The problem. The Ohio Hospital Association and the Ohio Organization for Nurse Executives announced in 2002 that Ohio's aging population and growing shortage of nurses would create a 19 percent gap in need versus nursing supply by 2015.
In response, in 2002 the two organizations created FutureThink, to explore new ways for Ohio's hospitals to provide the highest quality care with limited nursing resources. But without proper leadership and funding, the initiative was on the verge of floundering, with Ohio's nursing system and patient care at stake.
Background. In 1991, Jean A. Scholz, MS, RN, decided to leave bedside nursing at Riverside Methodist Hospital in Columbus, Ohio, to become director of nursing practice at the Ohio Nurses Association. Scholz had cared for acutely ill patients and their families at the hospital since 1986, and received the hospital's award for outstanding staff nurse leadership.
However, after earning her master's of science degree in 1990, Scholz decided she "needed a new challenge," she recalls. "There is nothing more rewarding than having the privilege of taking care of people. But I wanted to put the broader focus from my education to work."
Policy and practice. Scholz led the Ohio Nursing Association's nursing practice department for eight years. "I got a broad perspective on how nurses could influence policy—and not just policy but practice," she says. "I explored the many arenas where nurses function and it gave me perspective on how the health system could work."
In 1999, Scholz joined the Ohio Hospital Association as director of health policy, responsible for evaluating patient care and workforce policy for the state's four health systems and 170 community hospitals.
"Nurses make up about one-third of the hospital workforce, and nearly 60 percent of nurses work in hospitals," she says. "Without intervention now to improve the work environment for nurses, change the way we deliver care and help people stay well, the health care delivery system will struggle to provide high quality and safe health care to the residents of Ohio."
To tackle those challenges, the hospital association and the Ohio Organization for Nurse Executives created FutureThink. The initiative aimed to avoid "short-term solutions, such as providing signing bonuses" to nurses, says Scholz. "We were working to design, organize and implement a strategic plan to develop long-term solutions to nursing shortages."
In 2003, Scholz won a fellowship from the Robert Wood Johnson Foundation Executive Nurse Fellows program to help FutureThink fulfill its mission: nothing less than transforming health care.
The project. With RWJF funding, Scholz partnered with the Ohio Organization for Nurse Executives to run 13 focus groups with nurses and consumers around the state to answer a critical question: "If the health care system worked, if you had enough nurses, what would the system look like?" she says. The focus groups suggested this answer: "An effective health care delivery system will harness technology and maximize collaboration among health care team members to provide the best care for patients and make workforce woes a thing of the past."
Guided by this vision, FutureThink leaders developed five key objectives:
- Improve wellness through prevention
- Enhance care with technology
- Attract high-quality health care workers
- Educate future health care professionals
- Build accountability to communities
Scholz then embarked on efforts to fulfill those objectives. For instance, FutureThink sponsored local workshops for nursing executives who then led regional pilot projects. The projects included:
- Help people stay well. This nine-week education and exercise program aimed to foster healthy lifestyles and fight obesity among children aged 7–14.
- Improve the work environment. Hospital-employed educators served as nursing school faculty and clinical mentors, boosting enrollment at nursing schools.
- Create a core curriculum for nursing and allied health careers. Associates degree programs and hospitals worked to allow students in health careers to take core courses together, building collaboration and reducing redundancy.
In April 2005, FutureThink also sponsored a two-day workshop at which eight teams of hospital executives considered how to transform their work environments to attract and retain bright, diverse and talented staff.
These efforts convinced the Ohio Hospital Association Board of Trustees in August 2005 to recognize FutureThink as an official program with a new name: the FutureThink Institute. The institute's Transformational Leadership Academy provided workshops and consultations to help hospitals and nursing leaders improve patient care and reduce nurse turnover.
Although Scholz's fellowship ended in 2006, she continued to lead the FutureThink Institute for two more years, during which time she expanded the Ohio Organization for Nurse Executives and encouraged members to participate in the leadership academy. In 2008 Scholz left the hospital association to become president and CEO of the Denver-based Colorado Center for Nursing Excellence.
Scholz' perspective. Though the FutureThink Institute did not continue without her leadership, its work survives through collaborative efforts throughout the state, Scholz says. She points to Nursing 2015, a joint effort of the hospital and nursing associations and the nurse executive organization that aims to achieve better work environments and greater leadership capacity for nurses.
"Because of this unprecedented partnership, we have found it unnecessary to fight nursing's battles in the legislature," she says.
Scholz considers herself a change agent, and calls the work of FutureThink transformational. In a final report on her fellowship, she explains why:
"The questions that motivated our work in Ohio were similar to those spurring The Future of Nursing: Leading Change, Advancing Health, the landmark report by the Institute of Medicine and RWJF's Initiative on the Future of Nursing," observes Scholz. "How can we transform health through nursing? What does it mean to be committed to the health of a population? How can we make sure we have enough workers to take care of that population?"
When Scholz looks back on her fellowship, she is proud "of people coming together and creating their vision," and "the fact that I was recognized not just as a leader but as a champion of the relationship between nursing and health care."
RWJF perspective: Launched in 1997, the Robert Wood Johnson Foundation Executive Nurse Fellows program prepares registered nurses who are in senior leadership positions for influential roles in shaping the U.S. health care system.
"Nurses are in a unique position to serve in leadership roles and help transform our health care system," says Susan Hassmiller, PhD, RN, and RWJF senior adviser for nursing. "The Executive Nurse Fellows program is part of the Foundation's strategy for attracting, developing and retaining diverse and high-quality leaders and a workforce to improve health and health care."