BY , MS, RN, CCM, CHPN, CENP
Care management has proven to be an integral part of patient centered care models throughout the healthcare continuum (AHRQ, 2018). Building an effective care management team is key to program growth and staff retention. One way to achieve a cohesive team is to highlight successes and provide opportunities for professional growth. A clinical ladder is a tool that can be designed to inspire and reward staff by honoring their contributions to the organization. Clinical ladders help to feature the skill set of the individual staff member as well as promote the care management team overall. An added benefit is that clinical ladders have a halo effect that extends outside of the team (Coleman, Desai, 2019).
In this article, I would like to share my organization’s implementation of a clinical ladder to encourage the use of this approach in the care management setting. The steps involved in this innovative model benefit programs and elevate leaders in care management teams. We found that utilizing a clinical ladder also fosters a higher level of inter-professional collaboration within the entire organization.
WHAT ARE CLINICAL LADDERS?
Clinical ladders have been utilized in different forms since the 1970s, and most models are based off the Benner Theory of Expert to Novice approach to obtaining skills (Smalies, Bookless & Blumenauer, 2017). Clinical ladders have a history of being used in the nursing profession to increase job satisfaction and honor the nurses working at the bedside (Kacik, 2019). Even though the clinical ladder had its beginnings in nursing, the clinical ladder program can translate very easily to other disciplines. The best use of clinical ladder programs is when it is reflective of the organization’s priorities and values (Nelson, Sassaman & Phillips, 2008). Clinical ladders can be implemented for those involved in healthcare systems ranging from ambulatory settings, hospital systems to that of post-acute care workplaces (Ko, & Yu,2014).
WHY A CLINICAL LADDER
Our organization wanted a way to foster professional development, increase mentorship, enhance morale and empower our care managers and staff. We recognized the need for an option that would increase retention rates, staff satisfaction and provide a hiring benefit to compete in the field with other medical organizations. Our next step was to explore the use of clinical ladders to achieve organizational goals. A clinical ladder was a sensible solution to increase workforce engagement, thus allowing for star employees to be recognized and provide a needed opportunity for disengaged employees to engage again. We started with a foundation of Benner Theory of Expert to Novice and included the Dreyfus model of skill acquisition (Peña, 2010). Dividing skills into pillars or categories allowed for focusing on the specific skillsets (Stubblefield, 2005). The development of the program was built around these foundational elements.
FIRST STEPS
After having the foundational guidelines and researching evidence-based practice articles, we sought real world experience. We reached out to other organizations that had experience with implementing clinical ladder programs. Learning from their successes and approach helped to further define the program and goals for clinical ladder development. Learning from best practices and expected outcomes allowed for setting achievable expectations. Reoccurring themes of success and missed opportunities allowed us to build upon or steer clear of similar situations in our new clinical ladder program.
CONSIDERATIONS IN CLINICAL LADDER PROGRAM DEVELOPMENT AND IMPLEMENTATION
Timelines to plan, develop and implement a clinical ladder program can range, but our program was able to be implemented in less than 2 years from the idea phase to the actual roll-out of the program. Our clinical ladder was named IMAP-Individualized Mission Achievement Program. Below are steps that have proven successful in implementing a clinical ladder program in our organization.
Four steps to consider when starting a clinical ladder program at your organization:
- EMPLOYEE ENGAGEMENTSuccess of a program involves buy-in from the employees. An employee advisory committee can provide input, direction and support of the clinical ladder program. Inviting staff to participate in the structure of the program avoids it being viewed as a program that leadership alone developed.
- LEADERSHIP SUPPORTAs you take the program from idea to development, having leadership support is a crucial element. Clinical ladders can positively change an organization’s culture. The return on investment is measured in both staff benefit and organizational benefit. Requirements are specific and can include quality improvement projects, research, publications and volunteer work that all expand the organization’s brand as well as the leadership skills of the employee. Staff retention, recruitment and staff satisfaction scores are increased as well (Murphy, 2012). Overall about 5% of employees will participate, but the halo effect branches out to others that are aware there is a program option (Pierson, Liggett, & Moore, 2010).
- PROGRAM DEVELOPMENT/CORE COMMITTEETaking suggestions and input helps to build self-determined, measurable criteria that translate into clinical ladder points. Building upon the organization’s mission helps align criteria into categories. This is a perfect opportunity to involve leadership in the development of the categories and application of criteria. In the IMAP program, criteria used for points are grouped under Pillars (Baptist) Education, Service, Leadership and Quality Improvement. Input from the Leadership Committee helps to bring together the factors needed and organize the program elements Leadership is also needed to provide support for awards given at completion of the program. Awards for completion range from an increase in hourly pay to a lump-sum award. Also, some clinical ladders have options to obtain levels, or titles, based on the completion of the program.
- PROGRAM LAUNCHThe more information provided the better when launching a clinical ladder program. Assess what is best for your organization. Some suggestions are using the organization’s intranet, having time set aside in all team meetings to discuss, having a point person in leadership to help with any questions. Also, having a frequently asked questions (FAQ) sheet available helps to start conversations and provide information in general. Make sure the clinical ladder packet is readily available and not difficult for staff to find.
Clinical ladders are a great tool to provide recognition to care managers who go above and beyond their duties. It promotes advancement and pride in their chosen career. Involvement of staff and leadership in development provides opportunity for connections between all levels of the organization as well. The results can lead to a positive culture change, increased morale and highlight all that care managers contribute to the success of an organization.
REFERENCES
Bourgeault, R., & Newmark, J. (2012). The power of engagement: implementation of a career ladder program. Radiology management, 34(2), 27 – 39.
Benefits of a Clinical Ladder Nursing Program (July 22, 2020). Health Stream https://www.healthstream.com/resources/blog/blog/2020/07/22/the-benefits-of-a-clinical-ladder-nursing-program
Care Management: Implications for Medical Practice, Health Policy and Health Services Research, (publication 15-0018-EF), August 2018, AHRQ, https://www.ahrq.gov/ncepcr/care/coordination/mgmt.html
Coleman YA, Desai R. (2019) The effects of a clinical ladder program on professional development and job satisfaction of acute care nurses. Clin J Nurs Care Pract.; 3: 044-048.DOI: 10.29328/journal.cjncp.1001016
Kacik, A, (2019) Health systems redefine training to reenergize employees, Modern Healthcare; https://www.modernhealthcare.com/labor/health-systems-redefine-training-re-energize-employees
Ko, Y. K., & Yu, S. (2014). Clinical ladder program implementation: a project guide. The Journal of nursing administration, 44(11), 612 – 616. https://doi.org/10.1097/NNA.0000000000000134
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Peña A. (2010). The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective. Medical education online, 15, 10.3402/meo.v15i0.4846. https://doi.org/10.3402/meo.v15i0.4846
Pierson, M.A., Liggett, C., & Moore, K.S. (2010). Twenty years of experience with a clinical ladder: A tool for professional growth, evidence-based practice, recruitment, and retention. The Journal of Continuing Education in Nursing, 41(1), 33-40.
Smailes, P., Bokless, H., Blumenauer, C., (2017) Clinical Research Nurse Career Advancement Using Clinical Ladder Programs, ACRP, DOI: 10.14524/CR-17-0038
Stubblefield, A (2005) The Baptist Health care: Journey to Excellence, John Wiley and Sons, Hoboken, New Jersey.
, MS, RN, CCM, CHPN, CENP, is a certified nurse in care management with more than 25 years of nursing experience. Rebecca has led teams in disease management, program development, leadership development and community outreach. Rebecca is currently the director of Care Transitions at Pure HealthCare.
