As a Nurse Leader, I have recognized how difficult it is connect the practice of healthcare and the business of healthcare. In the current economic times it is vital to make that connection in order to maintain the high level of care required to manage patients and to attract and retain the best workforce possible. It has consistenly been a struggle to value, monetarily, the work done by nurses in order to discuss the financial needs of nursing departments and organizations. Generally, as quality of care or quality of providers goes up so does cost. Combining the business and practice of healthcare means not only finding the monetary value but also managing the practice as efficiently and effectively as possible. As I struggled with this, the opportunity to find a capstone project coincided with an opportunity to explore this very concern in the organization I was working in. This paper discusses the problem and the process change that could start to address this disconnect in the practice and the business of healthcare in a large retail health organization. The project does this through performance management specific to the goals of the organization thereby supporting the overall business. An employee engagement survey in a large retail health care organization identified the lack of understanding of how performance was measured as the top concern of the employees. To address this concern Quality and Performance (Q&P) Evaluations for Clinic Level Providers were developed, piloted, and then fully implemented. These evaluations consisted of 11 metrics that were truly affected by the provider and support the goals of the organization in clinical quality and customer service, and to certain extent revenue. In attempting to make a closer connection to the success of the organization and the role of the Managers of Operations (MOs) it was proposed to develop a similar tool where the metrics directly supported the goals of the organization relative to revenue, combining of the practice and the business of healthcare in this organization. The primary objective was to develop a Q&P with metrics that were objective, clearly affected by the MOs, and supported the organization goals. That could connect the practice and business of healthcare and allow nurse leaders to address the value of the nursing staff and nursing services in a variety of settings. The evaluation of the tool, the value of of the metrics, and the results on the Q&P compared to the budget, reports on quality, and customer service will identify success in the project or shortcomings of some part of the change. Any shortcoming would them be address and changes incorporated into the project, implemented and then re-evaluated. The Johns Hopkins Nursing Evidence Based Practice Model was selected for this practice change. This model is a nursing model and was developed for organizational changes thereby very easily utilized in this project: an organizational change in an organization that is about 95% nurses. The model was successfully integrated throughout the change. Many barriers become a reality in the implementation of the change that the author believes affected the results. The presumtion based on the literature and the pilot project is that when individuals understand the metrics and goals of those metrics of their performance evaluation, so long as they have control of those in some way there will be positive movement toward the goals. The lack of clarity in presenting the metrics, goals, and value of the metrics relative to the organizations goals seemingly changed the presumption of positive progress by the selected pilot group of MOs. The recommendation from the author is to recreate the change in another organization where the communication and support of the tool are enthusiastic. The leadership must value the metrics and those metrics must support the organizations goals and truly by influenced by the individual being evaluated. The author plans to implement similar evaluations in her current organization for providers and managers.
