Transcript Teal

Commitment to
Excellence in Nursing
Regulation
Kathy Apple, RN, MS, CAE
Executive Director
National Council of State Boards of Nursing
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
NCSBN Mission
The National Council of State Boards of
Nursing (NCSBN), composed of member
boards, provides leadership to advance
regulatory excellence for public
protection.
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Need for Study
• Multiple stakeholders were demanding
accountability
• Lack of clarity among stakeholders about
Board roles and responsibilities
• Trend toward outcome measurement at
state level
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Purpose of the Study
Establishment of a Performance
Measurement System
• Incorporating data from internal and external
sources
• Using benchmarking strategies
• Identifying best practices
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Phases of the Project
1. Validation of Board Roles
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Results of Phase 1:
• Roles Identified
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Establish scope of practice for nurses
Issue licenses to qualified nurses
Assure continued competence
Investigate complaints and impose disciplinary
sanctions as appropriate
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Phases of the Project
1. Validation of Board Roles
2. Identification of Performance Indicators
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Results of Phase 2:
• Technical Work Group developed
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Performance indicators
Outcome Indicators
Output Indicators
Efficiency Indicators
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Examples
• Performance Indicator
– Timeliness of complaint handling
• Outcome Indicator
– Average time for complaint resolution
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Examples, cont.
• Output Indicator
– Number of complaints resolved in FY
• Efficiency Indicator
– Average cost per completed complaint
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Phases of the Project
1. Validation of Board Roles
2. Identification of Performance Indicators
3. Tool Development
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Tool Development Process
• Original tools developed and piloted
• Original tools revised and further tools
developed
– 6 data collection tools for boards of nursing
– Surveys to collect data from 6 stakeholder
groups
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Board Surveys
1.
2.
3.
4.
5.
6.
Discipline
Licensure
Education Program Approval
Practice
Governance (Executive Staff)
Governance (Board President)
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Board Surveys Included
• Processes used, e.g.:
– Investigator caseloads
– Use of site visits or self-reports for education
programs
• Timeliness issues, e.g.:
– Days needed to processes license request
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Board Surveys Included
• Outcomes achieved, e.g.:
– Number of discipline cases closed
• Opinions, e.g.:
– From Executive Staff and Board President
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Stakeholder Groups
1. Licensed nurses
2. Health care employers
3. Nurses who had been the subjects of
complaints
4. Persons who had lodged complaints
5. Nursing associations
6. Nursing education programs
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Stakeholder Surveys Included
• Perceptions of board’s
– Timeliness,
– Fairness,
– Adequacy of regulation, etc.
• Satisfaction with board’s
– Communication with stakeholder group,
– Nursing program approval process, etc.
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Phases of the Project
1.
2.
3.
4.
Validation of Board Roles
Identification of Performance Indicators
Tool Development
Data Collection
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Data Collection
• Stakeholder contact information
submitted by boards
– Random samples selected from those
submitted
• 6 data collection tools sent to boards of
nursing
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Data Collection Wisdom
• Not all boards routinely collected the data
asked for
– Many boards used this as an opportunity to
improve/modify amount and types of data
collected
• Language/definitions (i.e., financial data,
board processes) differed among boards
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Phases of the Project
1.
2.
3.
4.
5.
Validation of Board Roles
Identification of Performance Indicators
Tool development
Data Collections
Reports of Findings
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Report Format
I.
Aggregate findings
A.
Data results
1.
2.
B.
II.
From board surveys
From stakeholder surveys
Relationships among variables
State-specific findings
A.
B.
Comparison of state with all states
Comparison of state with “like” boards
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Example of Comparison with Aggregate Data, i.e.,
Ed. Program Perceptions
Approval Process
State
Rating
Aggregate
Rating
Interval between
board visits
2.66
1.40
Preparation time for
board visits
2.45
1.41
Feedback/evaluation
provided by board
2.16
1.38
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Comparisons with Similar Boards
• Boards evidenced a wide variety of
resources, structures & processes
• Boards were compared to other boards
similar in a number a variables
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Comparison Variables
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Size of staff
Staff assigned to specific functions
Numbers of investigators
Whether or not state mandated reporting
of errors
• Processes related to complaint review
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Comparison Variables cont.
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Board structure
Standard of proof
Staff autonomy
Number of board meeting per year
Timeliness of discipline processes
Timeliness of licensure processes
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Comparisons of Sample Board with Other Boards
with Similar Numbers of Staff
Sample Similar
Board Boards
Number of staff involved with investigations
12
7.92
Number of board meetings/year
10
6.4
Complaints per investigator
116.9 95.78
Number of nursing programs
78 60.53
Nurses' perceptions of courteousness
Rate of complaints resolved
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
1.23
0.78
1.23
0.66
Phases of the Project
1.
2.
3.
4.
5.
6.
Validation of Board Roles
Identification of Performance Indicators
Tool development
Data Collections
Reports of Findings
Search for “best practices”
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
The Search for Best Practices
• Data were used to identify boards with
consistently high ratings in
– Outputs
– Effectiveness
• Ratings were explored in 5 functional
areas
– Discipline, licensure, education program
approval, practice and governance
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
The Search for Best Practices
• Selected boards were interviewed to
discover
– Practices common among boards with
consistently high ratings
– Differences from boards with lower ratings
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Discipline Best Practices
• Boards with the highest ratings on discipline
outcomes
– Delegated authority to board staff
– Communicated well with stakeholders
– Hired investigators and attorneys & actively
managed discipline process
– Trained and mentored investigative staff
– Applied discipline sanctions consistently
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Licensure Best Practices
• Boards with the highest ratings on licensure
outcomes
– Secured essential human and other resources
– Made an aggressive commitment to customer
service
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Education Best Practices
• Boards with the highest ratings on
education outcomes
– Provided consultative, as well as evaluative
services to education programs
– Took a leadership role in establishing
congruence between education and
regulation
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Practice Best Practices
• Boards with the highest ratings on
practice outcomes
– Facilitated understanding of legal scope of practice
– Made an aggressive commitment to customer service
– Established a high level of involvement with the
statewide nursing community
– Delegated authority to board staff
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Governance Best Practices
• Boards with the highest ratings on
governance outcomes
– Promoted an understanding of the respective roles of
staff and board members
– Built an effective working relationship and a high level
of trust between board and staff
– Facilitated an effective working relationship among
board members
– Demonstrated a commitment to board member
development
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Phases of the Project
1.
2.
3.
4.
5.
6.
7.
Validation of Board Roles
Identification of Performance Indicators
Tool development
Data Collections
Reports of Findings
Search for “best practices”
Development of Ongoing System of
Performance Measurement
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Commitment to Ongoing
Regulatory Excellence
(CORE)
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
CORE
• Nursing Boards educated on CORE
– Manuals prepared, distributed and explained
– Ongoing presentations and publications
• Best Practice “Tool Kit”
– Submissions by boards of systems and
processes that have facilitated best practice
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
CORE
• Ongoing improvement of data collection
system
– All survey items linked to outcome and/or
best practice
– Data collection streamlined
– Additional tools created and piloted
• Information Technology
• Finance
• Board Member
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Utilization of Data by
Boards of Nursing
Data has been used to:
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Support decision-making
Develop mandated reports
Provide information to legislators
Change data management processes
Improve stakeholder satisfaction
Streamline processes
Determine priorities
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Next Steps
• Identify and remove barriers to
participation
• Support member boards’ adaptations of
best practices
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Questions?
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Kathy Apple, RN, MS, CAE
National Council of State Boards of Nursing
111 East Wacker Drive, Suite 2900, Chicago, IL
60601
Phone: 312-525-3600, Fax: 312-279-1032
E-mail: [email protected]
www.ncsbn.org
Publication
Crawford, L. (2004). Evidenced-Based Regulation: A
Regulatory Performance Measurement System,
Research Brief Volume 8. National Council of State
Boards of Nursing: Chicago.
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri