Nurses Integral to Successful System Growth

Cleveland Clinic builds a new hospital, takes in a new system

The healthcare landscape has changed dramatically in the last decade. The ways in which caregivers identify diseases, provide treatment, interact with patients and receive payment are much different. Even the physical places where healthcare providers offer services are shifting. One thing that’s certain in this era of technological advancement and legislative reform is that transformation will continue.

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While some hospital systems face sweeping changes with anxiety and trepidation, Cleveland Clinic chooses to stay at the forefront and contribute to the industry’s reinvention. “At Cleveland Clinic, we are stripping away the superficialities and trying to answer the most basic question in medicine: What is best for the patient?” said Toby Cosgrove, MD, President and CEO of Cleveland Clinic, in a 2015 post on the healthcare system’s online physician blog, Consult QD. “We’re focusing on quality, access and affordability.”

In the past year, Cleveland Clinic has made two major moves that exemplify this focus – the healthcare system has aligned itself with a nearby health system and built a state-of-the-art regional hospital. Successful implementation of these moves hinges on input from all of Cleveland Clinic’s caregivers, including nurses.

Aligning with a respected regional hospital

On Nov. 1, 2015, Akron General Health System formally joined Cleveland Clinic as a full member of the organization. Integration of Akron General Health System, which has served its community (south of Cleveland) for more than 100 years, creates a regional network provider that offers access to a broader range of quality medical services.

“Across the country, hospitals are aligning to capture efficiencies, payment models and best practices,” says Mary McLaughlin Davis, DNP, ACNS-BC, CCM, Senior Director of Care Management for Cleveland Clinic’s nursing institute. “The alignment of these two organizations, both of which offer a high-caliber of care and have a long-standing place in their communities, makes perfect sense.”

The nursing institute is working diligently to ensure the more than 1,600 nurses who work for Akron General Health System will benefit from collaboration with Cleveland Clinic, starting with leadership. For example, the Akron General CNO and Senior Vice President Cherie Guster, MSN, RN, joined the Executive Nursing Institute Council and Executive Nursing Operations Council. Individual areas of nursing are involved in the alignment as well, including Connected Care, Case Management and the Emergency Department.

Cleveland Clinic’s Center for Connected Care helps patients as they move from the hospital to home or a post-acute care facility. Karen Mullen, MBA, BSN, RN, President of Akron General’s Visiting Nurse Service & Affiliates (VNSA), has been meeting with Connected Care and others at Cleveland Clinic. She says the relationship has gone exceptionally well so far.

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“You think of a big organization coming in and saying, ‘You will do this,’” she says. “That’s not been the case. The experience has been very collaborative and collegial.” During meetings, the two staffs shared best practices and compared staffing models, RN caseloads, job descriptions and more. In addition, VNSA nurses shadowed peers from Connected Care to better understand how they work.

Case Management teams at Cleveland Clinic and Akron General (which calls it Care Management) are still in the discovery stages, says Julie Huckriede, MSHA, BSN, RN, Director of Care Management at Akron General. They are exploring the current and future state of Case Management. One of the main areas of focus is departmental structure: Cleveland Clinic’s Case Management Department includes RNs and social workers, and Akron General uses an all-RN model. “The collaborative process is very exciting,” says Huckriede. “We are taking the best of all processes and coming up with an even better system.”

Similar work is taking place in the Emergency Department, where James Bryant, MSN, RN, NEA-BC, Cleveland Clinic’s ACNO of Emergency Medicine, is working hand in hand with Akron General on several initiatives. Bryant’s team has helped the regional hospital’s ED implement the split flow process and incorporate nurse practitioners into triage. They are also collaborating with Akron General on a new ED. “We are helping them design an ED that meets their needs today and for tomorrow,” says Bryant.

Building a state-of-the-art hospital

Another exciting change within the healthcare system is construction of the 126-bed hospital, which opened in November. Avon Hospital is an adult acute care hospital specializing in general surgery, medical/surgical and orthopaedics. “It’s a very efficient hospital with all the newest technologies,” says Dr. McLaughlin Davis. “Best practices have been implemented right from the start.”

Some of the high-tech features that will be utilized throughout the hospital include the following:

  • A voice communication system – “From day one, communication has been quick and efficient through the use of a secure mobile communication system,” says Avon Hospital Chief Nursing Officer Mary Sauer, MBA, BSN, RN, NEA-BC.
  • Interactive patient televisions –TVs are used to provide patient education and ongoing communication.
  • Vital sign device integration – When nurses on the medical/surgical units take patients’ vital signs, they are automatically entered into Cleveland Clinic’s electronic medical record system.
  • Single sign-on technology – Using “tap and go” technology, nurses can tap ID badges – which includes a radio-frequency identification tag – on a workstation to log in. Then instead of typing in codes, nurses can simply tap the badge at any workstation throughout the day when performing tasks.
  • Vital sign alert system – The Cleveland Clinic-developed system, called Vital Scout, alerts nurses to subtle changes in patients’ vital signs and helps them determine appropriate interventions.

“Nurses can leverage technology to provide care that is efficient, patient-centered and personalized,” says Sauer.

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Many people, including nurses, have provided input on the new hospital. Cleveland Clinic conducted research studies on the ideal medical/surgical and ICU rooms. It also built a mock patient room at Fairview Hospital, allowing everyone from hospital staff to community members to tour the rooms and offer suggestions for improvement. In addition, Sauer and Avon Hospital’s assistant nurse managers got the keys to the facility in August – two months before the opening.

“Before the first patient came, we had a lot of time to talk and make decisions on nursing care practices,” says Sauer. “We’re building a culture based on the experience that each and every person brings to the hospital.” This includes nurses like Laura Grothaus, RN, who serves as an assistant nurse manager on a medical/surgical and orthopaedics unit at Avon Hospital.

“I am so excited to be a part of this new team!” says Grothaus. She worked in the skilled nursing facility at another regional hospital for four years, then served in an interim position in a gastroenterology and hepatology unit at main campus while Avon Hospital was being built. “I couldn’t have asked for a better experience,” she says. “I have made many friends while strengthening my skill set at main campus, and I know my experience is beneficial for my new role at Avon Hospital.”

Creating a unified system

Ultimately, changes taking place at Cleveland Clinic are in response to a rapidly evolving healthcare industry. Changes are designed to put patients first, no matter where they receive care. “Our model for care coordination is unified across our system, so wherever a patient or employee goes, they will be able to recognize the work we’re doing,” says Dr. McLaughlin Davis. “The caliber of nurses, and their level of professionalism, contributes significantly to this cause.”