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Running head: LEADERSHIP STRATEGY ANALYSIS
Leadership Strategy Analysis
Maggie Siler
Ferris State University
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LEADERSHIP STRATEGY ANALYSIS
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Abstract
The purpose of this paper is to analyze the importance of nursing leadership in quality
improvement initiatives such as the ST Elevated Myocardial Infarction (STEMI) Performance
Improvement Team. It is of crucial importance that STEMI patients receive timely care to
improve outcomes, and ultimately reduce long term health care costs. The STEMI task force is
composed of administrators, nurses, corporate communications personnel, physicians,
emergency medical technicians (EMT’s), and emergency room technicians. Working
cooperatively toward the common goal of reducing time from diagnosis to definitive care for the
STEMI patient involves effective collaboration and communication among many disciplines,
including the general public. The focus of this paper is analyzing public education efforts
regarding the risk factors for, and symptoms of myocardial infarction, with emphasis on how to
best seek care. This is accomplished through nursing leadership in health promotion by the work
of the multidisciplinary STEMI Public Education committee.
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Leadership Strategy Analysis
Myocardial infarction and stroke are the leading causes of death in the United States
today (Lambert, Vinson, Shofer, & Brice, 2012). It is vitally important to further engage the
public with knowledge of the risks for, and symptoms of myocardial infarction/stroke. Creating
an affordable, effective public education program requires the collaboration of a diverse group of
like-minded individuals. Strong nursing leadership in quality improvement initiatives such as
health promotion for the general public is essential. Nurses are the front line of care and often
have an in-depth understanding of the needs of the population they serve. The following paper
will examine and analyze the work of the Northwestern Regional STEMI Public Education
Committee. Educational strategies, goals, and evaluation methods will be examined.
Background
Munson Medical Centers Regional STEMI Initiative (Munson Healthcare, 2010) has
been dedicated to improving outcomes for all STEMI patients since July 2009. The work of the
regional committee is directed by national guidelines and benchmarks set by the American Heart
Association’s Mission: Lifeline (American Heart Association, 2011). Since inception, the
committee has made great strides toward improving the delivery of timely care and patient
outcomes. Each STEMI case is individually reviewed and areas which require improvement are
addressed in an ongoing manner. The Centers for Medicare/Medicaid (CMS) has established a
measurable set of indicators which are documented and measured for each myocardial infarction
or stroke patient throughout their hospitalization. Utilization of these indicators helps ensure the
most current evidence based care for each patient (Leeper, Cyr, Lambert, & Martin, 2011). .
Engaging the general public through increased awareness of the risks for and symptoms of
vascular disease will add to the progress of this quality improvement initiative.
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Clinical Need
It has been evidenced that public knowledge regarding the risks for, as well as the signs
and symptoms of heart attack/stroke, and how to best seek care is alarmingly low (Elliott, 2008).
Evidence also demonstrates the earlier these patients receive care, the better their outcomes. On
analysis of data obtained by the STEMI committee, it was found that patients increasingly used
911/EMS to access care following times of increased public educational efforts (Fox, 2012).
Therefore, this is an evidence based project, and the author has taken the leadership role of
STEMI Public Education chairperson. This nursing leadership endeavor will further engage the
general public in self-care related to myocardial infarction and stroke. A multidisciplinary team
has been formed to address improving public understanding of the risks for and symptoms of
cardiac/vascular disease, as well as the importance of activating the Emergency Medical System
(EMS) to reduce time to definitive care, and further improve outcomes. The goal of this public
education committee is to improve patient accountability to outcomes and provide more efficient
use of our healthcare dollars.
Multidisciplinary Team
Public education is a crucial part of every nurse’s daily work. In a far reaching effort, a
multidisciplinary team is an effective method with which to approach any area of general public
education. Every professional involved brings a broad base of perspective and knowledge to add
depth and interest to the educational program(s) (Olson, Tooman, & Alvarado, 2010). Below
listed, please find a description of each collaborative STEMI Public Education committee team
member, including analysis of individual roles and contributions.
LEADERSHIP STRATEGY ANALYSIS
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Hospital Administration
Without the support of hospital administration, no program/effort can survive.
All care today must be evidence based, both for the patients as well as the
institutions benefit (Leeper et al., 2011). All programs must be evidence based,
cost effective and provided in a timely manner to ensure administrative support.
The STEMI public education committee has garnered financial support from
hospital administration to produce educational materials for use in various venues.
Corporate Communications Personnel
Institutionally based corporate communication departments are very sensitive to
the needs of the community involved. They create the face of the
institution. If one is working on an evidence based program in a hospital
environment today, the support of hospital based public relations is almost
always assured. Many institutions are able to produce institutionally “branded”
educational material to further draw public interest and increase
awareness and engagement. Media campaigns can be both effective and
expensive (Pender, Murdaugh, & Parsons, 2011, p. 252). In proper settings
including; health fairs, local festivals, and schools, a good deal of the general
public can receive life-saving information in a cost effective manner.
EMS/Emergency Medical Technicians
EMT’s are invaluable, especially in a rural area such as northwestern Lower
Michigan. In MI and stroke, time is of the essence. Efficiency is crucial, every
minute counts toward improving outcomes (AHRQ Research Activities, 2011).
Early electrocardiograms, IV access, and medications go a long way in the
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treatment of STEMI/stroke patients. Evidence states, if the general public
activates EMS in a timely manner, better outcomes will ensue and the healthcare
bottom line will improve. This is especially true in rural northern Michigan,
where knowledge deficits may be greater (Swanoski, Lutfiyya, Amaro, Akers, &
Huot, 2012). EMT participation will emphasize the importance of calling 911.
Emergency Room Technician
Personnel in this setting are crucial to expediting care with early electrocardiograms, and
lab work when a patient presents with cardiac/neurological symptoms (AHRQ
Research Activities, 2011).
Nurses
Nurses are the glue that holds the healthcare system together. They have an in depth
understanding of the needs of the population they serve. Nurses are also expert at
multidisciplinary collaboration, and quality communication. Patient education is
a natural part of the work of nurses. It is well suited that nursing take a leadership
role in a vital educational program such as this (Yoder-Wise, 2011, p. 452).
Physicians/Cardiologists
Physicians direct the care of every STEMI/stroke patient and are increasingly held
accountable to following evidence based guidelines to improve outcomes and
decrease healthcare costs (Leeper et al., 2011). The authority and encouragement
they offer help inspire the work of the committee.
Data Collection Method
The regional STEMI initiative currently evaluates a number of evidence based measures
established by the American Heart Association and the American College of Cardiology (Leeper
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et al., 2011) to compare the regional system of care to national data. Included in the metrics are;
percentages of patients accessing care through EMS, and the time from symptom onset to arrival
at the hospital (Fox, 2012). Both measures are applicable to evaluating the impact of increasing
public education efforts. If the general public has greater symptom awareness, a reduction in
time from symptom onset to arrival at the hospital should be observed. Success of the ongoing
educational program can also be measured by an increase in activation of EMS for MI/stroke
symptoms. These measures must be routinely evaluated and changes to the program can be
implemented according to the evidence observed. It would also provide beneficial feedback to
provide attendees at educational sessions with evaluation forms to further fine tune efforts.
Anticipated Outcomes
There are many varied and far reaching benefits to public education efforts. This is
especially true in areas crucial to health promotion. With heart disease as the leading cause of
death in the United States, nothing but good can come from increasing the general public’s
understanding of the risks for and symptoms for cardiovascular disease. Decreased morbidity
and mortality, as well as primary and secondary prevention of cardiovascular disease are the
main goals of this quality improvement initiative. There is a dearth of public awareness of the
risks of diabetes, overweight, smoking, hypertension, and hyperlipidemia as related to
cardiovascular disease (Elliott, 2008). Increasing the public’s knowledge base is the first step
toward improving individual accountability.
Increased personal accountability will lead to
improved public health and decreased costs to the already over-burdened health care system.
Observing measurable improvements in patient outcomes is an additional benefit (Leeper et al.,
2011) that would be experienced with a successful public education program. Making this
program community focused and low cost through volunteer efforts will be further advantages.
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Implementation Strategies
An important characteristic of nursing leadership in health promotion efforts is utilization
of current theory. Nursing theory helps answer questions, supports evidence based care and
management styles, as well as guiding clinical and organizational issue resolution (Yoder-Wise,
2011, p. 7). The Integrated Theory of Health Behavior Change (ITHBC) (Polly, 2009) was used
as the basis for this public education program. This theory is based on enhancing knowledge and
beliefs, as well as improving self-regulation skills, and augmenting social support toward lasting
changes. With this theory in mind, evidence based, institutionally branded educational materials
are currently being developed. The focus of this material includes the risk factors for, and
symptoms of cardiovascular disease, as well as the importance of activating 911 for those
symptoms. These materials will be made available at various community events such as health
expos, local events/festivals, and various service groups.
Volunteers from the education
committee will be present at the various venues to provide education. Many family members
attend these venues and can be appropriate social support for this important educational
undertaking. With the right material, popular venues, and a bit of volunteer time, an inexpensive
and effective public educational program can be undertaken.
Evaluation
The importance of public health promotion regarding early recognition of cardiovascular
symptoms and timely receipt of care, including secondary prevention (risk factor management),
is crucial to reducing mortality related to myocardial infarction (Leeper et al., 2011). It has been
established that increasing public education efforts improves outcomes both locally as well as
nationally (Fox, 2012). Evaluating regional STEMI data regarding symptom recognition (time to
seeking care), as well as method for seeking care (personal vehicle or EMS) after increased
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educational efforts will analyze the effect of this educational program (Leeper et al., 2011).
Following evaluation, theory/evidence based educational programs will be reviewed and
modified/expanded based on the results of the measured data (Polly, 2009). That is the science
of nursing.
Scholarship
Nursing theory focuses assessments, directs interventions supporting change, and
improves outcomes (Polly, 2009, p. 161). It also cultivates collaborative communication with
other disciplines (Polly, 2009).
General public health promotion related to cardiovascular
disease as the leading cause of death in the United States is vital. Theory is the essence of
evidence based health care. Use of theory is vital for every healthcare professional, and is of the
utmost importance to nurses, as they are the touchstone for all aspects of healthcare. A public
education program (based on nursing theory) regarding the risks for, symptoms of, and best
method to seek care for cardiovascular events can greatly impact patient outcomes and
healthcare costs.
In conclusion, nurses have their “fingers on the pulse” of the population they serve, and
are best suited to coordinate general public health promotion efforts.
Nursing theory and
evidenced based care provide solid ground to form public educational programs on. Programs
can be revised based on the evidence/measured data compared to national benchmarks. If even
modest improvements are met with better outcomes/lower costs, measurable success will be had.
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References
AHRQ Research Activities. (2011). Heart attack victims should use emergency transport
services, not self or family to get to the hospital. AHRQ Research Activities, 374.
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