Brief Communication

Translating evidence to practice in the health professions:

a randomized trial of Twitter vs Facebook

Jacqueline Tunnecliff,1 John Weiner,2 James E Gaida,3 Jennifer L Keating,1

Prue Morgan,1 Dragan Ilic,2 Lyn Clearihan,4 David Davies,5 Sivalal Sadasivan,6

Patitapaban Mohanty,7 Shankar Ganesh,7 John Reynolds,2 and Stephen Maloney1

1Department of Physiotherapy, Monash University, Frankston, Australia, 2Department of Epidemiology and Preventive Medicine,

Monash University, Melbourne, Australia, 3Discipline of Physiotherapy and University of Canberra Research Institute for Sport

and Exercise (UCRISE), University of Canberra, Canberra, Australia, 4School of Primary Health, Monash University, Melbourne,

Australia, 5Warwick Medical School, University of Warwick, Coventry, United Kingdom, 6JC School of Medicine & Health Scien-

ces, Monash University Malaysia and 7Swami Vivekanand National Institute of Rehabilitation Training and Research, Odisha,

India

Correspondence to Associate Professor Stephen Maloney, Department of Physiotherapy, Monash University, PO Box

527, Frankston, 3199, Victoria, Australia; [email protected]

Received 7 October 2015; Revised 21 April 2016; Accepted 30 April 2016

ABSTRACT

Objective: Our objective was to compare the change in research informed knowledge of health professionals

and their intended practice following exposure to research information delivered by either Twitter or Facebook.

Methods: This open label comparative design study randomized health professional clinicians to receive

“practice points” on tendinopathy management via Twitter or Facebook. Evaluated outcomes included knowl-

edge change and self-reported changes to clinical practice.

Results: Four hundred and ninety-four participants were randomized to 1 of 2 groups and 317 responders ana-

lyzed. Both groups demonstrated improvements in knowledge and reported changes to clinical practice. There

was no statistical difference between groups for the outcomes of knowledge change (P¼ .728), changes to clini-

cal practice (P¼ .11) or the increased use of research information (P¼ .89). Practice points were shared more by

the Twitter group (P< .001); attrition was lower in the Facebook group (P< .001).

Conclusion: Research information delivered by either Twitter or Facebook can improve clinician knowledge and

promote behavior change. No differences in these outcomes were observed between the Twitter and Facebook

groups. Brief social media posts are as effective as longer posts for improving knowledge and promoting

behavior change. Twitter may be more useful in publicizing information and Facebook for encouraging course

completion.

Key words: social media, evidence-based practice, communication, education, professional, computer-assisted instruction

INTRODUCTION

A significant gap remains between research generated healthcare

knowledge and clinical practice.1–3 Social media can rapidly link

researchers and clinicians from diverse geographical regions,

disciplines, and areas of practice; making it an ideal medium for

knowledge exchange and education. Approximately 25% of

health professionals currently use social media for obtaining

research information.4

Social media has been defined as a “collection of web-based

technologies that share a user-focused approach to design and func-

tionality, where users can actively participate in content creation

VC The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved.

For Permissions, please email: [email protected]

403

Journal of the American Medical Informatics Association, 24(2), 2017, 403–408

doi: 10.1093/jamia/ocw085

Advance Access Publication Date: 29 June 2016

Brief Communication

and editing through open collaboration between members of com-

munities of practice.”5 The use of social media in education may

lead to positive learning experiences,5,6 increases in knowledge and

skills,7–10 and changes to the clinical practices of health professio-

nals.10,11 However, there is a need for studies to evaluate the relative

effectiveness of different social media based applications.12

Two of the largest social media applications are Facebook (1.49

billion monthly active users) and Twitter (316 million monthly

active users).13,14 Both sites promote user interaction and allow

posting of text, videos, and weblinks; however, Twitter limits posts

to 140 characters. Neither site charges access costs. The popularity

and features of these sites indicate their potential application in

communicating research information and, therefore, were chosen

for investigation in this study.

OBJECTIVE

The primary objective of this study was to determine if research

information delivered by Twitter or Facebook would result in

greater changes in research informed knowledge and practices of

health professionals. The secondary aim was to compare participant

behavior and engagement with the two mediums.

METHODS

Design An open label randomized comparative design was used, with a

mixed methods approach to data collection and analysis. The Mon-

ash University Human Research Ethics committee (CF 14/1372 –

2014000640) approved the study.

Participants Health professional clinicians of any discipline (e.g., medicine, phys-

iotherapy, podiatry), geographical location, or level of expertise

(including undergraduate students), were eligible to participate.

Recruitment occurred via an email invitation distributed to clinical

affiliates and departments of Monash University, Faculty of Medi-

cine, Nursing and Health Sciences, Australia; Monash University

Malaysia; Swami Vivekanand National Institute of Rehabilitation

Training and Research, India; and the University of Southern Cali-

fornia. Professional associations representing professions registered

with the Australian Health Practitioner Regulation Agency15 were

also invited to distribute the invitation to participate via email or

their own social media sites.

Intervention A short course, consisting of the same 8 “practice points” or key

educational messages of 140 characters or less, on topics related to

tendon management were delivered to each group via posts on Twit-

ter16 and Facebook17 web pages. Each practice point was linked to

supplementary information in the form of peer-reviewed journal

articles or podcasts by clinical experts. The course was designed by

educational, clinical, and research experts, and was identical except

that the Facebook posts contained the practice point plus an addi-

tional 2–6 short written statements (1–2 sentences) that highlighted

key concepts from the supplementary information. The practice

points were delivered evenly over a 2 week period, to both groups at

the same time points. The pages were not restricted access.

Procedure Clinicians consented to participate by providing contact details

through an online survey. Those who provided a valid email address

were enrolled. Participants were stratified by role (student, clinician,

or other) and randomized to receive the practice points via Twitter

or Facebook. Participants received video and written instructions on

obtaining a social media account and accessing the practice points

from their allocated site. The instructions also encouraged interac-

tion on the allocated site. Participants were sent three reminder

emails at each data collection point to minimize attrition. The study

was conducted between August and October 2014.

Outcomes Data was obtained via an anonymous online survey completed 1

week before (baseline assessment) and after (post-intervention

assessment) the short course. A password was used to match pre-

and post-course data. Demographic details, information on tendon

management experience, and current use of social media were

obtained.

Outcomes were determined based on the Kirkpatrick hierarchi-

cal levels of evaluation 1–3.18 Participation and engagement data

was also collected. A data collection summary can be found in

Appendix 1.

Kirkpatrick Level 1: Participant Reactions The Social Media Use and Perception Instrument (SMUPI), a ques-

tionnaire of 10 items with high internal consistency,19 measured

attitudes towards using social media in continuing professional

development.

Kirkpatrick Level 2: Knowledge Sixteen multiple choice questions assessed knowledge (A–E

responses) (Appendix 2). One question correlated with each

“practice point” and one correlated with information from each

piece of supplementary information. The questions in both assess-

ments were identical, but question and response order were random-

ized to minimize score improvements based on pattern recognition.

Participants were not given assessment answers until the conclusion

of the study. Self-rated measures of tendon management confidence

and knowledge were also obtained.

Kirkpatrick Level 3: Behavior Change Participants were asked “has the education you have received via

social media during this trial changed the way you practice, or

intend to practice, with musculoskeletal clients?” and “has the edu-

cation you have received during this trial increased your use of

research evidence within your clinical practice?”

Participation was evaluated via the number of participants who

connected with the social media pages and completed the assess-

ments. Data on interaction was obtained through participant self-

report and from the number of times posts were approved of

(“liked” or “favorite”), shared or commented on.

Analysis Mixed linear models were used to analyze the repeated measure-

ments (pre- and post-exposure to the intervention) on the partici-

pants. The restricted maximum likelihood method (REML), as

implemented in the GenStat statistical package,20 was used to fit the

models, calculate predicted means and test, using F-tests, the main

effects of group (Twitter vs Facebook) and time (pre vs post) as well

404 Journal of the American Medical Informatics Association, 2017, Vol. 24, No. 2

as their 2-way interaction. Pairwise least significant difference tests of

the group-by-time means were based on these analyses and conducted

at the 5% significance level. Diagnostic plots of residuals were

checked for assumptions on which these methods are based. Analyses

of the 5-point Likert scale responses also used the restricted maximum

likelihood method as is customary with large datasets.21 The analyses

of binary response outcomes, measured post intervention, were based

on logistic regression models, also fitted using GenStat. Discrete count

data from Twitter and Facebook sites were analyzed using a variance-

stabilizing transformation in an analysis of variance.

RESULTS

Five hundred clinicians consented to participate. Five were excluded

due to an invalid email address, and one participant asked to be

removed. Four hundred and ninety-four participants were randomized.

The attrition rates from randomization to baseline assessment were

48.2% for the Twitter group and 41.7% for the Facebook group; the

difference was not significant [v2 (1, n¼494)¼2.09, P¼ .148]. Attri-

tion from baseline assessment to post intervention assessment was

32.8% for the Twitter group and 8.3% for the Facebook group; this

difference was significant [v2 (1, n¼494)¼17.37, P< .001]. Three

hundred and seventeen responses were analyzed (140 Twitter, 177

Facebook). There were 99 baseline assessments, 45 post intervention

assessments, and 173 matched baseline and post intervention assess-

ments. A consort flow-chart is available in Figure 1.

Demographics Demographic data and data on tendon management experience and

social media use was obtained from the baseline assessment and is

presented in Table 1.

Kirkpatrick levels 1, 2 and 3 Following the intervention, (the short course consisting of practice

points) there were statistically significant increases in SMUPI score,

self-rated confidence, self-rated knowledge and multiple choice

assessment score; but no statistically significant differences between

the groups in their changes over time. Participants in both groups

reported a change in practice/intended practice and increased use of

research in practice/intended practice as a result of the intervention

but there was no statistically significant difference between the

groups. This is shown in Table 2.

The Twitter page developed 428 “followers” and the Facebook

page received 155 “likes.” An estimated 10.0% (8/80) of the Twitter

group and 7.8% (9/115) of the Facebook group reported interacting

online. The difference between groups was not significant [v2 (1,

n¼195)¼0.28, P¼0.597)]. An estimated 42.6% (20/47) of the Twit-

ter group and 34.8% (24/69) of the Facebook group reported lack of

time as a reason for lack of interaction on the social media sites.

Statistically significant differences were found between groups

for number of times information was shared (mean shares per post

Twitter 10.40, Facebook 0.20, SED 3.030, P< .001) and approved

of (“liked”/”favourite”) (mean Twitter 14.00, Facebook 8.00, SED

1.414, P¼ .005).

DISCUSSION

This study has demonstrated that research information delivered by

either Twitter or Facebook can improve clinician knowledge and

Expressed interest in par�cipa�ng (n=500)

Excluded (n=6) n=1 complaint about process n=5 no email address provided

Randomized (n=494)

Allocated to Facebook (n=247)Allocated to Twi�er (n=247)

Comple�on of baseline Assessment (n=128)

Withdrew (n=1) Reason unknown

Comple�on of baseline Assessment (n=144)

Comple�on of post interven�on assessment (n=86)

Comple�on of post interven�on assessment (n=132)

Figure 1. Consort flow chart showing attrition of study participants.

Table 1. Participant demographics and participant characteristics

Twitter Facebook

N (%)a N (%)a

Baseline demographic data sets 128 144

Area of practice

Physiotherapy/physical therapy 95 (74.2) 98 (68.1)

Medicine 18 (14.1) 19 (13.2)

Osteopathy 2 (1.6) 3 (2.1)

Podiatry 7 (5.5) 11 (7.6)

Other 4 (3.1) 11 (7.6)

Not stated 2 (1.6) 2 (1.4)

Role

Undergraduate Student 33 (25.8) 36 (25.0)

Postgraduate Clinical Trainee 9 (7.0) 13 (9.0)

Clinician 78 (60.9) 78 (54.2)

Other 8 (6.3) 17 (11.8)

Not stated 0 (0.0) 0 (0.0)

Age

Under 18 0 (0.0) 0 (0.0)

18–24 28 (21.9) 39 (27.1)

25–34 59 (46.1) 64 (44.4)

35–44 31 (24.2) 28 (19.4)

45–54 8 (6.3) 8 (5.6)

55–64 2 (1.6) 4 (2.8)

65þ 0 (0.0) 1 (0.7)

Sex

Male 79 (61.7) 71 (49.3)

Female 47 (36.7) 71 (49.3)

Not stated 2 (1.6) 2 (1.4)

Country

Australia 48 (37.5) 59 (41.0)

India 14 (10.9) 14 (9.7)

Malaysia 5 (3.9) 6 (4.2)

UK 29 (22.7) 23 (16.0)

USA 12 (9.4) 17 (11.8)

Other 19 (14.8) 24 (16.7)

Not stated 1 (0.8) 1 (0.7)

Tendon management experience

Provide health care to clients with

tendon disorders once a week or more

61 (47.7) 62 (43.1)

Social Media experience

Use Twitter 75 (58.6) 66 (45.8)

Use Facebook 106 (82.8) 130 (90.3)

aPercent of group (Twitter or Facebook) that provided baseline data.

Journal of the American Medical Informatics Association, 2017, Vol. 24, No. 2 405

promote behavior change. No statistical differences in these out-

comes were observed between the Facebook and Twitter groups.

This research is consistent with previous literature that indicates

that web based or social media programs are useful as learning

tools,5,7,8,10,11 and can improve clinician knowledge and promote

behavior change.10

This study has also found that the provision of extra informa-

tion, beyond a 140 character message, did not impact on knowledge

or behavior change. Short messages may be beneficial to busy

healthcare workers as lack of time is often cited as a barrier to evi-

dence based practice.1 However, trustworthiness of information

gathered via social media is a key concern of clinicians.4 Our data

indicates that brief messages, when obtained from a reputable

source and linked to full sources of information may be acceptable

to clinicians.

There were two interesting differences between the groups.

There was greater overall attrition from the Twitter group. Site

familiarity may be a factor, as more health professionals use Face-

book than Twitter.4 In this study, over 80% of clinicians in each

group use Facebook; <60% in each group use Twitter. The prefer-

ence of clinicians to use Facebook over other social media sites for

obtaining research information may also be a factor.4 Therefore, the

use of Facebook may have encouraged online course completion.

The Twitter page developed a far greater following than the

Table 2. Kirkpatrick level 1–3 outcomes

Baseline measures

Predicted Mean (n)

Post-Intervention measures

Predicted Mean (n)

Difference (SED)b P-value

Kirkpatrick level 1 outcomes

SMUPIa

Twitter 40.34 (126) 41.85 (86) 1.51 (0.66) .024

Facebook 39.53 (143) 40.86 (127) 1.33 (0.58) .022

Difference (SED)b �0.81 (0.82) �0.99 (0.91)

P-value .326 .277 .841d

Kirkpatrick level 2 outcomes

Self-rated confidence in tendon managementc

Twitter 3.380 (128) 3.784 (86) 0.404 (0.083) <.001

Facebook 3.216 (143) 3.644 (131) 0.428 (0.072) <.001

Difference (SED)b �0.164 (0.106) �0.141 (0.116)

P-value .124 .227 .830d

Tendon management self-rated knowledgec

Twitter 3.181 (127) 3.727 (86) 0.546 (0.082) <.001

Facebook 3.027 (143) 3.570 (131) 0.543 (0.071) <.001

Difference (SED)b �0.154 (0.102) �0.157 (0.112)

P-value .135 .163 .975d

Multiple choice assessment total score (max score 16)

Twitter 7.649 (123) 10.308 (80) 2.659 (0.381) <.001

Facebook 6.599 (136) 9.435 (118) 2.835 (0.331) <.001

Difference (SED)b �1.050 (0.469) �0.874 (0.521)

P-value .026 .095 .728d

Assessment score for questions that addressed the practice points (max score 8)

Twitter 4.155 (123) 5.523 (80) 1.368 (0.233) <.001

Facebook 3.789 (136) 5.431 (118) 1.642 (0.203) <.001

Difference (SED)b �0.366 (0.259) �0.093 (0.293)

P-value .159 .752 .378d

Assessment score for questions addressing the supplementary information (max score 8)

Twitter 3.485 (123) 4.819 (80) 1.333 (0.211) <.001

Facebook 2.848 (136) 4.025 (118) 1.177 (0.184) <.001

Difference (SED)b �0.637 (0.255) �0.793 (0.211)

P-value .013* .006* .578d

Number reporting change (n) % of group (95% CI) P (between group

differences)

Kirkpatrick level 3 outcomes

Reported change in practice due to intervention

Twitter 59 (77) 77 (67-86) .11

Facebook 77 (117) 66 (57-74)

Reported increased use of research in practice

Twitter 55 (78) 71 (60-81) .89

Facebook 80 (115) 70 (61-78)

aTotal of ten items, each measured on a 5 point Likert scale, whereby higher score¼more favorable attitude. bSED¼ Standard Error of the Difference. cMeasured on a 5 point Likert scale 1¼ very poor, 5¼ very good. dP-value is for the F-test of a two-way interaction.

*Statistically significant difference between groups.

406 Journal of the American Medical Informatics Association, 2017, Vol. 24, No. 2

Facebook page, and more participants in the Twitter group shared

the received information within their own social networks. Twitter

is particularly useful in publicizing information, and it appears this

also applies to research information.

Social media promotes online social interactions, which may

enhance learning22 and promote change through social influence.23

Interaction in this study was encouraged in the course instructions, and

a tendon expert was available to answer questions. However, 10% or

less of the participants in each group reported interacting online. Over

30% of participants in each group cited lack of time as a key barrier to

interacting. Approximately 60% of clinicians are evidence

“pragmatists” – those to whom validity of evidence is secondary to the

daily demands of practice.2 Therefore, the interaction in this study may

reflect everyday professional use of social media for accessing research

evidence. Concerns about professional image may also influence online

interactions.4 Herein lies the paradox of social media based learning

communities; the openness and diversity which can enrich learning

may also negatively impact upon the socio–emotional aspects of group

formation which may be beneficial for collaborative learning.24

While significant improvements in knowledge occurred, the

improvements were small (an increase in total assessment score of

<3). A lack of time to read or listen to supplementary information

may have influenced this result. The practice points may also have

been lost among the large volumes of information that can appear

on social media accounts, or may have been filtered out by the social

media sites themselves.

There are several limitations to this study. Baseline measures

were collected shortly after randomization had occurred, potentially

resulting in chance bias. However, participant assessments were

anonymous, therefore randomization after completion of baseline

measures was not possible. There was no control group to assess the

impact of a learning effect from the assessment or to see if the course

was equally effective if delivered via email or text message. How-

ever, this study aimed to compare social media modalities and the

benefits and limitations of each. Participants from the Twitter group

had a statistically significant higher baseline assessment score for

knowledge related to the supplementary information. There are a

number of health professional information sharing sites on Twitter,

and participants allocated to Twitter may be more inclined to partic-

ipate if they had previous exposure to these sites. An error resulted

in 5 participants from the Twitter group obtaining the course infor-

mation for both Twitter and Facebook, however due to the small

number of participants affected, this is unlikely to have impacted the

results. Both Facebook and Twitter sites were publically available,

and participants were not asked to keep group allocation or infor-

mation confidential, meaning the groups may not have been mutu-

ally exclusive. However, participants were not informed of the

alternate group, and the diversity of participants limits the potential

impact of this confounding factor. The sites were open access; there-

fore people other than study participants may have interacted on the

sites. The same assessment was used before and after the interven-

tion however, question and answer order were randomized to limit

any potential learning effects. The high attrition rates may have

resulted in attrition bias,25 however, given that online courses often

have dropout rates of �50%26,27 the attrition level is not abnormal

for this type of education.

CONCLUSION

Evidence based “practice points” on tendinopathy management can

increase clinician knowledge and influence changes in practice,

whether delivered by Facebook or Twitter. No differences in these

outcomes were observed between the Twitter and Facebook groups.

Messages of 140 characters or less are as effective as longer posts in

conveying research information.

Future research directions may include investigating social media

interaction and the subsequent impact on learning and behavior

change, and how perceived e-professionalism influences clinicians

1A

	American Organization for Nursing Leadership (AONL)
	Competencies and Skills
AONL Leadership Domain	Example of Core Leadership Competency
Knowledge of the Health Care Environment & Clinical Principles	Ensures the use of patient safety & improvement sciences
Sub Domains	Example of Functional Leadership Director Competency
Nursing Practice & Application	► Ensure competencies & education/training ongoing ► Track & Trend assessment incident reports & develop plan of correction to address & improve patient safety. ► Quality & safety standards ►Review/Develop procedural directive for 100% participation in annual comp.
Economics & Policy Regulations	Ensuring adherence to standards (e.g. Joint commission, Magnet recognition, State boards, State legislation). Influencing healthcare policies & championing health equity & access.
Evidence-Based Practice	►Keep up w/literature to implement best practice. ►Use evidenced-based practice to improve standards of practice & development of P&P. ►Membership to national nursing organization. ►Conferences/presentations/poster abstract submission ►Research/publications ►Increase certifications in each unit by 10%

1B

	American Organization for Nursing Leadership (AONL)
	Competencies and Skills
AONL Leadership Domain	Example of Core Leadership Competency
Sub Domains	Example of Functional Leadership Director Competency
Patient Safety & Quality	Review & analyze quality & safety metrics for span of practice control ►Ensure those metrics are transparent and understood by staff – what they do drives these metrics. ►Data monitoring ►Sharing metrics ►Use current EBP to implement new pt safety protocols. ►Decrease falls by 15%

2

	American Organization for Nursing Leadership (AONL)
	Competencies and Skills
AONL Leadership Domain	Example of Core Leadership Competency
Communication and relationship Building	►Influences and persuades others, builds consensus, and gains cooperation from others to share information and accomplish goals. ►85% or > in leader communication on employee engagement survey
Sub Domains	Example of Functional Leadership Director Competency
Effective Communication	►Communicate the "Why"/validate understanding ► transparency ►meeting minutes ►Use "being" & "doing" communication style ►Openess in communication styles ►Ask for feedback/circle back on communication ►How does this look operationally ►Monthly mgrs meeting ►Montly staff meeting ►1:1 feedback/planning sessions with direct reports ►Perform quarterly 1:1 feedback sessions with direct reports ►Perform monthly staff meeting with agenda/minutes ►Establishes/maintains 3T interdisciplinary partnership annually
Relationship Management	►Be available/visible curious ►Check the pulse on how team and management is feeling ►Team building activities ►Leadership rally/strategic planning/vision casting at the division level ►Leadership rounding ►Rewards/recognition ►Stay interviews ►5 minutes with staff ►peer interviews ►Accountable for leadership rounding monthly (infection prevention – risk-EOC) & contractors ►Stoplight – reports/feedback provided quarterly
Influencing Behaviors	►Lead by example ►Get them by-in | meaningful feedback ►Engage staff in the process ►Engage in conversations about solutions not just problems ►Being & doing ►Mentorship ►Coaching ►Invested Leadership: ▪Know goals of staff ▪Provide shadowing opportunities ►Influencing staff to report as evidence by feeling that they have psychological safety ►ackowledgement of staff weekly – Care Badges ►ackowledgement of accomplishments – birthdays, anniversaries, other accolades ►Attain 80% or > in employee engagement survey in leader communication.

3A

	American Organization for Nursing Leadership (AONL)
	Competencies and Skills
AONL Leadership Domain	Example of Core Leadership Competency
Professionalism	Implements and maintains optimal, culturally competent healthcare across the lifespan, in all settings, addressing social determinants of health and health equity
Sub Domains	Example of Functional Leadership Director Competency
Professional Accountability	►Meet Regulatory compliance standards (TJC, AHCA) ►Develop and implement competency standards of practice ►Policy review ►Competencies ►Evaluation/Feedback sessions ►Certifications/Licenses ►Attending conferences ►Multidisciplinary meetings for pt. P.O.S. ►Maintain professional certification ►Maintain membership in prof. organizations (ex. AONL) 80% of nurse leaders members of AONL/prof. org.
Organizational Accountability	►Meet/Exceed metrics ►Quality improvement ►HCAHPS ►Track mortality rates ►Achieve 100% compliance (zero findings) fore regulatory standards. ►Develop and implement competency standards and standards of practice through: a) Annual policy review (100%) b) 100% compliance with licensure and certification renewals. c) Achieve 100% evaluation/feedback of staff. d) Attend a minimum of 1 (one) professional development conference per year. e) Maintain active membership in a minimum of 1 (one) professional organization. ►Meet & exceed metrics: a) Quality initiatives (set goals) b) PX c) Finance (set goals based on individual scorecards)

3B

	American Organization for Nursing Leadership (AONL)
	Competencies and Skills
AONL Leadership Domain	Example of Core Leadership Competency
Advocacy	►Ensure delivery of safe, compassionate care for all persons served (patients, staff, and customers) ►SpeakUp ►Addressing barriers/equipments ►RCA – finding? To effect process changes/staff satisfaction
Health Equity and Social Determinants of Health	►Education & policy review, training, competency leaders (NM, ANM, staff) ►Monitoring compliance/outcomes ►Community involvement ►Partner with FQHC's especially with pt. care information. ►Population Health usage and interventions.
Governance	►Participation in Councils ►Reporting compliance and making decisions ►Multidisciplinary Health Team P.O.C. Council ►Participate in systemwide decision making forums as evidence through departmental involvement in systemwide councils. ►Daily leadership rounding on 5-10 patients to ensure delivery of safe, compassionate care and positive PX. ►SpeakUp: conduct a minimum of 5 skip-level rounding to encourage speak up and staff feedback. ►Track and trend safety reports and RCA findings, and develop CAP to improve PX and employee engagement ►Participate in a minimum of 1 (one) community outreach per year. ►Create awareness of the use of Population Health to improve pt. outcomes. ► Participation in a minimum of 1 (one) hospital-specific, and 1(one) systemwide committee ►Establish/promote Shared Governance through UBC.

4A

	American Organization for Nursing Leadership (AONL)
	Competencies and Skills
AONL Leadership Domain	Example of Core Leadership Competency
Leader Within	Ensures that employees are appropriately recruited, selected, onboarded, educated, evaluated, and recognized.
Sub Domains	Example of Functional Leadership Director Competency
Reflective Practice	►Establish criteria to select candidates whose educational work experience aligns with JHS vision/mission. ►Trial multidisciplinary approach as evidenced by an inclusion interview panel approach. ►Involvement in surveys/think tank ►Ensure that leaders oversee completion of employee onboarding (NEO, weekly progress) ►30/60/90 Day touchpoint/eval 100% of the time for new employees
Foundational Thinking	►Critical thinker ►Building staff foundation at the point of interview
Career Development	►Provide mentorship& development opportunities as evidence by 90% participation in LDI ►Establish talent management strategies & succession planning ►Succession planning & mentorship – minimum 1 (one) person ►Clinical Ladder Development for employees by 2026 ►Ensure 30/60/90 retention meetings with new hires are completed by 95% ►Ensure 1 (one) mentee is enrolled in JHS Mentorship program per unit/dept.

4B

	American Organization for Nursing Leadership (AONL)
	Competencies and Skills
AONL Leadership Domain	Example of Core Leadership Competency
Sub Domains	Example of Functional Leadership Director Competency
Personal & Professional Accountability	►Increase certification through study groups or other venues by 2% yearly ►Hold leadership certification ►Become nationally certified in your specialty/certified as a requirement for hire within the first year to two years. ►Bring in course for your team to take prior to taking National certification in specialty. 25% of RN's will be nationally certified. ►Increase specialty certification among registered nurses across units/departments by 2% each year ►Increase enrollment in professional organizations for registered nurses across units/departments by 2% each year

5B

	American Organization for Nursing Leadership (AONL)
	Competencies and Skills
AONL Leadership Domain	Example of Core Leadership Competency
Sub Domains	Example of Functional Leadership Director Competency
Respect in the workplace	►Rounding → I-Round ►Shadow other depts. ►skip level rounds ►Loop closure ►1:1 with team members regulary week ►EMBA walks ►Speak Up-implement ►HR Rounding – per month ►Evals & feedback sessions ►no overdue ►The director will demonstrate inclusive collaboration and value teams contribution as evidenced by obtaining top 15th percentile of NDNQI survey results per FY
Decision Making	►Shared governance ►Policy review – council meetings ►involve frontline staff in decision making ►enduser involvement ►Role model use of data to drive decisions ►The director will make the decision making process using "group think" process of which group will include informal leaders of the frontline staff as evidenced by "group think" council meeting minutes for quarterly meetings.
Transformation and Innovation	►Staff meeting and minutes ►Councils ►Conferences ►Education/Higher learning ►HRO – GEMBA walks – developing at Culture of safety as evidence by safety incident reporting including near-misses ►using latest EBP to enhance pt. care ►DYADs ►Mentorship ►Fellowship programs ►The director will collaborate with educators, dept. leaders and informal leaders to generate and implement new ideas using EBP. This will be demonstrated by one project launch, completed to end, per FY, reviewed per quarter.

6

	American Organization for Nursing Leadership (AONL)
	Competencies and Skills
AONL Leadership Domain	Example of Core Leadership Competency
Business Skills and Principles	►Aligns and creates nursing/clinical objectives, goals, and tactics required to achieve the organization's strategic outcomes.
Sub Domains	Example of Functional Leadership Director Competency
Financial Management	►LOS for admissions – Review POC of shift for completion = D/C ►Review and maintain appropriate staffing levels – productivity – premium pay ►Flex and float staff as needed ► Utilization of staffing level ►Overseeing & meeting operational budget → quarterly ► Conscientious use of resources ►Reduce LOS for admissions GOAL: ↓ LOS by goals of divisions within 12months; Measure Track averasge LOS monthly & identify areas of opportunity ►Maintain within budgetary goals meet or exceed productivity levels ▪Goal: 98% – 100% productivity ▪Goal: Premium pay w/in targeted goal ►Conduct quarterly financial reviews w/departmental leaders. ▪Goal: Cost reduction by x amount
Strategic Management	► Cross-train nurses who wish to be dual specialty trained ►Shared governance and multiple departments participating ►Development of departmental goals aligned with JHS strategic goals ►Allocate resources to identified needs (ex. Staff) ►Biannual strategic plan review ►Meet with team to create a strategic plan yearly and meet or exceed action plan goals ►Plan and develop specialty specific goals to align w/JHS strategic goals (ex. DCF compliance, HAI, HCAPS, LOS, budget maintenance) ▪Goal: Successful implementation and meeting or exceeding 1 or above goals, biannually. ►Optimize staff utilization ▪Goals: Crosstrain at least 20% nurses to be dual specialty trained. ▪Goals: Diversity FTE mix
Human Resources Management	►Partner for proper staffing and reduce OT usage and agency use ►Reduce turnover/track retention data monthly → less than 9% at or less than organizaton goal ►Provide a healthy work environment ►Timely onboarding – less than 60days ►Continous onboarding of PRM to ↓ OT ►Increase staff engagement as evidence on staff engagement survey and Magnet RN NDNQI Survey ►Staff retention (develop/implement strategies) ►Collaborate w/HR partner monthly – monthly meeting to address openings/positions/HR issues ►Enhanced Staff retention ▪Goals: develop & implement retention strategies to reduce turnover by x % over the next year. ▪Measure: Review or maintain the turnover rate quarterly. ▪Measure: Review vacancy rate monthly.