1. Heritage Valley Health System Heritage Valley Beaver and SEIU Healthcare PA RNs Joint Leadership Collaboration for Quality Improvement

2. Objectives Outline Provide a background on Heritage Valley Beaver Describe our approach to building a collaborative relationship to improve care –What did we accomplish? –What did we learn? 1.Identify steps that can be taken in the work environment toward collaboration and quality care. 2.Identify the processes and communication skills needed for a functioning collaborative environment.

3. About Heritage Valley Heritage Valley Health System is a progressive community- based healthcare system located in southwestern Pennsylvania. Heritage Valley consists of: Two Hospitals: Heritage Valley Beaver, with 361 beds and Heritage Valley Sewickley, with 186 beds Four affiliated physician groups More than 400 physicians and nearly 4,000 employees, 580 Registered Nurses represented by SEIU Healthcare PA since 2001 at the Heritage Valley Beaver campus We offer a broad range of medical, surgical and diagnostic services at our hospitals and community satellite facilities, and in physician offices. Heritage Valley serves residents in: Western Pennsylvania: Allegheny, Beaver, Butler and Lawrence counties Eastern Ohio and the panhandle of West Virginia Background

4. Initial Structures Professional Practice Committee –Five staff RNs –Five Nurse Leaders –Meet monthly for 2 hours –Focus on Nursing Professional Practice Nurse Sensitive Indicators Labor Management Committee –Five staff RNs –Five Nurse Leaders –Meet monthly for 2 hours –Focus on matters of mutual concern related to contract administration RESULTS: Able to work through some issues through these structures, but not completely effective. Nurses seeking more effective voice in decision making.

5. A Different Approach Getting Started In the Fall of 2007: SEIU Union leadership approached hospital CEO and members of senior management. Wanted to focus on four areas 1.Trust 2.Respect 3.Communication 4.Voice in Nursing Hospital interested in enhancing the relationship with the union on a more strategic level.

6. Overall Structure Joint Leadership Meetings Comprised of –7 staff RNs together with SEIU Leadership –CEO, COO/CNO, VP Patient Care Services, Nursing Directors, VP of Human Resources and Manager HR Met Monthly for 2-3 hours Held our first meeting in October 2007

7. Improved Communication Conducted Town Hall Meetings Made changes in Nursing Practice Political Action Involvement Contract Negotiations PROGRESS what did we accomplish?

8. Communication Shared Heritage Valley Vision and RN Union Vision for our organizations and our relationship Developed a Joint Vision Created an Email Distribution for staff RN union leaders Regularly shared information about important issues and developments Supported the COO Blog PROGRESS what did we accomplish?

9. Town Hall Meeting Meetings throughout the day for RNs –Led by Union RNs and management –Included CEO and President of SEIU HCPA Used “polling” tool to get real-time input and data from RNs on –Communication –Satisfaction –Patient Care PROGRESS what did we accomplish?

10. The level of communication that I receive from 1. Excellent 2. Adequate 3. Poor the Union is…. Heritage Valley is…. 1. Excellent 2. Adequate 3. Poor Polling Results

11. My preference for receiving all communications is…. 1.Paper/Memos 2.Paper/Postings 3.Email 4.Face to Face 5.Other Polling Results

12. Changes to Nursing Practice and Patient Care Initiatives 1.Developed unit-based initiatives to improve Nurse satisfaction 2.Reviewed Nurses satisfaction scores on ongoing basis 3.Worked thru various Operational Initiatives –Step Down Unit –Admission Discharge Team –Shared Governance / Unit Based Practice Councils PROGRESS what did we accomplish?

13. Admission Discharge Team Initial concerns with amount of work required for admissions and discharges raised at Town Hall Meetings. Team formulated: Collaborative effort between management and front-line staff RNs Team created Job Description, Required Qualifications and staffing model Hired 4.4 additional FTEs Educated staff Communicated plan back to Nursing at subsequent Town Hall Meetings Implemented in Dec 2009 PROGRESS what did we accomplish? The ADT primary focus is expediting the admission and discharge processes, completing medication reconciliation and assuring compliance with Core Measures

14. Political Action The Union and management 1.Attended conference sponsored by Partnership for Quality Care (national labor-management coalition on health care policy) in Washington, DC 2.Spoke with elected local leaders regarding funding and legislation. PROGRESS what did we accomplish?

15. Contract Negotiations These meeting were instrumental in signing a one year extension to our contract in 2009 with wage and benefit freezes when the economy was bad. And in 2010, although we held traditional contract negotiations, both parties were able to successfully negotiate a 3 year contract. PROGRESS what did we accomplish?

16. Assessment of Progress At the end of each year we did an assessment of whether the meetings were successful and should we continue to have them. Used polling technology to complete the Assessment Both parties were in agreement that they were worthwhile to continue.

17. The Joint Leadership Meetings have improved the overall relationship between SMG & Nurse Union Leaders? 1.Strongly Agree 2.Somewhat Agree 3.Somewhat Disagree 4.Strongly Disagree 5.Not Sure Assessment Questions Polling Results

18. The meetings have resulted in better communication between SMG & Nurse Union Leaders? 1.Strongly Agree 2.Somewhat Agree 3.Somewhat Disagree 4.Strongly Disagree 5.Not Sure Assessment Questions Polling Results

19. The meetings are worthwhile and a good use of my time? 1.Strongly Agree 2.Somewhat Agree 3.Somewhat Disagree 4.Strongly Disagree 5.Not Sure Assessment Questions Polling Results

20. Lessons Learned Sharing our Vision and finding commonalities was key Regular meetings with support from the Top Being open and honest, even when difficult Commitment to the process Challenging to carry out the work in between meetings