Enhancing Organizational Culture to Meet the Needs of Women Implementing Shared Medical Appointments SMA Margaret Leas MSN RN Fargo VA Health Care System Acknowledgements Special thanks to the following people ID: 771376
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Enhancing Organizational Culture to Meet the Needs of Women: Implementing Shared Medical Appointments (SMA) Margaret Leas, MSN, RN Fargo VA Health Care System
Acknowledgements Special thanks to the following people: Fargo VAHCS Leadership and Women’s Health Team Claudia Dietrich - University of Mary Associate Professor and Project Advisor Project Team Members – Ruth Hursman, Elizabeth Blankenfeld and Rebecca Lafavor Glenda Trochmann, Dr. Kimberly Hammer - Fargo VA Organizational Contacts Dr. Elizabeth Yano - Research
Background Problem Purpose MethodsFormatMeasurementResultsConclusion Overview
VA has a strong history dedicated to caring for American Veterans Women - non-nursing military roles since WWI VA focus - predominantly directed towards men Women - gaining more attention One of the fastest growing subgroups of U.S. Veterans Background
Projected Veteran Population 2013 to 2043
Projected Percent of Female Veteran Population 2013 to 2043
Quality improvement data in a recent survey, evaluating women experiences at 12 VA sites, indicated 10% of the women surveyed experienced harassment at the Fargo VAHCS . Problem
Fishbone Diagram
You served, you deserve the best care anywhere
The purpose of this EBP project is to assist the VA in changing a male-dominated culture to a more female-friendly culture. Purpose Statement
Extensive literature review indicated SMA: Allow group interaction in a safe, confidential, and supportive group environment Potential to enhance organizational culture Beneficial for patient and clinic team Cleveland Clinic – Women Health SMAs since 2002 and see 6 patients in 90 minutes VA utilizes SMA for diabetes, hypertension and pain groups Methods
Kirsh et al. (2008)
Key Stakeholders Women Veterans, staff, facility Leadership support Created “welcome” videoBusiness Impact Increased efficiency Potential to increase access to care
SMA Format Adapted by combining the current VA SMA format with Cleveland Clinic’s Women’s Health SMA Trial 4 patients in 2 hour period Target population – post-menopausal women due for annual exam “Pilot” appointment held with women Veteran employees to critique prior to implementation
Project Outcome Measures Currently many efforts to enhance women’s health care through VA Research Team Post questionnaire completed at end of SMA Assess Emergency Department visitsSuccess:Expand, roll out to other teams, VISN, and nationallyMeasurement Plan
Success Behind the scene: Stop codes Group consentBrochuresDuplicableNurses can easily step into each other’s rolesAppointments Participation Focus Results
Questionnaire Feedback
Strengths: Immediate feedback from questionnaires Qualitative and quantitative data Low cost – high impactWeaknesses:SMAs limited to extended hoursNot for every one Project Measurement
Project still ongoing More focus groups Women Veterans’ Ratings of Care (Fargo) Data collectionEBQI results and future steps Baseline Jan-Mar 2014, WVs 3+ PC and/or WH visits, with 12-month follow-up Jan-Mar 2015 (weighted for attrition and non-response)
Low-cost high-impact approach to care Increases access to care Enhances organizational culture SMAs created a positive environment for women Veterans and created a sense of belonging Conclusions
The practice has expanded from the initial target audience of menopausal women to larger women’s pain groups with up to ten participants Plans include the addition of transgender groups Practice has been shared and is easily duplicated Conclusions
Margaret Leas, MSN, RN Women Veterans Program Manager Fargo VA Health Care System 701-239-3700 Ext. 3893 Margaret.Leas@VA.Gov Contact Information