarding RN Team Leads with their Manager  Promotes collaboration and top of scope nursing practice  Ensures support and relationships needed for nursing leadership  Pilot completed November 6 Care Coordination Curriculum  Rapid implementation of care coordination roles in KPNW  Patient-Family Centered Care is core  Renewing skills not required in recent years Implementing Strategies to Advance Nursing Education  BSN Program support initiated 7

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) Evaluation Discussion underway for future dashboard Reviewing available data to demonstrate nursing role  Process measures as preliminary indicators of RNTL impact on care delivery results: % of nurses showing “independent” in skills assessed via the Member Interaction Assessment after their 4 th month of coaching”  Working with analytics to measure impact of implementing nurse visits and advance nursing procedures: number of RN Visits instead of Physician Visits. Future opportunities  Develop nursing sensitive outcome metrics 8

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) What We Have Learned Leadership Development at the Speed of Change  Forming Ambulatory Nursing Leadership Council: commitment and lots to do  Ambulatory Nursing Leaders collaborated to lead Ebola Preparedness  Next: RN Leadership Roles part of 2015 Strategy  Next: Recruiting, Workforce and Leadership Development Time to Spread Inspiration and Engagement  Progress: bookmarks, elevator speeches, newsletter information, practice model, community events, onboarding  Next: Expand ANLC to include all RN Managers  Next: Planning for RN Summit  Next: Engage in community nursing organizations 9

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) Voice of Nursing In Action: KPNW Ambulatory Nursing Regional Orientation 10

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) 11 Regional Orientation “to organizational systems, mission, polices, etc.” Department “Time spent with a preceptor, mentor, buddy to learn the specifics of the job” and a “period of working independently, but being closely supervised”. Orientation Structure Wright, D The ultimate guide to competency assessment in health care. p 18.

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) Current State Gaps 12 Audience Only Back Office RN, LPN and MA Content “Skill” focused Lack of interpersonal and cognitive content Redundancies Timing Too late in orientation (up to 6 weeks)

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) Future State Solutions 13 Audience All Ambulatory RN, LPN, MA Content KP Integrated Health Care Model Service Spiral back to and build on important concepts RN and LPN- KP Nursing PPM and Nursing Process Timing 1 st class in 1 st week of employment

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) Ambulatory Nursing and Optimization Orientation (ANOO) New Class offered weekly  Focus on clinical culture and practice standards common to ambulatory patient care staff Content Overview  Welcome to KPNW- You’re a part of something big!  How we all work together to provide extraordinary care  Intro to the KP Nursing PPM, focusing on Patient and Family Centered Care  How we provide outstanding service  Service and Care Experience  Cross-Cultural Health Care  Communication and Documentation best practices  Orientation to orientation  KP Learn, KP HealthStream  Overview of the orientation process 14

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) Foundations Classes: Nurse and MA Revised Classes offered every other week  Focus on role specific expectations, skills and resources Nurse Foundations  KP Nursing Professional Practice Model (Module 1 and 2)  Application of the Nursing Process to Ambulatory Care  ANA Scope and Standards, OR/WA State Practice Acts, KPNW Policies and Procedures MA Foundations  Visit Management 15

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) January ‘15 Go-Live 16 Ambulatory Nursing and Optimization Orientation (ANOO) Nurse Foundations MA Foundations Other assignment specific ILTs and WBTs 1 st week 2 nd -3rd week 3 rd week +

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) What We Have Learned…. 17 Strategy: Slow and Steady Principles of Implementation: Must speak to nurses – support for their passion for nursing Keep the dialogue open and the conversation interactive Nurses need to feel empowered to affect change in their practice “The key to successful implementation in our facility has been, and continues to be, early engagement of respected, formal and informal nursing leaders.” – Adrienne Enghouse Labor Partner

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) What We Need Help With… Challenges: Time of uncertainty for both labor and management Initiative fatigue Questions/Requests for Assistance: Has anyone begun to embed PPM into job descriptions? How do we continue to provide inspiration for this work? Looking for creative ideas… Evaluation: Are we measuring correct outcomes to determine efficacy of the PPM? 18

NATIONAL PATIENT CARE SERVICES (INTERNAL USE ONLY) (INTERNAL USE ONLY) Q & A 19