KAISER PERMAMENTE STRATEGIC PLAN

Voice of Nursing 3.0: Building a Culture of Excellence

Voice of Nursing 3.0:
Purpose / Kaiser Permanente will lead the nation in achieving superior organization, nursing, patient, and community outcomes. The foundation to Building a Culture of Excellence begins with the Voice of Nursing 1.0 (3-Day Workshop) and Voice of Nursing 2.0 (Site Visit). The Voice of Nursing 3.0 (Magnet Excellence Components) provides a framework for nursing practice and research, as well as serving as a roadmap in shaping changes essential to the continued development of the nursing profession and to quality outcomes and patient care.
Kaiser Permanente Mission / Kaiser Permanente exists to provide high-quality, affordable healthcare services and to improve the health of our members and the communities we serve.
Perform,
Grow,
Lead / To advance our mission on affordability, we need to
  • Perform by transforming care, coverage, and cost
  • Grow through both core and new opportunities
  • Lead by increasing our relevance as a force for change in healthcare

Who We Are / Kaiser Permanente has over 54,000 nurses, who represent one-third of the Kaiser Permanente workforce.
The National Nursing Leadership Council (NNLC) is comprised of senior nursing leaders from inpatient, ambulatory, home health, advice call centers, labor representatives and patient partners. The NNLC establishes the strategic direction for nursing practice for all eight regions across the continuum. National Patient Care Services (NPCS) serves as internal consultants to NNLC leaders and is responsible for executing on the strategic plan.
Strategy Statement / To unite and align our over 54,000 nurses under one Vision, set of Values, and Professional Practice Model.
This will enable us to standardize practice where there is evidence and elevate nursing practice at Kaiser Permanente. Kaiser Permanente members would know they were being cared for by a Kaiser Permanente nurse, regardless of where they entered the system.
Nursing Vision / Nursing Professional Practice Model / Nursing Values
Kaiser Permanente nurses advance the art and science of nursing in a patient-centered healing environment through our professional practice and leadership.
Extraordinary nursing care.
Every patient.
Every time / /
  • Professionalism
  • Patient & Family-Centric
  • Compassion
  • Teamwork
  • Excellence
  • Integrity

Professional
Practice
Model / The Kaiser Permanente Nursing Professional Practice Model is based on the discipline and practice of nursing. The schematic design of our professional practice model demonstrates how each component is aligned and integrated to support nursing practice across the continuum and to meet the needs of our patients and their families. The model also demonstrates the contribution nursing makes in fulfilling Kaiser Permanente’s mission and vision. By fulfilling the expectations of our integrated nursing model, Kaiser Permanente patients and their families experience. Extraordinary Nursing Care. Every Patient. Every Time.
See Appendix A
Current
Situation / Kaiser Permanente senior healthcare executives and nurse leaders are looking for guidance to building a culture of excellence. The organization has invested heavily in its nursing workforce, technology and facilities, yet the results in quality and service that would define us as the “best” have not be achieved. While many quality indicators have improved, the nurse communication composite score is still below the 75% percentile.
For Kaiser Permanente to achieve high quality service and outcomes, a strong stable nursing leadership will be required. Kaiser Permanente experiences significant (Chief Nurse Executive) CNE, RN manager/director turnover rates. Literature sites one of the primary variables impacting RN manager turnover is lack of developmental opportunities and growth.3
  • NPCS is four years into execution of the Voice of Nursing – a program designed to empower and inspire nurses to engage in their profession and practice.
  • Due to unexpected delays (labor strikes, leadership turnover). Northern California is behind in the execution of the nursing strategy. NPCS is working closely with Northern California leadership to assist with the launching of Voice of Nursing 1.0 (eight sites remain to be socialized and scheduled).
  • There is growing interest in Magnet designation (SCAL, Hawaii, NW, and MAS) including ambulatory sites, but do not have the resources to hire external consultants. External consultants can cost $50k-$100k per year (ANCC).

Background / The American Nurses Association (ANA) Scope and Standards of Clinical Practice and Code of Ethics are the foundation for practice in the United States. In 2012, the Kaiser Permanente National Nursing Leadership Council (NNLC) approved the standards and code as foundational to nursing practice. The American Nurses Credentialing Center (ANCC) Magnet Recognition Program holds the gold seal for nursing excellence; its outcomes-driven model has proven results. The Magnet criteria servers as a framework for high performing healthcare organizations. In 2016, Kaiser Permanente NNLC approved the Magnet standards as the roadmap/framework for nursing in all Kaiser Permanente settings.
Voice of Nursing Timeline
  • In 2008, Kaiser Permanente nursing leadership across the continuum began the journey to unite and align nurses under one Vision, set of Values, and Professional Practice Model.
  • In 2012, National Patient Care Services (NPCS) developed the Kaiser Permanente nursing Professional Practice Model, which guides practice for all settings (inpatient, ambulatory, and the continuum of care).
  • In 2013, the Voice of Nursing 1.0 roll out began to start the enculturation of the Vision, Values and Professional Practice Model into all regions across the continuum.
  • In 2014, the Voice of Nursing 2.0 site visits began to assess and continue to educate nurses on professional practice, ANA Clinical Practice Scope and Standards, Code of Ethics, and the Kaiser Permanente Nursing Professional Practice Developmental Grid.
  • In 2015-2016, the Kaiser Permanente Nursing Accountability Model was developed along with an execution plan. Kaiser Permanente has seen some improvement in Nurse Communication Composite Scores, however, scores are still below the 75% percentile, which requires transformational change to become the best.
  • In 2016, Kaiser Permanente senior healthcare executives and nursing leaders began the journey of becoming a Culture of Excellence. Kaiser Permanente’s Voice of Nursing which includes the Vision, Values, and Professional Practice Model has been deployed or scheduled for deployment in 81% of Kaiser Permanente Medical Centers/regions. Currently, there are 8 hospitals remaining to be scheduled. Due to unexpected delays (labor strikes, leadership turnover) Northern California is behind in execution of the nursing strategy.
  • In 2016, NPCS was funded to develop a summit that will launch this work -Kaiser Permanente Magnet Strategic Plan: Building a Culture of Excellence.
  • In 4th quarter 2016, an extensive survey was conducted in 15 of the Kaiser Permanente hospitals to obtain an objective assessment of current state. Primary Drivers to achieve a culture of excellence were identified as: Leadership, Culture, Systems, and Performance Metrics.
  • In 2016-2017, National Patient Care Services (NPCS) in partnership with Diane Brown, Collaborative Alliance for Nursing Outcomes (CALNOC), and American Academy of Ambulatory Care Nursing (AAACN) began developing the first National Ambulatory Nurse Sensitive Metric.

Primary Drivers
for Change / Key strategic areas have been identified as primary drivers in Building a Culture of Excellence:
  • Leadership - Goals, incentives, strategy, and action plans aligned with regional and national priorities that cascade to every department and drives performance across a balanced scorecard.
  • Culture – Values are embedded at medical centers and department levels and effectively promote high quality, safe care and work environments and the best Kaiser Permanente experience across the continuum.
  • Systems – Core management and teams practice and advocates for consistent use of interdisciplinary teams that use inter-professional and patient-centered approaches.
  • Performance Metrics – Leaders and managers have easy access to tailored dashboards and tools.

WHY MAGNET?

For Kaiser Permanente to become the best healthcare system, a solid foundation of evidence-based practice must be built as well as a culture of accountability. The organization must leverage the power of nursing to be successful in building a culture of excellence. The American Nurses Credentialing Center (ANCC) Magnet Recognition Program is the gold seal for nursing excellence, and serves as a framework for high performing healthcare organizations. In 2016, Kaiser Permanente NNLC approved the Magnet Standards as the roadmap for nursing at Kaiser Permanente. The five Magnet components are:

  • Transformational Leadership
  • Structural Empowerment/Engagement
  • Exemplary Professional Practice/Interprofessional Collaboration
  • New Knowledge, Innovation & Improvements
  • Empirical Quality Results

See Appendix B

Using Magnet Standards as the framework can improve the Care Experience:
Studies demonstrate a significant link between Magnet hospitals and higher Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) scores.2Nurses practice in an environment that reinforces their professional role and autonomy, provides adequate resources, demonstrates consistent and high-quality managerial support and leadership, and includes nursing in an institutional decision making.

Using Magnet standards as the framework can improve Workforce Metrics:

Magnet framework focuses on developing transformational leaders who are engaged, empowered, and grow staff. Kaiser Permanente experiences significant RN manager/director turnover rates. Literature sites one of the primary variables impacting RN manager turnover is lack of developmental opportunities and growth.3

Using Magnet standards as the framework can improve Quality and Safety:

Literature supports that there is an overall financial return related to Magnet designation. By utilizing the Magnet standards and ANA Scope and Standards of Clinical Practice and Codes of Ethics as the framework would assist Kaiser Permanente with improved satisfaction, improved quality and safety, increase HCAHPS performance and superior business results related to investment in professional nursing practice.1,2

And using Magnet standards as the framework can improve Affordability:

Magnet organizations continually report positive financial impacts3.Financial cost of losing a single nurse, middle manager, or Chief Nurse Executive (CNE) has been calculated to equal about twice the nurse’s annual salary. (i.e. includes termination costs, costs of unfilled positions, advertising & recruiting costs, new staff hiring costs, new staff training and orientation costs). The average hospital is estimated to lose about $300,000 per year for each percentage increase in annual nurse turnover. Losing theses critical employees negatively impacts the bottom line of healthcare organizations in a variety of ways including contingent staff costs, increased accident and absenteeism rates.5

STRATEGIC GOALS 2017-2018
VOICE OF NURSING 3.0 KAISER PERMANENTE
MAGNET STRATEGIC PLAN: BUILDING A CULTURE OF EXCELLENCE

Goal #1: Utilize and align all staff/departments across organization entities by using Kaiser Permanente Nursing Vision, Values, and Professional Practice Model to achieve the shared agenda.
The foundation for the registered nurse’s role is based on the Kaiser Permanente Vision, Values, and Professional Practice Model. Building upon this foundation will lead Kaiser Permanente in achieving Magnet standards and achieving our organization’s mission and goals.
Strategies:
a)Complete the roll out of Voice of Nursing 1.0 in all regions by end of year 2018.
b)Continue check in calls, site visits, and GAP analysis to track and monitor professional practice and enculturation process as part of the cascade of accountabilities.
c)Design the Voice of Nursing 3.0 Summit: Building a Culture of Excellence to socialize and educate leaders on what it means to use the standards and principles as the foundation for professional practice.Secure leadership support to provide time and resources to communicate and implement the Voice of Nursing 3.0.
d)Translate challenges faced by nurses at all health care setting into viable solutions that promote excellence in nursing and positive outcomes for patients.
e)Explore how a shared decision making structure increases efficiency, promotes professional nurse autonomy, and empowers nurses closest to the point of care to have a greater impact on organizational outcomes.
f)Explore how peer feedback integration at all levels of nursing elevates practice ownership, self-regulation and quality/safety improvements.
g)Distinguish components of transformational leadership and how to create a high-performing, engaging, empowering, outcomes-driven culture.
h)Formulate strategies to leverage Kaiser Permanente organizational priorities and nursing strategy to optimize performance related to quality, safety, patient-centered care, prevention, and cost-effectiveness.
i)Recommend all nursing sites encourage/require registered nurses to complete the e-learning module Professional Nursing Practice: An Update over the course of the next two years.
Goal #2: Utilize professional practice standards as a framework to elevate and standardize nursing practice to ensure nursing excellence and achieve the organization’s mission.
The ANCC Magnet Recognition Program holds the gold seal for nursing excellence. Its outcomes-driven model has proven results in reducing costs through increasing nurse satisfaction, patient satisfaction (HCAHPS performance) and clinical outcomes. Nurses are key change agents in the improvement of quality and safety and Magnet criteria serves as a roadmap for high performing healthcare organizations to follow.
Strategies:
a)All inpatient, ambulatory and the continuum of care will socialize the Kaiser Permanente Magnet Strategic Plan: Building a Culture of Excellence by utilizing the ANA Scope and Standards of Clinical Practice, Code of Ethics and the Magnet standards as the framework for the organization.
Demonstration of excellence includes:
Model Components / Domains4
a)Transformational Leadership /
  • Quality of Nursing Leadership
  • Management Style

b)Structural Empowerment/Engagement /
  • Organizational Structure
  • Personnel Policies and Programs
  • Community and the Healthcare Organization
  • Image of Nursing
  • Professional Development
  • Shared Decision Making
  • Educational Modules

c)Exemplary Professional Practice/Interprofessional Collaboration /
  • Professional Models of Care
  • Quality of Care: Ethics, Patient Safety, and Quality Infrastructure
  • Quality Improvement
  • Consultation and Resources
  • Autonomy
  • Nurses as Teachers
  • Interdisciplinary Relationships

d)New Knowledge, Innovations, and Improvements /
  • Quality of Care: Research and Evidence-Based Practice
  • Quality Improvement

e)Empirical Quality Outcomes /
  • Quality of Care

Goal #3: National and regional stakeholders develop Magnet excellence standardize tools to support local efforts.
Kaiser Permanente regions are in various stages of enculturating the Voice of Nursing and several sites have begun the journey to Magnet designation (Southern California, Northwest, and MidAtlantic States). To standardize and elevate practice, learn from early adopters, and ensure cost avoidance; it is imperative that standardize tools be developed. Providing the roadmap for Kaiser Permanente nurses to follow (i.e. close existing practice and quality gaps) and gain global recognition for Nursing Excellence.
Strategies:
a)National Patient Care Services to work with leadership to develop a strategy in support of sites/regions that have committed to begin the Magnet journey using Kaiser Permanente lessons learned from Irvine Medical Center. (First Kaiser Permanente Medical Center to achieve Magnet Designation 2017).
b)Develop a business case for adoption of Magnet standards for sites/regions on the Magnet journey. Including return on investment (ROI) for developing internal Magnet consultants within the organization.
c)Develop a toolkit for sites to standardize and successfully enculturate this work.
d)Identify and train internal consultants to support sites in their journey – this will eliminate the need for individual sites to hire external consultants (costs range from $50k – $100K per year) and ensure consistency in how sites are prepared.
e)National Patient Care Services to develop a tracking tool to monitor progress of implementation and enculturation of the Voice of Nursing (Vision, Values, and Professional Practice Model).
f)Ambulatory metrics identified and adopted across all ambulatory sites.
a)Ambulatory metrics will be nationally benchmarked
b)The ANCC should establish a Magnet*-type recognition program for primary care practices, or incorporate a primary care focus into the existing Magnet* program. This would encourage primary care systems to create practice environments known for their excellence in nursing practice and high-quality care.6The ANCC has taken action on this recommendation and will publish their new standards in 4th quarter 2017.
g)Partner with HR to develop policy that supports the reporting within a tracking system for formal education and specialty information.
h)Standardize and elevate professional practice and tie back to national benchmarks
c)Nurse satisfaction
d)Patient satisfaction
e)Inpatient and Ambulatory nurse sensitive indicators (examples: HAPU rates, depression screening)
i)Develop transformational leadership
f)Competencies
g)Expectations
h)RN outcomes
j)Advance nursing practice
i)Degrees
j)Certifications
k)Conference attendance
l)Professional organizations
m) Academic board participation
  1. The Magnet Program criteria further aligns with the Institute of Medicine’s (IOM) Future of Nursing recommendations calling for a more educated nursing workforce to meet the demands of an evolving health care system; recommending the proportion of nurses with baccalaureate degrees be increased to 80 percent by 2020.
k)Create a data repository for extracting analysis, minimum data sets, and nursing practice and quality.
Goal #4:Update and revise the Kaiser Permanente Nursing Positioning Statement and excellence brand.
Highlight the critical and strategic role that RNs play in impacting patient, staff, and organizational outcomes across the continuum.
Strategies:
a)Review and update existing Kaiser Permanente Position Statement and key messaging framework.
b)Develop a stakeholder and communication plan to execute on Kaiser Permanente Nursing Positioning Statement (Branding)
  1. Disseminate and enculturate
c)Ongoing tracking and monitoring of plan
d)Develop annual Nurses Week theme and attach tools to website
e)Consider a National Annual Nursing Report and set up a template for all regions to use.

ORGANIZATIONAL STRUCTURE