Paula F. Coe MSN, RN, NEA-BC
Director, Center of Nursing Excellence and Innovation
WellSpan Health-York Hospital
York, PA
WellSpan Health….Who We Are…
Surgical and Rehabilitation Hospital
Gettysburg Hospital
York Hospital
York Hospital
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Hospital incorporated July 14, 1880
Currently, 572 bed community teaching
hospital
Employs 3,400 people/ 1200+ nurses
Serves a population of over 481,000 residents
in South Central PA.
RBC initiated in 2007
RBC adopted as Foundation of PPM in 2008.
Magnet® Recognized; January 2009
PA Nightingale Awards- Finalists and Nurse
Administration Award winners last 3 years.
(TL)
◦ YH CNO- Astrid Davis
◦ YH Clinical Directors
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Bonita Trapnell
Connie Gutshall
53.2% BSN direct care RN; 36.7% certified
RN’s. (SE)
JC certified; Stroke, Hip, Knee, Spine Center;
Bariatric Center of Excellence (EPP)
Where we started…
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Began our partnership with CHCM in
2007
◦ Care Delivery Model
◦ Schematic of PPM
◦ Alignment with Mission,Vision and Goals of
WSH and YH
◦ Work Complexity Assessment
◦ Organizational Structure to support initiatives
for both RBC and Magnet Journey’s
RBC Wave Schedule
Wave 1
Sept. 07
Wave 2
Sept. 08
Wave 3
Sept. 09
Wave 4
Sept. 10
Wave 5
Sept. 11
ED
T4
5 South
CCU
Cath Lab
6M
5M/EAU
4 SW
TSIUC
GI Lab
BHS
6 South
4 Main
OHICU
Vascular Lab
T2
T3
Peds
MSICU
PHAS
NICU
Imaging Nurses
MTCU
IV Team
Respiratory
Therapy
STCU
L&D
Non-invasive
cardiology
4 Main
Laboratory
3North A
Dialysis
OR
Housekeeping
PACU
SSU
CRT
Education
York WellSpan Hospital
Our Care Delivery Model: RBC
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Relationship-Based Care is a model of care in
which the patient and family are the central
focus
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The nurse and other members of the health
care team strive to understand what is most
important to the individual patient, and actively
engage them in all aspects of care
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It is a culture that supports caring & healing
Evolving and Evaluating the
PPM and CDM
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We are building and constantly perfecting our
professional practice environment that is
sustainable and fluid.
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We need to provide an infrastructure where the
Patient’s experience is at the center of our core
values, systems, and processes.
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Nursing’s role as the coordinator of the patients
care is the center of our professional practice
model
Professional
Recognition/Reward
Care Delivery
Model
Professional
Values
Management &
Governance
Professional
Relationships
Guiding Principles of Relationship-Based
Care
• Responsibility for relationship • RN primary coordinator of patient care-
and decision-making at all
levels including patients and
families.
• Work allocation and patient
assignments
(Consistency with assignments, Bedside Shift Report, Daily Huddles
and Safety Rounds) EPP
• Coordinate and collaborates with other
members of the health care team
• Develop individualized Plan of Care (POC)
with the patient (EHR Documentation) NK
• Other caregivers follow the POC within the
scope of their positions and licensure
• Patient assignments are based on continuity of
the relationships, complexity of the care
required, and the skill and knowledge of the
care giver. (Charge nurses, Pt. logistics, house supervisors,
direct care nurses) EPP
• Registered nurse has full authority for
determining the kind and amount of nursing
care provided to each patient. EPP
• Communication and delegation to other
caregivers (Handoff communication, bedside shift report,
nurse communication)
Guiding Principles of Relationship-Based
Care
• Communication with all
members of healthcare
team
• RN proactively seeks out information and
provides info to other members of the team
(Purposeful Rounding) EPP
• Coordination of communication between
patient/family and members of the healthcare
team (Rounding with providers and patients) EPP
• Communicate what matters most to the patient
to ensure needs and outcomes are met (White
Boards) NK, EPP
• Caring and healing
practice environment
• Patients are actively involved in their care and
experience a relationship with their nurse (Patient
Goals on White Board, Nurse Communication Composite) EPP
• Caring and healing practices are visible in
relationships, clinical interventions and the
physical setting (GLATS, Purposeful Rounding, Cleanliness,
Care Delivery Model) EPP
• Patient advocacy, patient safety and patient
education are high values and consistently
demonstrated in practice (Purposeful Rounding,Teach
Back, Falls, Pt Satisfaction, SDM Council ) SE, EPP
Guiding Principles of Relationship-Based
Care
• Process Improvement
• Measure all processes and quality care
outcomes related to our practice changes (NSI’s,
Core Measures,Value Based Purchasing) EPP
• Direct care staff and managers work together
to assure patients have what they need (Shared
Decision Making) TL, SE, EPP
• Simplifying work processes and workflow to
meet patient outcomes (LEAN, 5S, Focus PDSA,
Process Improvements, SDM Quality Council) SE, EPP
• Leadership/Management
• Leadership maintains a clear focus on the
work-supporting professional practice of
nursing (Joint Department of Nursing Meeting) TL
• Supports staff/rewards performance EPP
• Resolves issues and system problems related to
care delivery (SDM, Coordinating Council) SE
• Articulates expectations for performance and
competency (Blue Book,YH Operating Plan, Nursing
Strategic Plan) TL
Care Delivery Model and Professional
Practice Model
RBC Discharge Survey
Current YH Practice Reality
Skill mix-need to reignite the flame on best
practices with RBC-HCAHPS
• Changing environmental factors-fiscal
responsibility due to healthcare reform (HCR)
• Improve compliance with the following
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• ANA Staffing Principles
• PA State Practice Act
• Patient needs at point of care, skill mix, assignments,
competencies
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Need to align and “connect the dots” reality for
organizational, patient, and staff outcomes:
• Resources
• Fiscal accountability
• Outcome driven
WellSpan Patient Experience Goals
To provide an exceptional care experience—safe, timely,
effective, equitable, efficient and patient-centered—to each
and every patient, each and every time, every day.
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The Patient’s safety, care, needs, expectations and perceptions
are always our first priority
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We get to know them as people, not diseases or injuries. They
are always treated with courtesy, dignity and respect
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They are kept informed, are personally involved in care
decisions and their values and preferences are respected
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We reduce their anxiety and fears and build their confidence
and trust in us as their health care provider
“People” Improving the Patient Experience at York Hospital
# 2 Necessary skills for fulfilling
our service expectations
(video training)
WSH Guiding Principles
Patient Experience
•Patient is First Priority
•Treated with courtesy, dignity and
respect—care is personalized and
individualized (RBC and PPM)
•Involved in decisions, values and
preferences addressed, kept
informed (SDM)
# 1 Expectations of behaviors
for all WellSpan employees
WellSpan Service Expectations
•Make a great impression
•Respect privacy
•Offer a helping hand
•Respond to customer needs and
concerns
•Take pride in our facilities
•Measurement NRC Picker
Dimensions of care include: Respect,
Emotional Support, Physical Comfort,
Information, Family Involvement,
Coordination, Continuity
Caring Communication Skills
Reducing Anxiety
Great Greetings (Warm
Greetings)
Great Handoffs- BSR
Great Goodbyes
Heart-Head-Heart
Power of Presence
Acknowledging Feelings
Expressing Caring Nonverbally
Explaining Positive Intent
Blameless Apology
Gift of Positive Regard
# 3 A York Hospital
standard for applying
Service Expectations
with caring
communication skills
(GLATS)
Greet/Goodbye
Look
Ask
Touch
Share
A York Hospital model of care supporting patient and family centered care
Relationship Based Care Principles
•Responsibility for Relationship and Decision Making
•Work Allocation and Patient Assignments
•Communication with the Health Care Team
•Leadership / Management
•Process Improvements
•Caring and Healing Practice Environment
Exemplary Patient Experience at
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York Hospital
Measured by Nurse Communication, Quiet,
Cleanliness and Warm Greetings, Overall Rating
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Connecting the dots…
Patient Experience = RBC
 EP35 and EP35EO
 World Café Events
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Off site location
5-6 patients identified by staff
Each Wave uses feedback in PPM
Integrates theme of CDM from feedback
Magnet ® Redesignation
EP 1 and EP4
Care Delivery and Professional Practice
 Engage staff members
 Re-educate and engage staff in the PPM
 Preparation for Site Visit 2014
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RBC and Magnet Connected…
Pride, Passion Professionalism Event
December 2012
 PPM display
 Re-engage staff with the PPM
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◦ Prepare for Redesignation activities
Dissemination of Scholarly Work
Total scholarly work disseminated by York Hospital Nurses since
2007- Dimension of PPM/Collaboration with colleagues
across entities
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80 publications
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148 podium presentations
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303 poster presentations
Next Steps…
RBC ReVamp (All waves completed)
 Professional Practice Model evaluationschematic re-evaluation
 Maximize Care Delivery and Skill Mix
 Delegation and Communication
 Integrate and Align with WSH and YH
Strategic and Operational Objectives to
achieve outcomes
 Accountability at all levels to meet and
outperforms outcomes
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Questions?
Thank you on behalf of York Hospital Nurse Executive Team