Merging two robust Women's Services in Alignment with a Comprehensive Nusing Strategic Business Plan, "If you can dream it, you can do it." -Walt Disney

Purpose for the program:

In September of 2012, Yale-New Haven Hospital (YNHH), a 1000-bed tertiary care center, acquired the Hospital of St. Raphael’s, a 500-bed community hospital creating the 4th largest hospital in the United States. Affiliated with the Yale School of Medicine and the Yale School of Nursing, YNHH is a provider of choice for the greater New Haven area.  Women’s Services which is comprised of in-patient and outpatient high and low-risk obstetrics as well as gynecological services were provided at both campuses.  

The merger of two hospitals within a changing obstetric population trending towards outpatient antepartum care required a restructuring of services.

Proposed change:

The Women’s Services Leadership Team, launched initiatives to merge the two campuses utilizing a strategic plan developed by Hospital Senior Nursing Leadership for all service lines.  This plan provided a framework to operationalize process improvements and included four strategic dimensions with specific strategies. 

Strategy 1: Hardwiring the Common Purpose

Women’s services policies across the two campuses were revised by a multidisciplinary team to standardize practice. 

Strategy 2: Optimize Structured Operational Processes

An electronic medical record, barcoding, and fetal central surveillance systems were implemented at both campuses.

Strategy 3: Expand Effectiveness as a High Reliability Organization

A strategic decision was made to combine over 100 inpatient staff from Labor & Birth and Antepartum units to allow for more efficient utilization of nursing services and increase competence. A knowledge assessment was completed by nurses to individualize their education plans utilizing AWHONN’s Perinatal Orientation and Education Program.  Nursing competencies and new hire orientation were also standardized.

Strategy 4: Maximize Cost and Value Position

Improving the utilization of services was a consideration in the decision to consolidate antepartum and labor and birth units under one manager. The antepartum manager position was relocated to the growing outpatient area.  To reduce duplication, services such as MFM, neonatal intensive care and ambulatory services were consolidated.   To receive optimal reimbursement and improve the patient experience, a multidisciplinary team was formed to explore patient feedback and develop corrective initiatives.

Implementation, outcomes and evaluation:

Patient survey scores, results of nursing knowledge assessments and budgetary trends were utilized to evaluate outcomes.

Implications for nursing practice:

Flexible models that allow for staff to practice across settings facilitate increased flexibility and expands nursing knowledge. This is an example of how nursing leaders are at the forefront of evolving trends in inpatient and ambulatory obstetric care and have a direct impact on care provision.

Keywords:

Strategic plan, Cross training, Cost and value positioning