Applying System Learning From Individual Hospital RN Satisfaction Reports Janette A. Orton, MS, RN, CPHQ; Katreena Collette Merrill BSN, RN; Nancy Woods-Kershner, MSN, RN , , UT

2004 INITIAL RN SATISFACTION REPORT TABLE 1. RN Job Satisfaction Job NDNQI-Adapted Nursing NDNQI_Adapted Index of Work Satisfaction Scalesa Enjoyme Work Index Scalesb,c ntd

s EDUCATIONAL METHODS s Professi t e i s RN-RN RN-MD Decisio Professi Nursing Nursing r n

u Autono onal U

Group N Task inter I n t e r n - onal Pay Manage Adminis f

f my Develop o

o actions actions making Status ment tration # ä System data manager used 11 individual hospitals reports to # ment Top Quartile Comparison Units OBJECTIVES Below LCL Comparison data are owned by ANA and may not be published by NDNQI member hospitals compile system score for each table (see chart). *NDNQI *Facility *All units in all hospitals 5188 75877 47.2 66.8 58.5 47.3 51.1 64.8 40.8 61.5 56.4 53.6 54.0 *NDNQI *Facility *All units in all hospitals (Top Quartile) 53.2 72.9 64.5 53.7 56.9 70.9 47.3 67.6 62.6 59.5 59.9 n *NDNQI *Facility *All units in all hospitals (UCL) 47.5 67.1 58.7 47.5 51.4 65.0 41.1 61.8 56.7 53.8 54.2 System level *NDNQI *Facility *All units in all hospitals (LCL) 47.0 66.5 58.2 47.0 50.8 64.5 40.5 61.2 56.2 53.3 53.7 *Facility IHC Weighted Average 50.6 71.3 60.2 48.9 54.1 68.5 34.6 61.1 59.5 52.7 57.0 n *Facility IHC Average 51.1 71.3 60.3 48.1 54.0 68.8 35.1 59.4 58.2 52.5 58.0 ä Describe how one hospital system evaluated multiple hospital Hospital level 116 *Facility 10 120 49.8 69.0 62.9 46.5 52.5 67.8 38.4 60.0 56.6 56.6 56.5 118 *Facility 11 89 51.6 72.8 63.2 48.5 56.6 70.6 35.7 60.8 56.5 52.1 59.8 n 124 *Facility Cottonwood Hospital Medical Center 22 136 47.8 71.9 60.4 47.2 51.5 67.8 36.4 60.7 56.9 48.3 57.4 RN Satisfaction reports to apply system wide learning. Unit type (i.e., Critical Care, Pediatrics, Rehabilitation) 126 *Facility Dixie Regional Medical Center 19 274 49.2 70.1 58.5 45.7 51.1 64.4 28.7 57.1 58.7 52.2 55.6 128 *Facility LDS Hospital 45 551 48.5 69.5 58.6 48.3 53.4 67.3 35.0 60.0 60.6 50.0 55.0 130 *Facility 15 208 52.0 70.1 59.9 51.5 55.5 70.1 37.4 58.1 60.1 59.4 57.2 132 *Facility McKay - Dee Hospital Center 22 352 49.8 69.8 60.8 48.0 53.9 66.5 34.4 59.6 60.3 52.1 55.5 ä Describe how your system might coordinate multiple reports to ä Color shading was used to identify system, hospital and unit 134 *Facility 7 66 54.0 77.6 64.3 51.2 60.0 72.6 40.4 58.5 63.0 51.2 62.9 138 *Facility Primary Childrens Medical Center 20 514 55.3 73.8 63.1 53.3 56.8 73.0 35.2 67.5 61.4 55.7 60.8 144 *Facility Utah Valley Regional Medical Center 27 509 49.3 72.3 58.1 47.6 53.4 67.4 33.2 61.6 58.1 51.2 55.4 provide system and hospital learning. performance below the lowest confidence intervals or in the top 370 *Facility The Orthopedic Specialty Hospital 2 16 54.5 66.8 53.9 41.7 49.0 69.5 31.7 49.7 47.9 48.9 61.8 quartile for Tables 1, 2, and 3. 2004 INITIAL RN SATISFACTION REPORT TABLE 3. QUALITY OF CARE

Mean Unit Quality of Mean Unit Rating of % of RNs Reporting Selected Situations Last Shift ä Care on Unit Last Shift A report with results at system, hospital and unit levels was Admits, s s Enough discharge t e

i Change s Overall Important Enough Enough Adequate r n Last In time to s not u U in past good things Group N help to time with discharge prepared and distributed to all nursing units. f a a document f affected o shift general c d o b lift/move patients prep. # year day got done e # by REPORT PRESENTATION staffingf Top Quartile Comparison Units ä Standardized presentation developed to present findings at all Below LCL Comparison data are owned by ANA and may not be published by NDNQI member hospitals *NDNQI 1 *Critical Care 448 9,511 3.35 3.39 0.09 4.41 3.92 69 68 69 24 63 *NDNQI 1 *Critical Care (Top Quartile) 3.52 3.59 0.29 4.67 4.26 83 80 79 33 75 PURPOSE levels across Intermountain. *NDNQI 1 *Critical Care (UCL) 3.38 3.41 0.12 4.45 3.97 71 69 70 26 64 *NDNQI 1 *Critical Care (LCL) 3.32 3.36 0.06 4.36 3.87 68 66 67 22 61 1 IHC Weighted Average 371 3.6 3.7 0.3 4.8 4.3 81.7 81.3 78.3 31.9 73.7 1 IHC Average 3.6 3.6 0.3 4.7 4.1 80.3 73.9 72.4 31.3 76.2 ä Adapt NDNQI RN Satisfaction Reports to facilitate Intermountain 116 1 ICU(255) 5 3.6 3.6 0.2 4.20 3.40 40.0 20.0 40.0 0.0 60.0 118 1 ICU/CCU (255) 6 3.7 3.7 0.0 4.67 3.17 83.3 50.0 50.0 20.0 100.0 CONCLUSIONS 124 1 ICU(255) 10 3.7 3.7 0.4 4.3 4.0 60.0 70.0 80.0 10.0 60.0 Healthcare multi-hospital system learning. 126 1 ICU (250) 9 3.7 3.4 0.6 4.67 4.22 100.0 77.8 77.8 37.5 88.9 128 1 Cardiac Medicine (Cardiology) 330 7 3.57 3.71 0.00 4.43 4.57 71.43 85.71 57.14 85.71 71.43 ä 128 1 CICU(250) 26 3.38 3.35 0.04 4.36 4.32 96.00 80.00 80.00 56.00 68.00 System analysis and comparison of the reports is a valuable 128 1 MSICU(251) 15 3.53 3.47 0.67 4.71 3.93 73.33 80.00 80.00 13.33 73.33 128 1 RICU(254) 14 3.57 3.71 0.50 5.07 4.14 85.71 71.43 71.43 21.43 85.71 128 1 STICU(253) 28 3.75 3.96 0.32 5.00 4.32 89.29 75.00 78.57 0.00 85.71 method to impact nursing satisfaction. 128 1 TICU(252) 11 3.2 3.4 -0.2 4.82 4.27 100.0 81.8 72.7 9.1 100.0 130 1 ICU (255) 11 3.70 3.64 0.55 4.91 4.36 81.82 90.91 81.82 90.91 90.91 132 1 ICU (255) 28 3.54 3.54 0.11 4.15 3.89 75.00 57.14 67.86 0.00 42.86 ä 138 6 NICU (263)(In Peds group) 97 3.56 3.64 0.32 4.88 4.55 73.20 90.63 87.63 43.30 71.88 Sharing of information develops collegiality and promotes best 138 7 PICU (255) (Tech in Ped's) 62 3.81 3.89 0.45 5.19 4.58 91.94 93.55 77.42 29.51 77.42 INITIAL FINDINGS 144 1 Coronary Care/ CCU (250) 19 3.74 3.74 0.58 4.74 4.32 94.74 89.47 77.78 78.95 73.68 144 1 ICU (251) 23 3.74 3.74 0.57 4.52 4.17 69.57 69.57 78.26 4.35 69.57 practice. ä Three areas of potential for system performance improvement BACKGROUND were identified at Intermountain RN Satisfaction Survey TABLE 1. RN Job Satisfaction T-Scores a n 2005 Final Report ä NDNQI-Adapted Professional development opportunities b Hospital system began participation in NDNQI RN Satisfaction Shading comparison for Table 1, 2 & 3 to "All Units in All NDNQI-Adapted Index of Work Satisfaction Scales Nursing Work Index Scalesc Hospitals NDNQI Data". No comparisons are made for d t n n table 4, 5, 6 & 7 e m y t o n s Satisfaction with Nursing Administration j e g Survey in 2004. u n t n r n t m E r l a i o e t n e e a t i k y t b e t g S n n a g n o s s a a I m l i o m r J n n n i n k m a t o i y p s - s o o a s s D n n a N i i i s o a n Number Average n r t t l o o e P n M R i o t u c c T M e i Number f i - s - a a u v s o g N s

of Unit m

Pay (Salary) i r N e N e A n c d i f RN Satisfaction Survey of P R D R e s o

Respon Respon A r

r DISCUSSION D

2005 Final Report Units u ä P Individual hospitals requested comparison with other hospitals in ses se Rate N Comparison Units Comparison data are owned by ANA and may not be published by NDNQI member Intermountain System. hospitals ä Black and white shading is adequate to visually see areas of All Units In All Hospitals 9,301 144,207 64% 46.66 65.93 58.22 45.94 50.58 64.20 40.29 61.49 56.10 53.01 52.99 Top Quartile Cut Point 52.82 72.12 64.16 51.92 56.09 70.20 46.42 66.99 62.12 58.84 59.04 strengths and weakness.

ä I Upper Confidence Limit 46.86 66.14 58.42 46.14 50.79 64.42 40.52 61.68 56.30 53.22 53.18 Q

Reports were not available from NDNQI at a system level. N

D Lower Confidence Limit

N 46.47 65.72 58.01 45.74 50.36 63.99 40.07 61.29 55.91 52.80 52.80 n i

a ä t 2005 176 3117 68% 51.48 72.14 61.83 48.80 55.33 69.51 32.35 62.84 60.26 51.56 57.17 n Annual surveys do not give adequate time to prepare the report u o

m Prior Year (2004) 2835 61% 50.65 71.31 60.20 48.94 54.12 68.45 34.55 61.14 59.55 52.70 56.95 r e t n INTERVENTIONS I Change 0.83 0.83 1.63 (0.14) 1.21 1.06 (2.20) 1.70 0.71 (1.13) 0.22 and implement action plans at a system level. 116 Alta View Hospital 8 110 66% 52.88 72.95 61.13 46.23 54.72 67.52 32.13 61.26 55.95 56.36 57.15 118 American Fork Hospital 11 135 82% 51.67 73.60 64.72 51.64 59.05 71.56 34.58 62.56 60.24 53.62 58.44 ä ä Action plans at a system level were developed to improve Cottonwood Hospital Like unit comparison gave hospitals ability to communicate with 124 Medical Center 16 223 64% 49.38 73.66 63.73 46.79 54.38 68.96 32.14 61.83 60.05 48.68 57.34 Dixie Regional Medical specific results. 126 Center 20 362 80% 54.47 72.56 61.32 48.54 55.56 69.24 29.58 61.57 60.77 54.87 58.05 each other about best practice. 128 LDS Hospital 31 433 49% 50.65 71.34 62.83 48.26 55.38 69.20 33.35 61.48 59.33 51.70 55.39 ä 130 Logan Regional Hospital 14 192 76% 50.83 70.10 60.14 48.27 53.00 66.69 35.62 57.09 60.72 49.85 56.24 ä Standardized presentation and report was distributed to all McKay - Dee Hospital Satisfaction with nursing administration is a complex issue that 132 Center 20 415 65% 48.17 69.66 58.96 46.90 53.59 65.42 34.07 62.38 59.29 48.63 54.84

nursing units. 134 Orem Community Hospital 7 58 70% 60.26 82.82 65.19 53.20 64.41 78.11 35.81 65.09 65.96 55.80 64.76 may not be easily impacted due to organizational structure. Primary Childrens Medical 138 Center 20 660 72% 54.62 73.98 65.41 51.80 57.40 73.63 31.50 67.75 62.06 52.33 60.25 The Orthopedic Specialty ä 370 Hospital 2 26 64% 49.89 71.38 59.69 38.11 46.66 64.71 16.92 51.64 50.75 40.82 53.37 ä Executive Summary and Action Plan tool developed for use at Utah Valley Regional Changes in pay practices took 18 months to implement and 144 Medical Center 27 503 72% 48.52 70.51 57.90 48.00 53.69 68.42 31.89 62.24 59.84 50.87 55.22

hospital and unit level. Key (Tables 1 through 3 Only, No formatting other tables) therefore anticipate seeing improvement in 2006 report. At or above top Quartile Cut Point Between top quartile and Lower confidence Limit At of below Lower Confidence Limit