HealthTháng Mười Hai 02, 2022

Healthcare mega-mergers drive need for nursing policy and procedure standardization

While mergers and acquisitions in healthcare organizations may be down today, the majority are trending larger, presumably spurred on by the inevitability of value-based care. According to the latest edition of Kaufman Hall’s M&A Quarterly Activity Report, the second quarter of 2022 reached a record high in healthcare merger and acquisition revenue, with 13 transactions generating $19.2 billion.

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.

“We were introducing a new program on human trafficking. I literally went into Lippincott and typed those words in and discovered a program in Lippincott that could be assigned in our LMS to every person who was mandated to take the course in the emergency department and in the outpatient family health care centers. We took our professional development content and assigned the courses just like any other learning assignment. The nurses take the course and it’s noted back in the LMS.”
Melissa Harker, Network Director of Nursing Education at Hackensack Meridian Health

McNicholas adds that nursing skills checklists work in the same way. “Once the nurse completes the program in Lippincott, the skills checklist carries over into our LMS so that the nurses’ competencies are captured there as well. So, it truly is one source of truth. This allows us to use the checklist as a barometer for career growth, checking off skills as they are attained and identifying target areas for future focus. It also allows HMH to meet regulatory requirements by having everything in the LMS.”

Fast forward to Fall 2022 and HMH has recorded:

Measuring and evaluating ongoing usage

What’s next for HMH? “We’re going to be looking at access and behaviors,” says McNicholas. “How many times are nurses looking something up? Is it two times or 100? Are there any red flags to watch for? We’re at the beginning stages of the next phase beyond harmonization, which focuses on the impact we’re having on outcomes. Are outcomes better now that we’re not depending on a policy that might be out of date?

“That’s been my mantra. A policy that is looked at once every few years cannot compete with evidence that has been evaluated frequently. There is no way to match that. So, in my heart of hearts I know we are improving outcomes. The other day I was talking to another educator and she was saying that a policy that's a little older doesn't coincide with what’s in Lippincott, so she was not sure how to direct the nurses. I just looked right at her and I said, ‘well, maybe there's something wrong with your policy.'”

Learn more about how Lippincott® Solutions can support the standardization of policies and procedures.

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