In 2021, of the highest percentage of announced “mega merger” deals, the vendor or small partner reported more than $1 billion in annual revenue since 2015. And while these massive syndicates promise to cut costs through sheer economies of scale, they also pose unique challenges for large hospitals and healthcare systems. With hundreds of hospitals and thousands of nurses under their umbrella, they urge the need for greater standardization of nursing policy and procedures to ensure standards of care are met.
Hackensack Meridian Health (HMH), a nationally recognized healthcare system based in Edison, New Jersey, is a prime example of a large merger, growing from three hospitals to 11 over several years with more than 8,000 nurses employed . As HMH has learned, more hospitals and more nurses need greater standardization to manage increased complexity across the care delivery network.
Strive for quality care in all hospitals in the system
A consequence of mega-mergers can be inconsistencies between hospitals in the system, with nurses at different hospitals adhering to different policies and procedures. To ensure that quality of care does not suffer, it is imperative to bring these disparate groups together to provide cohesive care, especially in a decentralized environment where campuses can be widespread.
The challenge: Create one set of policies out of 5,000
When Hackensack University Health Network and Neptune, New Jersey-based Meridian Health merged to form Hackensack Meridian Health in mid-2016, it was seen as a way to transform the delivery of care in New Jersey. The newly formed network initially included 13 hospitals, including two academic medical centers and two children’s hospitals, as well as more than 120 ambulatory care centers, surgical centers and urgent care centers, bringing approximately 28,000 employees into the consolidated system. .
Today, Hackensack Meridian Health is the largest, most comprehensive, and most integrated healthcare network in the state and serves as a model for network integration in a system of its size. Across 11 acute care campuses, with nearly 5,000 policies to assess, they have successfully integrated and evolved into a single set of policies and procedures that all 11 hospitals follow. What was the ultimate challenge? Incorporate policies amid the COVID-19 health crisis that were intended for a diverse group of agencies and new team members, in addition to their existing staff.
“We wanted a source of truth for our network nurses — regardless of which campus they were primarily on,” said Miriam McNicholas, clinical policy administrator at HMH, ultimately getting policy integration “harmonized” .
Separating policies from procedures made for culture change
To begin, McNicholas inventoried the policies and realized that many of them were categorized as “policies” but were actually procedures. “When I started looking at them, I found 2,000 ‘policies’ on things like how to wash your hands, how to put on a Foley, how to do all these nursing duties. Not policies,” he said. she stated.
McNicholas wanted to move from just looking up procedures (not policies) for nurses to fully understand how to do something, using an evidence-based online resource. She understood that this would be a huge culture change, but necessary in all hospitals, as nurses were integrated or reassigned from one unit to another.
This need intensified during the COVID-19 pandemic, when HMH also recruited between 2,000 and 2,500 agency nurses in addition to the 8,000 to 9,000 they already had. They also had to consider the onboarding needs of graduate nurses who found themselves on the frontlines of the pandemic without ever having taken the NCLEX® exam.
Facilitate smooth transitions within the network
“We wanted to create a network-wide atmosphere where you could transfer from Raritan Bay Medical Center to Jersey Shores Regional Trauma Center, and those components of your education, your training, the items on your clinical checklists and your skills would all be aligned, no matter where you went in the network,” responded Melissa Harker, director of the nursing education network at HMH.
Centralization and streamlining of procedures
With these goals in mind, McNicholas used Lippincott Solutions, an integrated cloud-based software suite, as a central source of procedural information. Lippincott Solutions provides evidence-based, step-by-step guidance for over 2,200 nursing procedures and skills, which has equipped nurses with standardized procedures to mitigate risk, reduce variability in care, and maintain consistent compliance. Moving to a digital system has also reduced paper records, files and checklists.
This approach streamlined the way skills were assigned and checklists developed. By integrating Lippincott Solutions with the HMH Learning Management System (LMS), HMH programs could be assigned in the LMS and completed in Lippincott. “Here’s a great example of how it works,” Harker noted.
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