In 2010, healthcare reform created a level of uncertainty for hospitals and health systems across the United States. Instead of taking a “wait and see” approach for the impact of health reform, Novant Health jumped ahead of the curve in creating a sustainable model of care that meets consumer demands for affordable, high quality healthcare.
A Q&A with Sallye Liner, RN, chief clinical officer
Sallye Liner is executive vice president and chief clinical officer for Novant Health. A veteran nurse, she has lead Novant Health’s clinical transformation and helped redefine how Novant Health delivers care for patients at our hospitals.
Q: What is nursing transformation?
A: Essentially, nursing transformation means big changes that begin with re-thinking our care delivery processes while keeping our patients at the center of all decisions.
Before starting our transformation journey in late 2010, we discovered that nurses were involved in direct patient care activities for about 2.5 hours every 12-hour shift. Not only was that eye-opening, it was also completely unacceptable to us. We realized we needed to change the way we delivered care and get our nurses back to the bedside. To determine how to do this, we gathered a team of about 40 nurses from across Novant Health to design a new care team model, redefine the role of the nurse in the care team, and to give nurses more time at the bedside. We set an aggressive goal to have nurses spend 70 percent of their time, or 8.5 hours out of every 12 hours, in direct patient care activities.
Q: What is the care team model and how is nursing different at Novant Health today?
A: The care team model involves teams of nurses and support staff directly caring for patients. Central to this model is that registered nurses, licensed practical nurses and certified nursing assistants practice at the top of their licenses and certifications — meaning their tasks are what they are uniquely licensed to do. This is very different from the traditional method of having one nurse care for a specific number of patients.
Early results show that not only is our new model getting our nurses back to the bedside, but that more nurses are choosing to work at Novant Health. In 2013, we saw an 8 percent reduction in registered nurse turnover, compared to 2012. Also, 25 percent of those who had left Novant Health and returned as re-hires said they came back because they saw the positive difference in nursing care at Novant Health, compared to other hospitals and health systems.
Q: How does transformation impact patient care?
A: There are many reasons for transforming care, but most importantly it makes care safer for our patients. Since launching the care team model and other nursing transformation activities, hospitals across Novant Health have seen fewer patient falls, reductions in serious safety events, and a reduction in medication overrides, a precursor to medication errors. Patients also experience the care team to be more available, reducing the frequency of calls to the nursing station by 52 percent. Transformation is the right thing to do for our patients.
Q: How does implementation of the electronic health record impact nursing transformation?
A: Early results show that our electronic health record is positively impacting nursing transformation and helping us achieve our goal of nurses spending more time with patients. At Novant Health Presbyterian Medical Center (the first hospital in the Novant Health system to launch the electronic health record), nurses have been freed to spend 41 more minutes in activities directly related to care of patients per 12-hour shift, 75 more minutes actually in patient rooms, and 33 fewer minutes on documentation.
We expect this trend to continue across Novant Health as every facility comes online with the electronic health record over the next two years.