In most facilities, it is the season of strategic planning. Yes, that time of year when leadership looks at where your organization is, compares that to where your organization wants to be, and creates a strategic plan for how to bridge that gap. Directors of nursing services (DNSs) participate in strategic planning at different levels, depending on the size of the organization they work for. Whether you are a key decision maker at a smaller facility, or a clinical advisor to an organization with multiple facilities, you can be most effective in strategic planning and implementation if you follow these strategies.
1. Remember, you have the power to have a positive impact!
When it comes to strategic planning, the DNS has to be able to identify what the needs are and what the future opportunities are to improve resident care,” says nurse consultant Linda Winston, RN, MSN, BS, DNS-MT, RAC-CT.
“If you work at a larger facility or organization that has a high-level strategic plan in place, the role of the DNS is typically to look at that strategic plan and identify the need and then develop strategies to achieve set goals within the nursing department,” says Linda Shell, DNP, MA, RN, principal of lindashell.com.
“For example,” she explains, “if the strategic goal is to improve customer satisfaction, the DNS’s role would establish action items for staff around that for the nursing team. The DNS might require staff to ask if the resident or family has any questions or needs anything else before leaving the room. In a smaller facility, the DNS and the administrator typically develop the strategic plan. In this situation, the DNS would have more input that extends to thinking about mission and vision, as well as specific outcomes, such as Five-Star ratings, employee satisfaction, or pressure ulcer reduction.”
Regardless of what level input you have in strategic planning for the organization as a whole, be aware of how important the DNS’s input is in outlining the ways and means to improving resident care in the process.
2. Make sure your policies are up to date and communicate them to staff.
Sometimes, “strategic planning” can seem like a lofty thing, with so many actions and measures to meet ambitious goals. Shell reminds DNSs that “a strategy is a plan of action or policy designed to achieve a goal. So, if your fall numbers are up, maybe part of your strategy is to revisit and rewrite your falls policy.”
And of course, no policy—new or evergreen—is any good if staff members don’t know it well. “Sometimes we forget that one part of strategic planning is educating staff on policies and procedures. Once you establish your strategy, you need to make sure you are finding ways to communicate it to staff, stakeholders, and potential business partners appropriately,” Shell reminds us.
It’s also important to remember to share and promote strategic goals, such as improving your facility’s customer service rating, internally. “Strategic planning goals can be best communicated to staff responsible for actionable items by incorporating the goals into monthly leadership meetings. At these meetings, you can review progress and make assessments as necessary,” says Shell.
3. Get a grasp on the numbers.
According to Joanne Smikle, PhD, principal consultant of Smikle Training Services, it’s important to “follow the metrics that matter, and that includes what the reimbursement picture is. The MDS drives reimbursement to the facility, and so supporting your MDS coordinator and understanding what this person does is critical.”
Winston agrees: “In the reality of changing reimbursement, you have to be financially responsible and you have to be able to understand a financial forecast. Understanding these numbers can allow the DNS to support staff retention and acquire necessary resources.”
4. Understand the big-picture issues beyond clinical outcomes.
“A DNS has to understand the big-picture business issues,” says Winston. “Beyond the reimbursement structure, the DNS has to have a grasp on the regulatory structure, culture of workforce and workplace, resources available, and so much more. As the DNS, your role is to communicate how the big-picture issues (i.e., forecasting of resources) will affect residents, and translate and communicate that information to other leadership staff.”
If you are forecasting limited staffing resources because of turnover, for example, this means you will have limited assessment capability, which will likely lead to unnecessary emergency room visits, resident discomfort, and decline. “There is cascading impact on resident care that DNSs are faced with all of the time. When DNS Smith can outline the implications in advance, he can more effectively communicate with members of the leadership team to make sure that the nursing department’s needs are met.”
Winston has observed that “sometimes nurses are promoted to the DNS role because they have clinical expertise, which is great. What that means is that after new DNS Jones has assumed her role, she has to consciously broaden people’s view of who she is as a professional at the table, including asserting herself as a valuable team member. She needs to broaden her skill sets from clinical to regulatory to financial to environmental, knowing that the DNS role is a comprehensive one,” Winston stresses.
5. Know what you need and how to ask for it.
In order to be effective, “a DNS has to already be viewed as a credible partner by the leadership team,” says Smikle. Winston agrees, stressing that “in a room with the leadership team, there are competing values, and you need to have a sense for where your team members are coming from. As a DNS, your number one priority is resident care. In order to influence the team members and effectively ask for what you need, you need to remind them that in asking for something, you are not taking something away from them. Rather, this is how your need, when met, will effectively improve resident care. This moves the dynamic from competing values to a collaborative focus, and this is where you can build your credibility.”
6. Know your sphere of influence, and influence.
“As the DNS,” says Winston, “you are focused on resident care and resident outcomes. Your primary role is to understand your team members enough to be able to work effectively with them to make that happen. No DNS can do it alone. Understand how you speak to colleagues to assist in establishing a shared vision. All team members have their own strengths and opinions. As the DNS, your role is to bring everyone together for the same ends—improved resident care. It is a skill and it takes time. But if you can recognize your sphere of influence and learn how to communicate effectively, it broadens your view and changes how you are able to guide staff and move forward.”
7. Even when you are busy, remember the larger goal.
“One of our biggest hangups is that are we are so reactionary—to survey results, to staffing situations, to resident complaints, to customer service issues. On a daily basis, we find ourselves reacting,” says Winston. “Although it’s not feasible, it’s almost as if we need two teams—one reacting to all the day-to-day stimulation and one focused on forward movement. Although two teams aren’t possible, the idea is a good reminder of the balance needed between daily operations and the larger vision, so that we don’t lose sight of the larger vision.”
Shell agrees, adding that “the biggest challenge to strategy implementation for DNSs can simply be being too busy managing the everyday, and forgetting about the bigger pieces of leadership, like referring back to policies and procedures driven by strategic goals when putting out fires and being intentional about communicating with staff. We get busy every day, putting out fires and responding to the emergencies of the day. We need to think every day, What is our strategy and what do we do every day toward achieving that strategy?”
8. Don’t get hung up on limited resources.
“For DNSs doing strategic planning with limited resources, the key is to prioritize what you work on,” says Shell. “Staff are so busy, it’s wise to focus on goals one at a time so that you don’t get overwhelmed and forget to celebrate small successes.”
“Also,” she goes on, “it can be very helpful to identify change agents, perhaps a small team that can help you by giving input, auditing, and implementing strategic plans. This team can include floor nurses and other members of the IDT, including social workers and activity specialists.” She emphasizes: “We can never be islands unto ourselves. We are not good at everything. We need to find people who can fill the gaps.”
9. Understand your organization’s unique value and the challenges of your partners.
As facility leaders look toward accountable care organization bundled payment reform, Shell says, “it’s important for DNSs to understand who their partners are. Being a valuable partner where organizations want their patients to come and live will benefit resident care.”
She also emphasizes that it’s a good idea to share your strategic goals with partners and potential partners. For example, she says, “if your goal is to improve your customer service satisfaction rating from 75% to 80%, let your partners know that and how you are working to accomplish it. Make your goals and strategies part of staff meetings, orientations, newsletters, etc., in an effort to paint the bigger picture telling what your facility is all about.”
According to Shell, this is especially important as facility leaders think about partnering with acute care settings. “Administrators need to show they have a plan. This is also true for families who might be considering bringing a loved one to your facility. If you only have four stars, but you have a strategy in place to get your facility to five stars, and you can share that with the family, that is helpful.”
As you look to the coming year in the strategic planning process, preparing for the challenges ahead and crafting plans to achieve lofty goals, it’s important to remember that strategic planning is an exciting opportunity. It’s an opportunity to finesse leadership skills, to observe your staff and what motivates them, and to do what’s most important for any DNS—to advocate effectively for resident care.
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