Ladder to Success Development and Implementation of a Case Management Clinical Ladder Author: Kathleen Y. Bellamy, LISW, ACM-SW Institutions: Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
BACKGROUND
IMPLEMENTATION FRAMEWORK
Clinical ladder programs have been integrated into hospital nursing programs for years.
Project Design
Development and expansion of the case manager role has created a need for mechanisms to increase employee satisfaction and professional development.
Established two levels of clinical practice: Level II and Level III. Levels differ in areas of length of employment, point totals and project content.
While literature search shows benefits of clinical ladder programs, few encompass the unique qualities of the case manager. Successful clinical ladders are tools to promote leadership development and provide strategies to challenge highly motivated staff. James Case Management department committed to support development of a ladder program in 2012.
OBJECTIVES 1. To provide an opportunity to promote clinical excellence in case management practice. 2. To encourage evidence based practice and research opportunities in case management. 3. To provide a recruitment tool and increase retention. 4. Create a workplace of choice for our institution and department.
PROJECT DEVELOPMENT Creation of a peer-driven committee to spearhead the development process and conduct needs assessment. Extensive literature review regarding clinical ladder efficacy, studies related to retention and recruitment and examples of ladder programs. Utilized this information as a foundation. Department leadership committed to work with Human Resources to develop sustainable compensation plan. Outline developed to create structure and design, assign point value system based on evidence based practice and research. Ongoing continuous quality improvement to review projects, update Process took 2 years from initial concept to implementation.
PARTICIPANT DATA Clinical Ladder Survey- Participants
Formalized application process began for staff in 2014.
Creation of Clinical Ladder Review Committee: comprised of leadership teams to review and score ladder applications. Successful candidates awarded compensation based on a percentage of base salary and paid out as a supplemental lump sum. Qualitative Review
Number of responses: 11
Staff Retention: Has the clinical ladder program promoted a positive professional growth experience for you?
Is the financial benefit of the clinical ladder program an incentive for your participation?
18%
9%
• Increase expertise in the field of case management
Slightly positive
18% 64%
Not positive
• Encourage evidence based practice
91%
Would you recommend to clinical ladder program to your colleagues?
• Professional development • Opportunity to engage in various day to day activities
9%
Yes No
Definitely yes
• Personal pride in project results
Probably yes
• Increased staff recognition
0%
100% 36%
55%
Probably not Definitely not
PROJECT GROWTH
REFERNECES Drenkard, K. & Swartwout, E. (2005). Effectiveness of a clinical ladder program. The Journal of Nursing Administration, 35, 502-6.
The program has seen increased participation
Question 4: Does the Clinical Ladder Program help with staff retention? 100% responded: yes In what ways has the Clinical Ladder Program benefited the department?
Job Satisfaction:
Will you continue to participate in the clinical ladder program?
Question 1: Does the Clinical Ladder Program benefit the department? 100% responded: yes
Question 3: Does the impact of the Clinical Ladder Program support an ongoing financial commitment? 100% responded: yes
• Provides employee empowerment Professional Development:
Yes No
Positive
Number of responses: 3
Question 2: Does the Clinical Ladder Program help with recruitment of new staff? 100% responded: yes
• Opportunities to provide employees with financial incentives
Extremely positive
0%
Clinical Ladder Survey- Leadership Number of leadership members surveyed: 4
The clinical ladder program has helped augment a growing case management department in the following ways:
Number of ladder participants surveyed: 12
Program evaluation completed in 2018
LEADERSHIP DATA
CONCLUSIONS
2014 Applicants
4
2015 9
2016 12
2017 11
2018 19
Knowles, B.W. (2008). The development of a career ladder for acute care case managers. Professional Case Management, 13(6), 331-7. Riley, J.K., Rolband, D.H., James, D. & Norton, H.J. (2009). Clinical ladder: nurses’ perceptions and satisfiers. Journal of Nursing Administration, 39(4), 182-8.
“Retaining experienced and vested case managers” “Provides opportunity for professional growth of staff and leadership for department. Provides ability to contribute to department goals/projects” “Professional development through education and projects, precepting and mentoring, encourages certification, improves retention, incorporates use of evidence based practice. Projects lead to quality improvement in care and outcomes. Opportunity for recognition. Bonus structure improves compensation”
Successful
4
8
12
10
?
The case management department continues to grow- going from about 40 in 2015 to 96 in 2018. This program provides new opportunities to meet the needs of a growing department.
Smailes, P., Bookless, H. & Blumenauer, C. (2017). Advancement Using clinical ladder programs. Clinical Researcher, 31(6). Watts, M. (2010). Certification and clinical ladder as the impetus for professional development. Critical Care Nursing Quarterly, 33(1), 52-9. Zehler, J., Covert, C., Seiler, L., Lewis, M., Perazzo, J. & Beery, T. (2015). One rung at a time: what effect clinical ladder participation? Nursing Management, 46(4), 30-37.