Governor’s Task Force on Nurse Workforce and Patient Care

Meeting Summary May 31, 2007

Meeting Participants:
Task Force Members Sen. Betty Boyd (D-Lakewood), Senate District 21 Ned Calonge Chief Medical Officer, Colorado Department of Public Health and Environment Sue Carparelli President & CEO, Colorado Center for Nursing Excellence Ken Cochran CNO, Colorado Plains Medical Center CJ Cullinan Staff Nurse, Craig Hospital and Julia Temple Long Term Care Colleen Goode Vice President of Patient Services, University of Colorado Hospital Eve Hoygaard President, Colorado Nurses Association Nurse Practitioner Family Planning Clinic Judy Hutchinson Staff Nurse, Orthopedics, Exempla Lutheran Hospital Donna Kusuda Vice President of Quality and Risk Management, HealthONE Kate Mixdorf Vice President of Nursing/Quality Operations Heart of the Rockies Regional Medical Center Sharon Pappas CNO, Porter Adventist Hospital Bernie Patterson Staff Nurse, Ambulatory Surgical Unit Boulder Medical Center Kristy Reuss Department Head, Department of Health Sciences, Mesa State College Nancy Smith Dean and Professor Denver School of Nursing Patty Stewart Senior Staff Nurse SICU Medical Center of Aurora Kathy Van Soest Director TCU & CAIR North Colorado Medical Center Bob Yakely Vice Speaker, CMS House of Delegates Participating by Phone Mary Pat DeWald Staff Nurse, Sexual Assault Nurse Examiner Integrated Health, Inc. Members Absent: Rep. Jim Kerr (R-Littleton) House District 28 Rep. Jack Pommer (D-Boulder) House District 11 Staff: Chris Adams Facilitator The Adams Group Lynn Marie Bell Project Coordinator The Adams Group

Facilitator: Chris Adams, chris@theadamsgroup.org Project Coordinator: Lynn Marie Bell, bell@theadamsgroup.org

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Overview of Key Points and Decisions:
    Governor Bill Ritter addressed the Task Force, highlighting the opportunity before members to make a substantial contribution to health care in Colorado. Draft bylaws were discussed and approved. Task Force members shared their perspectives on Items A-H of the Executive Order. The Task Force selected resources with which each member will become familiar. Members agreed to forward articles and web addresses to the Project Coordinator for dissemination to all members. The Task Force discussed guiding principles for a nurse quality measurement process. A draft set of principles will be discussed at the next meeting.

Member Perspectives on Items A-H of the Executive Order
Commissioners shared a wide variety of perspectives on the work of the Task Force. Some perspectives include:  Public safety should be the highest goal of the task force. We need to find good solutions that provide appropriate information for patients and contribute to good health outcomes.  This effort is part of a broader national effort to select nurse-related care markers. Other states are watching Colorado.  It will be important to identify or develop nurse-centered outcomes that are broadly recognized as being important.  Each member has an important role to play on the Task Force based on her or his own experience.  It is exciting and important that nurses have the opportunity to participate in a process such as this Task Force, which provides the opportunity for a different type of conversation than in the Legislature.  The collaborative process is key to resolving the issues of quality care, appropriate staffing and patient outcomes.  We need to put any past history behind us and look at all issues in a fresh way.  We need to be careful about how we look at data as the interpretation of facts can tell different stories.  We need to provide information that is understandable and applicable to the lay consumer that will influence patient decisions.  Nurse satisfaction and the nursing environment are keys to providing quality care and improving patient outcomes.  Experienced bedside nurses must play an important role in determining the quality of the nurse and patient environment.  We need to consider rural and small hospital perspectives, not just large urban hospitals.

Facilitator: Chris Adams, chris@theadamsgroup.org Project Coordinator: Lynn Marie Bell, bell@theadamsgroup.org

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Comments from Governor Ritter
   Collaboration is key to resolving contentious health care issues. This Task Force represents a new approach to resolving issues that the legislative process has not adequately addressed. The task force is doing important work that will complement and inform other healthcare reform efforts such as the 208 Commission.

Discussion of Ground Rules
Ground Rules for the Task Force were presented and approved. Members requested additional clarification on how Colorado’s Open Meetings law applies to the Task Force.

Review of Suggested Data Sources
The Task Force reviewed a list of data sources suggested by task force members prior to the plenary session. As a result, the following decisions were made:  The Task Force identified national examples of nurse staffing reporting and measures (Item B of the EO), including the NQF, NDNQI, AHRQ and JCO measures.  The Task Force identified additional resources that it agreed to become familiar with, including the Hospital Report Card, nurse satisfaction surveys, and articles by Aiken, Needleman and Buerhaus, among others.  Members agreed to be responsible for researching specific electronic and/or hard copies of resources.  Members will forward resources to the Project Coordinator who will create a resource library and disseminate resources to all Task Force members. Presentations to the Task Force  The Task Force requested presentations or meetings with: o representatives of The Joint Commission project who are undertaking a test of nursing sensitive measures developed by the National Quality Forum. Steven Summer of the Colorado Hospital Association will help to arrange this. o the committee that is responsible for the Colorado Hospital Report Card. Two members of that group, including its chair—Donna Kususda —are also Task Force members, and will help to arrange this.

Discussion of Guiding Principles for a Quality Measurement Process for Nursing
 Members discussed the meaning of the Executive Order’s directive to “develop guiding principles that will lead to a quality measurement process for nursing."

Facilitator: Chris Adams, chris@theadamsgroup.org Project Coordinator: Lynn Marie Bell, bell@theadamsgroup.org

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Members made many points to be reflected in the guiding principles including: information must be understandable to the public, the process must be evidence- and outcome-based, measures must be nationally endorsed and vetted, the process should be standardized across facilities yet customizable, and they should reflect acuity. Data collection should be feasible and economically sound, and it should reflect the bedside environment.

Interaction with the 208 Commission Governor Ritter asked the Task Force to consider how its mission and scope of work related to the 208 Commission, which is primarily focused on health care access and coverage, though it is also reviewing proposals to increase safety and improve quality. The Task Force agreed that that the work of the two bodies should coordinate to the extent that it is useful and practical. The Task Force agreed on two steps regarding the 208 Commission:  The co-chairs will nominate interested task force members to the 208 Commission's provider task force and rural care task force.  In July or August, a meeting will be arranged between some task force members and 208 Commissioners.

Schedule of Next Meetings
 The Facilitator will circulate a date picker program to all members to reschedule the June, July and September meetings. Task Force members approved the August 24, October 26, November 30 and December 19th meeting dates.

Facilitator: Chris Adams, chris@theadamsgroup.org Project Coordinator: Lynn Marie Bell, bell@theadamsgroup.org

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