High Reliability: Partnering Together to Transform Care

By Kelly Hancock, DNP, RN, NE-BC

Cleveland Clinic’s recent 9th Annual Nursing Leadership Summit was one for the books. The theme was “High Reliability: Partnering to Transform Care,” and the discussion was rich.

Joining a handful of other committed healthcare organizations, Cleveland Clinic is currently on an incredible journey to become a high reliable organization (HRO) – dubbed by The Joint Commission as today’s gold standard in healthcare. Our vision is to improve and transform the quality of healthcare. And imperative to our success is ensuring Cleveland Clinic’s caregiver teams are consistently working together to create and lead change that positively impacts how care is delivered.

Throughout the past two years, the Stanley Shalom Zielony Institute for Nursing Excellence has been serving as a health system role model in this area. And this year’s Nursing Leadership Summit included a showcasing of several nurse-led projects and initiatives that are successfully unifying caregivers through best-in-class communication and collaboration.

The day-long summit also offered the more than 450 nurse leaders in attendance insights into how the Cleveland Clinic nursing organization is aligning its high reliability strategic priority with the health system’s top goals, which are:

1. To always put patients first by continuously improving quality, safety and the experience of care Cleveland Clinic provides.
2. To make Cleveland Clinic the best place possible for caregivers to work.
3. To continue to reduce the cost of care for Cleveland Clinic patients by making care more affordable.
4. To responsibly grow and develop to sustain Cleveland Clinic’s mission to positively impact healthcare through great clinical care, research, education and innovation.

As it does every year, the summit included a combination of guest presenters, deep discussions, interactive group work and panel presentations.

9th Annual Nursing Leadership Summit Highlights

Highlights from the day, included:

• Connection of Advanced Practice Registered Nurses (APRNs) with the Strategic Agenda.
  • Associate Chief Nursing Officer (ACNO) of Advanced Practice Nursing, Meredith Lahl Foxx, MSN, MBA, APRN, shared how vital APRNs are to the future of healthcare and Cleveland Clinic’s objective to providing care that is high-quality, timely and affordable. Ranked the 2 hospital in the country by U.S. News & World Report, Cleveland Clinic’s nearly 1,200 APRNs work in every clinical setting throughout the health system.
• Impact of an Advanced Practice Provider-Led House Officer Program.
  • Led by Christine Lynch, MSN, APRN, Director of House Officer Team and APRN/PA Director for the Anesthesiology Institute, this presentation included an overview of how Cleveland Clinic has transitioned its House Officers from contracted physician providers to Cleveland Clinic advanced practice providers (APPs) and the great impact the transition has made. For example, in a one-year post-implementation survey distributed to caregivers at Cleveland Clinic’s South Pointe and Euclid Hospitals (the first two hospitals to implement the program), results showed improved ICU patient management, improved global house officer responsiveness, improved communication, and improved procedural competencies, and attention to detail.
• Team-Based Care in Chronic Care Clinics.
  • Led by Kristine Weiss Adams, MSN, CNP, ACNO of Care Management and Ambulatory Services, this panel presentation featured nurses from two of Cleveland Clinic’s seven Chronic Care Clinics who offered insight into the role of the nurse practitioner in the chronic care clinic setting; differences between the clinic care setting and primary care; the contributions the clinics have on patient care, and more. Cleveland Clinic’s Marymount and Lutheran clinics, for example, are delivering highly personalized care in 15-minute appointments, lowering hospital readmission rates, and improving preventive healthcare in local communities.
• Clinical Nurse Specialists (CNSs) Partnering Together for High-Quality Care.
  • Facilitated by Myra Cook, MSN, APRN, Coordinator of Advanced Practice Nursing, presentations by Kathleen Burns, DNP, APRN, Medina Hospital and Tina DiFiore, MSN, APRN, Hillcrest Hospital, showcased examples of CNS-led projects that are helping Cleveland Clinic achieve a culture of zero patient harm. The first presentation highlighted the newly developed Vital Scout vital sign alert system that alerts nurses to subtle changes in patient vital signs and helps determine appropriate interventions. And the second featured the new infant-driven feeding program (IDF) that gives NICU babies a more successful feeding experience through the development of a feeding scale, which scores the baby on oral readiness, interventions and the overall feeding.
• Best Practices and Continuous Improvement Initiatives.
  • Featuring a number of nurse-drive success stories from Cleveland Clinic’s Solutions for Value Enhancements (SolVE) program and Continuous Improvement (CI) initiative, nurses from throughout the health system showcased how their work is welcoming ongoing quality improvement, achieving excellence in quality and safety, and creating a refined platform for patient-centered care delivery. Success stories included examples, such as: transitions of care in pediatrics at Willoughby Family Health Center to better individualize care; a new discharge phone call program at Fairview’s emergency department to improve patient experience; and reducing nurse manager stress at Cleveland Clinic’s main campus.

Following a special recognition of Cleveland Clinic’s 2017 year-to-date DAISY Award for Extraordinary Nurses honorees, the summit closed with a simple message that applies to any healthcare organization currently on or considering the journey to high reliability: “Strong leadership and persistent mindfulness are the foundation for the future.”

Kelly Hancock is the Executive Chief Nursing Officer of the Cleveland Clinic Health System, and Chief Nursing Officer of Cleveland Clinic Main Campus.

Follow Kelly on Twitter at @kkellyhancock.