How To Launch A New Nursing Organization Within An International Health System

By Kelly Hancock, MSN, RN, NE-BC

On May 31, 2015, Cleveland Clinic Abu Dhabi completed its phased opening of more than 250 outpatient clinic rooms, 150 inpatient beds and an emergency department – serving patients around-the-clock in more than 30 medical and surgical specialties.

Planning and preparation for the opening of Cleveland Clinic Abu Dhabi has been years in the making. This includes the structuring and formation of Cleveland Clinic’s Abu Dhabi nursing team, which grew from approximately 40 nurses in August 2014, to roughly 400 at the beginning of 2015, and today encompasses more than 600. With locations throughout the globe, Cleveland Clinic health system firmly believes in operating as “One Cleveland Clinic,” which in the simplest terms, means that no matter where a patient goes throughout our health system, they will receive the same level of expert world-class care in a high-quality, safe environment.

I recently spoke with Ann Williamson, PhD, RN, NEA-BC, chief clinical and nursing officer at Cleveland Clinic Abu Dhabi, on the key requirements for launching a successful nursing program within an international health system – specifically, how to ensure cohesive, consistent operations and patient care that align with the rest of the health system. Below are some of the highlights from our conversation.

Q: When considering how to structure and formulate operations for the Cleveland Clinic Abu Dhabi nursing team, what were your top priorities?

A: In terms of establishing a structure for our nursing operations, our top priorities were creating a foundation that would ensure we had the right nurses, in the right places, at the right times – with strong nursing leadership driving our decisions. We also aimed to create a work environment that would allow our nurses to provide the best patient care possible with the technology and resources they needed, while presenting opportunities for professional development and growth.

From day one, we sought to make sure our nurses were actively involved in readiness activities for the hospital opening. Our nursing staff helped lead key activities such as mock operations, training for activation and preparing the clinical environment for patient care. We also launched our shared governance structure with four of our core operational councils prior to the official opening and held meetings with the remaining councils immediately following.

We hit the ground running with our recruitment and retention council, which sponsored a wonderful inaugural celebration of International Nurses Day on May 2. Our clinical informatics council has been instrumental in the implementation and ongoing optimization of our electronic health record system, while the practice council is hard at work contributing to decision-making surrounding care delivery. Additionally, the patient safety and quality council has been focusing our multidisciplinary team on the key nurse-sensitive indicators of falls, hospital acquired pressure ulcers and more.

Q: How did you align these priorities with those of the Cleveland Clinic Abu Dhabi organization, Cleveland Clinic Nursing Institute and Cleveland Clinic health system?

A: For all three facets – Cleveland Clinic Abu Dhabi, the Nursing Institute and the health system – we looked at the coinciding mission, vision and values to make sure the direction we were headed was aligned.

Early on we decided a top priority was to promote teamwork and interprofessional collaboration. We began by having all our clinicians train together. From new caregiver orientation, to clinical caregiver orientation, equipment training and beyond, nurses, doctors, technologists and pharmacists were all in the same sessions learning together. We also worked together to develop mock-operations’ scenarios to help us prepare for seeing our first patients. A. Marc Harrison, MD, chief executive officer for Cleveland Clinic Abu Dhabi, holds ‘town hall’ meetings regularly to make sure all caregivers are aligned throughout the organization and that nursing has a seat at the table – from the boardroom to various committees and working groups.

As far as the Nursing Institute goes, we adopted the mission and vision of Cleveland Clinic nursing within our organization and we patterned our professional practice model after the health system model. Our nurses undergo Performance-Based Development System (PBDS) assessment upon hire and take the same medication safety and ECG exams as those hired at any other health system hospital. We also adopted the Nursing Institute immersion and coaching programs.

Alignment with the health system is demonstrated through our adoption of Cleveland Clinic patient experience training – customized to Abu Dhabi, with a strong Patients First philosophy. We stay abreast of the initiatives back in Cleveland, such as hand hygiene compliance, and we transfer best practices here. We’re just implementing the SNAP (scrub now and prevent) initiative to promote professional accountability for hand hygiene compliance.

Q: How did you work to ensure the nursing operations and patient care you are providing at Cleveland Clinic Abu Dhabi is consistent with the Cleveland Clinic Nursing Institute?

A: Leadership really sets the tone for integration and our Nursing Institute has an extremely strong executive leadership team that makes sure the voice of Cleveland Clinic Abu Dhabi nursing is always heard. My leadership team and I have been actively involved with the comprehensive nursing leadership team from the day we stepped into our positions.

As shared earlier, we’re adopting as many best practices from the Nursing Institute as possible – including daily huddles, hourly rounding, nurse manager rounding and more. Our professional practice model, shared governance structure, and other aspects of nursing are all based on the health system standards. I attend nursing leadership meetings in Cleveland on a regular basis and all of our Abu Dhabi nursing leaders have strong, positive relationships with their counterparts throughout the health system.

We are also fortunate to be included in a large number of health system communications initiatives. We participate in weekly calls with various nursing leaders to make sure we stay aligned and are supported in delivering on the Cleveland Clinic mission in Abu Dhabi. Our nurses have full access to the Nursing Institute intranet and to the medical library that not only supports our evidence-based practice efforts, but will also help us launch a nursing research program in the near future.

Q: If you had to make one recommendation to other nurse leaders who are fulfilling roles similar to yours, what would it be?

A: Putting patients first is the North Star – no matter where you go. This means both providing the highest quality patient care and empathetic and compassionate relationships.

Q: Is there anything else you would like to add?

A: I would add is that international healthcare does pose challenges related to language, culture and scope of practice, but these are surmountable – and shared governance helps ensure that various points of view are incorporated into decision-making. It’s an exciting time to be involved in healthcare delivery in an international environment!

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