Recommendtion for Improvement

Purpose and Overview

Nurse consultation involves the application of change management principles and visionary leadership to the improvement of healthcare organizations. Guided by evidence-based practice and ethical principles of the healthcare profession, nurse consultation is a process involving multilateral communications, quantitative assessments, goal-setting, and strategic change management. Advance practice nurses can collaborate with nurse leaders to identify problems, analyze those problems and their root causes, and identify meaningful and feasible methods of achieving desired changes and measurable outcomes.

The purpose of this consultation is to work with nurse leaders, administrators, and executives to help the local healthcare organization better meet their goals and improve patient satisfaction. Nurse consultation requires the use of multiple, rigorous empirical methods. The data collection processed used in this case include both qualitative methods like interviews and focus groups, as well as quantitative data gathered from HCAHPS scores, patient metrics, and patient surveys. Although the current consultation strategy does not require formal comparisons with local organizations, other area healthcare institutions can offer meaningful points of comparison when inspiring change. The data collection methods will tacitly refer to the community, its needs, and also the need for the organization to better embrace corporate social responsibility models in their operating strategies.

Description of Organization

Jackson Health System in Miami, which comprises six individual organizations including Jackson Memorial Hospital, is a cluster of healthcare institutions that include teaching hospital, children’s hospital, and a range of specialized care centers. A total of 9000 employees work in the Jackson Health System, including physicians, nurses, and administrators. As a health system, Jackson recognizes the value of integrating multiple healthcare domains under one rubric: both geographic and cultural. The unified health system at Jackson depends on a hierarchical bureaucracy, but one that does also provide significant autonomy to its individual organizations or brands like the Holtz Children's Hospital. Jackson’s organizational structure includes a Board of Directors and Senior Officers including Chief Compliance Officer, Chief Financial Officer, Chief Transition Officer, and Chief Nursing Officer. Corporate offices work alongside but separate from the healthcare officers, such as the Human Resources Officer, and the Corporate Directors of Public Safety and Public Relations.

Comprising as it does six different hospitals and twelve specialty care centers, as well as a system of clinics and pharmacies and several long-term treatment facilities within the parent structure, Jackson Health System offers a comprehensive range of medical products and services for a diverse metropolitan area. Jackson Health System offers specialized care that is unparalleled in the South Florida area, including trauma care, and also proudly proclaims itself to be the only hospital in the state to offer every type of organ transplant (Jackson Health System, 2018, “About Us”). Affiliations with a number of other health care institutions expands the role Jackson Health System plays in the community, providing community-based services and services for medical education and research. Jackson Health System is also a teaching hospital affiliated with the University of Miami Leonard M. Miller School of Medicine, which itself has 1000 full-time faculty members.

Primary Needs of Population

The Jackson Health System serves a geographically wide and demographically diverse area. Several of its hospitals and specialized care centers offer services that cannot be found elsewhere in the region or even in the state, making it a magnet institution too. Jackson Health System provides neonatal care, geriatric care, and everything in between. The diverse patient population within the immediate Miami-Dade County possibly includes almost three million individuals, more than two-thirds of which are Hispanic/Latino, and almost twenty percent of which are African American (United States Census, 2010).

According to a report by Miami-Dade County (n.d.), local identifiable risk factors are largely related to lifestyle including obesity-related diseases and diabetes. While teen obesity numbers have improved, adult obesity has actually increased (Miami-Dade County, 2011). In “Measuring What Matters,” a Miami-Dade County Community Health Report Card update, the county also identified other major concerns of the population that can be addressed via improvements to the healthcare system, including prenatal care deficiencies and problems related to low birth weight and infant mortality. Immunization numbers have also been on a decline, with resulting public health concerns (Miami-Dade County, 2011). Substance abuse and alcohol-related problems are also major issues of concern, as are high rates of sexually transmitted diseases. Rates of HIV/AIDS have also been increasing, and remain twice the Florida average (Miami-Dade County, 2011). Rates of cancer in the area have actually been decreasing, according to the Miami-Dade County (2011) report. As the largest and leading healthcare organization in Miami-Dade County, Jackson Health System is on the front lines of public health services and has a distinct role to play in improving county health outcomes.

Nurse Leader’s Role

This consultation depended on the help of a nurse leader within the Jackson Health System, the Vice President and Chief Quality Officer Kevin Andrews. Andrews worked as a nurse practitioner for several years within the Jackson system before shifting to a position of leadership within the organization. As Chief Quality Officer, Andrews considers himself a liaison between the community and the organization. Andrews pays close attention to performance metrics and outcomes and was chiefly responsible for suggesting the implementation of nursing consultation during the process of change management at Jackson. When asked about his formal position and influence within the Jackson Health System, Andrews focuses on the data-driven nature of his role. The Chief Quality Officer knows that health outcomes and patient metrics are linked to reimbursements and funding, as well as to the ethical obligations of the institution. Therefore, the Jackson Health System depends on Andrews and his team for remaining solvent and competitive. Informally, Andrews helps motivate other nurse leaders to implement procedural changes that will result in measurable performance and patient outcome improvements.

Characteristics of Organization

Current Strengths

Jackson Health System is entrenched in the community, has strategic affiliations with local specialty care facilities, and also functions as a teaching hospital. Therefore, Jackson’s core strength is its role in the community and within the healthcare sector in general. Several Jackson organizations, notably the Holtz Children’s Hospital, are ranked relatively high on nationwide rankings like the U.S. News & World Report 2017-2018 evaluation. In addition to the remarkable metrics from Holtz, the Jackson Health System also boasts the ability to pair patients with appropriate treatments and services, with easy access to a number of specialized care centers in the area.

Current Weaknesses

Several weaknesses have been identified based on the data collection instruments and formal evaluations. The Jackson Memorial Hospital, the main hospital within the Jackson Health System, is a poor performer on most meaningful metrics. One of the most important weaknesses is safety. The Leapfrog Hospital Safety (2018) grade of 2.181 reflects the high rates of Methicillin-resistant Staphylococcus aureus (MRSA), a common but preventable staph infection. Also notable is the low score on patient satisfaction surveys, which have been covered extensively in the media. An article in the Miami Herald points out that although most Florida hospitals also receive poor marks from patients, Jackson Memorial is the only one in South Florida to receive the one-star rating—the worst possible rating (Herrera & Rau, 2015). Likewise, the U.S. News & World Report 2018 rankings indicated the two out of five stars for overall patient experience within the Jackson Health System.
Current Evidence-Based Practice Activities

Closely affiliated as it is with the University of Miami Leonard M. Miller School of Medicine, evidence-based practice is the cornerstone of the Jackson Health System. Current evidence-based practice activities are embedded at every level and type of healthcare practice, product, and service offered throughout the Jackson Health System. Most notably, the effective performance and clinical outcomes at the Holtz Children’s Hospital depend on the use of evidence-based neonatal and infant care. The only exception would be the lack of evidence-based practices that would have prevented the high rates of MSRA infections (Leapfrog Hospital Safety, 2018).

Quality Improvement Projects

Reflecting on poor performance on patient satisfaction surveys and also on the HCAHPS scorecard, Andrews identified several quality improvement projects currently in development within the Jackson Health system. The projects receiving the majority of attention, focus, and funding are related to patient experience and how to improve patient perceptions. Improving the patient Web portal and other changes have required the collaboration of the information technology department at Jackson. Andrews also points out that the Quality and Safety Department at Jackson is working on the development of a dedicated team of nurses who focus on patient interactions and service excellence via feedback with patients and families.

Recommendations for Change

Given that Jackson Health Center’s primary weakness is in the realm of patient satisfaction, it follows that the recommendations for change focus on creating patient-centered products, services, and procedures. Until now, patient-centeredness has not been a top priority at Jackson, which has possibly spread itself too thin via an ambitious and bloated organizational structure. If Jackson wants to improve its patient satisfaction outcomes, it will need to make concrete patient-centered changes including improvements to the overall patient experience, advocacy for disenfranchised communities, and improved communications between healthcare staff and patients.

Recommendations for organizational change include the development of a workgroup dedicated to patient satisfaction. The workgroup should consist of members of multiple Jackson organizations and departments, including information technology. Working with members of the information technology department will help Jackson Health System streamline its patient portal and create a more user-friendly experience that facilitates information sharing and transparency. Moreover, the information technology department can ensure that all health informatics systems are upgraded to improve safety outcomes and reduce medical errors.

Communication between nurses and patients was identified as a major reason for the low patient satisfaction. Therefore, the workgroup will focus on strategic, concrete methods of facilitating communication within the diverse patient population. The cultural competency of nursing staff needs to be reassessed, with a special focus on how Jackson Health System is meeting the needs of the Haitian community in Miami-Dade. While Jackson’s organizational structure has traditionally focused on diverting resources to helping the poor, offering and accepting referrals, and addressing the staggering number of uninsured patients, recommendations for change do include raising funds from high paying patients including medical tourists –something that has already been suggested as a key strategy for change (Rodriguez, 2012). Many of the services being offered to patients do not currently facilitate the inclusion of family members in the decision-making process, which is why changes do need to be made to a more patient-centric and culturally appropriate healthcare experience. Dedicated patient care personnel need to solicit input from patients and ensure that patient needs are being met throughout the healthcare process.

Rationale

The recommended changes will address the weaknesses of the organization and the needs of the community with concrete and feasible structural changes requiring a minimum of financial resources. With patient satisfaction as the top concern, Jackson Health System can create a new, perhaps temporary, workgroup that identifies the communications needs of patients and assigns highly skilled staff to addressing those needs in a culturally appropriate manner. Quality assurance also requires the cooperation of all nursing staff on reducing preventable staph infections. Resources for patient care need to be liberated, devoted towards meeting the public health and safety concerns related to lifestyle factors. Working with Miami-Dade County in improving the local infrastructure and increasing access to health information will also help raise patient perceptions and ratings, while improving patient outcomes within the Miami-Dade community.

Measures and Benchmarks

For the recommended changes to be cost-effective and meaningful, Jackson Health System needs to rely on a system of nationally recognized benchmarks and metrics. The patient experience surveys offered at discharge and used to compile the data in the U.S. News & World Reports will remain an important measure because of their impact on media and public relations. Similarly, the patient ratings cited in media surveys like those in the Miami Herald will offer opportunities for ongoing performance evaluation. Over the next several years, Jackson should experience improvements in patient experience survey outcomes, as well as overall patient outcomes and reduced rates of staph infections. Close attention will be paid to survey data related to communication, nurse-patient interactions, and the user experience of patient electronic health portals. Benchmarks for measuring health and safety concerns like staph infections include those used by the Leapfrog Hospital Safety Grade systems. Finally, Jackson Health System may want to consider developing its own proprietary patient satisfaction survey instrument that is adopted to meet the specific needs of the local population.




References

Herrera, C. & Rau, J. (2015). South Florida hospitals score 3 out of 5 stars in patient satisfaction. Miami Herald. http://www.miamiherald.com/news/local/community/miami-dade/article18713358.html
Jackson Health System (2018). About us. http://www.jacksonhealth.org/jackson-memorial-about.asp#gref
Leapfrog Hospital Safety Grade (2018)
Miami-Dade County (n.d.) Health. http://www.miamidade.gov/greenprint/planning/library/milestone_one/health.pdf
Miami-Dade County (2011). Measuring what matters in Miami-Dade County. http://www.miamidadematters.org/content/sites/miamidade/Miami_Matters_health_report_card_2010.pdf
Rodriguez, R. (2012). Philanthropy for a profitable international program. Medical Tourism Magazine. http://www.medicaltourismmag.com/philanthropy-for-a-profitable-international-program-a-case-study-at-jackson-health-system/
U.S. News & World Report Rankings (2018). Jackson Health System—Miami. https://health.usnews.com/best-hospitals/area/fl/university-of-miami-jackson-memorial-medical-center-6390573
United States Census (2010). https://www.census.gov/quickfacts/fact/table/miamidadecountyflorida/POP060210