The nursing shortage has led to more than a scarcity of RNs at the frontline of care. Healthcare organizations are faced with vacancies for professionals to perform quality management, or QM, activities as well. Metropolitan Jewish Health System, Brooklyn, N.Y., met the recruitment challenges with an innovative initiative design to educate and prepare nurses for QM roles.
Metropolitan, a recognized leader in the field of integrated healthcare, includes participating agencies and programs that serve more than 40,000 individuals and families in the greater NY metro area. The services consist of managed care, home care, hospice, palliative care, skilled nursing facilities, and adult day healthcare.
QM vacancies call for quality candidates. When focused advertising and recruitment campaigns to fill several QM positions yielded few qualified nurses’ resumes, Metropolitan looked for a novel approach to fill them. The Metropolitan Quality Management Program Leadership team, led by myself and supported by three directors who cover the Home and Continuing Care, Long-Term Care, and Managed Care divisions, held brainstorming sessions to discuss recruitment challenges. The team decided to create a learning environment within Metropolitan aimed at providing the education, skills, practical experience, and mentoring of nurses who would become competent QM coordinators.
A Program Is Born
Within three months, three directors of Quality, and the directors of Infection Control, Health Information Management and Professional Practice/Outcomes Management, developed the Metropolitan Quality Management Institute, or QMI, a robust educational program with content committed to quality and patient safety. They created a curriculum with several modules that include —
Introduction to the history of quality in healthcare
Development of a QA Plan and evaluation; Evidence-based practice; Performance improvement conceptual models
Team leading and facilitation skills
Use of statistical process control tools and data management
Risk management and legal issues in healthcare
Root cause analysis and failure mode and effect analysis
Health information management, HIPAA, confidentiality, and the medical record
Basic epidemiological theory and infection control surveillance, control and prevention
New York State regulatory requirements
The Joint Commission standards
Center for Medicare/Medicaid Services conditions of participation
External data sets and publicly reported measures
Benchmarking and dashboards
The “Metropolitan QMI” curriculum was guided by study content for the Certified Professional in Healthcare Quality, or CPHQ, exam, with the expectations that the QM coordinators would be prepared to sit for the CPHQ Certification exam within two years.
CPHQ status, according to David S. Loose, RN, MSN, CPHQ, chair of the Healthcare Quality Certification Board, recognizes professional and academic achievement by individuals in the field of healthcare QM. The CPHQ program, fully accredited by the National Commission for Certifying Agencies of the National Organization for Competency Assurance, is the only international voluntary certification program in the field of healthcare QM to achieve this accreditation, Loose says.
Once the curriculum was completed, the Metropolitan Nurse Recruitment Department assisted in the development of recruitment and advertising strategies.
Historically, nurses have most often filled the role of QM/QA coordinator. According to Thomas Smith, RN, president of the National Association for Healthcare Quality, 43% of NAHQ is comprised of nurses. The decision was made to target nurses, but other qualified healthcare professionals would be considered as well.
We decided to market the initiative internally first to provide incumbents an opportunity to apply. The response was positive but did not yield enough candidates to fill all four positions. To enhance the selection of candidates, Metropolitan undertook an external advertising campaign and successfully recruited nurses, social workers, and therapists.
Of the 16 applicants selected, a panel of QM directors interviewed seven candidates, focusing attention on candidates’ experience in healthcare, QM, leadership or management, regulatory affairs, accreditation processes, teamwork, and project management.
Four candidates were accepted and offered full-time positions within one of the three Metropolitan divisions and, as part of the recruitment strategy, provided QM exposure in several delivery models across the system.
Next, directors, experts in a particular area, presented the module pertaining to their expertise to participants in four-hour blocks of time, every other week. Within six months, all participants had completed the QMI. At the end of each session, participants evaluated the learning objectives inherent in each module.
Incumbent QM coordinators participated in the QMI to ensure consistency in the program’s implementation.
Proof in the Outcomes
As a result of QMI’s success, many of Metropolitan’s leaders have expressed an interest in providing modules tailored to leadership and management needs throughout the system. These will be available in January 2009.
“Before the curriculum was even developed, we knew we wanted a program that offered far more than the standard education on healthcare quality,” said Eli S. Feldman, Metropolitan’s president and CEO. “The first group of participants to complete the program has proven that our approach was right on target. Not only are they far more knowledgeable on quality management issues, they also are among our best advocates and recruiters.”