CNOs From 6 Award-Winning Hospitals Share Their Secrets to Nursing Quality

The American Nurses Association has released the six winners of its 2013 National Database of Nursing Quality Indicators awards at its 2014 ANA Quality Conference in Phoenix. These hospitals demonstrated the sustained ability to meet and exceed the ANA's standards for patient safety and quality of care benchmarks. Here, chief nursing officers from organization each shared some features of her hospital's success, as well as advice on how other hospitals might achieve excellence in nursing.

Craig Hospital (Englewood, Colo.).

Craig Hospital is a 93-bed rehabilitation hospital specializing in neurological, spinal cord and traumatic brain injuries. However, it strives to do better than its rehabilitation counterparts. "When we look at the NDNQI, we benchmark ourselves against Magnet hospitals instead of rehabilitation hospitals. The standards are stricter," says Diane Reinhard, RN, MBA, vice president of patient care services and CNO of Craig Hospital.

Meeting these stricter standards is particularly challenging for Craig Hospital in light of the niche patient population it serves, which makes several conditions more challenging than for general patient populations. These conditions include hospital acquired conditions and falls, which are especially problematic for patients who are learning to move again after traumatic injuries.

Craig Hospital's strategy to meet and exceed the Magnet benchmarks is to share NDNQI data among staff. "And just because you don't achieve a benchmark once in a while doesn't mean you're a bad facility. It just means you have an opportunity to listen to staff and get great ideas," says Ms. Reinhard. She says having committed staff has helped Craig Hospital achieve excellence in nursing: The leadership team does their part by doing their best to listen to the staff's ideas, figuring the frontline staff know best.

What is Ms. Reinhard's advice for an exemplary nursing program? "Be very open with the data. It's your nurses' data. Also, [nurses] don't practice in a vacuum. In order for our scores to be excellent, it takes a village. It takes complete uniformity from everyone who touches the patient."


King Faisal Specialist Hospital & Research Center-Jeddah, Saudi Arabia.

The 450-bed King Faisal Specialist Hospital is the first international hospital to earn the NDNQI award. The hospital has a culturally diverse nursing force. "Our nurses come from The Philippines, India, South Africa, Malaysia, other Middle-Eastern countries, Europe, Australia and North America. We have about 30 different nationalities," says Sandra Lovering, RN, executive director of nursing affairs at the hospital.

Despite the variety in staff, the entire team has a singular focus on patient care and benchmarks outcomes for excellence. To achieve this focus, the hospital does plenty of work on cultural understanding, communication and conflict management to integrate its workforce, holding patient care workshops on a regular basis.

The hospital uses NDNQI data especially to focus on things like nurse-nurse and nurse-physician interactions, the understanding of which helps with the onboarding of new team members.

King Faisal Specialist Hospital is currently in the midst of building a new "medical city," which will double the hospital's bed count. Ms. Lovering says the challenge will be to continue to provide excellent outcomes, but she is confident the nursing staff's focus on excellent patient care and patient satisfaction can facilitate that with any number of beds.

What is Ms. Lovering's advice for improving standards? "Everyone wants to beat the bench. To do this, commit to being the best you can be, rather than accepting 'this is how we are,'" she says.


Parkview Whitley Hospital (Columbia City, Ind.).

Parkview Whitley Hospital is a 30-bed hospital serving a rural community 1,000 times that size. The hospital uses a professional practice model grounded in evidence and collaboration to guide the delivery of nursing care.

According to Bridget Johnson, MSN, vice president of patient services at the hospital, Parkview Whitley's goal is to deliver an evidence-based and compassion-driven experience for every patient. Part of that mission involves good interpersonal relationships among nurses and physicians, who trust one another to make the right decisions for the patient and correct one another when and if necessary.

The hospital has sustained its NDNQI nurse satisfaction scores above the 90th percentile for the past three years. They have all also exceeded the national average on all indicators measured in the facility. "It is because of the support of our board, administration, physicians and coworkers. It is about everyone doing the right thing at the right time for the right reasons," says Ms. Johnson of the hospital's nursing success.

Ms. Johnson says in order for nurses to excel, they must have the resources required to provide exemplary patient care. "It is about having a culture that fosters mission, vision and practice, and it is about setting those ideals as accountabilities. It is about caring for each other, too, so we can care for our patients," she says.


Stony Brook (N.Y.) University Hospital. Margaret Duffy, MS, RN, NEA-BC. Interim Chief Nursing Officer.

At Stony Brook University Hospital, Interim CNO Margaret Duffy, RN, says her team is focused on how structures and processes of care are related to outcomes. She says staff involvement is critical for improving and maintaining quality.

Teams of staff nurses at Stony Brook receive education on quality improvement, and they monitor and audit quality alongside clinical nurse specialists. They are also part of quality council meetings and a shared governance structure, through which nurses are directly exposed to how their work affects quality indicators. They also learn how to be nurse leaders in an on-site training program.

In addition, a major part of nursing at Stony Brook involves disseminating knowledge. "We make sure to publish work we do with a monthly quality spotlight, recognizing units that either have been able to sustain quality metrics or have made considerable progress in improving metrics," she says. This information is shared at nursing meetings across the organization.

Ms. Duffy says for nursing excellence, hospitals need hard work. "It starts with transformational leadership, transparency and really getting the culture embedded into the organization. It's about making sure you're getting safety culture to the frontline staff, rather than just assuming it's happening," she says.


Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA.

The 74-bed UCLA Steward and Lynda Resnick Neuropsychiatric Hospital takes up a floor at the main Ronald Reagan UCLA Medical Center, though it is separately licensed. It is comprised of three units: a child and adolescent unit, a general psychiatric ward and a medical psychiatric ward.

Patient to nurse ratios are generous, exceeding NDNQI benchmark levels, says Pat Matos, RN, CNO and director of nursing at RNH. Each ward has a care delivery system comprised of "two neighborhoods," each of which has its own nurses. The hospital's EPIC platform, implemented in March 2013, helps keep documentation clear and quality high.

To keep the quality bar high, the RNH nursing program posts monthly benchmark data on each unit, ensuring quick action when it is needed. Kandace Whiting, program director for the hospital's Magnet program, says that while its numbers are good, the nursing program's skills are also exemplary. "We're an inclusive hospital in terms of accepting feedback. We are receptive. When we see what the trends are, good or bad, we ask 'why?'"

What is Dr. Matos' advice for maintaining patient care? "Commitment to the patient is the number one factor in all aspects of patient care. When it's not, every aspect suffers."


Shriners Hospitals for Children-Chicago.

Terry Wheat, director of patient care services and CNO, oversees nursing at Shriners Hospitals for Children-Chicago, which specializes in pediatric orthopedics and plastics. The 60-bed hospital, one of 22 hospitals in the Shriners system, includes a six-bed pediatric intensive care unit, six inpatient rehabilitation beds and 48 medical-surgical beds.

SHC has recently focused on changing how nursing staff prepare patients for surgery, given the trend toward more same-day, rather than inpatient, procedures. While initially skeptical they could successfully negotiate the switch, having previously prepared for mostly several day-stay inpatient procedures, extra education for families, training nurses to lead improvements and staying mission driven made the logistics a reality.

In addition, SHC focuses on empowering nurses of every skill level and age, mentoring young nurses alongside more seasoned team members, so quality and safety stay front-and-center. "We're mission driven here, which is huge," says Ms. Wheat. "That's what makes us stand out. The staff are happy, and they really come to work with enthusiasm," she says.

Ms. Wheat's tip for excellence in nursing? "Be proactive, and have nurses own the data, so when something falls apart they catch it. They can figure out better ways to document and collect data, and they can be proud of it."

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