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Much anticipated and long awaited hospital-specific patient experience scores (HCAHPS) were unveiled this week on the national website Hospital Compare (www.hospitalcompare.hhs.gov). These measures will be added to WHA’s CheckPoint Web site later this year, as will hospital specific measures relating to select diagnoses and procedural mortality outcomes. These developments signal an important evolution in health care measurement public reporting...the advent of meaningful outcome measures that will be available to patients and families seeking information about their health care.

For four years, public reporting has focused on hospital quality and safety process measures. Those measures generally provide information regarding compliance with evidence-based clinical processes that are known to improve patient outcomes. The focus has been on heart disease, pneumonia, preventing surgical infections and preventing medical errors. Wisconsin results have been outstanding, as evidenced by the AHRQ 2007 Report which found the state ranking tops in the nation for hospital measures and second only to Minnesota in 2008. Importantly, every clinical measure that has been publicly reported has seen improvement over time...in some cases dramatic improvement. [The same is true for ambulatory measures reported by the Wisconsin Collaborative for Health Care Quality (WCHQ)]

But some have offered up that process measures don’t go far enough to interest and engage consumers. They’ve demanded information about patient outcomes as a necessary addition to current public reporting efforts, and those demands are now beginning to be met as described earlier.

The hospital-specific patient experience scores are unique as they measure patients’ perception of key service indicators. For example, a composite score for "responsiveness of staff" includes responses to the questions "During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?" and "How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?" In addition, two global questions rate the patients overall experience with the hospital and their willingness to recommend the hospital to friends and family.

So how do Wisconsin hospitals stack up compared to hospitals in other states on the patient experience scores? It is anticipated that Wisconsin’s state averages will be higher than the national averages. While these initial patient experience scores place Wisconsin in good stead, we should also understand that they immediately become a Wisconsin-specific benchmark floor going forward. And it is a near certainty that public interest in these and future outcomes measures will propel public reporting to a new level of consumer engagement.

Steve Brenton
President

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Cost control efforts by Wisconsin hospitals are paying off. A new paper just added to the WHA toolkit’s Health Care Cost section explains that hospitals have reduced costs while continuing to make improvements in quality and value. Many of the improvements are attributable to new information technologies. Wisconsin hospitals are investing in better IT systems resulting in greater efficient, quality and ultimately better health care value. The paper can be downloaded at: http://www.wha.org/financeAndData/pdf/HospitalsReducingCosts-2008.pdf

On March 7-8, 65 physician leaders from 37 different hospitals throughout the state attended the Wisconsin Hospital Association’s third annual "Physician Leadership Development Conference," held at The American Club in Kohler. Presented by American College of Physician Executives (ACPE) faculty, the conference was designed to assist new and potential physician leaders make the leap from their traditional clinical training to taking a new leadership approach to decision-making and problem solving. The topics addressed this year included understanding the basics of health care finance and how hospitals are reimbursed, as well as the principles of negotiation.

The idea for a conference of this type to be held in Wisconsin is to be able to offer nationally-recognized leadership education without the high travel and lodging costs of many of the out-of-state programs. That idea came from members of WHA’s Council on Medical & Professional Affairs, many of whom are physician and nurse leaders in their own organizations.

Attendee feedback from each year’s conference, along with feedback from the Council, helps WHA staff develop the curriculum each year. Attendee evaluations continue to show strong interest in WHA continuing this conference as an annual event, exposing new physician leaders to additional important health care topics. Almost two-thirds of the 2008 participants had attended at least one previous physician leadership conferences.

The 2009 event is scheduled March 13-14 at The American Club in Kohler. Share this date with your medical staff and encourage new and potential physician leaders to attend. Also remember the conference offers a "host" registration option, allowing you or another member of your hospital administration to attend with your physician leaders and take advantage of the one-on-one networking opportunity.

Remember, the deadline to submit your honored employee’s name and essay to WHA for the Wisconsin Health Care Employee Pride Program is TODAY (March 28), and the deadline for reserving a sleeping room at the Kalahari Resort is April 4 (or when the group block is full – and it’s filling up fast!). Access Pride Program submission materials on the Web site at www.wha.org/workforce/pride_2008.aspx.

The Wisconsin Health Care Employee Pride Program celebrates the pride and caring that health care employees bring to their work. We hope you and your hospital plan to be part of that celebration on May 1 at the Kalahari Resort in Wisconsin Dells. Pride honorees consistently tell WHA that the Pride Program recognition and award dinner are a career highlight. For more information, contact Shannon Nelson at snelson@wha.org or Mary Kay Grasmick at mgrasmick@wha.org or call 608-274-1820.

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Wheaton Franciscan Healthcare - St. Joseph achieved Magnet designation for excellence in nursing services by the American Nurses Credential Center’s (ANCC) Magnet Recognition Program® on March 19, 2008. The Magnet Recognition Program recognizes health care organizations that demonstrate excellence in nursing practice and adherence to national standards for the organization and delivery of nursing services.

St. Joseph Hospital went through a rigorous evaluation that included extensive interviews and reviews of nursing services. Of the more than 5,000 hospitals in the United States, only 287 have met the standard and achieved Magnet status. St. Joseph is the seventh Wisconsin hospital/hospital group to achieve this national recognition.

According to WHA’s Judy Warmuth, "Magnet status recognizes the attributes that make hospitals attractive places to nurses to work and care for patients. The effort required to apply and achieve this status is enormous. It is a credit to the entire staff of St. Joseph’s that they achieved this designation."

Recent visits to Hudson Hospital by Wisconsin Senator Russ Feingold (D) and Wisconsin Congressman Ron Kind (D) demonstrate that Hudson’s growing region is high on the radar for input on health care legislation. Both leaders visited the hospital and clinic campus in the past week to share ideas and learn more about the hospital.

"We make it a priority to partner with our local and state leaders to ensure we are able to continue to meet the growing health care needs of our region," said Hudson Hospital CEO and President Marian Furlong.

Even the local newspaper was there to cover the visits. The following excerpt is from a March 26 article by Randy Hanson in the Hudson Star-Observer.

If you have a grassroots story to tell, please contact Jenny Boese/HEAT at 608-268-1816 or jboese@wha.org.

Nurse leaders and managers are reminded to register today for the Wisconsin Organization of Nurse Executives (W-ONE) annual convention, scheduled April 16-18, at the Radisson Hotel in downtown La Crosse. Anyone who has responsibilities for leading and managing RNs will benefit from the educational agenda and is welcome to attend. Attendance is not limited to current W-ONE members or to registered nurses.

This program has been approved for 5.75 nursing contact hours. Aurora Health Care is an approved provider of continuing nursing education by the Wisconsin Nurses Association Continuing Education Approval Program Committee, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

The brochure and registration form are available on the W-ONE web site at www.w-one.org. For registration questions, contact Lisa Geishirt at 608-274-1820 or email at lgeishirt@wha.org.

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Impending retirements in the certified registered nurse anesthetists (CRNA) workforce will make recruiting these professionals ever more difficult for Wisconsin hospitals. Forty percent of full-time CRNAs have been in practice 21 years or more, according to Wilma Gillis, president of the Wisconsin Association of Nurse Anesthetists (WANA), told the WHA Workforce Council at their March 27 meeting in Madison.

CRNA positions are already hard to fill, particularly in non-urban locations in Wisconsin. Gillis had several suggestions that would improve the recruitment situation, including the addition of another CRNA program in Wisconsin is needed. WANA has been unsuccessful in their attempts to encourage a Wisconsin nursing program to open a nurse anesthetist program. They are particularly hopeful that a private school of nursing would consider a program. Both WANA and the National Association of Nurse Anesthetists are willing to offer their support to make this happen. Gillis said other ways to recruit CNRAs could include offering to support an applicant for Master’s education who may not have achieved that degree and create a multi-facility pool so that CRNA’s would not need to be on call 24/7. She also reported that some Wisconsin hospitals support employees to obtain their nurse anesthetist education at an out-of-state program, knowing there is a risk they might not return to Wisconsin to practice.

Also attending the meeting was Karen Eisberner, immediate past present of WANA. Karen believes that non-urban settings can be made more attractive to CRNAs by allowing them to practice a wider range of skills, for example, in pain management programs.

Gillis also reported that WANA is undertaking a survey of their 573 practicing members to better understand retirement plans, regional location of members, current vacant positions and recommendations for recruitment to Wisconsin. WANA will share the results of that survey with WHA, giving WHA the opportunity to assist in actions and programs that could increase the number of CRNAs in Wisconsin.

The Workforce Council agenda also included a request for input from Council members on new credentialing initiatives for health occupations. WHA’s Judy Warmuth reported on the growing number of occupational groups that have recently sought licensure or enhancements to licensure via the legislative process including radiographers, dietitians, physical therapists and genetic counselors. WHA has been invited to testify before the Pharmacy Examining Board on the topic of a credentialing process for pharmacy technicians. Response times and service levels from the Department of Regulation and Licensing are already unacceptable and WHA is concerned that additional licensed groups will further degrade the service from R& L with no impact on safety of the public.

The Baby Safety Shower hosted each year by Aurora West Allis Memorial Hospital is a community event planned and presented by students in the School Age Parent Program of the West Allis/West Milwaukee School District.

The Baby Safety Shower is an invaluable learning experience for the young women enrolled in the School-Age Parent Program who are having babies or are new moms. The goal of the program is for them to continue their education and graduate from high school.

In addition to teaching the School Age Parent Prenatal classes, which include information on preparation for labor and birth, care of the newborn, and infant massage, Cynthia Finger has worked closely with the school district, the West Allis Health Department, other community agencies and the students themselves to coordinate the annual Baby Safety Shower for the past nine years. She is the childbirth education services coordinator for the Aurora Women’s Pavilion at West Allis Memorial Hospital and facilitates the students’ work in presenting the Baby Safety Shower.

The students are responsible for researching topics related to child and maternal health, such as the effects of smoking, drugs, alcohol and diet pre- and post-pregnancy, and Sudden Infant Death Syndrome, to name a few. The students are responsible for displaying and presenting the information to the public. The hospital provides the space, the display boards, the educational, creative services and event-planning support. Working with Cynthia, students coordinate the involvement of important community agencies, such as the West Allis Fire Department and Safe Kids Coalition, in the event. They’re also responsible for staffing their own information booths.

Each year, more than 100 community members attend the Baby Safety Shower.

In fulfilling all their responsibilities to provide important health and safety information to the community, students in the School-Age Parent Program acquire the knowledge they need to be confident and successful parents, and in the process gain work experience and skills they can use in the future.

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In May 2007, Spectrum ran a story on the different ways Saint Joseph’s Hospital supports the training of health care professionals of tomorrow. This month, we focus on a training program that’s helping students further their careers in nursing.

Terry Annis, heart care clinical manager and certified clinical nurse specialist at Saint Joseph’s Hospital, is currently a preceptor to Jackie Pfeifer, a registered nurse who’s training to become a clinical nurse specialist (CNS).

Pfeifer is in a graduate program, pursuing a Master of Science degree in nursing. She’s in a medical surgical acute care tract for a clinical nurse specialist role, which is an advanced practice role. "In order to become a clinical nurse specialist, after the students graduate, they must take a certification exam for their particular specialty," said Annis. "This is one of the protected titles under the advanced practice nurse role, which includes the titles of nurse practitioner, nurse anesthetist, nurse midwife and the clinical nurse specialist."

"What I am doing is providing Jackie a clinical practicum education so that she can fulfill the requirement in order to graduate and to take the certification exam," added Annis. Jackie has nearly completed seven semesters, including 500 clinical hours for this program.

"I take an online class through Texas Christian University. I do the didactic component in the online classroom, and then Terry helps me apply what I learn in the clinical setting," said Pfeifer. She said she works anywhere from 6 – 10 hours a day, one or two days a week. She added that a typical semester consists of 180 clinical hours, completed within in 10 – 14 weeks. "Coming from a staff nurse position in the surgical care unit, I’ve been able to see more of a global perspective of patient populations rather than focusing just on the critical care patients. "I can see their progression throughout their hospitalization, the different types of patient populations that are affected, and lots of initiatives that are coming from Ministry and out of clinical care," said Pfeifer. "It’s amazing how much thought goes into certain decisions, and there’s a lot of behind-the-scene work that goes into a lot of the decision-making process."

Some of the objectives of the course include:

• Continuously improving patient care processes that can benefit the system

• Integrating change strategies throughout the system

• Developing policies and procedures that enhance the practice of nurse providers and the interdisciplinary team

• Developing, piloting, evaluating and incorporating innovative models of practices, as well as evidence-based and best practice models

Once her preceptorship is complete, Pfeifer plans on presenting her thesis statement in Texas at the end of July. She then graduates, and she plans to take the American Association of Critical Care Nurses - Clinical Nurse Specialist certification exam in October. She will then continue her employment at Saint Joseph’s Hospital in the new role as a critical care clinical nurse specialist.

Annis said that while many nurses at Saint Joseph’s Hospital are pursuing advanced degrees, several follow the nurse practitioner tract and leave to explore private practice or clinics.

In order for a graduate student to complete their clinical in an approved setting, they must work with someone who meets the qualifications to be their preceptor/mentor. In this case, it has to be someone that has their Master’s degree in nursing and is functioning in an advanced practice nurse role, said Annis. She said there’s usually no more than one student in a preceptorship at one time, since there are so many hours involved in such a short period of time, and the mentor needs to be able to provide time for guidance and to work together on the projects.

When Pfeifer completes the program, Annis has plans to preceptor another graduate student. Annis said it’s important to find a site that will provide the clinical experiences that meet their objectives.

"We don’t have a lot of CNSs in the Ministry system," said Annis. "The nationwide volume of clinical nurse specialists is very limited. Saint Joseph’s has the opportunity to "home grow" a staff person who is interested in pursuing Master’s level education and career advancement within the organization."

"Terry’s been a tremendous help in guiding me through the nuances of the organization, helping me look at the global perspective," said Pfeifer. "Everything has been very positive."

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