Questions: • An action plan for addressing the situation. The action plan should

Question

Questions:

• An action plan for addressing the situation. The action plan should include the goal/s of any solutions, both short term and long term action steps to achieve the goal/s, and major risks which could be encountered in the pursuit of the goal/s and the responses to deal with any perceived risk.

• A summary of the case study analysis.

Organization Munson Medical Center is a 391-bed, nonprofit hospital in Traverse City, in a rural region in Michigan. The largest hospital in northern Michigan, it is the regional referral center for the northern part of Michigan’s Lower Peninsula and the eastern part of the Upper Peninsula, serving residents in 24 counties. Tertiary care services include neurosurgery, trauma, neonatal ICU, and others. Munson also has a family practice residency and is a training site for five nursing schools. In addition to its main campus, Munson provides local specialty clinics in several communities throughout the area. It is a member of Munson Healthcare, a nonprofit health care system. Munson has been tracking patients’ satisfaction with their care through Press Ganey surveys for more than 10 years. It also closely monitors its HCAHPS results, particularly since the Centers for Medicare and Medicaid Services (CMS) began collecting these data. James Fischer, M.S., M.B.A., R.N., vice president for patient services and chief nursing officer, says that Munson aims for every hospital unit to be in the top 10 percent nationwide in terms of patient satisfaction, as measured by Press Ganey and HCAHPS. The organization also aims to be in the top decile on CMS core measures of care processes, as well as in employee engagement as measured by a Press Ganey survey that Munson began using in the spring of 2007. The hospital’s senior management council and Board of Directors review patient satisfaction scores on a monthly basis. Munson has been intermittently in the top decile for the past decade, but there was some slippage several years ago that prompted the hospital to take action before scores eroded further. “For units not in the top decile, we establish incremental goals,” Fischer says. “For units already there, we want them to stay there.”

Strategies for Success

The following strategies and factors appear to contribute to patients’ satisfaction with their care at Munson Medical Center. High Nurse-to-Patient Ratios and Shared Governance Munson administrators regard having relatively high nurse-to-patient ratios as fundamental for ensuring patient satisfaction and good health outcomes.1 “If nurses are spread too thin,” says Fischer, “they won’t be able to meet patient needs or establish relationships with patients and families.” Recommendations for minimum nurse-to-patient ratios vary considerably, from one nurse per 10 patients (recommended by hospital associations) to one nurse per three patients (recommended by nurses’ associations).2 California, the only state to mandate nurse-to-patient ratios, requires minimum ratios of 1:5 in medical/surgical units, 1:2 in critical care units and ICUs, and 1:3 in step-down units. Munson’s nurse-to-patient ratios meet or surpass California’s standards, and are maintained even though the state of Michigan does not mandate minimum nurse-to-patient ratios. They are: • Medical/Surgical units – 1:4 during days and 1:4 or 1:5 during nights. • Critical care units – 1:1 or 1:2. • Step-down unit – 1:3. Munson also practices “shared governance,” whereby staff nurses participate in hospital decisionmaking and policymaking. Under this model, nurses are given greater authority and responsibility for patient care as well as greater control over their professional practices.3 Fischer feeds ideas to nurses on ways to improve patient care from conferences, reports, and professional literature. Nurses then choose strategies and develop or adapt them for their units.

Relationship-Based Care Munson is in the process of implementing “relationship-based care,” a model of care that emphasizes the importance of collaborative relationships.4 It is focusing on strengthening three types of relationships: • between care providers and their patients and families; • among care providers; and • between care providers and themselves (i.e., taking care of oneself). Most important in terms of patient satisfaction, Munson works to build good relationships between providers—particularly nurses—and patients and families. A three-day workshop focuses on the three types of relationships. Though attendance is not mandatory, staff are strongly encouraged to attend and allocated time to do so. Staff are shown techniques for demonstrating their respect for patients; instead of prescribing ways to speak with patients, the teaching method relies on role-playing and education. Other training occurs at the unit level, at which a cross-section of staff meet regularly to develop plans to strengthen relationships on their units. Further, a few simple procedures and tools help to build nurse–patient relationships. At the beginning of every shift, nurses spend three to five minutes at bedsides to establish rapport with patients, discuss the goals for the day (e.g., get out of bed two times and walk independently to the end of the hall), and elicit their priorities and concerns. Each room includes a dry-erase board on which nurses write their names, the names of the nurse assistants, goals for the day, and any special considerations. This serves as a visual reminder to patients of who is caring for them and how to contact someone if they need assistance. Munson is also piloting a shift-to-shift bedside report. When nurses finish their shift, they give verbal reports to incoming nurses in front of patients and their families. The new nurse is introduced, patient goals and progress are reviewed, and the incoming nurse establishes or renews a connection with the patient and family. According to Fischer, patients and their families have said that they appreciate this process. Munson uses initiatives such as an internal recognition system to promote staff morale. It is also encouraging staff to take care of themselves in order to provide good care to patients. Some units have relaxation rooms with massage recliners and soothing music to rejuvenate nurses, aides, therapists, and other staff. Acuity-Adaptable Care Three years ago, Munson’s Heart Center implemented on two floors the “acuity-adaptable” care delivery model, whereby a patient stays in the same room from admission through discharge. By eliminating most patient transfers, the model is intended to reduce medical errors, falls, missed treatments, and lost belongings and to improve staff and patient satisfaction, clinical outcomes, and efficiency. Staff members adjust the level of care as patients’ needs change, providing critical care, step-down care, and/or regular care in specially designed “universal rooms.” While this model entails cross-training of nurses to accommodate a range of acuity levels and a substantial investment in equipment, it has been shown to enhance efficiency.5 Hospital administrators are conducting a cost analysis of the model at Munson. The investment was about $3.8 million per unit. So far, patient satisfaction scores on the two units serving cardiac patients with universal rooms average 99 percent in the Press Ganey survey, as benchmarked against peer hospitals. Private rooms are a key feature of the acuityadaptable model and, according to Fischer, an important way to enhance patient satisfaction. Though the majority of Munson’s rooms are semi-private (two patients), it has created 80 private rooms, each with a patient zone, caregiver zone, and a family zone (see text box). As Munson grows to meet demand (based on its increasing population base and referrals to the hospital), it hopes to increase the number of private, acuity-adaptable rooms. Identifying and Meeting Patient Needs Munson has established protocols for inquiring about and responding to patients’ individual needs and preferences. For example, an initial report sheet, completed upon admission, asks basic questions about how patients want to be referred to and their treatment preferences and priorities. Maternity unit nurses are encouraged to write personalized notes wishing new mothers success a week after their discharge. Also, Munson is piloting in its general medical unit and stroke unit a “Quiet Time” from 2 p.m. to 4 p.m. every day, during which lights are dimmed and noises kept to a minimum. The goal is to promote rest by reducing the constant “hustle and bustle” of hospital stays—a simple modification that has been well received by patients and their families. Ongoing Measurement and Incentives Munson’s Board of Directors, senior management, and the rest of the management team receive monthly reports on Press Ganey surveys. Each month, the prior month’s patient satisfaction scores and other performance indicators are reviewed on a unit-by-unit basis by administrators and frontline staff, and improvements or declines are investigated. Each hospital unit in turn creates a plan and goals for improving its scores. Unit managers have financial incentives to improve: about 20 percent of their annual bonus, which is an additional 7.5 percent of salary, is tied to meeting these goals.6 Results Munson has just begun to focus on HCAHPS scores. Based on surveys from 2007, Munson performs better than the national average in nine of 10 domains of care (Table, page 5). Nevertheless, leaders acknowledge there is room for improvement, including opportunities to increase patient throughput and reduce waiting times in the outpatient area. They also believe that providing relationship-based care will help improve their scores by enabling them to meet the emotional needs of patients and families, communicate effectively, and show compassion and understanding about the inconveniences of hospitalization. Lessons Learned Munson leadership has learned some important lessons in its drive to improve patient satisfaction. Fischer stresses the following: • always keep a focus on patient satisfaction; • engage frontline staff in the process of improvement; • measure, monitor, and give staff feedback on patient satisfaction on a frequent (e.g., monthly) and ongoing basis; • share patient satisfaction scores and plans for improvement among administrators, managers, and staff; and • maximize use and creation of private patient rooms.

Explanation / Answer

Action plan refers to a technique implied to ensure that your business vision is implemented successfully thus it helps to illustrate the manner in which the group can utilize the business policies to meet its goals. An action plan consists of a number of action steps and alterations to be conveyed about in your group of people.

Ideally an action plan should be build up primarily at the beginning of the business once you have identified and conceptualized ideas, process, goals and policies for your group. If you build an action plan when you are actually prepared to initiate the stuffs get done then it can facilitate you with a sketched out summary on how to manage your business effectively.

VMOSA (Vision, Mission, Objectives, Strategies, Action Plans) model is generally implemented and put into use by the administrators while framing business policies and deciding the business goals. Thus its important action plan should be comprehensive, understandable and should contain issues pertaining to situations relevant to prevailing market situations and conditions.

Thus action plan should comprise of information and ideas that you have accumulated in the brainstorming sessions related with your business policies and approach. Business strategies should concentrate on wide-ranging objectives that needs to be achieved action plans will indeed help you to establish the definite actions that you need to implement to help make your visualization a reality.

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