Professional Governance: The First Steps

Professional Governance: The First Steps
Speakers Ann Bindra MSN, RN Alexis Fitten, BSN, RN, CCRN Bindu Kumar, MSN, RN, BMTCN Rebecca Lahr, BSN, RN, CCRN, NE-BC Maria Madden, BSN, RN Administrative Support: Kissy Vasquez Administrative Support: Kelli Obazee Speakers Gina Maltase, BSN, RN Mary Lawanson-Nichols, MSN, RN, NP, CNS, CCRN Jordan Sugar, BSN, RN, OCN Yesenia Valle, BSN, RN, OCN Coleen Wilson, MSN, RN, NE-BC •No relevant financial relationships with commercial interests exist for any speaker.

Agenda and Housekeeping Items
Group activities and iPads Please silence pagers, cell phones Downloadable handouts online Welcome ! Good Morning. Quick Introduction of Course Coordinator and facilitators Breakfast We have 4 hours today to focus on Professional Governance ( previously known as shared governance here at UCLA Health) There will be a break about midway through the class. In order to get what you need out of this class Questions are welcomed and encouraged, however, as the content unfolds your questions may be addressed in the next content section. Please keep this in mind. Keeping in consideration our agenda we ask that you please hold questions until after each section. There will be time for table discussion and questions after each section. You may be wondering why you have the large poster on your table.? The poster is for you and your tablemates to share and look at throughout the class. Please leave them here for tomorrow's class to use as well. We encourage you to discuss and write questions together and then working with your table you may nominate a scribe and a spokesperson for your table. Thank you for your understanding. In an effort to stay in alignment with sustainability we have “gone green”. Today's content may be viewed and downloaded on an electronic device. Restrooms- are located on the 3rd floor just below us, Please silence our cell phones, pagers and other electronic devices. Slides to follow along World Café Thank you for being here! We have a full morning agenda with lots of activity this afternoon! We know that as nurses we like to move around so we planned booths for this afternoon. This event was at max capacity so please I encourage you go back and share this information with your colleagues who were unable to attend . We hope everyone is enjoying breakfast. Bathrooms are out to the hall next to us. As a reminder lets silence all electronic devices. Why am I passionate about professional governance ( shared governance) Clarify term is interchangeable, because everyones voice can be heard. Raise your hand if you do NOT want your voice to be heard.,,, Of course- Who doesn’t want to be heard? We all DO! That’s the power of Professional governance it puts the right people at the right table at the right time to make the right decisions! Before we jump into the learning objectives. Id like to thank the Professional Governance Steering Committee for all their hard work over the past year, plus to help with this restructure. A special thank you to the Staff engagement work-group for helping get us here to this day with all the fun learning activities that they’ve planned for you.Thank you for being here to learn about Professional Governance and We look forward to a great day!!!

Learning Objectives Understanding of the nursing strategic plan at UCLA Health Describe Transformational Leadership Responsibility Authority Accountability Model (RAA) and expectations Describe how Relationship-Based Care is used as a care delivery model and an operational framework to improve patient outcomes and patient/staff satisfaction. Explain UPC structure, process and reporting outcomes. Relate structure and purpose of a UPC Meeting. Articulate steps of a successful UPC meeting Explain professional governance restructuring, facility and system councils. Identify the necessary steps for practice council project development Tableau, project submission (agenda, minutes, charter, by-laws and communication, transferor of knowledge). Describe how Relationship- Based Care is used as a care delivery model and an operational framework to improve patient outcomes and patient/staff satisfaction. Recognize Jean Watson’s Interpersonal Caring Healing Framework and Kristen Swanson’ Middle-Range Theory of Five Caring Processes; and how the theorists of Relationship-Based Care provide a framework for caring and healing practice Explain UPC structure, process and outcomes. Utilize various process improvement tools and model. Define the model of the Transformational Leadership Cycle and its use in transforming care. Articulate the steps in planning for change and, I2E2 as a model for sustaining change. Articulate steps of a successful meeting (agenda, minutes, charter and transferor of knowledge). Identify the seven dimensions of the Relationship-Based Care Model and how they integrate as a framework, for a caring and healing environment that is patient/family centered. Recognize the alignment of RBC to Magnet© Organizations. Translate how caregivers impact patient care.

onlinepoll.ucla.edu/polls/2051
Pre-Course Quiz onlinepoll.ucla.edu/polls/2051 Welcome ! Good Morning. Quick Introduction of Course Coordinator and facilitators Breakfast We have 4 hours today to focus on Professional Governance ( previously known as shared governance here at UCLA Health) There will be a break about midway through the class. In order to get what you need out of this class Questions are welcomed and encouraged, however, as the content unfolds your questions may be addressed in the next content section. Please keep this in mind. Keeping in consideration our agenda we ask that you please hold questions until after each section. There will be time for table discussion and questions after each section. You may be wondering why you have the large poster on your table.? The poster is for you and your tablemates to share and look at throughout the class. Please leave them here for tomorrow's class to use as well. We encourage you to discuss and write questions together and then working with your table you may nominate a scribe and a spokesperson for your table. Thank you for your understanding. In an effort to stay in alignment with sustainability we have “gone green”. Today's content may be viewed and downloaded on an electronic device. Restrooms- are located on the 3rd floor just below us, Please silence our cell phones, pagers and other electronic devices. Slides to follow along World Café Thank you for being here! We have a full morning agenda with lots of activity this afternoon! We know that as nurses we like to move around so we planned booths for this afternoon. This event was at max capacity so please I encourage you go back and share this information with your colleagues who were unable to attend . We hope everyone is enjoying breakfast. Bathrooms are out to the hall next to us. As a reminder lets silence all electronic devices. Why am I passionate about professional governance ( shared governance) Clarify term is interchangeable, because everyones voice can be heard. Raise your hand if you do NOT want your voice to be heard.,,, Of course- Who doesn’t want to be heard? We all DO! That’s the power of Professional governance it puts the right people at the right table at the right time to make the right decisions! Before we jump into the learning objectives. Id like to thank the Professional Governance Steering Committee for all their hard work over the past year, plus to help with this restructure. A special thank you to the Staff engagement work-group for helping get us here to this day with all the fun learning activities that they’ve planned for you.Thank you for being here to learn about Professional Governance and We look forward to a great day!!!

Professional Governance Vision
Nursing excellence is at the forefront of UCLA Health's outstanding patient care. UCLA Health Nursing empowers the professional nurse to recognize their unique gifts, to give voice to ideals, to strive for personal, professional, and academic excellence, and to accept the challenge of the human experience. Tim Porter O’Grady: As nurses, we have shared for long enough….it is time we embrace our professionalism NURSING SYSTEM STRATEGIC PLAN Nursing Strategic Priority Evaluate and implement professional governance infrastructure to strengthen nurse engagement and voice in shared decision-making.

UCLA Health From bedside to boardroom. Sitting on the same councils.

Empowered U We are empowered through established structures and processes to achieve higher levels of professional development, participate in decision-making, teach and develop others, and contribute to the community. Overall goals include: To promote a more inclusive, reorganized governance model for nursing practice. To empower every nurse as a leader. To provide a forum for transparent, consistent communication across the continuum. To support healthy relationships, build trust and role clarity.

Alignment of Models Professional Practice Model
We all know at UCLA health we have a very strong PPM, which we are all very familiar with. In fact we have 2. On the screen you’ll notice we have RR and SM on your left and RNPH PPM on the right. Both models include our Relationship Based care delivery model ( here and here). We want to emphasize this RBC care- delivery model is not going away. RBC is embedded as a foundation of our PPMs. Resnick Neuropsychiatric Hospital Professional Practice Model is specific to the specialty of psychiatric nursing, although core to our Professional Practice Model establishes the foundations for professional practice and patient care delivery. Just before we enter the doors of the hospital, we take off our personal persona/identity and we put on our professional identity. That professional identity is defined by this UCLA Professional Practice Model. It tells us how to be, how to behave, what our values and beliefs are. We have agreed to behave according to this professional practice model. Notice the dotted lines between the circles, this represents a fluid relationship between the concepts Dr. Maria O’Rourke, founder of the Institute for the advancement of Professional Practice, and key contributor to the revision of the CA Nursing Practice Act in 1974, has been promoting professionalism in nursing for 50 years. Dr. O’Rourke worked closely with UCLA Health in the development of the UCLA Professional Practice Model. OUR RBC MODEL IS OPERATIONALIZED THROUGH UNIT PRACTICE COUNCILS, Components are the same as the UCLA Health Professional Practice Model. Brief walk through of first (Patient/Family/Community) of PPM and first ring of the PPM Vision, Mission, Values, and CI-CARE Our professional practice model incorporates Relationship Based Care on the second ring. Relationship Based Care is our care delivery model and it is how our unit practice councils are operationalized at UCLA Health

Relationship-Based Care
Let’s talk more about RBC ! It is in the second ring of our PPM.

Relationship-Based Care
The PPM and RBC model are NOT going away. They are foundations of Practice and Professional Governance is built from them ! In healthcare our Core Business is Caring for and Healing Patients Relationship-based care is a way of achieving our core business it is the second ring of our professional practice model. It’s a culture of caring, and a way of being that focuses on three relationships: Relationship with patients/families Relationship with colleagues Relationship with self This is our Care Delivery Model! Relationship-Based Care is operationalized through professional governance, Unit Practice Councils. Professional governance is a structure and process in which staff participate fully in activities that have an impact on their work. Patient, family and community are always at the center This can be seen throughout our Professional Practice Model and Relationship-Based Care Model Thinking of Professional Governance in alignment with our overarching goal So Why do we use models: Concrete representations of a concept or idea. Help us visualize ideas more clearly and help us see the "big picture" and how things are related; Models Practical and efficient in helping us explain our ideas. Guide us in our decision-making and determine how we think and act. Help to control and improve practice performance. Now that we’ve reviewed the models for PPM and RBC, we’d like to introduce you to a new model for UCLA health professional governance. The two theorist of Relationship-Based Care are Jean Watson and Kristen Swanson. The second concentric circle of the PPM is the Relationship-Based Care (RBC) Delivery Model which supports the delivery of the professional practice of nursing. This model identifies the way every UCLA employee and RN delivers nursing care – namely by offering all care through a human-to-human relationship. Watson’s Theory of Human Caring and Swanson’s Five Caring Processes provide the theoretical basis for creating a caring and healing relationship with patients and their families. Through a shared governance structure this model serves to clarify the essence of nursing and guide the thinking and decision-making to ensure best practice that improves patient outcomes. Ask if anyone has participated in Shared Governance and what their experience has been. Were you involved? What was it like? Give the Red light, yellow light, Green light example. UNIT PROJECT—Nurse status board outside of med room; method of identifying who needs assistance. Name and Nurses phone # RED—needs help now; should talk with YELLOW—busy now but maybe later GREEN—I can help There are two theorist, Jean Watson and Kristen Swanson, anyone familiar with the work of Jean Watson or Kristen Swanson? Explain Watson: Creating healing environment at all levels (physical, non-physical, subtle environment of energy and consciousness), whereby wholeness, beauty, comfort, dignity, and peace are potentiated. Explain Swanson: Swanson’s theory says if we do the 5 caring practices, the patient can’t help but get better. Even if your patient is dying you can help your patient get better by doing these 5 things. Maintain Belief: we maintain the belief that no matter how horrible the patient’s situation, there is an optimum that is obtainable. We will help the patient to obtain that optimum and we will not give up and will stick by the patient to achieve that optimum. Knowing: when we meet someone we immediately form assumptions just by the way they look or talk. Then, when we speak with them and hear what they have to say, often those first assumptions are blown to bits and replaced with reality. Being with or Listening is very different from hearing. Listening is an active thing. When I listen to the patient I’m putting the things he says to work. Intentionally making yourself authentically available in the moment, therapeutic communication. Doing For: Comforting, Protecting Preserving Dignity. Enabling: Supporting, advocating. Walk the Amber Story through Swanson’s Model. Amber had a Rare autoimmune disease (only 500 cases). Nurse told her this crying was part of her disease. AM meds the next day, patient was crying and sobbing. Stopped with giving meds…and sat down with the her and used these 5 Caring Process to interact with her. And discovered… She has 2 Small Children, a Husband who has to work (for insurance), family is in Lompoc (distance from hospital) and no way to contact anyone (no cellphone-limited resources). She was Suicidal and very depressed. Collaborated with primary nurse and tapped into resources (Pal Care CNS Edith) and was able to get a computer for the duration of her say (communicate with family, skype with her kids). She was discharged to long term care facility. DID WE CURE HER DISEASE? No, That depression was part of the disease but the suicidal ideation stopped. Psychiatry note stated—impacted by her being able to communicate with her family and children. DID THIS CREATE A HEALING ENVIRONMENT FOR THE PATIENT? Yes!! THIS IS WHY IT IS IMPORTANT TO APPLY THEROY TO PRACTICE.

Review of the Team www.chcm.com It Takes a Village:
Colleagues have a bond built on a shared purpose: Our sacred trust to provide humane compassionate and expert care and service to patients and their loved ones. Team Members: Proactively communicate system problems, such as issues with equipment, supplies or the patient’s room to the appropriate manager. Team members will offer their ideals/contributions to creative problem solving of process issues. Koloroutis, M., Evens, M., & Wessel, S. (2011). Relationship-Based Care Leader Practicum. Minneapolis, MN: Creative Health Care Management

Professional Governance Structure NEW 2018 Model
Coleen to present new model.

Shared Governance is Professional Governance
Professional governance is a structure and process. Team Members participate fully in all activities that have an impact on their work. Each member’s performance becomes the obligation of peers. Ownership and responsibility for patient care and patient outcomes are now team processes. A practice council is Shared Governance is a structure and process in which clinicians participate fully in all activities that have an impact on their work. Shared Governance is how Relationship Based Care is carried out. Each team member’s performance becomes the obligation of peers rather than just management. Ownership and responsibility for patient care and patient outcomes is now a team process looking horizontally at each team member’s contribution. Each team member is called forth to be a Leader, a role model and a change agent: a transformational Leader. Decisions are based on data and evidence. The Focus shifts to outcomes, understanding that there must be value-driven results. Koloroutis, M. (Ed.). (2004). Relationship-based care: A model for transforming practice. Minneapolis, MN: Creative Health Care Management.

Unit Practice Councils
Professional Governance Model Coordinating Council System Councils Facility Councils Unit Practice Councils Leader Practitioner Patient Family Community Scientist Transferor of Knowledge Table groups of 5 each. Place poster in center of table for their reference. Speak about the Coordinating council and Facility and System level councils

Professional Governance Unit Practice Councils Coordinating Council System Councils Facility Councils Unit Practice Councils Leader Practitioner Patient Family Community Scientist Transferor of Knowledge We are here today to speak about the new structure of the Unit Practice Councils-there function isn’t changing

Unit Practice Councils Structure and Charter
Purpose The primary purpose of the Unit Practice Council is to plan, implement, and continuously improve the unit/department-specific Relationship-Based Care (RBC) delivery model and related outcomes. Focus is patient and family centered care. Scope Promoting the professional practice of nursing as an intellectual discipline by continuously improving patient outcomes and patient safety. We have redesigned the UPC to give it a standardized purpose and scope; in which all UPCs will operate out of to continuously improve patient outcomes and patient safety, as guided by the organization’s goals, but specific to the unit/ department's needs. The UPCs primary purpose is to plan, implement, and improve specific patient outcomes and safety, by promoting professional practice.

What is the Purpose of the Practice Council?
Improve patient/staff outcomes and patient safety through: EMPOWERING frontline leaders DEVELOPING plans based department’s needs and goals LEADING plans through consensus-based decision-making process that includes communication with 100% of staff and supported by leadership. Some of you who are just joining, may be wondering what is the reason for a PC. Maybe you’ve heard various thoughts from your colleagues. EMPOWERING frontline leaders with the resources, knowledge and support to make changes directly affecting the outcomes of patients, colleagues and working environment. DEVELOPING plans based on principles and outcome measures as guided by the department’s needs and goals LEADING plans through consensus-based decision-making process that includes communication with 100% of staff and supported by leadership. Koloroutis, M. (Ed.). (2004). Relationship-based care: A model for transforming practice. Minneapolis, MN: Creative Healthcare Management.

Practice Council Composition
Staff from all levels of care and shifts RNs, CCPs/ Technicians, ACP/ACCP, Unit Director/ANII, Clinical Nurse Specialist/Educator, health care team, PT/OT, Outpatient provides, techs should representative of 10% staff UCLA Health RBC Leads: Ann Bindra: Nursing Professional Development Specialist Maria Madden: Relationship-Based Care Educator Koloroutis, M. (Ed.). (2004). Relationship-based care: A model for transforming practice. Minneapolis, MN: Creative Healthcare Management.

Unit Practice Councils Membership Terms
Commitment 2-year minimum 4-year maximum* Opportunity to reapply and serve beyond 4-year commitment allowed if roles not fulfilled Succession Plan Exiting officers mentor oncoming officers Chair will serve as mentor to Co-Chair Chair will transition to Facilitator role So, Who makes up the UPC? The UPC council will represent all job classifications and shifts. The UPC will include 10% of unit staff. Members will be Registered Nurses, Clinical Care Partners/Administrative Care Partners, Technicians, and all other members of the multi-disciplinary team Members will serve a 2-year minimum and 3-year maximum commitment on the council, unless they hold a leadership role. For instance, a member who has served one year can then transition to co-chair, then they will eventually become chair and then facilitator. Thus allowing for service on the UPC after the 3-year maximum- clearer Also it will be an option to have the ability to reapply and serve beyond the 3-year commitment if mandatory roles are not fulfilled. In order to provide guidance and support for the UPC when they are transitioning between leaders the PG committee has developed a succession plan for exiting officers. This includes mentoring the new officers to their role. The Chair will serve as a mentor to Co-Chair, and then Chair will transition to Facilitator role.

Unit Practice Councils Meeting Structure
UPC Meetings Monthly in the work environment Maximum of 4 hours All meetings are “working meetings” consisting of: First part of meeting Approval of minutes/review agenda (template on Website) Report feedback from staff Review ongoing projects Second part of meeting Divide into workgroups Third part of meeting Report back to UPC group about progress UPC meetings will be held monthly in the hospital for up to a maximum of 4 hours. We realize that there are many different care settings and facilities. We will use an inpatient setting for an example but this may look different for an ambulatory clinic which operates Monday-Friday. Meetings should consist of Approving of minutes, discussing feedback from unit staff, reviewing projects, dividing into work groups to accomplish project goals, and reporting back as a group to review progress. Due to commitment to special projects, extra hours may be given to members to work on projects. We will discuss more about Leadership’s role regarding UPC shortly

So let's problem solve a little bit and see if we can figure out who does what on the UPC.
Alright ! Let's review some roles in a game! Please divide in teams of 2 to accomplish this. Half the room to each poster.

Unit Practice Councils Roles
Chair Co-Chair Facilitator Recorder The above 4 roles must be filled by a Nurse Member (with potential lead role) Social Communicator Researcher Quality Improvement Now that we have discussed how the UPC is structured we will examine each role in the UPC and its function. There are four required roles which are to be fulfilled first. These roles include: Chair Co-Chair Recorder Facilitator In addition to the required roles we have created additional roles to be filled by other members on the UPC: Communications Officer Research Officer Quality Improvement Officer Social Officer The idea behind these other roles is that everyone serving on the UPC will have a defined responsibility so there are no idle members Ok now, let's discuss each role in greater detail.

Unit Practice Councils Roles and Responsibilities
Chair and Co-Chair Serves as a member on New Transformational Leadership Councils Organizes and disseminates meeting agendas Keeps UPC focused on assessing unit needs, developing and implementing action plans and meeting strategic goals Meets with Unit Director and plan agendas *Extra hours may be given to members to work on projects as needed during the month. Ok now, let's discuss each role in greater detail. The Chair serves as a member on the Transformational Leadership Council. It is the duty of the Co-Chair to attend this meeting in the chairs absence. The Transformational Leadership Council will be discussed in detail in the next section. In preparation for upcoming meetings, the Chair or Co-Chair will meet with the Unit Director to create meeting agendas. 3 days prior to each meeting the CHair or Co-CHair will disseminate the meeting agenda along with the previous meetings minutes to UPC members.This is to ensure a highly productive and organized meeting. It gives members a chance to review the material and plan for the meeting. With guidance from the Unit Director, the Chair and Co-Chair, keep the UPC meetings and members focused on assessing unit needs, developing and implementing action plans to address those needs for meeting the Health Systems strategic goals.

Recorder Record minutes Record decisions in the minutes template Maintain parking lot items Ensures minutes are ed to the Unit Staff, Unit/Department Director, and Clinical Nurse Specialist/Educator Facilitator Keeps group on track/time keeper Encourages input from all members, reinforces behavioral expectations Makes suggestions to Chair about group process Assists group to reach consensus Suggests use of parking lot when appropriate Chair will transition to this role The primary duty of the recorder is to document the meetings minutes and decisions in the new standardized minutes template. An example of the new minutes template is provided in the resource materials. The Recorder will also be responsible for ing the minutes to the entire staff, Unit Director, and Clinical Nurse Specialist or Educator once approved by the UPC. During the meeting, the recorder is also responsible for keeping track of parking lot items. These items are issues that must be revisited at a later time because they cannot be resolved immediately. Maintaining parking lot items ensures the meeting remains focused and on track. The Recorder will also post minutes on the UPC Bulletin Board and in the employee lounge for other staff members to read. The last of the mandatory roles is the Facilitator- This role provides guidance for all meetings to ensure that the meetings are remaining professional. The facilitator assists the Chair and Co-Chair to ensure the meeting is being conducted in accordance with the meetings agenda, and helps promote participation from all members. It is this roles responsibility to be the time keeper of the meeting. The Chair transitions to this role at the end of their term.

Research Officer Explore evidence-based practice and ways to improve patient care. All RNs will have access to Tableau. Quality Improvement Officer Report out on monthly data HCAHPS scores, Tableau, Unit Dashboard (sepsis, falls, pain satisfaction scores, etc.) The following roles are to be filled if there is an excess of four members on the council. Research Officer: The Research officer is responsible for exploring evidence based practice using peer reviewed literature and internal best practice recommendations to support UPC projects and improve patient care. Quality Improvement Officer: Will be responsible for reporting out on data ie HCAHPS scores, sepsis fall outs, falls, pain satisfaction scores, etc.) and maintain the quality data boards on the units with current outcomes. While all UPC members will have access to Tableau, the Research and Quality Officer will be responsible for bringing forth the data to help support and guide UPC projects.

Social Responsible for planning special events Recognizing staff who have obtained their certifications Provide support to those staff members who may be experiencing undue hardship Foster positive relationships amongst staff Communicator Update UPC bulletin board Ensure communication tree is updated and topics sent out each month Social Officer: Responsible for planning UPC social and professional events for example recognizing staff who have obtained their certifications, provide support to those staff members who have lost loved ones in their family, and fostering positive relationships amongst staff. The Communications Officer will assist the Recorder in updating the UPC bulletin board and ensuring the communication tree is updated.

Member Learns about Relationship-Based Care Maintains communication with assigned communication network (tree) Offers ideas from colleagues in communication network Member: The Member role includes all new representatives to the UPC. New members must be a part of the UPC for a year before transitioning to another role. All new members of the UPC are required to take the Reigniting the spirit of caring course, view the Relationship-Based Care orientation, and attend the UPC workshop within 6 months of joining the council. Members are responsible for maintaining communication with the assigned tree and sharing UPC information with their portion of the communication tree. The member role will use the 1st year to prepare for being selected as an officer in the future as leadership is rotated and responsibility is shared. Again, the reason the PG steering committee has created these additional roles is to support the UPC in productivity. In creating these roles we understand that not all additional roles can be filled perhaps due to lack of membership. Maybe 10% of your unit/department is only 5 members therefore it will be up to the UPC to determine which of the non-mandatory roles the 5th member will fulfill. And also allows for less cumbersome role i.e facilitator to take on more responsibility.

Unit Leadership Provides guidance and support by attending all UPC meetings Serve 2 year term on a system or facility council Develops a shared vision for RBC with UPC and staff Solves unit systems issues that are beyond the scope of the UPC Provides time for UPC to meet by adjusting the schedule to cover meeting times Provides guidance and reviews content of presentations, posters/abstracts and reports for completeness Follows up with attendance and accountability concerns Unit Leadership Being a Nurse Leader here at UCLA Health is one of the most important roles in a successful Professional Governance. It starts right here in this room. I am going to go over the roles and responsibilities for Unit Leadership Provides guidance and support by attending all UPC meetings UDs are expected to attend all UPC meetings. It is just as important that the UD attends as is it for the UPC members to attend. It is a shared responsibility with the Chair and Co-chair to manage the UPC. The UDs are there to be mentors, coaches, and facilitators. As leaders, we want to support the professional nurse and being present is the first step. In the event that you cannot attended one of the UPC meetings, you will need to send a leadership representative in your place. Serve 2 year term on a system or facility council All Nursing leaders are to serve on one of the facility or system councils for 2 years. We will be breaking down each facility and system council and their membership here in just a bit. Develops a shared vision for RBC with UPC and staff Each UPC should have a vision on how RBC looks for their unit or department specifically. Warren Bennis stated, “leadership is the capacity to translate vision into reality”. We want unit leadership to foster this vision with their UPC keeping in mind our Values that ensure integrity, compassion, respect, Teamwork, excellence, and discovery in the work we do daily. Solves unit systems issues that are beyond the scope of the UPC Example would be when one unit wanted to move the Tv’s in there pt rooms. They needed to get all of engineriing evolved, finance, and legal involved. It was a great idea, but it wasn’t as simple as just moving the tvs. Provides time for UPC to meet by adjusting the schedule to cover meeting times We want to make sure we are setting a schedule that allows coverage for UPC members to attend meetings. Provides guidance and reviews content of presentations, posters/abstracts and reports for completeness There are a lot of great resources that the Center provides for submitting abstracts and posters for presentation. Guide your UPC to these resources and review the content for completeness. Follows up with attendance and accountability concerns As Leaders, it falls into our scope of

Unit Leadership Mentor Council members to foster understanding of UCLA Health nursing standards, application to practice, and their role in professional governance Assist with dissemination of information from Council Assist Council members with organization-wide practice changes that affect patient outcomes Empower staff to become nursing leaders Facilitate interprofessional collaboration when needed Remove barriers to the Council’s success Unit Leadership Continued Mentor Council members to foster understanding of UCLA Health nursing standards, application to practice, and their role in professional governance Mentor staff to advocate for their own practice, by providing coaching and guidance. Collaborate and guide staff with decision-making processes, we want to be careful to not make decisions for the UPC but with the UPC We are there to support staff as they lead and create system-wide cultural changes to improve quality outcomes, deliver efficient care, and support the Magnet journey Be sure to encourage the use of research to support and guide evidence-based practice changes Assist with dissemination of information from Council Example? Assist Council members with organization-wide practice changes that affect patient outcomes Empower staff to become nursing leaders John Maxwell said, “Leaders become great not because of their power, but because of their ability to empower others”. Empower staff to become independent Mentor staff to advocate for their own practice Facilitate inter-professional collaboration when needed This could be with our Physician Colleagues or other members of the multidisciplinary teams. We might need to set up meetings or foster team work. Remove barriers to the Council’s success Example

We want to be aware of what happens when Leadership is too involved or under-involved?
UPC is meant for the front line staff to have a voice in change. As leaders, we want to foster this communication, respect, and commitment to practice.

Guiding Structures Bylaws Charter
Charter and by-law set the foundation for Professional Governance Charter and By-Laws are published on our nursing website As the new structure is set to begin in 2 weeks the expectation is that all UPC members need to review the UPC Charter and Kelli to upload PowerPoint ! Show nursing website ! Signed document between new practice council member and unit leadership BY-LAWS Provides consistent structure for all practice areas and organizational roles so that each area no longer works in mini-silos a foundation for new professional governance structure through the composition of councils, committees, special meetings and task forces Establishes requirements for all council members and chairs, including selection process, term limits, duties and expectations guidelines for decision-making and voting requirements. meeting schedules as well as the guidelines for those meetings. a one-stop shop for all communication and dissemination of information

Unit Practice Council: Accountability
The Council is accountable for the outcomes and must review and evaluate the effectiveness of the implementation Key Points: Why is this important to me? Establish a baseline Track and trend the data. Collect a minimum of 3 data points post-interventions Reassess and implement changes as needed. Repeat this process until it becomes part of the unit culture. Celebrate successes The Vison can be Developed in an early meeting developed with leadership or when attending Re-Igniting the Spirit of Caring. Develop a team vision for the ideal future for the Practice for the patient, family and collegial relationships. Review the mission, vision and values of UCLA Health System. Discuss specific ways you live the mission, vision and values in daily practice in your unit or department. A shared vision will serve as a guide for your planning. Wessel, S., Evens, M., & Person, C. (2011). Implementation Guide for Relationship-Based Care. Minneapolis, MN: Creative Health Care Management.

Practice Councils have Level 3 Authority RAA
Practice Councils have Level 3 Authority RAA = Responsibility, Authority & Accountability Practice counicls have Level 3 Authority: When and what decisions can we make? Data has been used to identify a need for change. Examples: quality indicators, core measures, surveys, audits A two-way communication process has been established with 100% of the staff. A consensus-based decision process was utilized in determining the action plans. Collaborative planning has occurred among UPC, staff and leadership As a group, the UPC has been given the authority to make changes on issues that affect the patient and nursing practice but may be limited by budget constraints. Creative Health Care Management. (2011). Relationship-based care: Implementation guide (3rd ed.). Minneapolis, MN: Creative Health Care Management.

Four Levels of Authority.
Level I Collect Data Level 2 Collect Data, analyze, make recommendations Level 3 Collect data, analyze determine actions, PAUSE to communicate, act Level 4 Assess and act, informing others after taking actions Practice Councils Authority Levels of Authority to establish clear expectations for decision making Level I Collect Data Level 2 Collect Data, analyze, make recommendations Level 3 Collect data, analyze determine actions, PAUSE to communicate, act. Level 4 Assess and act, informing others after taking actions Practice councils have Level 3 Authority: When and what decisions can we make? Data has been used to identify a need for change. Examples: quality indicators, core measures, surveys, audits A two-way communication process has been established with 100% of the staff. A consensus-based decision process was utilized in determining the action plans. Collaborative planning has occurred among UPC, staff and leadership As a group, the UPC has been given the authority to make changes on issues that affect the patient and nursing practice but may be limited by budget constraints. A Caring Leaders directly influence caring interactions with patients and families by virtue of their own caring interactions with staff. Swanson’s processes are adapted to caring leader behaviors: (57). This goes back to the second ring of our professional practice model Maintaining a Belief: A caring leader has faith in others to get through difficult or challenging events. A caring leader finds meaning in challenges and participates solutions. Holds and conveys a Hope filled attitude Sees the possibilities in situations Respects and values all people Does whatever it takes to do the “right thing” Follows through on Commitments Knowing: A caring leader strives to understand an event as it has meaning to others. Seeks to understand the others person’s perspective Avoids making assumptions Seeks to understand others experiences Being With: A caring leader is emotionally present and available to another. Suspends judgement Promotes healthy, productive interactions Consciously monitors own reactions Models healthy personal boundaries Offers support Doing For: A caring leader provides help and service to others as appropriate. Initiates actions to resolve problems Gets things done Models desired behaviors Enabling and Informing: A caring leader facilitates another’s development and passage through events and transitions. Articulates expectations Seeks and supports opportunities for growth and development Serves as teacher, coach and/or mentor Leads with purpose and Integrity “Caring is the heart of leadership” S. W., M. E., & C. P. (2011). Relationship-Based Care Implementation Guide. Minneapolis, MN: Creative Health Care Management

Practice Councils have Level 3 Authority RAA = Responsibility, Authority & Accountability
When and what decisions can we make? Data has been used to identify a need for change. Examples: quality indicators, core measures, surveys, audits A two-way communication process has been established with 100% of the staff. A consensus-based decision process was utilized in determining the action plans. Collaborative planning has occurred among DPC/UPC, staff and leadership. As a group, the UPC has been given the authority to make changes on issues that affect the patient and nursing practice but may be limited by budget constraints. Practice counicls have Level 3 Authority: When and what decisions can we make? Data has been used to identify a need for change. Examples: quality indicators, core measures, surveys, audits A two-way communication process has been established with 100% of the staff. A consensus-based decision process was utilized in determining the action plans. Collaborative planning has occurred among UPC, staff and leadership As a group, the UPC has been given the authority to make changes on issues that affect the patient and nursing practice but may be limited by budget constraints. Creative Health Care Management. (2011). Relationship-based care: Implementation guide (3rd ed.). Minneapolis, MN: Creative Health Care Management.

Transformational Leadership Cycle: Model The Way
Begin Where You Are Learn by doing & reflection Inspire a shared vision Lead with Purpose Go with the energy REDO THIS SLIDE Begin where you are This means that as a leader I have my eyes wide open. I see and accept what is. Each day provides new opportunities and possibilities. There is no room for carrying resentments from yesterday. It means celebrating and appreciating strengths and identifying and changing what is unacceptable (63). Lead with Purpose Commitment to an unshakeable focus on care and service. This means maintaining caring relationships among out team members and supporting therapeutic relationships between nurses and patients and their families (64). Create Awareness To lift up what is important and encourage others to do the same. Go With The Energy Align with the positive energy, or with people who can see the possibilities and take ownership for moving change forward. When you focus you energy is focused on what can happen those in the middle will begin to align with the positive energy. Inspired a Shared Vision Steps one through four create a solid foundation for inspiring a shared vision. These steps open up new conversations and create a new level of awareness and possibility When people are encouraged to speak from their hearts about what is truly important in their work environments, when leaders listen, and when action is taken toward creating what people ask for, the environment transforms into one that is relationship-based. Learn by Doing and Reflection Putting our words and plans into action, take risk and have the courage to pursue what we value-even if the results are not perfect. A key barrier to effective results is the fear of making a mistake. Change happens one person at a time and have significant impact. Create Awareness Koloroutis, M. (Ed.). (2004). Relationship-based care: A model for transforming practice. Minneapolis, MN: Creative Healthcare Management.

Lewin’s Stage Model of Change
Take a moment to consider Lewin’s Stage Model of Change. Unfreezing (Step 1) Motivate participants by preparing them for change Build trust and recognition for the need to change Actively participate in recognizing problems and brainstorming solutions within a group. Movement (step 2) persuading employees to agree that the status quo is not beneficial to them and encouraging them to view the problem from a fresh perspective, work together on a quest for new, relevant information, and connect the views of the group to well-respected, powerful leaders that also support the change Refreezing (Step 3) reinforce new patterns and institutionalize them through formal and informal mechanisms including policies and procedures Hartzell, S. (2014). Lewin stage model of change. Retrieved from

PHASES OF Practice Council WORK
Know the RBC Principles and your unit’s/Departments vision Read Relationship-Based Care (book) Model RBC at all times RBC Principles and reflective Questions Prepare Organize the Practice Council – assign Chair, Co-Chair, etc Create Mutual Agreements, review PG By-Laws and Charter Create Communication Network Discuss Meeting Management Structure Group Development Use of Communication Network Relationship-Based Care Principles* Questions to Guide Unit-Specific Plans- Tableau Planning This mimics the Nursing process- as Nurses we use ADPIE, in UPC we function as a group to achieve this. A Exhibit healthy interpersonal relationships with each other b. Communicate with 100% of your team c. Arrive at decisions by consensus Wessel, S., Evens, M., & Person, C. (2011). Implementation Guide for Relationship-Based Care. Minneapolis, MN: Creative Health Care Management.

PHASES OF Practice Council WORK
Time to pause and review Practice Council work Successes and challenges Relationship of unit leadership, clinical staff and UPC Consult with Unit leadership Review/ Support Choose a day to begin implementation and announce it Continuous learning and development, not perfection Periodic reviews and status checks are carried out Implement Gather information about what works Promote continued development Celebrate successes Problem-solve related issues Refresh Practice Council membership (charter) Continuous Evaluation Wessel, S., Evens, M., & Person, C. (2011). Implementation Guide for Relationship-Based Care. Minneapolis, MN: Creative Health Care Management.

DEVELOPING ACTION PLANS
Assessment Choose project Discuss with UD/CNS/Educator Conduct literature review Educate staff on proposed action plan Record baseline Incorporate staff recs Form action plan Share with everyone 1. Assess your unit using the RBC Principles & RBC Self-Assessment a. With unit leadership, review baseline outcomes measurements: 1. nurse-sensitive indicators 2. core measures outcomes 3. patient satisfaction b. Gather input of 100% of clinical staff 2. Decide on most important patient care improvement issues 3. Discuss with unit leadership the appropriateness of choices of action plans 4. Record baseline outcomes data. 5. Educate clinical staff on need for action plan. 6. Research literature and latest evidence to suggest action plan steps. 7. Use clinical staff’s ideas & suggestions whenever possible. 8. Using research, evidence and staff’s ideas, put together an action plan. Creative Health Care Management. (2011). Relationship-based care: Implementation guide (3rd ed.). Minneapolis, MN: Creative Health Care Management.

Unit Practice Councils Meeting Structure
UPC Meetings Monthly in the work environment Maximum of 4 hours All meetings are “working meetings” consisting of: First part of meeting Approval of minutes/review agenda (template on Website) Report feedback from staff Review ongoing projects Second part of meeting Divide into workgroups Third part of meeting Report back to UPC group about progress UPC meetings will be held monthly in the hospital for up to a maximum of 4 hours. All meetings are “working meetings” consisting of: We realize that there are many different care settings and facilities. We will use an inpatient setting for an example but this may look different for an ambulatory clinic which operates Monday-Friday. For the average inpatient unit the first 1.5 hours: used to approve minutes, review agenda items, report feedback from staff, review ongoing projects and assign roles and direction of work for the rest of the meeting. Next 2 hours approximately: members divide into workgroups, conduct evidence-based research, speak with staff and monitor practice (i.e. audits). Last 30 minutes approximately: members reunite, share accomplishments/action items. Chair summarizes the meeting action items and talking points to share with staff. Meeting minutes are recorded and disseminated prior to the end of each meeting. Unit Leadership is encouraged to be present during first 1.5 hours and last 30 minutes.

Necessary meeting items
Agenda Sent by chair/co-chair in advance Follows set template Includes items that follow strategic goals and scope of council (charter) Minutes Taken by designated council member Edited and sent out by Recorder (same day) to staff and uploaded to BOX Sample Revised Minute template Sign in sheet Reflects names of current council members with credentials by unit Serves as source for attendance tracking Displays representation from all roles Go to Nursing website ! Professional Governance . How will you measure your results? What are your outcomes? Where will you get the data? Are your outcomes aligned with Council goals (Charter)? 2. Priorities – what absolutely must be covered? Results – what needs to be accomplished? Sequence – in what order will you cover the topics? Timing – how much time will you spend on each topic? Be sure your minutes reflect deliverables with specific Council members assigned. 3. Stay on topic. List all tasks generated at the meeting. Make a note of who is assigned to do what, and by when. At the close, quickly summarize next steps. Be sure your minutes reflect discussion summary and next steps.

Pass around laminated templates and hang poster up !

Ronald Reagan-8-ICU UPC Communication Board

Ronald Reagan- 6-ICU UPC Board

Report out tree- Each council member is responsible for a network of people on their unit. This includes bringing their ideas to the UPC as well as communicating the UPCs projects/initiatives/outcomes. How is it done on your unit? Example: 6 ICU- each member is responsible for 10 staff to report out to and that includes finding out how they like to receive information

Communication How will you communicate to your staff? What solutions do you have ? Let's Talk more about Communication !! Distribution Lists for the Facility and System Level councils UPC's should create an outlook group contact Contact Marina Lawson for support with creating an group Communication is key ! It allows for dissemination of information for all to hear. Everyone is in the know !

Unit Practice Councils Reporting Outcomes Reporting Outcomes
World Café Event End of Fiscal year, prior to new members selection New member selection begins in May and new members will start in July. This will allow unit goals and projects to align with UCLA Health fiscal year goals. ALL THE HARD WORK WILL PAY OFF Present at EBP or at World Café World Café: 3/14/18 - Introduction of PG DIS Survey: 3/11-24/18 UPC Standardization to begin on 4/1/18 Membership changes for UPC and Councils to begin with Fiscal Year 2019 Restructure Actualization: 7/1/18 DIS Survey: 9/2-15/18 Facility Showcase: 5/19 Top three presentations to be sent to June 2019 World Café 2019 Play UPC ROLES GAME in teams of their UPC units RRUCLA- in a formal annual report and scheduled UPC presentation of outcomes at the Quality Outcomes Council. SMUCLA-, formal, poster development and presentation of outcomes in the UPC Summit as guided by the Transformational Leadership Council. RNPH- report out of project outcomes monthly to the Steering Committee and participation in the annual RNPH Summit. Recommendation: Include this??? All reporting Summits (i.e. UPC Summit) moved to June. With member selection beginning in May and new members starting in July, this will allow unit goals and projects to align with UCLA Health fiscal year goals. Reintroduce World Cafe in 2019 Two-week midpoint check in (electronically or in person) between UPC members regarding projects, audits, and research assigned to accomplish between meetings to facilitate accountability

Professional Governance U Guide Innovation- Tool
SO you have a project or IDEA ! SUBMIT It so it can go up for review. Right now its on the Homepage

Change Request Workflow
This is the workflow for a staff member to submit a practice change request.

Coordinating Council Review Rubric
This is the rubric for the Coordinating Council to review the change request. Higher points are given for a project that is feasible, aligned with Council and Health System goals, financial resources and staff/stakeholders available or an overall low need for resources.

Let’s Talk about Outcomes
And How to measure them! ! - Action plans based on the RBC principles and outcomes measures selected with unit leadership - Measuring data that matters from the point of care to the boardroom - Engaging the clinical team in selecting measurable indicators - Using data to improve clinical care and processes at the point of care - Celebrating success through evidence and evidence and measurement

UNIT & HOSPITAL LEVEL OUTCOMES
Outcomes help us understand if our results are: above average or below average Patient Satisfaction Quality Indicators RN Satisfaction Other Metrics Identified by your Practice Area Nursing Dashboard

ORGANIZATIONAL GOALS OVERSIGHT TEAM
HEALTH SYSTEM EXECUTIVE TEAM REDUCING RISK-ADJUSTED MORTALITY IMPROVING PROCESS AND OUTCOMES MEASURES IMPLEMENTING VALUE-BASED REDESIGN ENHANCING THE PATIENT EXPERIENCE REDUCING PREVENTALBE READMISSIONS STRENGTHENING PATIENT SAFETY CLINICAL Oversight Team PM: Cheryl LeHuquet PC: Anahat Dhillon, MD Oversight Team PM: Robert Martin, PsyD PC: Roger Lee, MD BO: Sherry Watson Oversight Team PM: Christine Ahn PC: Eric Esrailian, MD BO: Laura Yost Oversight Team PM: Namgyal Kyulo, DrPH PC: Rick Harrison, MD BO: Ellen Wilson Oversight Team PM: Cheryl LeHuquet PC: Chris Cooper, MD Oversight Team PM: Robert Martin, PsyD PC: Zach Rubin, MD BO: Brenda Clemens CLINICAL Sepsis Hospice/Palliative Care Rapid Mortality Review Code Blue Team Rapid Response Team CMS Core Measures Population-Based MSSP Quality Gate Measures ValU Leadership Team Value Quotient TDABC Nurse Communication Pain Management Discharge Information Ambulatory Staff CMS Readmission Indicators AMI, Pneumonia, HF, COPD Transitions of Care Home Health SNF Selected Service Line Optimizations AHRQ PSIs VTE CLABSI Iatrogenic PTX CAUTI SSI Decub Ulcers OPERATIONAL OPERATIONAL Performance Excellence Data Analytics (Crimson, Cogito) Physician Quality Officers Nursing Alignment (Magnet) Clinical Documentation Improvement 59 Link to O/C Templates

Unit Dashboard A helpful starting point is to check your unit dashboard! Check with Manager how before initiating a project. Data Should always ave 3 number sets. Pre- middle and post, especially to be considered a MAGNET exemplar. What does Green, yellow and red mean? Does anyone know?? Ensure you contact Bryant Duong at RR for access to Tableau SM/NPH?

How to initiate a Project
From the Mednet homepage in the center column View Analytics OHIA portal Capacity | MOVERS | Tableau server A database for all current and ongoing projects All nursing and UPC members to have access Contact Tracy Guy and Bryant Duong if you do not have access

How to initiate a Project
From the By-Laws appendices Lean Quality Improvement Tools A3 Lean Quality Improvement Tools A4 Hybrid EBO QI Tool A3 EBP Focus PDCA PG Council Meeting Minutes Templates

Sweet steps for UPC success…
No I don’t have real cupcakes! But I do have a fun poster board to help with your success as a UPC member. Continually advance the profession we must have a commitment to lifelong learning and Professional development.

Resources for Strengthening Leadership Skills
CORE Human Health Human Resources (leadership courses) Advisory Board Frontline nurse leaders Leadership Academy Leadership assessments Free personality test Annual self-appraisals and peer feedback Association of California Nurse Leaders Harvard Business Leadership Assessment

“Never doubt that a small group of thoughtful committed citizens can change the world; indeed, it’s the only thing that ever has.” Margaret Mead

Professional Governance Model Coordinating Council System Councils Facility Councils Unit Practice Councils Leader Practitioner Patient Family Community Scientist Transferor of Knowledge Transformational Leadership To cultivate strong professional practice and positive outcomes at UCLA Health by means of strategic planning, advocacy, influence and oversight.. The TL Council engages and supports the UCLA Health Empirical Outcomes Council (EOC) in achievement of shared goals across the health system. Purpose The primary purpose of the Exemplary Professional Practice (EPP) Council is to assure the adoption of evidence-based best practices to optimize patient, nursing and organizational outcomes. The Council upholds the commitment to and implementation of the Professional Practice Model; cultivates a culture of safety that empowers nursing staff to take advantage of the opportunities and resources available to them, and equips clinical nurses with a comprehensive understanding and utilization of professional role-based practice. The EPP Councils will support and collaborate with the UCLA Health Practice Council (PC) on shared goals and activities The primary purpose of the New Knowledge, Innovations, and Improvements (NK) Council is to drive continuous improvement and innovation at UCLA Medical Center, _______________ by means of evidence-based practice (EBP), nursing research, innovation, and technology adoption in nursing practice. NK Council members will strive to contribute to the science of nursing by enhancing or developing new care processes through the application of existing and/or new evidence. The NK Councils will support and collaborate with the UCLA Health Nursing Research and Innovation Council (RIC) on shared goals and activities. The primary purpose of the Structural Empowerment (SE) Council is to empower and engage nurses in cultivating strong professional practice at UCLA Medical Center, ____________ through the implementation of effective structures and processes to foster nursing excellence. SE Council members promote professional development, nurse recognition, engagement in relationships and partnerships across the health care continuum, and a positive image of professional nursing. The SE Councils support and collaborate with the UCLA Health Professional Development Council (PDC) on common goals and activities.

Transformational Leadership Councils
Scope Strategic Planning Effectiveness, efficiency, performance Advocacy and Influence Guide change process Visibility, Accessibility, and Communication Establish methods for nurses to access formal nurse leaders Oversight of Quality and Safety Monitor activities and outcomes of each facility council and UPCs. Scope of Activities Strategic Planning Align mission, vision, values, and strategic and quality plans with the organization’s priorities to improve performance Provide mechanisms for all nurses to advocate for resources to support nursing and organizational goals Improve the organization’s effectiveness and efficiency Advocacy and Influence Assist the CNO with organization-wide changes Guide the change process Visibility, Accessibility, and Communication Solicit input from nurses on how to improve the nurse practice environment and patient experience Assist the CNO with visibility and accessibility to direct care nurses Establish methods for nurses to access formal nurse leaders Oversight of Quality and Safety Monitor activities and outcomes of each facility council and UPCs. Provide guidance and feedback to assure council alignment, effectiveness and contribution to nursing excellence. Membership: Unit Practice Council (UPC) chair (from each unit/department), Unit Director (UD), Clinical Nurse Specialist (CNS), Assistant Unit Director, Facility Council Chairs, Nursing Quality Outcomes/Magnet Coordinator, Analyst, Patient Experience representative ad hoc Leadership: Clinical nurse chair and co-chair Executive Sponsor: Chief Nursing Officer

Transformational Leadership Councils
Membership Unit Practice Council (UPC) Chair (from each unit/department) Unit Director (UD) Clinical Nurse Specialist (CNS) Assistant Unit Director Facility Council Chairs Nursing Quality Outcomes/Magnet Coordinator Analyst, Patient Experience Representative (ad hoc) Leadership: Clinical Nurse UPC Chair and Co-Chair Executive Sponsor: Chief Nursing Officer Scope of Activities Strategic Planning Align mission, vision, values, and strategic and quality plans with the organization’s priorities to improve performance Provide mechanisms for all nurses to advocate for resources to support nursing and organizational goals Improve the organization’s effectiveness and efficiency Advocacy and Influence Assist the CNO with organization-wide changes Guide the change process Visibility, Accessibility, and Communication Solicit input from nurses on how to improve the nurse practice environment and patient experience Assist the CNO with visibility and accessibility to direct care nurses Establish methods for nurses to access formal nurse leaders Oversight of Quality and Safety Monitor activities and outcomes of each facility council and UPCs. Provide guidance and feedback to assure council alignment, effectiveness and contribution to nursing excellence. Membership: Unit Practice Council (UPC) chair (from each unit/department), Unit Director (UD), Clinical Nurse Specialist (CNS), Assistant Unit Director, Facility Council Chairs, Nursing Quality Outcomes/Magnet Coordinator, Analyst, Patient Experience representative ad hoc Leadership: Clinical nurse chair and co-chair Executive Sponsor: Chief Nursing Officer

Exemplary Professional Practice Councils
Scope Professional Practice Model Care Delivery System Interprofessional Care Accountability, Competence, and Autonomy Ethics, Privacy, Security, and Confidentiality Culture of Safety and Quality of Care Exemplary Professional Practice Council You’ll notice that councils here is plural. There will be one EPP Council per facility. Scope of Activities Professional Practice Model Involve nurses in the implementation and evaluation of the professional practice model at the facility level Care Delivery System Promote the delivery of relationship-based care with colleagues, patients and families Promote interprofessional collaborative practice Incorporate regulatory and specialty standards/guidelines into the care delivery system Evaluate professional organizations’ standards of practice Use internal and external experts to improve the clinical practice setting Interprofessional Care Provide nurses with leadership opportunities in collaborative interdisciplinary activities Encourage nurse participation in interprofessional groups that implement and evaluate coordinated patient education activities Accountability, Competence, and Autonomy Provide nurses with resources to support decision-making in autonomous nursing practice Perform nursing peer case reviews Support and promote nurse autonomy through the organization’s governance structure for shared decision-making Ethics, Privacy, Security, and Confidentiality Encourage use of available resources to address ethical issues Culture of Safety and Quality of Care Evaluate and improve workplace safety for nurses Involve nurses in the facility-wide proactive risk assessment or error management Involve nurses in the review, action planning, and evaluation of patient safety data at the unit level Involve nurses in the implementation and evaluation of national or international patient safety goals. Evaluate and improve workplace safety and healthy practice environments for nurses Membership: Clinical Nurse from each unit/department, Unit Director, Clinical Nurse Specialist, Administrative Nurse 1, Assistant Unit Director, subject matter experts (SME) for nursing quality/safety indicators Leadership: Clinical Nurse Chair and Co-Chair Administrative Sponsor(s): CNS and UD/Manager

Exemplary Professional Practice Councils
Membership Professional Nurses at the direct care level (ANI,CNI/II/III) Unit Director Clinical Nurse Specialist Assistant Unit Director Subject Matter Experts (SME) for nursing quality/safety indicators Leadership: Clinical Nurse Chair and Co-Chair Administrative Sponsor(s): CNS and UD/Manager

New Knowledge, Innovations and Improvements Councils
Scope Research Coach nurses, use published research findings Support human rights Disseminate knowledge Evidence-Based Practice Translate knowledge into nursing EBP Innovation Discuss, review and support innovations/adoption of technology Participate in design and use of space to support practice Scope of Activities Research Coach nurses at all levels to evaluate and use published research findings in their practice Engage nurses in the conduct of research Ensure clinical nurses support the human rights of participants in research Facilitate dissemination of knowledge generated through nursing research and EBP projects Evidence-Based Practice Translate new knowledge into new nursing evidence-based practices Innovation Discuss, review, and support innovations in nursing practice Involve nurses in the following: 1) Evaluation and allocation of technology and IT systems to support practice, or 2) Architecture and space design to support practice

New Knowledge, Innovations and Improvements Councils
Membership Professional Nurses at the direct care level (ANI,CNI/II/III) Unit Director Clinical Nurse Specialist (RIC member) Assistant Unit Director Nurse Scientist Nurse Informaticist Nursing Quality Outcomes/Magnet coordinator Leadership: Clinical Nurse Chair and Co-Chair Administrative Sponsor: CNS or UD/Manager Scope of Activities Research Coach nurses at all levels to evaluate and use published research findings in their practice Engage nurses in the conduct of research Ensure clinical nurses support the human rights of participants in research Facilitate dissemination of knowledge generated through nursing research and EBP projects Evidence-Based Practice Translate new knowledge into new nursing evidence-based practices Innovation Discuss, review, and support innovations in nursing practice Involve nurses in the following: 1) Evaluation and allocation of technology and IT systems to support practice, or 2) Architecture and space design to support practice Membership: Clinical Nurse from each unit/department, Unit Director, Clinical Nurse Specialist (NPRIC member), Assistant Unit Director, Nurse Scientist, Nurse Informaticist, Nursing Quality Outcomes/Magnet coordinator Leadership: Clinical RN Chair and Co-Chair Administrative Sponsor: CNS or UD/Manager

Structural Empowerment Councils
Scope Professional Engagement Commitment to Professional Development Commitment to Community Involvement Recognition of Nursing Scope of Activities Professional Engagement Encourage and support nurse participation in professional governance and other structures and processes to support nursing excellence. Encourage and support nurse participation in local, regional, national, or international professional organizations. Commitment to Professional Development Support nurses’ continuous professional development, including professional nursing certification. Support clinical advancement processes and leadership development. Provide opportunities to improve nurses’ expertise in teaching a patient or family Participate in reviewing and evaluating organizational structures and programs that support professional development. Commitment to Community Involvement Support nurses’ participation in community healthcare outreach Develop partnership between nurses and the community based on identified community needs. Recognition of Nursing Recognize nurses for their contribution in addressing the strategic priorities of the organization. Participate in planning and implementation of recognition programs.

Structural Empowerment Councils
Membership Professional Nurses at the direct care level (ANI,CNI/II/III) Unit Director, Clinical Nurse Specialist Assistant Unit Director Nursing Professional Development Specialist (NPDS) Center for Nursing Excellence (The CENTER) NPDS Nursing Quality Outcomes/Magnet Coordinator Leadership: Clinical Nurse Chair and Co-Chair Administrative Sponsor(s): NPDS and CNS or UD/Manager Membership: Clinical Nurse from each unit, Unit Director, Clinical Nurse Specialist, Administrative Nurse I, Assistant Unit Director, Nursing Professional Development Specialist (NPDS), The Center for Nursing Excellence (The CENTER) NPDS, Nursing Quality Outcomes/Magnet Coordinator Leadership: Clinical RN Chair and Co-Chair Administrative Sponsor(s): NPDS and CNS or UD/Manager Membership: Clinical Nurse from each unit, Unit Director, Clinical Nurse Specialist, Administrative Nurse I, Assistant Unit Director, Nursing Professional Development Specialist (NPDS), The Center for Nursing Excellence (The CENTER) NPDS, Nursing Quality Outcomes/Magnet Coordinator

Professional Governance System Councils Coordinating Council System Councils Facility Councils Unit Practice Councils Leader Practitioner Patient Family Community Scientist Transferor of Knowledge Wording Emphasize going to councils is WITH executives not TO

Empirical Outcomes Council
Scope To review identified system outcome measures and make/approve recommendations for strategic intervention to optimize performance. To assure that nursing performance and related outcome metrics align with the strategic priorities of the organization and the nursing department. For Example: Nurses from one UPC develop a serenity room that empirically demonstrates a decrease in felling overwhelmed, a decrease in experiencing trauma and increase in compassion satisfaction. This is brought to the Empirical Outcomes Council for approval for System implementation It is noted on patient satisfaction surveys across the system that patient satisfaction scores regarding nursing education about medication is below benchmarks. Clinical nurses propose that there be an extra prompt in the AVS system wide to ensure that when patients are discharged that they understand their discharge medications

Empirical Outcomes Council
Membership Magnet Program Director Professional Development Specialist Nursing Quality Improvement Specialist From each entity: UD/Manager, CNS, Transformational Leadership Council chairs, Nursing Quality Outcomes/Magnet Coordinator, Nursing Quality Analyst Leadership: Clinical Nurse Chair and Co-Chair Executive Sponsor: Member of Chief Nurse Executive Council The examples of the serenity room and AVS enhancement would go to the Empirical outcomes council because it would require the approval, guidance of or appraisal of the Magnet Program Director so magnet exemplars can be identified as they are implemented rather than having to scramble before certification or re-certification. As well the Professional Development Specialist, Nursing Quality Improvement Specialist would be there. And from each entity there would be representation of UD/Managers for buy-in and finances, CNS for clinical guidance, Transformational Leadership Council chairs, Nursing Quality Outcomes/Magnet Coordinator and Nursing Quality Analyst. Leadership: Clinical Nurse Chair and Co-chair elected from the Transformational Leadership Council Executive Sponsor: Member of Chief Nurse Executive Council

Practice Council Scope
To foster exemplary patient care through the development, review, revision, approval, and dissemination of clinical nursing policies, guidelines, and practice alerts To ensure that policies and guidelines are based on the latest research and evidence. To oversee and provide input by clinical nurses in collaboration with nursing leadership on the approval process for nursing policies and guidelines. To review nursing policies and revise, approve and disseminate them To ensure policies are research and evidence based To make sure there is clinical nurse input Example: It is determined by the facility exemplary professional practice committees that Falls are above benchmarks at SM, RR, and RNPH. As a result of new evidence-based innovation, the falls policy (that all three hospitals are scoped into) needs a change. The purpose of the Practice Council is to provide a mechanism for UCLA Health Nurses to implement and maintain standards of clinical practice and patient care consistent with evidence-based practice and the requirements of regulatory agencies.

Practice Council Membership
Chairs/Co-Chairs from the Exemplary Professional Practice Council Unit Director CNS Nursing Professional Development Specialist APRN/NP Nurse Scientist/EBP Specialist Leadership: Clinical Nurse Chair and Co-Chair Executive Sponsor: Member of Chief Nurse Executive Council The system falls example would need approval, guidance and support from: read off the membership

Research and Innovation Council
Scope To support, encourage, and facilitate nurses’ participation in research activities (utilization and conduct) so that optimum patient outcomes are achieved. The RIC functions under an operational strategic plan that promotes system-wide, multi-disciplinary research, evidence-based practice, innovation and technology adoption. The purpose of the Research and innovation Council is to increase the scientific foundation of practice through innovation and nursing research activities throughout UCLA Health, including research and innovation infrastructure, development, utilization, education and dissemination. To support nurses participation in research and innovation To promote system-wide, multi-disciplinary research, evidence-based practice, innovation and technology adoption For example introductions of new smart phones and ipads for patients would be a technology innovation that would go system wide. Another example would be introduction of new equipment

Research and Innovation Council
Membership Chairs/Co-Chairs from the New Knowledge & Innovation Council (4) Nurse Scientist Unit Director CNS Nursing Professional Development Specialist APRN/NP Nursing Informaticist Leadership: Clinical Nurse Chair and Co-Chair Executive Sponsor: Member of Chief Nurse Executive Council The smart phone, ipad and equipment example would need approval, guidance and input from: Read off the membership

Professional Development Council
Scope To increase current clinical nurse education levels and professional certifications To promote professional nursing clinical advancement and career development To ensure that educational activities are relevant to the advancement of nursing excellence. To increase meaningful recognition of nurses DAISY, Nurses Week The purpose of the Professional Development Council is to provide a mechanism for UCLA Health nurses to participate in analyzing their own developmental and learning needs, and in planning to enhance clinical competency, ongoing knowledge and skill development, and to promote continuous professional growth. Increase professional certifications Promote clinical advancement and career development Ensure that education is relevant Provide recognition of nurses Examples would be the development of revised requirements for CNIII, Daisy Awards, Nurses Week activities, revising nursing competencies and ways of measuring competency

Professional Development Council
Membership Chairs/ Co-Chairs from the Structural Empowerment Councils (4) Unit Director CNS Nursing Professional Development Specialist APRN/NP Nursing Informaticist Leadership: Clinical Nurse Chair and Co-Chair Executive Sponsor: Member of Chief Nurse Executive Council Daisy awards, revisions of clinical ladders, developing new competencies, and planning nurses week activities and recognition would best be served by membership that included:

UCLA Health Professional Governance Model
Coordinating Council Purpose: The primary purpose of the Professional Governance Coordinating Council (PGCC) is to assure alignment of all professional governance activities across UCLA Health. The Council will review reports from each system council and make/approve recommendations and referrals to appropriate groups. The Council assures that nursing activities, performance and related outcome metrics align with and support the strategic priorities of the organization and the nursing department

Professional Governance Coordinating Council
Scope of Activities Nursing Strategic Planning Collaborates in the strategic planning process in alignment with organizational Provides oversight and support for professional governance councils to assure ongoing effectiveness Establishes methods for effective two way communication between clinical nurses Charters new workgroups and makes referrals to councils/others for performance Assures accountability for council deliverables Scope of Activities Nursing Strategic Planning Collaborates in the strategic planning process in alignment with organizational priorities. Assures integration and collaboration with nursing and interprofessional colleagues and departments. Infrastructure Effectiveness a. Provides oversight and support for professional governance councils to assure ongoing effectiveness. b. Establishes methods for effective two-way communication between clinical nurses, formal leaders and councils related to all aspects of practice and the practice environment. c. Charters new workgroups and makes referrals to councils/others for performance improvement initiatives as needed. d. Assures accountability for council deliverables. III. Advocacy and Influence a. Advocates for resources to support nursing practice and outcomes. b. Engages in policy and legislative activities in alignment with mission, vision and strategy. IV. Visibility, Accessibility, and Communication a. Solicits input from all councils to assure that all nursing voices are heard. b.Facilitates leadership visibility and accessibility for nurses at all levels.

Scope of Activities, continued Advocates for resources to support nursing practice and outcomes. Engages in policy and legislative activities in alignment with mission, vision and strategy. Visibility, Accessibility, and Communication Facilitates leadership visibility and accessibility for nurses at all levels. Continued. Advocates for resources to support nursing practice and outcomes. b. Engages in policy and legislative activities in alignment with mission, vision and strategy. IV. Visibility, Accessibility, and Communication a. Solicits input from all councils to assure that all nursing voices are heard. b. Facilitates leadership visibility and accessibility for nurses at all levels.

Members CNEC members (8) Unit Director from each system council (4) Clinical Nurse Specialist from each system council (4) Chair from each system council (4) Transformational Leadership Chairs from each entity (4) Leadership: Elected Chair and Co-Chair Executive Mentor: Chief Nursing Executive Membership: CNEC members (8), Unit Director from each system council (4), Clinical Nurse Specialist from each system council (4), Chair from each system council (4), Transformational Leadershipchairs from each facility(4) Leadership: Elected Chair and Co-Chair Executive Mentor: Chief Nursing Executive

Professional Governance Model Coordinating Council System Councils Facility Councils Unit Practice Councils Leader Practitioner Patient Family Community Scientist Transferor of Knowledge Questions ???!! HOURS EXPECTATION for COUNCIL MEMBERS by COUNCIL Of note for all these meetings, there was discussion around additional ad hoc work to support the councils that may be outside of these estimates. But I think it’s a place to start discussion and give unit leadership and clinical RN’s a general expectation: EOC: 16-20 hours for TL Chairs and Co-Chairs (attending TL, EOC, CC, and prep/travel time) hours for other system chairs of PC, PDC, and RIC (attending their system meeting- 4 hours, 1 planning for agenda, 90 min for CC, 2 hours for EOC. In addition to any chair/co-chair work) Of note, PDC defined their hours as 8-9/month, PC set the expectation of approximately 12/month, so I gave a general range PDC: Bedside RN's SE Chairs: 16 hours SE Co-Chair: 5 to 9 (if serving as an alternate for chair) SE Subcommittee leads: 6 SE Members: 2 hours at facility + PDC if attending= 6 Other PDC Members PDC member= 4 PDC Chair PDC Chair= 4 for PDC +1 planning for agenda+ 90 min for CC+ 2 hours for EOC= hours PC: Approx. 12 hours for chair/ co-chair Approx. 4 hours for attendees Approx. 2 hours for Facility level EPP -with the caveat for additional time for dissemination of information per unit leadership request -need participation at strategic planning meeting on 10/5, need at least 20 clinical nurses for a minimum of 4 hours RIC (of note, these hours may change based on recommendations and timing for new member trainings, the discussion was mostly around hours expectation for new members, rather than chairs/co-chairs since they’ve been identified above) Hours expectations for new attendees: -CITI Training: 4 hours -Research process: at least 6 hours for the following topics: identifying a subject, PICO Questions, lit search and analysis using a rubric, survey design, QI/PI/research, data analysis , writing an abstract- this may change into a self-paced, self-study model, (at least an hour per topic) Once onboarded, the hours expectation is approximately hours for bedside RN’s: -NK at facility: 1.5 hours -NK-RIC Travel Time at 1 hour -RIC at system: 4 hours -more expectations around the time of conferences, grand rounds, etc.

POST- Course Quiz onlinepoll.ucla.edu/polls/2050
Jeopardy Welcome ! Good Morning. Quick Introduction of Course Coordinator and facilitators Breakfast We have 4 hours today to focus on Professional Governance ( previously known as shared governance here at UCLA Health) There will be a break about midway through the class. In order to get what you need out of this class Questions are welcomed and encouraged, however, as the content unfolds your questions may be addressed in the next content section. Please keep this in mind. Keeping in consideration our agenda we ask that you please hold questions until after each section. There will be time for table discussion and questions after each section. You may be wondering why you have the large poster on your table.? The poster is for you and your tablemates to share and look at throughout the class. Please leave them here for tomorrow's class to use as well. We encourage you to discuss and write questions together and then working with your table you may nominate a scribe and a spokesperson for your table. Thank you for your understanding. In an effort to stay in alignment with sustainability we have “gone green”. Today's content may be viewed and downloaded on an electronic device. Restrooms- are located on the 3rd floor just below us, Please silence our cell phones, pagers and other electronic devices. Slides to follow along World Café Thank you for being here! We have a full morning agenda with lots of activity this afternoon! We know that as nurses we like to move around so we planned booths for this afternoon. This event was at max capacity so please I encourage you go back and share this information with your colleagues who were unable to attend . We hope everyone is enjoying breakfast. Bathrooms are out to the hall next to us. As a reminder lets silence all electronic devices. Why am I passionate about professional governance ( shared governance) Clarify term is interchangeable, because everyones voice can be heard. Raise your hand if you do NOT want your voice to be heard.,,, Of course- Who doesn’t want to be heard? We all DO! That’s the power of Professional governance it puts the right people at the right table at the right time to make the right decisions! Before we jump into the learning objectives. Id like to thank the Professional Governance Steering Committee for all their hard work over the past year, plus to help with this restructure. A special thank you to the Staff engagement work-group for helping get us here to this day with all the fun learning activities that they’ve planned for you.Thank you for being here to learn about Professional Governance and We look forward to a great day!!!

Evaluation Link Show the participants through the Mednet Nursing homepage

Let’s Play !

Professional Governance: The First Steps
If you have any questions regarding this course or to request a consult from the Center for nursing excellence. Please contact me in the link provided.

References 2013 American Nurses Credentialing Center (ANCC)
Guanci, J. (Speaker, Writer). (2013). Out with the old, in with the new: Magnet manual revision [Audio podcast]. Retrieved from Koloroutis, M. (Ed.). (2004). Relationship-based care: A model for transforming practice. Minneapolis, MN: Creative Health Care Management. Swanson, K. (2013). Nursing as informed caring for the well-being of others. Journal of Nursing Scholarship. Watson, J. (2015, April 27). Welcome to Human Caring. Retrieved February 17, 2016, from Wessel, S., Evens, M., & Person, C. (2011). Implementation Guide for Relationship-Based Care. Minneapolis, MN: Creative Health Care Management. Wisdom of geese [Video file]. (n.d.). Retrieved April 4, 2016, from

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