Members of the 15CD clinical practice council show their “Allowing for Miracles” bracelets, relating to Caritas process 10.

In a step toward achieving Magnet designation, BWH submitted a body of evidence on April 1 that demonstrates how the hospital meets 49 standards within the five components of the Magnet model: Transformational Leadership, Structural Empowerment, Exemplary Professional Practice, New Knowledge, Innovations and Improvements, and Empirical Outcomes. The 75 initiatives selected for submission are examples of our deep commitment to quality, nursing excellence, interprofessional collaboration and innovation. Throughout the year, we will use “Magnet Matters” to share some of these examples with you. We hope you will be inspired by the broad range of examples and the work being done across BWH.

Transformational Leadership
Nursing’s Mission, Vision, Values and Strategic Plan Align With the Organization’s Priorities to Improve the Organization’s Performance

Example 1: Building Caritas Leadership Literacy to Improve the Patient Experience

Infusing BWH nursing practice with Watson’s Human Caring Theory, grounded in the 10 Caritas processes, directly aligns with the institution’s commitment to providing high-quality, safe patient care. A first step was to build Caritas literacy among BWH nursing leadership. The Department of Nursing held three leadership development seminars from April to July 2016. During these interactive forums, nursing executive directors, program directors, nurse directors and associate chief nurses participated in group activities, didactic sessions and simulation.

The goal was to increase Caritas literacy among nursing leadership by 10 percent by the end of 2016 and, by extension, improve two related nurse-sensitive Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores by 2 percent:  “Communication with Nurses overall” and “How often did Nurses treat you with courtesy and respect?”

Perceptions of nursing leaders were tracked over the course of the program to determine how Caritas processes were being incorporated into their leadership practices. At the end of the program, the survey showed a 27 percent increase in Caritas leadership competencies compared to before the program. As a result of these new leadership practices and subsequent clinical practices, increases in HCAHPS scores for “Communication with Nurses overall” rose by 4 percent, and “How often did Nurses treat you with courtesy and respect” went up by 9.46 percent.

Example 2: Integrated Care Management Program Reduces Nonemergent ED Visits

High-risk elders with multiple chronic conditions or advanced illness often face challenges in accessing the right care at the right time in the right place. To help prevent nonemergent Emergency Department (ED) visits among this patient population, BWH started the integrated Care Management Program (iCMP). The iCMP places clinical nurse care coordinators directly into primary care settings, where they become an essential part of the primary health care team. Clinical nurse care coordinators participate in joint office visits with primary care providers, follow up with patients who have missed appointments and lead the coordination of the patient’s care needs throughout the system. The goal of the program was to decrease nonemergent ED visits by 5 percent after entry into the program and assignment to a clinical nurse care coordinator.

On average, patients enrolled in the program between January and June 2015 were 76 years old, had more than three acute-care hospitalizations per year and were taking more than 12 medications. After the first year, medical services fell significantly, and there was a 27 percent reduction in nonemergent ED visits among high-risk Medicare beneficiaries who received this service. This outcome confirmed that iCMP participants were about one-fourth less likely to visit the ED for nonemergent reasons than their counterparts not enrolled in the program.

In addition, this program led to higher satisfaction rates among patients and providers – 99 percent of patients enrolled in iCMP were satisfied with the program; 92 percent of providers would recommend the program to other providers; and 93 percent credit the clinical nurse care coordinators with improving the care coordination of their high-risk patients.