Knowledge Transfer Best Practice:Morristown Memorial Hospital (Atlantic Health)

By: AARP Outreach & Service | Source: AARP.org | February 2, 2009

Organization Profile
 
Morristown Memorial Hospital is part of Atlantic Health, a nonprofit organization that delivers quality health care services to more than 5 million people in northern and central New Jersey and in the New York metropolitan area. The 629-bed hospital supports more than 5,000 employees, has more than 36,700 admissions, and has nearly 264,000 outpatient visits each year.
 
Overview
 
Morristown Memorial Hospital is part of a prestigious group. It’s one of the 287 health care organizations that the American Nurses Credentialing Center recognized for nursing excellence. In fact, the hospital received that national honor twice. And during each application process, it rediscovered the importance of knowledge transfer in improving overall nursing performance and treatment outcomes.
 
 
Business Challenge: Maintain High-Quality Patient Care
 
In the late 1980s, the Academy of Nursing published a research paper exploring why some hospitals were able to attract and retain quality nurses. It identified 40 such hospitals throughout the United States and referred to them as "magnet hospitals." While the facilities shared similar characteristics, their primary trademark was nursing excellence. Based on the findings, the American Nurses Credentialing Center launched the Magnet Recognition Program, which recognizes hospitals every four years for their nursing excellence.
 
Morristown Memorial Hospital in Morristown, N.J., was one of the original 40 hospitals. It received magnet recognition in 2001 and again in 2005, said Trish O'Keefe, the chief nursing officer at the hospital, which employs 1,259 registered nurses. Only about six percent of all health care organizations in the United States have achieved similar status.
 
The magnet application process has proved an excellent reason for the hospital to closely examine its current programs, policies, and procedures. Nurses throughout the facility must exceed and implement new standards of patient care, sharing their knowledge and insights with other nurses within and across different units.
 
"Part of this process is defining the standards and giving evidence to the credentialing center that we don't only meet their standards but exceed them from an excellence perspective," said O'Keefe.
 
Still, hospital directors know that their employer’s ultimate success will be measured in more ways. Of the 9,872 employees at Atlantic Health, 37 percent are age 50+. If knowledge transfer doesn't occur between nurses who are new and those who have experience, valuable knowledge and skills could easily disappear. Such a loss could jeopardize the hospital’s ability to provide patients with the best possible health care.
 
Business Solution: Promote the Sharing of Knowledge and Wisdom
 
Executives at Morristown Memorial Hospital recognized the tremendous value of retaining the experience and wisdom of older employees. That’s why the hospital expanded its knowledge-retention practices through a series of new programs aimed to bring employees near retirement together with more recent hires.
 
Morristown Memorial partnered with Unleashed Inc., to create an online, voluntary mentoring program. The program is a key part of the hospital’s succession-planning process, says O’Keefe.
 
Last year, she said that 15 experienced registered nurses and 15 new nurses were selected for the pilot group in testing the program. The employees met each other at a kickoff meeting, then were asked to connect with each other at least once a month, via e-mail or through the online system at Unleashed. Mentors helped younger nurses develop road maps or strategic plans for their career development and monitored their progress. Unleashed also sent reminders to participants to log on and created a list of appropriate behaviors for both mentors and protégés. For example, mentors had to be teamwork-oriented and customer-focused; they had to demonstrate their care for others and to create a climate in which people want to do their best. Likewise, protégés had to be results-driven, motivated to exceed work goals, and willing to share knowledge with others.
 
Besides mentoring, older nurses are also teaching different types of critical-care certification courses. One is a medical/surgical certification course, in which nurses are trained to care for both surgery patients and those with medical cases, such as pneumonia, explained Corky Holm, the hospital’s HR manager for strategic recruitment.
 
Holm recently began focusing on jobs at risk of not being filled because of potential shortages. Will there be enough skilled workers to fill them? Other than nurses, she related, medical technologists, environmental aides, and dietary service workers will also be in short supply.
 
So will operating-room nurses. Holm reported that six OR nurses at her organization are projected to retire by 2010. To prepare for the turnover, a system-wide operating-room internship program was created. While five nurses are currently enrolled, the program is now offered online so that even more nurses can participate.
 
Another structured program is called "Higher Learning.” In the program, experienced nurses mentor their junior colleagues for an entire year. Besides receiving hands-on training, newer nurses can also expand or sharpen key skills through in-house courses, such as one on conflict resolution.
 
To further promote knowledge transfer, the hospital also divided the job of nursing into several key functions or areas. It refers to the specific areas, such as professional or organizational development, as "forces of magnetism." Hospital management then selected from nearly each of  45 different departments nurses who were effective mentors, excelled at their jobs, were strong communicators, and built long-lasting relationships with other departments. Each of the nurses became a "magnet champion": Each one concentrates on a key function of nursing.
 
The main job of the magnet champions is to reach out to peers across the hospital, searching for examples of best practices within their assigned areas. When they find those best practices, the nurses teach those practices to other peers. The magnet champions meet monthly with Cheryl Saylor, a retired registered nurse, who serves as the outgoing magnet coordinator. Saylor worked at the hospital for 25 years and helped implement many progressive changes, which in turn helped her employer receive magnet awards. Under a hospital program that brings retirees back into the workplace for special projects, she returned to work to mentor the new magnet coordinator.
 
As part of the application process, magnet champions engage in many different activities that promote knowledge transfer. For example, they:
 
Produce a quarterly e-newsletter filled with stories about creative ways in which units are exceeding standards of clinical care. Examples include identifying the best way to screen for abuse among patients visiting the emergency department, or conducting monthly open-medical-record reviews to ensure that each patient chart and record is complete

Attend weekly during a six- to eight-week period meetings conducted by Saylor and other experienced nurses. Courses teach new nurses essential skills, such as effective writing, research, and critical thinking

Participate in annual forums held by various departments, such as neuroscience, covering topics related to the magnet application. Although attendance is voluntary, nurses can also log on to the hospital’s intranet to review the same material

Expand their skills and become certified nurses, which is a necessary component of a magnet hospital
 
Even volunteers in its emergency department came up with a creative way to exchange knowledge. They wrote a 25-page orientation booklet, which contains volunteers' suggestions and observations collected over the years.
 
"We essentially mentor the entire hospital when we put in our magnet application," explained Saylor. "We also have to prepare for a site visit. Magnet appraisers come for four days and want to visit every single unit. In preparation for this, not only do physicians have to be prepped, but also the ethics committee, the advanced practice nurses, and shared governance council."
 
Outcomes: Empowered Workforce, Better Patient Care
 
While the hospital always enjoyed a strong retention rate, turnover dropped even further, from approximately six percent in 2000 to three or four percent in 2008, said O'Keefe. She believes the key reason behind this low turnover rate is its shared-governance framework, in which nurses constantly share information with each other and are empowered to make decisions.
 
Certification of nurses is another marker of quality. At a typical magnet hospital, she said, 20 to 25 percent of its nurses are certified. But at Morristown Memorial, that number is nearly 45 percent.
 
More examples:
The pilot program for online mentoring of nurses was so successful that the hospital has since made it a mandatory requirement for all nurses who recently graduated from nursing school.

Hospital retirees can participate in a program called the "1,000-Hour Club," which was recently introduced. Just like Saylor, other retirees return to work on special projects or assignments throughout the year.

There's now a waiting list of new nurses eager to participate in the "Higher Learning" year-long mentorship program. 

"We don't want to lose the added value that older workers bring to the table," explained Holm. "That has been a topic of conversation over the years that we just keep pounding at. If it weren't for them, we wouldn't be such an excellent organization,” she said. That's why we continue to provide all of these programs and initiatives."