One Hospital’s journey to excellence

Author(s): Kerrie Guerrero, DNP, MBA, RN, NE-BC

Follow Houston Methodist The Woodland’s Hospital as it achieves ANCC Pathway to Excellence® designation.

Takeaways:

  • A new 187-bed acute care hospital embarks on the Pathway to Excellence® journey.
  • To ensure a successful journey, the hospital set a vision and took a strategic approach.

Houston Methodist The Woodlands Hospital (HMTW), a nonprofit 187-bed acute care hospital located in the suburbs of Houston, Texas, opened its doors on June 26, 2017, and by August 2019 had earned American Nurses Credentialing Center (ANCC) Pathway to Excellence® designation. Working toward this designation was an immensely rewarding and educational journey. Nurses and nursing leadership collaborated to cultivate a hospital-wide work environment where positivity, engagement, and empowerment flourish among nurses at all levels.

Setting the vision

Before hospital construction was completed at HMTW, I joined the leadership team as vice president and chief nursing officer (CNO) and immediately set the vision to achieve Pathway designation. My goal was to create the ideal nursing culture, and the Pathway standards provided the framework to achieve it.

By January 2018, just 7 months after opening, we formally began our Pathway journey. We first developed a robust shared governance structure and then took a detailed look at the Pathway requirements, completed a gap analysis, and set a timeline.

The journey

It was clear from the beginning that a strategic approach was necessary to achieve Pathway designation. Part of that strategy was building a formal Pathway leadership structure with a Pathway program coordinator and 12 Pathway champions. Champions were selected based on their active involvement in shared governance and their excitement about the journey. The coordinator served as the point person and leader of the journey. To keep us on track and ensure the Pathway culture permeated the nursing team, her primary responsibility was our Pathway journey. The champions (clinical nurses, educators, and leaders from across the organization) helped ensure the nursing team received communication and answered questions about the designation process.

The launch

To communicate with the whole nursing team about the Pathway journey, we developed a theme and held a kickoff celebration. We partnered with our marketing colleagues to brand our Pathway to Excellence journey with a cruise ship named the USS Nightingale. On June 1, 2018, the first branded email was sent to all nurses in the organization. We used a USS Nightingale cruise ship header in all Pathway communication to differentiate it from other organizational communications nurses receive every day.

We followed that with a kickoff celebration where nurses could pick up their Pathway Passports and get them stamped at six different ports of call, representing the six Pathway standards: shared decision-making, leadership, safety, quality, well-being, and professional development. This celebration helped educate HMTW nurses about Pathway and the benefits of designation, and it boosted their commitment to the journey.

The application and communication

On June 22, 2018, HMTW submitted its official application for Pathway to Excellence. After ANCC accepted our application to move forward, they provided us with a document submission date of April 1, 2019. Now we had to develop a plan to increase our communication and ensure all nurses were engaged in the process.

The leadership team featured each of the Pathway standards as a monthly topic on a cruise ship–themed “tour guide” and weekly “huddle cards.” Each monthly tour guide focused on a different Pathway standard. (Click here to view a sample tour guide.) For example, one of the guides included examples of how HMTW focuses on the well-being of nurses and staff. The huddle cards, which were a much shorter version of the tour guide, provided detail about each standard and gave specific examples of how HMTW embraces it. The cards were given to each unit for discussion in daily shift change huddles. The Pathway to Excellence journey also was an agenda topic at each monthly shared governance meeting. HMTW continued to grow and hire new staff and open new units in 2018 and 2019. With over 250 new nurses joining the team in less than 2 years, the theme and detailed communication plan proved vital to our success.

Between July 2018 and January 2019, the Pathway program coordinator and champions gathered information and documentation to demonstrate how HMTW meets each of the Pathway standards. The coordinator met with nurses at all levels to highlight specific examples from their units that demonstrate the organization’s positive practice environment.

Next, a writing team (made up of clinical nurses from the shared governance councils, department leaders, and me) was formed. The Pathway program coordinator and the director of clinical education created a timeline and tracking tool with roles and responsibilities for all sections of the document and specific deliverable due dates. After all elements of performance narratives were written, the director of clinical education edited the document, which was then sent to the coordinator and me for final review.

I found watching the Pathway team and nurses collect stories and examples to document how HMTW meets each of the Pathway standards fulfilling. The hospital had been growing by leaps and bounds, and the document preparation and writing process allowed the nurses to reflect on the incredible culture they had created in less than 2 years.

The completed Pathway document was submitted on March 30, 2019. In May 2019, HMTW was notified by ANCC that our documentation met all the requirements needed to advance to the next phase of the application—the nurse survey.

The survey

The purpose of the nurse survey is to supplement and validate the written documents. Nurses are invited to share their perceptions of the workplace environment in a confidential, 20-minute survey, which includes 28 questions on varying aspects of the work environment. To achieve Pathway designation, a minimum of 60% of all eligible nurses must participate in the survey, 75% of the nurses must respond favorably to 21 of the 28 questions, and 50% must respond favorably to all of the questions. ANCC requires that survey participants log in to the survey using their nursing license number. In an effort to eliminate barriers to survey participation, each nurse received a luggage tag with a card that included the survey dates and his or her license number.

We had 3 weeks from the time we were notified that we could proceed to the nurse survey to the survey launch. To ensure continued engagement during the lead-up to and during the nurse survey, the shared governance and leadership teams held Pathway education events and celebrations. We wanted staff to have fun, so we created a Pathway Jeopardy! game (a roving travel cart with questions and prizes about Pathway) and a photo booth with the USS Nightingale in the background. The nurse survey officially opened at 8 am on June 11, 2019 and closed at midnight on July 2, 2019.

The results and celebration

The ANCC Pathway to Excellence director scheduled a call for August 15, 2019, to give us our Pathway results. The hospital executive team, nursing leadership team (including the Pathway program coordinator and champions), and several clinical nurses were in the room for the call where we were officially designated as a Pathway to Excellence organization. HMTW’s USS Nightingale’s voyage had reached its long-awaited destination.

The organization’s success can be largely attributed to our strategic approach to submission. Examples of overwhelming success with the process include an 85% participation rate in the nurse survey (all 28 questions scored over an 80% favorable response) and the feeling of purpose, passion, and pride that resonated throughout the nursing team. Several people across the organization invested valuable time and effort to bring our vision to reality. This designation truly belongs to the HMTW nurses; it is their success. To celebrate our Path­way designation, the HMTW leadership team hosted a celebration luau where, in keeping with the cruise theme, each nurse in the organization received a beach towel, a traditional Hawaiian dinner, cake, cookies, and some fun in the photo booth with the USS Nightingale in the background.

Challenges and benefits

We faced some unique challenges in our Pathway journey, but we overcame them with good communication and strong leadership. (See Unique challenges.) Now we can reap the benefits of Pathway designation, which include improving nurse satisfaction, retaining the best nurses at all levels, cultivating interprofessional teamwork, championing high-quality nursing practice, and supporting organization growth. Specifically, HMWT nurses now lead the shared governance councils and have influence over their nursing practice and patient outcomes, hospital councils and goals have been formalized, and nurses actively contribute to our vision of unparalleled safety, quality, service, and innovation.

Unique challenges

The Houston Methodist The Woodlands Hospital (HMTW) Pathway to Excellence® designation was successful and rewarding, but we faced some unique challenges.

  • Learning curve. When HMTW opened, we employed approximately 150 nurses; 30% were internal transfers from within the Houston Methodist system and 70% were new to the Houston Methodist culture.
  • Rapid growth. By the time of the Pathway nurse survey, we had 465 eligible nurses (300% growth).
  • New services, units, and nurses. The tremendous and immediate success of the hospital meant launching new services, establishing new units, and onboarding new nurses and teaching them the Pathway standards.

Persistence and vigilance were required to ensure all nurses understood the benefits of Pathway and what the designation means for their practice and work environment.

The journey continues

The Pathway to Excellence journey and designation galvanized the HMTW nursing team and helped us build a culture where nurses can practice the art and science of nursing. The Pathway designation will be an asset as HMTW continues to recruit top talent to join our rapidly growing nursing team, and it laid the foundation for our next adventure: our Magnet® journey and goal of achieving dual designation.

Kerrie Guerrero is the vice president and chief nursing officer at Houston Methodist The Woodlands Hospital in The Woodlands, Texas.

References

American Nurses Credentialing Center. ANCC Pathway to Excellence® program. nursingworld.org/organizational-programs/pathway

Pabico C, Graystone R. Comparing Pathway to Excellence® and Magnet Recognition® programs. Am Nurs Today. 2018;13(3):46-50.

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