Neurological Rehabilitation

Clinical Leadership Clinical outcomes for patients, professional satisfaction, and hospital performance all benefit from effective clinical leadership” (Mountford et al, 2009)

Overview  To review the gaps in nursing service provision  To identify opportunities for improvement in coordination of services, nursing care, patient satisfaction, team communication and hospital performance

Team Leader The purpose of this presentation is to highlight the merit of a new and innovative clinical nursing ‘Team Leader’ position on the Neurological Rehabilitation Unit at West Park Healthcare Centre.

Nurse Manager  Daily Operational function  Orientation of new staff/students  Administrative duties  Coordination of Nursing on the floor  Supervisory role

Needs Assessment  Communication Issues  Rounds  Case Management/Coordinated Approach  Review of Referrals  Program Evaluation

Strategic Planning  Patient Care/Coordination  Team Function  Performance Indicators  Program Planning/Resource Management

Team Leader An evolution of the nurse ‘manager’ shifting focus to leadership vs. management Hybrid of a ‘service leader’ and a ‘frontline leader’

Team Leader To ensure the provision of coordinated and consistently high quality patient care, maintain organizational and professional standards, facilitate growth and development of the staff and the program, and to liaise with our internal and external partners

Performance Indicators  Functional Independence Measure (FIM)  Occupancy level on the unit  Length of Stay  Therapy provision (amount and type)  Alternate Level of Care (ALC) beds  ‘Response Time’  ‘Wait Time’  Start of therapy post-stroke (# of days)

Response Time The date the referral was sent to the receiving facility to the date of first response (accept, deny, re-direct, send back) Current: 1.9 days Goal: 1.6 days

Functional Independence Measures Score (FIM) FIM is an outcome measure, validated and reliable in the stroke and ABI population that measures functional independence and burden of care. Current Mean Change: 19.7 Goal Mean Change: 21.5

Length of Stay The amount of time (in days) a patient stays in hospital Current: days Goal: 31 days

Occupancy The number of hospital beds occupied by patients expressed as a percentage of the total beds available Current: 84.49% Goal: 90.06%

Alternate Level of Care (ALC) Beds When a patient occupies a bed in a hospital that does not require the intensity of resources/services provided in that particular care setting 2010/11 fiscal year (to date): 5 Goal: 0

Stakeholders  Patient  Acute Care referral sources  Ministry of Health and Toronto Central LHIN

Budget  One extra RN on day shift (7am-3pm), Monday to Friday  Minimum 5 years experience on the Neurological Service  $37.00/hour or $72,150 per year  In-charge premium $1.70/hour or $ per year  Total expense: $75, per year

Funding First Year:  Hospital funding – full cost Second Year:  Anticipated savings in 0ne-to-one care and other costs associated with more ‘appropriate’ patients.  cost of one-to-one care alone was $47,000

Alternate source of funding Toronto Central LHIN - HSIP program Health System Improvement Pre-Proposal Allows health service providers to articulate a request for funding – typically one-time only funding – in order to implement a new health service that the organization has not previously provided, or to improve efficiencies and reduce barriers to care

Alternative  Absorb the position internally within the normal day shift nursing complement  The ‘In-Charge’ nurse for the day has partial responsibilities of a ‘Team Leader’  Backfill 4hours on day shift with an RPN to allow time and opportunity for the In-Charge nurse to perform her ‘Team Leader’ duties (total cost per year: $26,460)

Challenges  Funding  HR/Union/Administrative process  Everybody will want it, so no one gets it  No template, no competitors have a similar position

Leadership Our business in life is not to get ahead of others, but to get ahead of ourselves E. Joseph Cossman

Opportunities  Pilot Project, evaluate, publish or present  Leaders in Best Practices in Stroke Care  ‘Stroke Services Distinction Program’ - Accreditation Canada  Hospital-Wide Initiative  Leadership opportunity, career growth, job satisfaction, retention

Leadership Innovation distinguishes between a leader and a follower Steve Jobs

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