Creative Implementation of Leadership Project

1. Creative Implementation of Leadership Project DUY TRINH FROSTBURG STATE UNIVERSITY NUR 406

2. Personality Type/ Leadership Characteristics ESFJ with Extravert (78%), Sensing (25%), Feeling (12%) and Judging (56%) Strengths: Always look for win-win situations Very loyal Sensitive and warm Know how to connect people Good with practical matters Weaknesses: Often obsessed with status May be inflexible Unwilling to improvise Very vulnerable to criticism Often too selfless Reflection of Project Providers take it upon themselves to insure the health and welfare of others in their care. Providers happily give their time and energy to make sure the needs of others are met. Providers are skilled in maintaining teamwork among their helpers Providers love to talk with others. Providers are gregarious. Presentation Style

3. Created Facility RIGHT CHOICEURGENT CARE CENTER

4. RIGHT CHOICE Urgent Care Center • 10 examination rooms • One Trauma room • One X-ray room • One Laboratory room • One Supply room • One Medical Attending Physician room • One Break room for Staff

5. Staff of RIGHT CHOICE Urgent Care Center • Office receptionist, office manager, 2 Family Nurse Practitioners (FNPs), 2 Physician Assistants (PAs), 1 Medical Doctors, 3 full-time Registered Nurses (RNs), 3 part-time Registered Nurses, 2 PRN Registered Nurses, Director of Nursing –DON (myself), and Administrative Staff (President, Vice President, Treasurer, Secretary). • FNPs, PAs rotate through office hours and on call hours at Urgent Care Center • Medical Doctor oversees the urgent care center • Registered Nurses (Full-time, Part-time, Per-diem) assist in office hours and run the business of the the urgent care. • The RIGHT CHOICE Urgent Care Center opens 7 days a week 7am-12mid-night.

6. Mission, Vision, Values of RIGHT CHOICE Urgent Care Center • Our Mission RIGHT CHOICE Urgent Care Center is to serve the community by providing outstanding patient care. • Our Vision RIGHT CHOICE Urgent Care Center will be: * Putting our patients at the center of everything we do * Harnessing our integrated capabilities to delivery high quality of care for our patients * Serving the underserved and disadvantaged, and advancing excellence and innovation through health care • Our Values * Customers: Our patients and subscribers are our first priority. * People: Our people are our greatest asset. * Excellence: Our goal is excellence in everything we do. * Integrity: RIGHT CHOICE Urgent Care Center is built on a foundation of honesty, and integrity. * Teamwork: We foster and promote a culture that encourages teamwork. * Leadership: Responsiveness and transparency will always be hallmarks of our operating model. * Community: We are committed to making the communities we serve healthier, stronger, better places to live.

7. Legal Considerations • Standardize the patient care • Update with current health care information • Staff acknowledge the policies and procedures of the urgent care center • Staff is provided with high-quality equipments and new-updated version of the equipments. • Staff maintain their licenses active. • Staff are offered supports from managers/supervisors. • Routine meetings to notify changes in the urgent care center.

8. Ethical Considerations • Become aware of own values and ethical aspects of nursing • Be familiar with nursing codes of ethics • Seek continuing education opportunities to stay knowledge about ethics in nursing • Respect the values, opinions and responsibilities of other health care professionals ANA Code of Ethic for Nurses (approved July 2001) • The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems • The nurse’s primary commitment is to the patient, whether an individual, family, group, or community. • The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. • The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care. • The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth • The nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality healthcare and consistent with the values of the profession through individual and collective action • The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development • The nurse collaborates with the other health professional and the public in promoting community, national, and international efforts to meet health needs • The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.

9. Cultural Development • Shared leadership is applied for this urgent care center. • “Reorganization, decentralization, and the increasing complexity of problem solving in health care have forced administrators to recognize the value of shared leadership, which is based on the empowerment principles of participative and transformational leadership” (Sulllivan, 2012, pg. 43). • The benefits of shared leadership: • Self-directed work teams: as the DON, I and staff manage our own planning, organizing, scheduling, and day to day work activities. • Shared governance: decision making is conducted by staff. • Co-leadership: two people work together to execute a leadership role. In this case, I am a DON and a nursing educator for nursing staff.

10. Team Creation • It begins with a collection of individuals who are assembled, ready to begin a new team by advertising available jobs. • HR select the possible candidates and refer them to DON for further interview process. • DON goes through the interview and selects the possible candidates. • With passed background and cleaned drug test, job offer is given. (Sullivan, 2012, pg. 204-206) • This urgent care center has 3 full time RNs, 3 part-time RNs, and 2 PRN RNs and a DON-myself.

11. Tips for Team Leader-DON • Clinical teams have three goals: • Provide good clinical care • Provide good service to patients and their families • Use resource wisely (myself & other medical staff: NPs, Pas, MDs) • The quality of care provided by a clinical team depends on how well the team members work together. • Everyone who works for urgent care center is part of the patient care team. • Work with the team we have. • Diversity is not only a policy. We are welcome everyone. • Address the needs and concerns of the team members.

12. Staff Development • Orientation: a well-planned orientation reduces the anxiety that new employees feel when beginning the job. • As a DON and with HR, I make sure the new employees have information about benefits, mission, governance, general policies, and procedures, safety, quality improvement, infection control, and common equipment. • As the new employee, “they often have unrealistically high expectations about the amount of challenge and responsibility they will fin their first job” (Sullivan, 2012, pg. 231-232). DON corrects any unrealistic expectations and help to to set up their own realistic goals.

13. Staff Development (cont.) • Receptor: can be used to assist new employees and to reward experienced staff nurses. • As a DON, I usually assign a experience nurse to receptor the new nurse. • The preceptor teaches unfamiliar procedures for the new ones • The preceptor helps the new ones cope with “reality shocks” • The preceptor serves as a staff nurse role model demonstrating work-related tasks. • It is an learning experience for the preceptors.

14. Staff Development (cont.) • Mentoring: “Mentors take a greater role than preceptors in developing staff” (Sullivan, 2012, pg. 233). • “A mentor is a wiser, and more experienced person who guides, supports, and nurtures a less experienced person” (Sullivan, 2012, pg. 233). • There are 3 stages in mentoring: the initiation phase, the breakup stage and the lasting friendship stage. • At urgent care, we do not provide mentoring style for the new employees.

15. Staff Development (cont.) • “Coaching is strategy suggested to address nurses’ job dissatisfaction” (Sullivan, 2012, pg. 234). • A coach helps the staff members focus on: • Solving a specific problem or conflicts that interfere with the employee’s satisfaction at work • Coaches are often DON, or HR • Identifying the exact nature of the problem • Delving into embedded issues • Reducing the turnover from issues that can be resolved. • Coaching is also the process of helping employees improve their performance and is also a tool to reinforce positive behaviors. • “Coaching sessions should last no more than 5-10 minutes” and including the following steps: • State the targeted performance in behavioral terms • Tie the problem to consequences for patient care • Having stated the problem behaviors • As for the suggestions to solve the problems • How formal should the coaching session be • Arrange for follow-up meetings (Sullivan, 2012, pg. 258-259).

16. Leadership Theory • Shared leader: “The essential elements of this leaders are relationship, dialogues, partnerships, and understanding boundaries.” (Sullivan, 2012, pg. 43) • Make a list of all the jobs to be done • Find out what their skills and their interests • Look at the duties and the skills and divide the jobs • Ensure communication open between staffs • Provide opportunities for staff to experience the case based on their interests and their capabilities “Nothing is particularly hard if you divide it into small jobs” by Henry Ford

17. Forcasting • Look at problem in many different ways and find new perspective that no one else has taken • Make novel combinations that include combining, recombining ideas, images, and thoughts into different combinations no matter how incongruent or unusual. • Able to form relationships, to make connections between dissimilar subjects, to think in opposites, to think metaphorically and to prepare myself for chance. • Develop budget estimates, keep track of purchase and expenses to make sure they are in line with budget guideline. • Involve everyone into this forecasting step because it will effect everyone of this organization.

18. Forcasting (cont.) • PROS: • Able to predict the trends of the future • Prepare for the changes • Look at the issue the whole view • CONS: • Take a lot of time to collect/prepare/ process data • It is just a statistical data • Might be fall into the same mistakes

19. Regulator Agency • The Maryland Health Care Commission: considers the following: cost effectiveness, quality of care, geographic access to care, and financial assess. • The Office of Health Care Quality: oversees licensing requirements. It also is legally required to evaluate all urgent cares and to investigate and respond to all consumer complaints. • The Health Service Cost Review Commission: regulates the rates urgent care can charge for care.

20. Accreditation Agency • Accreditation Association for Ambulatory Health Care, INC: as part of their quality oversight of ambulatory health care provider. Generally speaking, recognition means the acceptance of accreditation for licensing, certifications, or specific contracting purposes. • The Joint Commission: to promote the quality, value, and optimal outcomes of services. It also provide information about common program strengths as well as areas needing improvement.

21. Local Regulations RIGHT CHOICE Urgent Care Center is also subject to local regulations including: local building codes, fire safety regulations, water sanitation codes, and zoning regulations.

22. Tools used to utilize patient safety and quality care • Plan-Do-Study-Act: to establish a functional or casual relationship between changes in process and outcomes. • Six Sigma: involves improving, designing, and monitoring process to minimize or eliminate waste while optimizing satisfaction and increasing financial stability. • Root cause analysis: is formalized investigation and problem-solving approach focused on indentifying and understanding the underlying causes of an event as well as potential events that were intercepted.  I usually this tool a lot at my urgent care to identify the trends and assess risk of nursing care. Also I use this tool to develop and implement an action plan consisting of improvement designed to reduce the future risk of events and to monitor the effectiveness of those improvements. • The Pareto Diagram: to separate the significant aspects of the problem from the trivial ones.

23. Marketing Plan • Advertisement though media: TV, radio, newspaper and internet. • Target patients vary from newborn to geriatric population. • Long hours of service: 7days a week 7am-12 mid-night • Experienced nurses, Know ledged doctors, and Caring Staff • Accept variety of health insurances which allow more patients come to RIGHT CHOICE Urgent Care Center. • Allow patients without insurance have treatments with small amount of money for down and make a monthly payment through loan agency. • Treat everyone regardless his/her age, gender, race, religion with respect and dignity.

24. How to promote RIGHT CHOICE Urgent Care Center “There are 4 Ps of marketing: Product, Place, Price, and Promotion.” (Sullivan, 2012, pg. 202-203). A critical component of any recruiting effort is marketing the organization and available positions to potential employees. • Product: is the available positions within the center; several aspect need to be addressed: professionalism, standards of care, quality, service, and respect. • Place: refers to the physical qualities and location such as: accessibility, scheduling, parking, reputation, and organizational culture. • Price includes: pay and differentials, benefits, sign-on bonuses, insurance, and retirement plans. • Promotion includes: advertising, public relations, direct word of mouth, and personal selling.

25. Retention of Staff • Respectful collegial communication and behavior: team orientation, presence of trust. • Communication-rich culture: respect for diversity, clear and respectful. • A culture of accountability: role expectations are clearly defined. Everyone is accountable. • Shared decision-making at all levels: participate in system, organizational and process decisions, formal structure exists to support shared decision-making. • The encouragement of professional practice and continued growth/development: allow staff to control over their practice, CEUs /EUs/certifications are supported. • Recognition of the value of nursing’s contribution: reward and pay for performance; career mobility and expansion.

26. Motivation of Staff • “Motivation describes the factors that initiate and direct behavior” (Sullivan, 2012, pg. 229-230). Motivated employees are more likely to be productive than are non-motivated workers. • As a DON I need to: • Emphasize individual needs or the rewards that may satisfy those needs. • Motivating staff with praise or recognition or identifying the causes for the negative aspects • Positive reinforcement is the best way to change negative behaviors • Reinforce behaviors that are successively closer approximations to the desired behaviors. • Emphasize the role of rewards and their relationships to the performance of desired behaviors.

27. Accountability • Every one at RIGHT CHOICE Urgent Care Center is responsible for his/her actions. • Administrative personals are responsible for their administration process: laws, regulations, accreditation, licensure, staffing. • DON is accountable for the nursing staffs’ actions, and educate the staff. • Nursing staffs is responsible to conference/meetings, in-services, education, renew licenses or certifications. • Financial Department is responsible for the finances, budgets, staff, and supplies.

28. Human Resources • The HR of Cooperate Office will scan through applications and send to DON the list of possible candidates for nursing jobs. • As the DON, I am responsible for hiring new staff, retention, succession, staffing/scheduling, disciplining, and terminating staffs, if necessary.

29. Networking • My supervisor is the President, Vice President, and the physicians of RIGHT CHOICE Urgent Care Center. • I work closely with FNPs, PAs, MDs, nursing staff, Treasures, Secretary, and Front Desk Customer Services. • I usually work Monday_Friday 8am-5pm. I am usually on-call besides these hours. Staff can contact me anytime through my personal email, office email, and my cell-phone number. • I have the relationship with other DONs of other franchise offices of RIGHT CHOICE Urgent Care Center. • I have built the connection with ER nurses, ER doctors of local hospital. • Educate yourself through CEUs/EUs/ Presentations about quality improvement, quality assurance, patient safety, mediation management, air-way managements. • Pursue higher education in nursing by obtaining MSN in Public Health and MBA.

30. Disaster Preparedness • RIGHT CHOICE Urgent Care Center is located in Annapolis MD. • RIGHT CHOICE Urgent Care Center is the only one urgent care center in Annapolis, MD. • RIGHT CHOICE Urgent Care Center is 1.5 miles away from Anne Arundel Medical Center, 16.5 miles to BWMC, 20.5 miles to Prince George County Medical Center. • RIGHT CHOICE Urgent Care Center is close to Highway 97, Highway 50 which leads to Interstate 495 and Intrastate 695. Close to BWI and IAD airport. • Disaster drills are practiced once a year in June. Fire drills are practiced monthly on the second Monday of the month. • Disaster plans include: evacuation plans, open communication to staff-patients-health care providers, connection with other local facilities, and transportation to the nearest facilities. • Core competencies for Nurses to prepare for mass casualties include: “Critical thinking, assessment, technical skills, and communication” (Sullivan, 2012, pg. 297).

31. Critical Issues • Staff to be trained to have Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS). • Keep the nursing staff with active licenses. • Provide education for staff if need regarding: new equipments, new procedures, new protocols, or new guidelines. • Yearly disaster drills, monthly fire drills are required for staff to enroll. • 50% meetings is required to attend by DON. • Urgent meeting is needed if something crisis comes up. • Yearly evaluations for staff.

32. Retirement Plan • Benefits are available through RIGTH CHOICE Urgent Care Center benefit package if you are at least part-time employee. • Health care benefits, education assistant program, 403b, life insurance, short-term and long-term disabilities, vision health care insurance, and dental insurance. • Retired nurses get discount if they join the clinical organization such as: SNA, ENA, OPNA, ORNA… • Get involved into the community or get a PRN job or even try to become a educator for local hospital/ elementary school / churches… • The important thing of the retirement plan is to plan for succession.

33. Succession Plan • “Due to an aging nursing workforce, as well as the overall shortage of nurses, succession planning at all levels of nursing management is essential to ensure a smooth transition after a manger leaves or retires” (Sullivan, 2012, pg. 235-236). • As the DON of RIGHT CHOICE Urgent Care Center, the succession plan is a strategic process that is a natural outgrowth of leadership development, which require: • Identify those with the potential to assume greater responsibility in the organization • Provide critical development experiences to those that can move into key roles • Engage the leadership in supporting the development of high-potential leaders • Build a data base that can be used to make better staffing decisions for key jobs • Improve employee commitment and retention • Meet the career development expectations of existing employees • Counter the increasing difficulty and costs of recruiting employees externally (Sullivan, 2012, pg. 235-236).

34. References Accreditation Association for Ambulatory Health Care, INC. Retrieved on June 25th 2013 from http://www.aaahc.org/en/accreditation/ Amer, K. (2012). Quality and Safety for Transformational Nursing: Core Competencies. Pearson: Upper Saddle River, NJ. ANA Codes of Ethics. Retrieved on June 25th 2013 from http://nursingworld.org/codeofethics Personality Type and Leadership Characteristic: ESFJ. Retrieved on June 25th from http://www.personalitypage.com/ESFJ.html Sullivan, E. (2012). Effective Leadership and Management in Nursing. Pearson: Upper Saddle River, NJ. The Health Service Cost Review Commission. Retrieved on June 25th 2013 from http://www.hscrc.state.md.us/ The Joint Commission. Retrieved on June 25th 2013 from http://www.jointcommission.org/accreditation/accreditation_main.aspx The Maryland Health Care Commission. Retrieved on June 25th 2013 from http://mhcc.dhmh.maryland.gov/SitePages/Home.aspx The Office of Health Care Quality. Retrieved on June 25th 2013 from http://dhmh.maryland.gov/ohcq/SitePages/Home.aspx