Research Paper Assessment

Name: Jean Biacsi Date: September 22, 2012 Student ID: Email: jandebiacsi@gmail.com

Complete your 2000 word research paper and insert it in the space below. Then email this document as an attachment to assessment@icoachacademy.com

Coaching for Mid-level Nurse Leaders is the Key to Successful Healthcare Reform

Copyright 2012 Jean Biacsi. All Rights Reserved

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Coaching for Mid-level Nurse Leaders is the Key to Successful Healthcare Reform

Jean Biacsi RN MBA Certified Professional Coach Program International Coach Academy

Coaching done well may be the most effective intervention designed for human performance. Atul Gawande M. D.

Copyright 2012 Jean Biacsi. All Rights Reserved

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Table of Contents

Abstract. 4 Introduction.. 5 State of the Health Care Industry. 6 Implications for Mid-Level Nurse Leaders7 Retention vs. Turnover8 The Business Case for Investing in Nurse Leaders9 The Role of Coaching10 Calculating Return-On-Investment11 Conclusion.12 References.13

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ABSTRACT

The purpose of this research paper is to provide the reader with the evidence that the provision of coaching for the mid-level leader, specifically as it pertains to nurse leaders will lead to positive results. The healthcare industry is undergoing an enormous transition with the catalyst of this change being health care reform. Research indicates that nurse leaders will play a pivotal role in the success of the industrys transformation. The professions leaders recognize the gaps in the nurse leaders educational preparation and have cited coaching as a key component of any plan to support and prepare nurse leaders to take on the expanding roles demanded by reform. The industry has historically functioned on very narrow margins and with the onset of pay for performance the margins will be further reduced. The result is limited financial resources. Under this scenario the executives in the industry require solid evidence that the investments that are made will provide a substantial enough return to justify the use of the scarce financial resources. The power of coaching to improve performance at one of the most critical

and influential levels of the organization is supported by the professions leaders.

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INTRODUCTION

There has not been a period in the healthcare industry history where the need to have all leaders, at every level of the organization, prepared and ready to expand their individual roles and play key roles in the successful transformation of the industry as there is now. Unfortunately, many leaders, and particularly nurse leaders, have not been educationally prepared or supported to confront these massive changes. Many articles have been written by leaders within the profession, and outside of the profession, as well as multiple studies that include coaching as a key component of any plan for successful reform. Research has supported the value of coaching to transform behaviors that lead to markedly improved performance which then results in improved quality and significant financial success. Yet with all this data that suggests the profound value of coaching, skepticism persists. Given the limited financial resources being experienced by the industry in its entirety, the imperative to be able to demonstrate a quantifiable return on any investment has never been greater. This paper will focus on the drivers behind the current state of the industry; the implications for mid-level nurse leaders; retention vs. turnover; strategies to address the challenges ahead; the business case for investing in coaching for nurse leaders and techniques to measure and demonstrate quantifiable return on investment data.

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STATE OF THE HEALTHCARE INDUSTRY

The Patient Protection and Affordable Care Act (ACA) was passed by Congress in 2009 in response to alarming increases in healthcare costs; the lack of health insurance coverage and access to care for millions; and the declining quality of clinical care. The healthcare system, as a whole, is severely broken and incentives are upside-down. In truth, the industry is not about healthcare but all about sick care. Revenues for all levels of providers of care are based entirely on the provision of care and services rather than on prevention. The transformation that is necessary is both broad and deep and riddled with controversy from within the industry and outside. In a recent Gallup Survey titled, Nursing Leadership from Bedside to Boardroom it states, Nursing will be at the center of this reformNurses must learn to consider both patient and the health system while working on a team and being a better team player. Not every player in the industry is pleased to read about the potential role enhancement that this monumental change may bring. As with most change, there will be resistance, not just from physicians who are concerned that the role expansion will be carved out of the physicians current scope of practice but also from patients and, not surprisingly, from the nurses themselves.

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IMPLICATIONS FOR MID-LEVEL NURSE LEADERS

The expansion of the nurse role, which is such a critical component to the success of health care reform, will require the nurse leader to become knowledgeable about business; finance; personnel management; career development and staff support while managing the clinical environment that the leader oversees. Many of the aforementioned functions were not taught during the nurse leaders academic educational preparation. In addition there will be many new roles that have not yet been designed but will include the necessity of skills and competencies that few nurses possess. Key to the organizations success will be the ability of the nurse leader to recognize how their decisions, at the department level, impact the entire organization. Unfortunately, nurses are not being included in the design of healthcare reform. A study done by Gallup and funded by the Robert Wood Johnson Foundation, identified why that was the case. There is currently no structure in place for people to listen to what nurses have to say. Not only are nurses not prepared to seize the opportunities on the horizon but there arent enough well-educated and prepared nurses to fill the roles we currently have open. The Institute of Medicine recommends that the nursing profession increase the number of Baccalaureate prepared nurses (BSN) to 80% from the current 50% by the 2020. In a recent NURSE.com article titled, Vacancy-Whos the Boss? Why nurses are reluctant to fill or stay in Management Positions the author quotes the results of a recent survey of 1000 nurses. Of the 1000, fully 50% plan to retire within 8 years. There will be seasoned, experienced nurse leaders in those numbers and formal Copyright 2012 Jean Biacsi. All Rights Reserved Page 7

succession planning at that level, is virtually non-existent. Nurse leaders note that the support and encouragement of a mentor/coach is one of the major factors in their seeking a management position. Judith Warner wrote in her March 12, 2012 Time Magazine article, High Status Stress that the mental and physical health benefits associated with greater affluence due to increasing wages with promotions fade away the higher you go in an organization. Research indicates that as you near the top, life stress increases so dramatically that its toxic effects essentially cancel out any positive aspects of succeeding. Having authority over others binds people to all sorts of interpersonal conflicts and management turmoil leading to off-the-charts stress.

RETENTION VS. TURNOVER There are many reasons why good employees quit a job and the unfortunate truth is that most are preventable. The issue of turnover has been studied by Human Resource (HR) executives since the early 1950s when researchers like Dr. Gallup and Frederick Herzberg examined human needs and job satisfaction. Decades of research support the original findings of those studies; 35% of all employees who quit a job cite their immediate boss as the driving motivation. In a January 2012 article published by Forbes magazine the author distilled the top 10 reasons top talent leave an organization down to one: when they are badly managed and the organization is confusing and uninspiring. The solution is to create an organization where those who manage others are hired for their ability to manage well, supported to get even better at managing, and

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held accountable and rewarded for doing so. All of the components of the solution represent exactly what a coach brings to the table. The factors that contribute to nurse leader longevity and excellent job performance were studied by Barbara Mackoff,Ed D. and Pam Triolo, RN PhD Those factors are: 1.) Engagement; 2.) Culture of regard; 3.) Support for their Decisions; 4.) Educational Mobility. Engagement has been found to be a key factor in reducing mortality and preventing errors. The author of, Coaching the Big Game from NURSE.com April, 2012, states, Formal coaching programs are gaining ground as researchers and leaders find the practice of providing coaching boosts a nurses job satisfaction and confidence. Executives who focus their efforts on creating a culture that supports a healthy work environment will improve staff satisfaction. The results of a healthy work environment are enhanced retention; improved patient outcomes and dramatic performance improvement. The methods to accomplish having an engaged staff are: support, recognition, teamwork and good physician/nurse relations.

THE BUSINESS CASE FOR INVESTING IN NURSE LEADERS Nursing research has proven the link between patient outcomes and nurses who are engaged and empowered. The Agency for Healthcare Research and Quality (AHRQ) studied and reported on the cost of medication errors alone to be approximately $17.1billion per year. Medical errors represent the 6th leading cause of death in the United States and the cost of the deaths is calculated by the Institute of Medicine as $29 billion per year. Copyright 2012 Jean Biacsi. All Rights Reserved Page 9

Any improvement in the average length of stay (ALOS) will reap monetary rewards in reduced expenses. If one were to consider just the costs associated with turnover the business case to invest in the mid-line nurse manager is clear. The cost associated with replacing one staff nurse is estimated to be 1.2-1.3 times the annual salary and for a nurse leader the cost is even higher. Studies support that retaining nurses increases morale, decreases errors and improves continuity of care, according to a recent journal article.

THE ROLE OF COACHING If training and education together were enough to change behavior and improve performance it is unlikely anyone would voluntarily smoke a cigarette. In two separate studies (Oliver,et al,1997 and Strayer&Rosset, 1994) it was observed that following up training events with a coaching relationship had dramatic results. The first demonstrated that following training for executives with coaching increased performance 4 times as much as training alone. Coaching provides exercises around key competencies such as goal setting; taking action in consideration of system-wide impact; problem-solving; taking responsibility; evaluating outcomes and being held accountable. Organizational leaders are in the best position to create interest and momentum around job satisfaction. Dr. Donald Clifton, in the late 1960s, focused his research on the study of what makes people flourish. His team discovered that change happens most efficiently at a local level, at the level of the front-line-manager. Daniel R. Tobin wrote in his 1998 article, The Fallacy of ROI Calculations that learning and coaching should be thought of as the wheels and tires of any organizational Copyright 2012 Jean Biacsi. All Rights Reserved Page 10

change. Any new model car must have wheels and tires but you would never ask the leader of that department to do an ROI to justify having wheels and tires on the new car. A leadership development firm in Manchester, England observed, 40% of newly promoted managers and executives fail within 18 months of assuming a new role. The leadership position, at any level of an organization, is a lonely position. A fact that supports why 60% of CEOs from Fortune500 companies, when surveyed, stated that they had their own personal coach. A Fortune Magazine, 2/19/01, article shared the results of a poll of Executives and Managers who had had 6-12 months of coaching. Each participant was asked to give a conservative estimate of the monetary payoff from coaching. The average response placed the value at six (6) times the cost and fully 61% reported a marked increase in job satisfaction.

CALCULATING RETURN ON INVESTMENT

Despite all the qualitative evidence that coaching is an extremely worthwhile investment the coaching industry must establish an effective evaluation system that takes into account that no two coaching assignments are the same and no two coaches have the same approach. For leaders in healthcare the argument to include coaching in any plan to reform the delivery of care and improve performance must include solid returnon-investment evidence. If care is taken both in terms of assumptions and process before the engagement begins, the return on investment predictions from coaching will be at least as good as any other return on investment measurement. The coach should ask the intended client how Copyright 2012 Jean Biacsi. All Rights Reserved Page 11

they will know if the coaching engagement provides the desired outcome? What are the exact metrics expected to improve and what is the current metric being measured? Where no tools exist the coach should create one based on the behaviors the client expects to see modified in the coaching engagement. Establish current baseline metrics from which to measure progress. Set a realistic timeline, behavior change is slow and for an engagement to be able to demonstrate substantive and sustainable improvement it could take a year or more. Ask the client to describe their current culture. If a supportive culture and a healthy work environment are not in place the possibility that any effort to change behavior will be successful is quite small. Peter Drucker, Strategy and Management expert, is quoted, Culture eats strategy for breakfast. An executive team may have the best strategy in the world but if the culture does not support the required changes success is unlikely. Experts suggest you calculate the economic value of behavioral changes through the use of the following metrics: improved productivity; decreased absenteeism/turnover; decreased length of stay ( LOS); improved quality metrics; decreased turn-around-time; increased patient satisfaction scores; increased value of innovation suggestions in the pipeline and an improved reputation.

CONCLUSION The American Hospital Association published a report in January 2011 titled, A Call to Action: Creating a Culture of Health. Seven recommendations were identified and Recommendation #3: Provide a Variety of Program Offerings for Employees with at least one of the offerings being an intensive coaching activity. Copyright 2012 Jean Biacsi. All Rights Reserved The American Page 12

Organization of Nurse Executives has stated their support of the use of Executive/Business Coaching services for their members. The research findings support the efficacy of coaching and, if metrics for measurement are clearly and accurately identified prior to the launch of any coaching engagement, the ability to demonstrate a positive return-on-investment will be present. Few healthcare organizations have achieved the status of a healthy work environment. The industry knows what the requirements and components are to make it happen yet it remains elusive. Coaching may be the link that has been missing in the execution of previous plans.

Definition of Insanity: Continuing to do what you have always done but expecting to achieve different results.

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REFERENCES
Aiken, Linda et al. (2008) Effects of Hospital care Environment on Patient Mortality and Nurse Outcomes. Journal of Nursing Administration. 39 (7/8):45-51 Bernard, Paul (2006) A Study - ROI and Coaching: Applying metrics to Measure the Effectiveness of Coaching Brooks, Chad (Mar. 8, 2012) The Real Reason People Quit Their Jobs News Trends Daily Clinch, Therese RN., (July-Aug., 2012) The Need for High-Level Care Coordination, Texas Nursing Voice Volume 6, No. 3 Cunningham, Joyce. (Aprl-May, 2012) Gallup Survey Nursing Leadership from Bedside to Boardroom, Texas Nursing Voice, Vol. 6, No. 2 Gatson, Cecilia RN, PhD, FAAN (2012) Nurses Nurturing Nurses (N3). NURSE.com/management Gawande, Atul MD, (2011/10/03). Personal Best. The New Yorker, Annals of Medicine Retrieved from: http://www.newyorker.com/reporting/2011/10/03 Jackson, Eric (1/18/2012) Why Top Talent Leaves: Top 10 Reasons Boiled Down to 1. Forbes Magazine Retrieved from: www.forbes.com/sites/erikanderson Jones, C., (Jan. 2008). Revisiting Nurse Turnover Costs: Adjusting for Inflation Journal of Nursing Administration. Pgs. 11-18 Retrieved from: Fisher, Anne (2/19/01) Executive Coaching with Returns a CFO Could Love; Fortune Magazine http://money.cnn.com/fortune/fortune_archive/2001/02/19 Retrieved from: www.TransformationalCoaching.com/action.htm Retrieved from: www.AHA.org/Advocacy-Issues/HealthforLife/Culture.shtml A Call to Action: Creating a Culture of Health Retrieved from: (12/2010) http://www.iom.edu/Reports/2010/The-Future-of-Nursing-LeadingCopyright 2012 Jean Biacsi. All Rights Reserved Page 14

Change-Advancing-Health.aspx The Future of Nursing Institute of Medicine Retrieved from: http://www.coachfederation.org/includes/docs/050ManchesterExecutive Coaching YieldsWorkLifeSoluti.doc Work/Life Solutions, Inc. (January 4, 2001) Executive Coaching Yields Return on Investment of Almost Six Times Its Cost Retrieved from: http://www.rwjf.org/pr/product.jsp?id=51088 Accessed on April 25, 2012. RN Work Project Robert Wood Johnson Foundation Schmalenberg, Claudia RN, MSN and Marlene Kramer RN, PhD (August, 2009) Nurse Manager Support: How Do Staff Nurses Define it? Critical Care Nurse Vol. 29, No. 4 Sherman, Rose O., RN.EdD, NEA-BC, FAAN (May 1, 2012) Evidence-Based Effective Nursing Leadership. NURSE.com Sherrod, Dennis, RN, EdD (Aug. 2012) Keeping Colleagues- Nurse Retention NURSE.com Retrieved from: http://ce.nurse.com/ce328-60/keeping-colleagues-nurse-retention-is-everyonesresponsibility/ Shirey, Maria RN, MS, MBA, NEA-BC, FACHE (Sept/Oct. 2008) Succession Planning in Nursing- Who Are Tomorrows Leaders? Clinical Nurse Specialist: The Journal for Advanced Nursing Practice. Vol. 22, Number 5, Pg. 214-217 Stoltzfus, Tony. (2005) Leadership Coaching, pg. 38 Tobin, Daniel R. (1997) The Knowledge Enabled organization: Moving from Training to Learning to Meet Business Goals Warner, Judith (March 12, 2012). High Status Stress. Time Magazine. Pg. 78 Williams, Ray (2/06/08) The Impact of Executive Coaching National Post Worley, Christopher G., PhD. (Feb. 2012). Organizing for Agile and Sustainable Healthcare: The Alegent Health Case. Center for Effective Organizations

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