Christiana Care Health System, headquartered in Wilmington, Delaware, is one of the country's largest health care providers, ranking 16th in the nation for hospital admissions. As an organization, Christiana Care places a strong emphasis on employee performance and engagement in support of corporate values, which include caring, patient safety and quality, and other key areas. To support these values, the organization has a robust talent management program in place where employees clearly understand the link between the work they do on a day-to-day basis and the organization's values.
Nurse-to-nurse peer reviews are an important part of this strategy, and are completed online using an automated system from Halogen Software. This automation of the peer review process has enabled the organization to:
- Provide a mechanism for nurse-to-nurse feedback in a confidential, safe, non-threatening forum that promotes and supports on-going professional development
- Ensure Magnet® compliance requirements are met by documenting participation rates using a staff-driven process, while also addressing shared governance requirements
- Create and reinforce values consistent with the American Nurses Association (ANA) Code of Ethics for Nurses
Meeting Magnet requirements with peer reviews
Christiana Care's talent management programs are closely aligned with the organization's core values, and regulations set by The Joint Commission and by Magnet for nursing. To meet Magnet requirements, the organization's Advisory Council for Nursing Directors identified the need to provide a more structured and global peer review process for all nurses as a necessary component to the organization's existing talent management process.
Timothy Holden, Christiana Care's Manager of Patient Care Finance and advisory council member, explains, "In collaboration with our nursing shared governance councils we supported peer review for our nurses as a priority. The nursing peer review process is built around the ANA Code of Ethics and the hospital's six core values. Introducing peer reviews into the overall talent management process for our nurses ensures we're able to meet Magnet requirements while making participation as seamless as possible. And as a result of automating this process, nursing management has confidence in their accreditation documentation."
RN and Nursing Director of Patient Care Services, Dot Fowler, led the development of the nursing peer review program and worked with direct care nurses to develop and pilot the initial questions included in the program. Based on the nursing staff's feedback following two pilot and evaluation periods, the final peer review questions were implemented system-wide in 2008. This input and feedback from direct care nurses was critical to the successful implementation of the program.
Implemented as part of Christiana Care's existing talent management system from Halogen Software, the automated peer review process, easily met the organization's requirements. Since Christiana Care's employees were already familiar with Halogen Performance™ Healthcare and thus comfortable using the system, completing nursing peer reviews with Halogen 360 Multirater™ didn't require complex training. As Holden explains, this ease of use is an important aspect to the way in which Christiana Care administers performance appraisals and peer reviews since each process must be performed independently.
"The flexibility of Halogen's solution enables our nursing team to keep their peer reviews separate from performance appraisals, which is critical to maintaining the nursing culture within our organization and to ensure they are used as a learning tool. However, the administrative burden of managing peer reviews would have been far too cumbersome to do offline. An online system helps us ensure we meet the guidelines set out by Magnet and the ANA," said Holden. "Halogen's system allows easy adjustment of the tool as required modifications and changes are identified, and it also provides reporting capabilities that facilitate identification of educational opportunities. The process has also been customized to meet the needs of specialty services such as our Visiting Nurses Association and Helen F. Graham Cancer Center."
Magnet requires that nurses have the opportunity to participate in nursing peer review as well as conduct a self-evaluation of performance. With this approach, and using Christiana Care's existing talent management process and online system, each individual nurse selects four evaluators while the nurse manager selects two additional anonymous evaluators. The system makes tracking the process easy, which is a key time-saving measure given the large number of peer reviews that need to be executed.
Peer reviews deliver added value
Since rolling out peer reviews more than three years ago, Christiana Care has received positive feedback from its nursing staff and nurse managers. Having the Halogen solution in place enables the organization to gather feedback quickly and efficiently. Managers can track how many evaluations each individual is participating in, as well as track their progress through the process to ensure completion. Additionally, the team can easily ensure everyone required to participate in the process is doing so.
Currently Christiana Care has 2590 nurses participating in the peer review process, which not only supports Magnet, but also guidelines from the American Nurses Credentialing Center (ANCC). Christiana Care's Chief Nursing Officer, Diane Talarek, explains, "Most of the questions are done on a scale, and then there are three specific questions that require a written answer. These open-ended questions enable us to gather some critical information on being a leader and on teamwork. Often this is where our nurses receive insightful feedback that they can use in their personal development. As we go into our third cycle with this process, we find our nurses really see the value of this approach and the positive impact it has on their professional development. The benefit is the ability for our Nursing Councils to create a safe, non-threatening peer review process that promotes development."
Christiana Care now has an extremely well-documented peer review process that does so much more than just meet regulatory requirements. "The goal going into this process was to address our Magnet requirements, which we definitely have accomplished," says Talarek. "Not only do we have confidence in our accreditation documentation, but we have also gained additional value from the peer review process in the form of employee coaching and development, in our employees' personal investment in career growth, and in shared governance with a critical group of employees. The end result is that we are able to assure compliance with the ANA Code of Ethics for Nurses, give and receive developmental feedback peer to peer, deliver on our core values and deliver top notch care to our patients."