NURSING 409

David Bailey, RN

Curline Dixon, RN

Virginia Echebin, RN

Laetitia Kavanaght, RN

Eunyoung Kim, RN

Souleyman Kindo, RN

Kimberlyn McKay, RN

Sean Petty, RN

Christine Turner, RN

PERFORMANCE IMPROVEMENT

PROJECT

CONTINUUM OF CARE

PATIENT

ORGANIZATION

INTERACTION

CULTURE

Goal: Develop a plan that

fosters positive interaction through the use of current processes, polices, and communication methods.

To implement a new culture that vales the patient, the community, and the organization at all levels.

IMPROVING THE PATIENT’S EXPERIENCE

The group shared perspectives, insight, and background experiences to collaboratively define the patient’s experience within the ambulatory care setting.

We have recognized the impact of a positive patient experience before, during, and after the delivery of care.

Interventions focuses on the interaction and perception of the client, the culture of the organization, and the continuum of care.

To develop the institution definition of patient experience we plan to encourage a more integrated quality experience that exceeds the expectations of each patient.

IMPROVING THE PATIENT’S EXPERIENCE

IMPROVING THE PATIENT’S EXPERIENCE

WHO ARE THE STALKHOLDERS:

IMPROVING THE PATIENT’S EXPERIENCE

The Patient

The Physicians

Registered Nurses

Specialty Clinical Area

Community Members

Factors that may drive the improvement process:Increased patient satisfactionIncreased staff satisfactionBetter patient outcomesHigher revenue

Factors that may restrain the improvement process:CostOrganizational inertiaPatient’s accustomed to the status quoInability to successfully implement changesIncreased workload of staff/providers

IMPROVING THE PATIENT’S EXPERIENCE

What regulatory standards relate to this problem:The Professional Standards of PracticeState Practice ActsPolicies and guidelines of the practice setting

(Nursing World, 2012). Policy and Procedure Manual

Purpose: To provide guidelines for practice in the ambulatory setting.

Policy: Ambulatory care policies and procedures will be reviewed

annually.

IMPROVING THE PATIENT’S EXPERIENCE

Appointment System

◦ Policy: Access to health care services at St. Barnabas Hospital

Ambulatory Care Network will be available to the public through the appointment system.

◦ Procedure: Patient appointments are made utilizing the network wide

HBO registration system.Patients who attend the clinics may make a follow up

appointment at the end of the visit.Patients may call for an appointment using the network

ambulatory appointment desk lines which are printed on appointment cards.  

IMPROVING THE PATIENT’S EXPERIENCE

Approximately 500 patients are seen by the ambulatory center daily.

Patients arrive 15 minutes before their scheduled appointments.

The wait time often exceeds 15 minutes for most patients. The typical time spent with the doctor is 15-20 minutes.

The scheduled times for the appointments are: Monday- Friday, 8:30am – 11:30am and 1:00pm- 3:30pm.

After 3:30pm, it is only emergency cases, they would come in at 3:45pm, and no appointments would be made after 4:00pm.

IMPROVING THE PATIENT’S EXPERIENCE

Standards of Care Related to the Patient Experience:

Ambulatory Care Department MissionTo provide comprehensive medical services to all members of

the community in which the hospital is located. The services provided are those that are needed by the

community residents, and are organized to facilitate such use. To this end the following goals and objectives have been

established.  

IMPROVING THE PATIENT’S EXPERIENCE

To this end the following goals and objectives have been established.

◦ To provide services that are convenient and available with efforts to eliminate barriers to service.

◦ To treat all patients with respect and courtesy. To assure patient confidentiality

◦ To provide comprehensive primary care to adults and children◦ To provide preventive health services and education to patients in order

to prevent disease and promote wellness. ◦ To maintain continuity of care with the same physician team to the

extent possible considering vacations, schedule changes, etc..◦ To provide support services to assist patients with physiological social

and financial problems. ◦ To work with community agencies to improve the health of the

community as a whole and individual community members by coordinating referrals to and from other agencies.

IMPROVING THE PATIENT’S EXPERIENCE

General Care Policy

Purpose: ◦ To establish a mechanism for patients to voice complaints regarding their

care. Policy: ◦ Every patient must be entitled to voice grievances without fear of reprisal.

Any complaints about the services provided should be investigated. Procedure: ◦ All complaints should be addressed by an Administrator or Nurse Manager,

with attempts at resolution.◦ Patient complaints, both written and verbal, should be referred to the Patient

Representative for investigation and follow up. Research suggest that long waiting times were associated with lower patient

satisfaction. Time spent with the physician is a strong predictor of patient satisfaction

(Anderson, Camacho & Balkrishnan, 2007). 

IMPROVING THE PATIENT’S EXPERIENCE

Standards of Care Related to the Patient Experience:

◦ Patient Centeredness One of the six aims of the Institute of

Medicine (IOM) is to provide patient centered care.

This emphasizes the importance of access and coordination of information and care.  

Within the context of St. Barnabas Clinic, the coordination in the waiting area is facility centered and the patient experience could be enhanced.

Measured Perception of Quality Care:

◦ Patients are now able to rate their experience in the ambulatory care center with the CHAPS survey.

◦ This rates their perception of the quality care received and addresses their overall experience and communication with staff and physicians.

Surveys help to build compliance and rapport with patients. 

IMPROVING THE PATIENT’S EXPERIENCE

PATIENTS SURVEY

IMPROVING THE PATIENT’S EXPERIENCE JCAHO's New Patient Flow Standard 

New Leadership Standard on Managing Patient Flow

Identify the relevant patient care standards, nursing practice, and/or organizational standards that relate to the problem:

Standard LD.3.10.10:The leaders develop and implement plans to identify and mitigate impediments to efficient patient flow throughout the hospital.

Specific indicators:

measure components of the patient flow process. monitor capacity, support services, and safety of hospital services. Monitors area that receive patients. 

Timeliness - National Healthcare Quality Report 2011:

Timeliness in health care is the system’s capacity to provide care quickly after a need is recognized.

It is one of the six dimensions of quality the Institute of Medicine established as a priority for improvement in the health care system (IOM, 2001).

Measures of timeliness include time spent waiting in doctors’ offices and emergency departments (EDs) and the interval between identifying a need for specific tests and treatments and actually receiving services.

IMPROVING THE PATIENT’S EXPERIENCE

AHRQ Health Care Innovations Exchange Reducing wait times and enhancing patient satisfaction at two urban clinics in NYC

Problem addressed Lack of preparedness during the first hour of the day often results in extended wait times for

patients and reduced productivity, patient satisfactions, and quality of work.

Innovative Activity End-of-day checklist to prepare for the next day’s opening. Reevaluating staffing levels and implementing staffing assignments to ensure that all levels were

appropriately assigned based on patient volumes .

Encouraging patient self-advocacy Encourage patients to advocate for themselves regarding wait times .

Results Shorter waits More satisfied patients Improved patient-provider interactions

IMPROVING THE PATIENT’S EXPERIENCE

Develop a plan for improving the process or practice identified:

In order to improve the patient’s appointment experience, the following can be implemented:

Intercom System: Patient’s names are called in an orderly fashion

Electronic Numbering System:

To assist with letting the patients know that they are next when being called to be seen by the receptionist.

To assist those patients who are hearing impaired or who speak a language other than English, to know that their number is being called.

 Label each clinic door with either ‘A’, ‘B’, ‘C’ or ‘1’, ‘2’ or ‘3’ label To decrease the confusion as to which door the patient is being called to go through. 

IMPROVING THE PATIENT’S EXPERIENCE

Paper ticket number machine for the patients who need to be seen by the clinics receptionist:

The patients will remain seated until their number is called.

Decrease the safety hazard that is being created by patients standing in line and blocking the elevators.

Prevent patients who are using a wheelchair or walking with an ambulatory device from getting from one side of the clinic to the next.

IMPROVING THE PATIENT’S EXPERIENCE

Privacy dividers between each receptionist:◦ The privacy dividers will enhance the patient’s sense of well-

being by them feeling comfortable enough to make their reasons for visiting the clinic known.

Patient Scheduling System:◦ Patients who are computer literate can enter their information

into the scheduling computer if they have an appointment that day.

IMPROVING THE PATIENT’S EXPERIENCE

Identify the indicators for measuring the success of the performance improvement plan? ◦ Use of Survey Method:

A self completed questionnaire can be given to the patients as soon as they checked in.

The purpose and procedure of the survey are explain to the patients and they are asked to complete the questionnaire after their visits that will help capture the data about the patient’s waiting experience.

◦ One to one personal interviews

◦ Using a scale based : In this method ,the patient typically rate their satisfaction with the

numbering system on a 1-4 scale. (very satisfied ,somewhat dissatisfied ,somewhat satisfied, and very satisfied)

IMPROVING THE PATIENT’S EXPERIENCE

How will you monitor whether improvement has occurred?◦ There is faster floor of

service ◦ There is less patients waiting

time◦ Less confusion in calling out

names since the numbers are displayed

◦ More patients been attended. A better patient’s

experience and satisfaction

IMPROVING THE PATIENT’S EXPERIENCE

Anderson, R., Camacho, F, & Balkrishnan, R. (2007). Willing to wait? : The influence of patient wait time on satisfaction with primary care. U.S. National Library of Medicine. Retrieved on 11/26/2012 from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810532/

Appointment System. Ambulatory Care. St Barnabas Hospital Network. Retrieved on 11/28/2012 from:http://sbhwiki/wiki/AmbulatoryCare/AppointmentSystem

General Care Policy Documents. St Barnabas Hospital Network. Retrieved on 11/28/2012 from:http://sbhwiki/wiki/AmbulatoryCare/GeneralCare

REFERENCES:

Policy and Procedures Manuals Review. Ambulatory Care. St Barnabas Hospital Network. Retrieved on 11/28/2012 from:http://sbhwiki/wiki/AmbulatoryCare/PolicyAndProceduresManualsReview

Professional Standards (2012). Retrieved on 11/26/2012 from:http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandards

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy of Sciences. 

U.S. Department of Health and Human Services. (2012). Consumer Assessment of Healthcare Providers and Systems (CAHPS). Adult Visit Questionnaire Version 2.0. Retrieved from http://cahps.ahrq.gov/clinician_group/

REFERENCES:

JCAHO. (2004). New Leadership Standard on Managing Patient Flow for Hospitals. Joint Commission Perspectives, 24(2), 13-14.

 Agency for Healthcare Research and Quality. (AHRQ). (2011). National Healthcare Quality Report. Retrieved from http://www.ahrq.gov/qual/nhqr11/nhqr11.pdf

 Agency for Healthcare Research and Quality. (AHRQ). (2009). Revised Processes Related to Daily Opening Reduce Wait Times and Enhance Patient Satisfaction at Two Urban Clinics. Retrieved from http://www.innovations.ahrq.gov/content.aspx?id=1904

REFERENCES: