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Achieving the Triple Aim in Nursing:The Bellin ExperienceLaura Hieb, BSN, RN, MBA, NE-BC, Chief Nursing Officer, Bellin Health
Lois Van Abel, BSN, RN, MBA, NEA-BC, Director of Nursing, Bellin Health
C23This presenter has
nothing to disclose
December 9, 20141:30-2:45 p.m.
12/8/2014
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Objectives
Define the production system as it relates to the
functional unit of nursing
Describe how the culture of nursing supports strategies
and influences outcomes
Describe at least three common platforms that impact
the Triple Aim measures
Bellin Health Serving a Market of 636,682 people
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What is the Nursing Infrastructure?
3,757 Employees
920 nurses
60% BSN or higher
23% certified in area of specialty
System structure of shared governance via unit and system-wide councils
Bellin College part of health system
Nursing Advancement Program participants ~ 173RN Program ~ 122
Team Facilitator Program ~ 37
Educator Program ~ 14
Nurses Rock Video
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7
What Features/
Functions Should
Our Products Have?
What Should
We Make?
How Will We
Make It?
What Do We Need
to Improve/
Redesign?
Do People Buy Our
Products?
Products and
Services
SYSTEM OF
PRODUCTION
SYSTEM OF
MEASUREMENT
Is It Made Well?
SYSTEM OF
IMPROVEMENT
SALES
MARKETING
- Market/Customer Knowledge
- Organizational Knowledge
PLATFORM
PLANNING
ALIGNMENT AND
DEPLOYMENT
ROAD MAP
BRANDS
Strategic Position
SYSTEM OF
LINKED MEASURE
Focus
Platform
Knowledge
Action
ResultsOFFERED / CHOSEN
“VOICE OF THE MARKETPLACE”
External Focus
“VOICE OF THE CUSTOMERS”External Focus
High Performance Health Care ModelThe Business of Health Care
©Knox 2000
-------------------------------------------------------------------------
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“VOICE OF THE PROCESS”Internal Focus
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2
3
4
5 6
© Pete Knox
H Q
$
After
Care
Five Views of the Production System
Knowledge
of the
Individual
Connected Patient Experience - ProductValue
2
34
Wellness/
Prevention
Acute
Care
Community
Health
1
5
Functional
Commonality
Ex: Nursing Platform
Knowledge
of the
Population
Individual
Department
Package Pricing
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Production System Design:
Key Principles
Align with System Strategy
Drive commonality
Build a production system that delivers on the Triple Aim
Incorporate the patient voice
Measure outcomes
Common Platforms of WorkBedside handoffs with the shift change
that incorporate patients and families in
the care handoff process.
In room computing to enhance clinical
time at the bedside and provide real time
patient information
Multidisciplinary rounds to enhance care
team input and direct communication into
the patient care plan
Patient call backs that assist in smooth
transitions of care
Comfort and safety rounds imbedded in
all patient care areas
Staffing by acuity to provide safe staffing
levels with optimal patient outcomes
Patient voice incorporated into redesign
Bar coding for safe medication
administration
Video monitoring to assist in keeping
‘high risk for falls patients’ safe
Vital sign integration to enhance real time
documentation and communication of the
patient status
White boards for patient centered care
communication
High risk for “postop over sedation”
protocol in place in all applicable areas
Use of Nurse Compass for productivity
management
Staff huddles – shift change
Standard rooming platform across all
Epic sites
MEWS
RN care coordinators (In progress)
10
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Key Elements for Engaging Nurses
Building culture
Setting the stage with cascaded
nursing goals
Embedding performance
management
Measuring success
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Building Culture
A key to an environment of improvement and success
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Building Culture
Nurse Residency Program
Nursing Advancement
Program
Welcome to new hires
Hangin’ with Hieb
Rounding
Meeting with leaders on the
unit
Employee listening sessions
Annual NDNQI RN satisfaction
survey
Daisy Award
Focus groups for strategic
direction
Team Facilitator day away
System-wide council day away
Annual Pulse survey
3% FTE budget for meetings,
innovations, quality work
Experiment with new nursing
roles (centralize expense)
VIP Awards-Bush Nursing
Award
Using Nursing Goals within Councils to
Drive Change
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Performance and Engagement Process
Plot Performance & Engagement on
Grid
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Trended Results for the Performance
Feedback & Development ProcessPerformance/Engagement Matrix
0
1
2
3
4
5
6
7
8
9
10
0 1 2 3 4 5 6 7 8 9 10
Performance
Eng
agem
ent
5%
2%3%
2% 2% 1%0.0%
2.0%
4.0%
6.0%
8.0%
2008 2009 2010 2011 2012 2013
Perc
ent
Low Engagement/Low Performance
14%19% 18%
3% 4% 1%0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
2008 2009 2010 2011 2012 2013P
erc
ent
Low Engagement/High Performance
High Performance/High Engagement
78% 79% 77%90% 92% 93%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
2008 2009 2010 2011 2012 2013
Perc
ent
High Engagement/Low Performance
2% 2%
5%3%
4%
1%0.0%
2.0%
4.0%
6.0%
8.0%
2008 2009 2010 2011 2012 2013
Perc
ent
NDNQI RN Satisfaction Survey
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Comprehensive Platform for Engaging
Nurses
Three Common Platforms that
Impact the Triple Aim
20
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Designing Care Across a Continuum by
Incorporating the Patient Voice
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Stroke Care Across the Continuum
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Safety and Improved Outcomes
Through Innovation
Giving staff time to redesign
Setting goals
Measuring outcomes
Spreading great innovations
23
Modified Early Warning System
(MEWS)
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Impacting Cost through New Roles
Adding new roles
Following the IOM report
Testing new roles that impact population health
Transition from Traditional to Reformed
Healthcare
Nurse Leader, October 2014, Vol. 12, Issue 5, p. 41
26
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RN Care Coordinators
Cost
$-
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000
$120,000,000
$140,000,000
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013
FY2014
Gross Patient Revenue & Total Operating Expenses
Gross Revneue Total Expenses
$-
$500
$1,000
$1,500
$2,000
$2,500
$3,000
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013
FY2014
Gross Patient Revenue & Total Expenses Per Adjusted Patient Day
Revenue per Adj Pt DayExpense per Adj Pt Day
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Results
-$6,000,000
-$4,000,000
-$2,000,000
$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Bellin Memorial Hospital Nursing CenterIncome (Loss) From Operations
Thank you!
Contact information:
Laura Hieb CNO: 920-433-7436
Lois VanAbel DON: 920-433-3791
30
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References
Powers, C., Normand, L., Whitcomb, K. (November
2014). Is clique behavior sabotaging your nursing team?
Nursing Management, Volume 45, Number 11, 38-43
The Business of Healthcare: High Performance
Healthcare Model, Pete Knox, Bellin Health (2000)
Performance & Engagement Process, Bellin Health
(2014)
