In 2021, of the heftiest percentage of “mega merger” transactions announced, the seller or smaller partner reported more than $1 billion in annual revenue since 2015. And although these massive unions hold the promise of lowering costs by sheer economies of scale, they also bring unique challenges for large hospitals and health systems. With hundreds of hospitals and thousands of nurses under their umbrella, they are prompting the need for greater standardization of nursing policy and procedures to ensure adherence to care standards.
Hackensack Meridian Health (HMH), a nationally recognized healthcare system based in Edison, New Jersey, is a prime example of a large merger, going from three hospitals to 11 over several years with 8,000+ nurses employed. As HMH has learned, more hospitals and more nurses requires greater standardization to manage increased complexity across the care delivery network.
Striving for quality care across system hospitals
A consequence of mega mergers can be inconsistencies across system hospitals, with nurses from different hospitals adhering to varying policies and procedures. To ensure quality of care doesn’t suffer, it is imperative to bring these disparate groups together to deliver consistent care, especially in a decentralized environment where campuses may be widespread.
The challenge: Creating one set of policies out of 5,000
When Hackensack University Health Network and Neptune, N.J.-based Meridian Health merged to form Hackensack Meridian Health in mid-2016, it was viewed as a means to transform care delivery in New Jersey. The newly formed network was initially comprised of 13 hospitals, including two academic medical centers and two children's hospitals, as well as more than 120 ambulatory care centers, surgery centers and urgent care centers, bringing about 28,000 employees into the consolidated system.
Today, Hackensack Meridian Health is the largest, most comprehensive and integrated healthcare network in the state, and serves as a model for network integration in a system of its size. Across 11 acute care campuses, with almost 5,000 policies to evaluate, they have successfully integrated and evolved to a single set of policies and procedures that all 11 hospitals follow. What was the ultimate challenge? Integrating policies amid the COVID-19 health crisis that were intended for a diverse group of agency and new team members, in addition to their existing staff.
“We wanted one source of truth for our network nurses – regardless of which campus was their primary location,” stated Miriam McNicholas, the Clinical Policy Administrator at HMH, ultimately achieving “harmonization” from the policies integration.
Separating policies from procedures made for a culture shift
For starters, McNicholas inventoried the policies and realized that many of were categorized as “policies” but actually were procedures. “When I started looking at them, I found 2,000 ‘policies’ on things like how to wash your hands, how to put in a Foley, how to do all these nursing tasks. Not policies,” she said.
McNicholas wanted to make the shift from having nurses just look up the procedures (not policies), to having them fully understand how to do something, using an evidence-based online resource. She understood it would be a huge culture shift, but a necessary one across the hospitals as nurses were onboarded or reassigned from one unit to another.
This need intensified during the COVID-19 pandemic, when HMH also brought on between 2,000-2,500 agency nurses in addition to the 8,000-9,000 they already had. They also needed to consider the onboarding needs of nurse graduates who found themselves on the front lines of the pandemic without ever having taken the NCLEX® exam.
Facilitating smooth in-network transitions
“We wanted to create a network-wide atmosphere where you could transfer from Raritan Bay Medical Center to Jersey Shores Regional Trauma Center, and those components of your education, your training, the elements of your clinical checklists and competencies would all be harmonized, no matter where you went in the network,” replied Melissa Harker, Network Director of Nursing Education at HMH.
Centralizing and streamlining procedures
With these goals in mind, McNicholas leveraged Lippincott Solutions, an integrated, cloud-based software suite, as a central source for procedure information. Lippincott Solutions provides evidence-based, step-by-step guidance for 2,200+ nursing procedures and skills, which equipped the nursing staff with standardized procedures to mitigate risk, reduce variability of care, and maintain consistent compliance. Moving to a digital-based system also resulted in reducing paper folders, files, and checklists.
This approach streamlined how competencies were assigned and checklists developed. By integrating Lippincott Solutions with the HMH learning management system (LMS), HMH programs could be assigned within the LMS and completed within Lippincott. “Here’s a great example of how it works,” Harker noted.