Patient and Family Perspectives: Engaging Your Customers In Quality Improvement Initiatives July 31, 2007 Vernon Henderson, BA, Patient & Family Care Volunteer

Patient and Family Perspectives: Engaging Your Customers In Quality

Improvement InitiativesJuly 31, 2007

Vernon Henderson, BA, Patient & Family Care Volunteer

Leah Henderson, Patient & Family Care Volunteer

Peachy Hain, MSN, RN, Nurse Manager

Millicent De Jesus, MSN, RN, Clinical Nurse IV

One of the Nation’s Largest Medical CentersOne of the Nation’s Largest Medical Centers

Cedars-Sinai has evolved into one of the most dynamic

and highly regarded medical centers in the world.

We’re located at:8700 Beverly Blvd.

Los Angeles, California

We have received Magnet Excellence in Nursing

designation from the American Nurses Credentialing Center

(ANCC).

Los Angeles Community Is Our HomeLos Angeles Community Is Our Home

Cedars-Sinai serves theLos Angeles County market area – with more than 9 million people. Our primary service area, comprising some 2.3 million people, represents approximately 75 percent of Cedars-Sinai’s total inpatient discharges.

Cedars-Sinai partners with hundreds of community organizations on programs to improve the health of our community.

ServiceService Entire continuum and spectrum of

services

— 952 Licensed Beds Intensive Care Acute Medical/Surgical Care Pediatrics Neonatology Psychiatry Perinatal Rehabilitation Comprehensive Treatment

Services Comprehensive Oncology

Services

On average, every day we serve:

— 802 Inpatients

— 20 OB Deliveries

— 205 Emergency Room patients

— 70 Surgeries

— 4 Trauma patients

— 700 Outpatients - visits and procedures

Most Preferred Overall HospitalMost Preferred Overall Hospital

Awards & RecognitionsAwards & Recognitions

Since 1990, Cedars-Sinai has been named consecutively in an independent survey by the National Research Corporation (NRC) as Southern California’s “gold” standard in healthcare.

Los Angeles residents rated Cedars-Sinai “number 1” for:— Best Overall Quality— Most Preferred Hospital Overall— Best Doctors— Best Nurses— Best Image and Reputation— Most Personalized Care

Our Commitment to Quality CareOur Commitment to Quality Care

California Award for Performance Excellence

AARP Ranking

Magnet Excellence in Nursing

Most Wired Hospitals

Our Mission Our Mission Cedars-Sinai has evolved to become the largest nonprofit, independent healthcare organization in the western United States

Cedars-Sinai is committed to:

— Leadership and excellence in delivering healthcare services

— Expanding the horizons of medical knowledge through biomedical research

— Educating and training physicians and other healthcare professionals

— Striving to improve the health status of our community

“Quality patient care is our priority. Providing excellent clinical and service quality, offering compassionate care, and supporting research and medical education are essential to our mission.”

VisionVision

Nursing is valued for its contributions to patient and health care in an environment that promotes career development, interdisciplinary practice, community service and research.

Goals of Cedars-Sinai NursingGoals of Cedars-Sinai Nursing Provide care that is safe, patient centered, equitable, lean, reliable, based

on evidence Improve the health of the community through education referral and

expanding access to care Conduct research to improve nursing assessment, interventions that are

linked to positive patient care outcomes and community needs Create and sustain nursing as a Magnet service recognized by staff,

patients and the public for excellence Create new models of care for the profession to recruit, retain and develop

a qualified workforce to meet the demands for nursing care across settings Create delightful, efficient and effective work environments for patients,

families, nursing and interdisciplinary team members

Teamwork Between Support Departments

MD-RNCollaborationMD-RNCollaboration

Charting by exception

Coordination of Care

PATIENTS

PatientCenteredness

Safety &Reliability

Vitality

Lean

CSMC Quality Goals Aligned with IOM and TCAB GoalsCSMC Quality Goals Aligned with IOM and TCAB Goals

SAVINGLIVES

ENHANCINGVALUE

SERVICEEXCELLENCE

CSMCQuality Goals

TCABDesign Targets

Effective

Equitable

Timely

Efficient

IOM Goals

PatientCentered

Safe

Structure and Process to Achieve the GoalsStructure and Process to Achieve the Goals

Structure: Unit Based Shared Governance, Interdisciplinary practice committees- Patient Care Council, PICs, MD-RN Collaboration, Quality Council

Process Teams: TCAB design, implement and evaluate tests of change to achieve aims

What is TCAB?What is TCAB? TCAB = Transforming Care At The Bedside

National initiative sponsored by Institute for Health Care Improvement and Robert Wood Johnson Foundation to find new ways to improve patient care while improving work environment for healthcare workers

Cedars-Sinai is one of the original 13 hospitals in the US invited to participate in initial 2-year project.

Now on Phase III of TCAB Project— Cedars-Sinai is one of ten of the original 13 hospitals that continue

to participate

Overall Goals of TCABOverall Goals of TCAB To develop one or more models of care at the bedside on

medical and surgical units that will result in:

• Improved quality of patient care (Safety and Reliability)

• Improved quality of patient service (Patient Centeredness)

• More effective care teams (Vitality and Teamwork)

• Improved staff satisfaction and retention (Vitality)

• Greater efficiency (Lean)

Who We Are – Pilot UnitWho We Are – Pilot Unit 8 South is made up of two 24-bed

surgical units

— 8SE: Primarily admits post-surgical GI cases, including various bowel resections and lap gastric bypasses

— 8SW: Admits post-surgical urological procedures such as transurethral resections of the prostate, radical retropubic prostatectomies, transvaginal slings

— Both units admit other subspecialty cases including those r/t trauma

Involved in Quality Initiatives

— Magnet, IHI, Staffing Effectiveness, CalNOC – Falls, Pressure Ulcers, Restraints, Medication Errors

Actively involved in various Performance Improvement Projects as Pilot Units

— January 2002 to 2004 - Patient Care Model Re-Design

— June 2004 to present – Transforming Care At the Bedside (TCAB)

Strong Interdisciplinary Team Involvement – Physicians, Nurses, Social Worker, Case Manager, PT/OT, Dietician, Home Health, Pharmacist, Respiratory Therapist, Enterostomal Nurse, Patient and Family Volunteer

The TCAB Core TeamThe TCAB Core Team Interdisciplinary Team involved in the Pilot Units’ Performance

Improvement projects:— Physician Champion— Nursing Staff— Social Worker — Case Manager— PT/OT — Registered Dietitian— Home Health— Pharmacist— Respiratory Therapist— Enterostomal Nurses— Patient & Family Care Volunteers (Patient Representatives)

Unit Posters to Encourage Patient/Family Involvement Unit Posters to Encourage Patient/Family Involvement

First part of poster describes TCAB, the

Model for Improvement used, and lists sample of innovations already

underway.

Unit Posters to Encourage Patient/Family InvolvementUnit Posters to Encourage Patient/Family Involvement

Second part of poster displays initial results on improvement with

patient care.

It also displays current tests of

change on the unit and next unit TCAB meeting, inviting not

only staff but also patients, visitors, and

family members to attend meeting and/or give suggestions on

improvement.

Act Plan

Study Do

The Model For ImprovementThe Model For Improvement

What are we trying to accomplish?

How will we know that change is an improvement?

What change can we make that will result in animprovement?

Volunteer Services – An OverviewVolunteer Services – An Overview The Volunteer Program at Cedars-

Sinai Medical Center began in 1976 with approximately 50 volunteers

Currently, there are over 2,000 volunteers

— 1998 – Service Hours contributed equaled 215,000 hours

Services have expanded to > 400 different assignments throughout CSMC

Volunteering at CSMC reflects the community it serves (i.e., diverse volunteer population and ethnic backgrounds)

Average number of volunteer years = 4

Volunteer Services include:— Adult Volunteer Program— Teen Program— Independent Student Program

Patient and Family Care VolunteerPatient and Family Care Volunteer Responsibilities

— Provide assistance to patients and families in negotiating the hospital system

— Provide comfort and support to patients/families confronted with surgical and medical procedures

— Make daily rounds on assigned nursing units/lobby areas— Assist patients in preparing for discharge— Assist health care team by providing patient support— Listen and offer companionship to patients/families

Patient and Family Care VolunteerPatient and Family Care Volunteer Responsibilities

— Communicate to health care team identified patient/family needs— Assist patient/family with identifying resources within the medical center

and community— Be sensitive to the needs of the patient/family— Reading to patient— Assisting patient with orientation to room upon admission— Assisting patient with meal set-up/menu selection

8 South Pilot Unit

Patient and Family Care Volunteer Services+

Performance Improvement Projects

(i.e., Patient Care Model Re-Design, TCAB)

Patient Involvement, Patient Safety, and Patient Satisfaction

Collaborative Effort Collaborative Effort

+

=

Benefits of Patient/Family Engagement in Benefits of Patient/Family Engagement in Improvement InitiativesImprovement Initiatives

Review of Literature— Patient Satisfaction Surveys: Patient input extremely valuable and instrumental

in developing surveys geared towards patient definitions of “good nursing care” (Larrabee & Bolden, 2001)

— Enhancing patient participation in care and decision-making - a dynamic process; central to nursing practice. There is potential for facilitation and creation of opportunities for patient participation (Tutton, 2005)

— Patients prefer to participate in their care, while professionals, although acknowledging the potential value of patient participation, prefer patients to be passive recipients (Cahill, 1998)

Benefits of Patient & Family Engagement in Benefits of Patient & Family Engagement in Improvement InitiativesImprovement Initiatives

Review of Literature— A model of patient involvement, the Addenbrooke’s patient panel, in a large

teaching hospital resulted in positive successes in providing patient perspective to improve service (Webb & Benstead, 2002)

Successes of patient panel: promoted open debate between staff and patients, created effective collaborative work, encouraged patient feedback, improved access to hospital, assisted others to improve service user involvement

— Active involvement of patient/family in the design and implementation of an education poster to prevent falls in conjunction with ongoing patient/family feedback to make poster more appealing and effective for patients – resulted in marked decrease in falls on the unit over the pilot period (Jeske et al, 2006)

Story ofStory of Vernon and Leah Henderson - Vernon and Leah Henderson -

Cedars-Sinai’s 8 South Pilot Unit Cedars-Sinai’s 8 South Pilot Unit Patient RepresentativesPatient Representatives

Vernon & Leah’s Involvement in TCABVernon & Leah’s Involvement in TCAB Personal experience as a patient / family member

— “Unbelievable medical care” received as a patient on a med/surg unit— Care team went “above and beyond” to ensure comfort— Surviving a life-threatening illness life-changing experience

vowed to volunteer when retired to “give back” to Cedars

Roles and Responsibilities as Patient and Family Care Volunteer— Typical day as volunteers on 8 South— Strong relationship with staff and nurse manager— Provide support to patients/families

Patients often reluctant to share complaints or concerns with staff out of fear of retaliation

Patients sometimes more likely to discuss problems with a volunteer

Vernon & Leah’s Involvement in TCABVernon & Leah’s Involvement in TCAB How they became involved in TCAB

— Attendance at weekly unit and Steering Committee meetings— Contributions to TCAB initiatives (unit-based & house-wide)

Designing surveys Talking with patients

— Asking questions to identify problems and find immediate solutions

Unit staff depend on them for support of patients and unit as a whole

— Participation at national conferences— Public speaking opportunities to share personal experiences on TCAB

pilot unit— Involvement in the national TCAB Advisory Committee

Vernon & Leah’s Involvement in TCABVernon & Leah’s Involvement in TCAB Motivating factors

— They are part of a close knit “family” when they are on the unit Sense of belonging Part of a team Opinions and input valued

— Patients identify with them more, having been “on the same boat” as them a few years back.

— Inspired by the positive changes seen in Cedars-Sinai as a result of their innovations

“The TCAB team is committed to accomplishing something. It’s a great

feeling to know that a hospital as good as Cedars, one of the best in the country, and the unit where we volunteer – the best unit

in the hospital – wants to make improvements and we’re a part of it.”

- Vernon Henderson

“If I was able to walk out of a room and know that I helped a patient, then I’ve

done my job. That’s a good day, bringing a smile to the face of a patient because

I’ve resolved their issue.”

- Leah Henderson

Sample Contributions to TCAB TeamSample Contributions to TCAB Team

Test of Change: Test of Change:

Early Patient Discharge Initiative

Patient Satisfaction Survey With Nursing Care - SamplePatient Satisfaction Survey With Nursing Care - Sample

Date: _______________

Room Number: ___________

Dear Patient:

Please answer the following questions to the best of your ability. Any comments, suggestions, and feedback from you will be greatly appreciated to enable us to provide better care for our patients.

1. My nurse made me feel: ________________________________________________________________

2. I am glad my nurse: ________________________________________________________________

3. I wish my nurse would have: ________________________________________________________________

4. I feel my nurses are looking out for my safety. 1 2 3 4 5

1 = Strongly Disagree

2 = Disagree

3 = Neutral

4 = Agree

5 = Strongly Agree

5. Comments: ________________________________________________________________________________________________________________________________

THANK YOU!

PATIENT SATISFACTION SURVEY WITH

NURSING CARE

Post-Discharge Survey - SamplePost-Discharge Survey - Sample

Post Discharge Test-of-Change

1. Did you have confidence and trust in the nurses treating you?

2. If you had any anxieties or fears about your condition or treatment, did a nurse discuss them with you?

3. Was it easy for you to find someone on the hospital staff to talk to about your concerns?

4. Did someone tell you about medication side effects to watch for when you went home?

5. Did they tell you what danger signals about your illness or operation to watch for after you went home?

6. Did they tell you when you could resume your usual activities, such as when to go back to work or drive a car?

POST-DISCHARGE

TEST-OF-CHANGE

Developed and conducted survey

just prior to patient discharge

Survey data compiled weekly by Vern, findings presented monthly to the staff,

trends identified, and solutions to improve care proposed.

Patient Room Reminder Poster – Early DischargePatient Room Reminder Poster – Early Discharge

PREPARING FOR YOUR DISCHARGE

Please be sure to have the following ready : Before your Actual Discharge D ate:

• KEYS to Your HOME • CLOTHES to WEAR

• PRESCRI PTI ONS from Your DOCTOR

On the Day of your Discharge ,

• You will receive Discharge I nstructions from

your Nurse & a copy will be provided to you. • Have transportation available to pick you up from the hospital by 10:00 AM.

REMI NDER:

DI SCHARGE TI ME I S 10:00 AM.

I f your ride home is not here by 10:00 AM , please arrange to be picked up from the Discharge Waiting Area on the Street Level - South Tower Lobby.

For any questions or concerns, please speak to the Charge Nurse.

THANK YOU!

Contributed ideas to content and

format of flyer/poster

Dear Patient: Welcome to Cedars -Sinai Medical Center.

Although you are just being admitted, we would like to provide you with some information that we hope will make your stay with us a little easier and make your discharge

go more smoothly. When you a re discharged you will need both clothing to wear and the keys to your house – if you don’t have them with you, please arrange to have them brought in.

Discharge time is between 10:00 a.m. and 11:00 a.m. I f a f amily member or f riend is not available to p ick you up when you are discharged, the Social Worker can assist

you in arranging alternative means of getting home (e.g., medical van, taxi). I f you would rather wait f or your family member or f riend to pick you up, please let them know you will be waiti ng at the Street Level, South Tower

Waiting Area. Thank you for choosing Cedars -Sinai Medical Center for your health care needs.

Letter to Patients – Early DischargeLetter to Patients – Early Discharge

Contributed ideas to content of

letter to patients

Discharge Waiting Area – Patient SurveyDischarge Waiting Area – Patient SurveyDischarge Waiting Area

Post-Discharge Interview Dear Patient: In an attempt to improve the efficiency of our patient discharge process , we have instituted a Discharge Waiting Area for our patients. This is to help insure that once the discharge order ha s been given, we can make room available for other patients who need to be transferred from the OR/ ED. We want to see if it is possible to do this without the inconvenience to our patient s and to insure that the discharge is as comfortable as possible The following questions are to get your feedback about your recent experience with our Discharge Waiting Area so we can learn and improve our discharge process. Please a nswer each question using a 1-5 scale where:

1 = very dis satisfied/uncomfortable 2 = somewhat dissatisfied/uncomfortable 3 = neutral 4 = somewhat satisfied/comfortable 5 = very satisfied/very comfortable

• How satisfied were you with the explanation that was given when you were

discharged from your room to the waiting area? • How comfortable were you while waiting in the S treet South waiting area? • How satisfied were you with the assistance that was provided by the

volunteer during the time you had to wait in the Street South area? • Did you utilize the meal vouchers you were provided with? (YES or NO ) • What (if anything) could we do to make your experience more comfortable

while waiting for your ride in the Street South Discharge Waiting Area ? Please comment on the following:

Waiting area: Unit staff: Volunteers at Street South: Other: • Were you offered alternative transportation upon discharge? (YES or NO) If

so, did you or did you not choose to accept? Thank you for your time and assistance.

Contributed ideas to design and

content of patient survey



Patient Room White Board Redesign

Patient Room White Board Redesign ProposalPatient Room White Board Redesign Proposal

PATIENT NAME:_________________ GOALS FOR TODAY: - - - TESTS/PROCEDURES: - - - DIET: __________________________ ACTIVITY: ______________________ TREATMENTS: __________________ OTHER:

ROOM: 8802 DATE:__________ PHONE #: (310) 423 -8802 RN: ____________ CP: ________ ___ OUR GOAL IS TO GET YOU READY FOR DISCHARGE BY: ____________ KEY ITEMS YOU WILL NEED UPON DISCHARGE: __ KEYS __ PRESCRIPTION __ CLOT HES __ TRANSPORTATION __ PERSONAL ITEMS : GLASSES, DENTURES, VALUABLES , ETC.

DISCHARGE TIME IS 10:00 AM . IF YOUR RIDE IS NOT HERE WITHIN 2 HOURS FROM THE TIME YOUR PHYSICIAN DISCHARGES YOU, PLEASE ARRANGE TO BE PICKED UP AT THE SOUTH TOWER, STREET LEVEL DISCHARGE WAITING AREA.

Gathered ideas/feedback on content and format of display board from multiple patients on the unit at time

of test of change; boards now in each patient room


Test of Change: Test of Change: Staff Patient

Assignment Board Redesign

Staff Patient Assignment Board RedesignStaff Patient Assignment Board RedesignDate: __________ NCT: _____________ MANAGER: PEACHY B. HAIN

Charge RN: _____________ Cell #: 3 -8740 8 SOUTHEAST X3 -6747

DAYSHIFT (Place staff photo m agne ts he re ) NIGHTS HIFT (Place staff photo m agne ts he re ) INTERDIS CIPLINARY TEAM (Place staff photo m agne ts he re )

CELL #: _________ RN _________ RN _________ RN ___________ RN __________ RN X3 -8711 X3 -8718 X3 -8719 X3 -8721 X3-8722

ROOM MD RN CP ROOM MD RN CP

8801 8802

8803 8804

8805 8806

8807 8808

8809 8810

8811 8812

881 3 8814

8815 8816

8817 8818

8819 8820

8821 8822

8823 8824

PATIENT VOLUNTEER NAME:

EVS DISPATCH X3 - 2071 DAYS: EVES: NIGHTS:

DISCHARGES

Gathered ideas/feedback on content and format of display board from multiple patients on the unit at

time of test of change



Unit Business Cards for Patients/Families

Unit-Specific Business Cards for Patients/FamiliesUnit-Specific Business Cards for Patients/Families

8700 Beverly Blvd., 8 SoutheastLos Angeles, CA 90048Nursing Station Phone (310) 423-6883www.cedars-sinai.edu

8 South General SurgeryRoom ________Phone (310) 423-________

Cedars-Sinai Medical Cedars-Sinai Medical CenterCenter

Contributed ideas/feedback on content and format of unit business cards to be given to patient/family

upon admission to unit

Patient/Family Survey – Business CardsPatient/Family Survey – Business Cards“WELCOME” Business Cards

Patient/Family Survey Post-Test of Change

Please rate your answers to the statements noted below based on the following rating scale:

1 = Strongly Disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree

The Nurse has given me a business card & I know how to reach the p atient room and/or nurses ’ station easily for questions/concerns .

1 2 3 4 5

Receiving the business card has m ade communication easier for me.

1 2 3 4 5

Designed patient/family survey



Condition H Brochure for Patients/Families

Condition H Brochure – Side 1Condition H Brochure – Side 1

Welcome to Cedars -Sinai Medical Center

The Staff at Cedars-Sinai Medical Center are committed to providing you with the best quality service by ensuring that all of your needs are met in a timely and professional manner. This guide will assist you in identifying the appropriate resources to best meet your needs. Feel free to call the services provided .

Our Credo

We are committed to being one of the nation’s premier health systems and pledge to deliver the finest care and services to our patients, t heir

families and our community.

We warmly welcome all who entrust us with their care and promise to

treat them with compassion, dignity and respect.

8700 Beverly Blvd. Los Angeles, CA 90048

Resource

Guide

For Patients,

Families, and

Visitors of Units

6SW, 6NE, 6NW,

6CVIC, 7SE, and

8SW

Provided feedback on design and content of

brochure

Condition H Brochure – Side 2Condition H Brochure – Side 2

RESOURCES

We encou rage you to speak to your nurse, Charge Nurse, or Unit Manager for any concerns or questions you may have. Please do not hesitate to also contact any of our services below.

HOSPITALITY SERVICE (310) 423 -4444

Open 24 hours a day

PATIENT RELATIONS (310) 423 -3683

Open daily 8:30 AM – 5:00 PM

CASE MANAGEMENT (310) 423 -4446


SOCIAL WORK SERVICES (310) 423 -6346


CHAPLAINCY (310) 423 -5550


CONDITION H (NEW) (310) 423 -8288

Access Condition H by calling 3 -8288. The operator will ask for your name, room number, patient name, and patient or family concern. The operator will immediately activate a “Condition H” where a Nursing Task Force member will come to your room to assess your situation. Additional clinical support will be called in as needed. In offering our famil ies the Condition H option, we want you to know that you are our partners in care. We believe in teamwork and ask that you be a part of our team when visiting your loved ones. If you have any questions, please do not hesitate to discuss them with your nu rse or doctor.

Patients, families and visitors are encouraged to call Condition H (Help) in the following cases:

1. I f a not iceable medical change in the patient occurs and the health care team is not responding.

2 . I f there is confusion regarding the patient’s plan of care despite communication attempts made by the patient or family member.

Contact Hospitality if you need assistance with your room, food, valuables, or parking.

Patient Relations Representatives are registered nurses who provide assistance to patients and families to ensure their stay is as comfortable and pleasant as possible. They visit patients, interpret Medical Center Policy, and deal with any potential or existing problems that may arise.

Jewish, Catholic, and Christian Chaplains are available for the spiritual needs of patients and family members.

Case Managers are registered nurses w ho provide assistance with health ins urance and financial resources .

Social Workers are licensed personnel who provide emotional support and assistance with discharge needs and smooth transition to home.

Provided feedback on design and content of brochure

Condition H Brochure – Patient SurveyCondition H Brochure – Patient Survey

CONDITION H ORCHESTRATED TESTING

PATIENT Preliminary SURVEY

Date of Survey: __________________ Unit: _______________ Room #: ____________ 1. The nursing staff reviewed and discussed the Resource Guide brochure with me

and/or my family. YES / NO 2. The Resource Guide brochure provides me with the necessary resources I need to

access during my hospitalization . YES / NO 3. The nursing staff educated me and my family on the Condition H line, its purpose

and criteria for initiating a call. YES / NO 4. I/We believe that having direct access to the Condition H line is an excellent way for

patients and families to feel safer and more secure in the care received in the hospital. YES / NO

5. Given the current quality of care I am receiving, I do not feel the need to access the

Condition H. YES / NO Thank you.

Provided feedback on content of

patient survey



Pain ManagementPain Management

Pain Management Post-TOC Patient SurveyPain Management Post-TOC Patient Survey

88% 88%92%

98%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Are you aw are of w hat

pain medication you are

receiv ing?

If so, has someone

review ed the medication

w ith you?

Are you aw are of the

Frequency of your

medication and w hen your

next dose is due?

Do you feel that

everything is being done

to control your pain?**

Pain Management Survey 8SE/W Sept 17 - 24 2004

n=49

**Based on Picker Survey

Question

Conducted patient

survey and created

graph as analysis of

initial survey results



Bedside Walking Bedside Walking RoundsRounds

Bedside Walking Rounds – Poster

WALKING ROUNDSWALKING ROUNDS

• Why? _• PATI ENT SAFETY

> “Failure to rescue ” during change of shift> Patient survey – NO CARE/Service during change of shift (feels neglected)> Incoming RN may not see patient until 1hr -2hrs after start of shift> Inability to ask outgoing RN/CP for clarifications> CUSTOMER SERVICE!!!

• BARRI ERS _> Staff arriving late to begin work at 0700/1900 > Late arrival leads to OVERTIME!> Overtime leads to staff dissatisfaction> Cycle: “Domino Effect ”

Implementation:Effective Monday, J anuary 17 th at

0700, the change of shift walking rounds will be in FULL FORCE throughout ALL OF 8 SOUTH!

PURPOSE PURPOSE -- Brief introductions of incoming RN/CP to patientBrief introductions of incoming RN/CP to patient-- Quick visual assessment of patient/environmentQuick visual assessment of patient/environment

Bedside Walking Rounds – Patient Survey

0% 0% 0%

23%

77%

0% 0% 0% 0%

15%

85%

0%

8%

92%

0%

20%

40%

60%

80%

100%

1 2 3 4 5 N/A 1 2 3 4 5 N/A YES NO

1 DO YOU FEEL YOU HAVE/HAD SUFFICIENT OPPORTUNITY TO

BE INVOLVED WITH YOUR PLAN OF CARE?

2 DO YOU FEEL THE TRANSITION OF CARE FROM ONE NURSE TO

ANOTHER AT CHANGE OF SHIFT IS/WAS A SM OOTH PROCESS?

3 DO YOU HAVE ANY

RECOM M ENDATION/

SUGGESTIONS FOR IM PROVING

EITHER # 1 OR #2?

TCAB

Change of Shift Walking Rounds

1/7 - 1/13/2005 N = 13

Conducted patient survey and created graph as analysis of

initial survey results



Interdisciplinary Team Interdisciplinary Team Walking RoundsWalking Rounds

Interdisciplinary Team Walking Rounds – Patient SurveyInterdisciplinary Team Walking Rounds – Patient SurveyInterdisciplinary Team Walking Rounds

Patient Post-Survey Questions

Dear Patient: Earlier today you participated in our unit’s very first Interdisciplinary Team Walking Rounds. The purpose of the walking rounds is to allow you, the patient, to be more involved in your care planning and discharge planning. We would like to ask you a few questions related to your recent experience with the IDCP Walking Rounds.

1. Did you find it helpful / beneficial to you, as a patient, to have the Interdisciplinary team t alk about your care plan in the privacy of your own room?

YES / NO

Comments: ____________________________________________________________________________________________________________________________________

2. Did the IDCP walking rounds allow you to act ively participate in your own care planning? Were all your questions answered?

YES / NO

Comments: ____________________________________________________________________________________________________________________________________

3. What, if any, would you do differently to get you more involved in your plan of care? ____________________________________________________________________________________________________________________________________

Conducted patient survey

Interdisciplinary Team Walking Rounds – Post-TOC Survey CommentsInterdisciplinary Team Walking Rounds – Post-TOC Survey Comments

aInterdisciplinary Discharge Planning Rounds – Patient Post Survey Comments. May 2005 6 Patients interviewed, all felt that it was beneficial and felt that allowed them to actively participate in their own care. Comfort level that people are on your side , not just 1 person. Makes me feel more comfortable I like it! Many questions at one time are able to be answered Made me feel empowered Better than having each person come in alone, all disciplines available so questions can be answered. Very helpf ul, great program! Very cohesive, very together even though the first time doing it Team is backing up Nurse/Charge Nurse More explanation is needed as far as what the patient is supposed to do, wasn’t sure how to respond. Need to know what the expecta tions of the patient are Makes you feel that everyone is on board This process can help the family members, especially if the family needs to learn a specific skill or need to arrange3 the home in preparation for discharge Information about Medicare co verage and Home Health Care and my walker took a load off my mind. Someone I can call and get information and get a straight answer. Very nice, nice to be included.

Created summary of comments

from patient survey

conducted by volunteers

Tests-of-Change Involving Patients & FamilyTests-of-Change Involving Patients & Family

Patient-CenterednessPatient Care Paths

Business Cards

Patient Assignment Boards

Bedside Walking Rounds

Patient Room Display Boards

Video Rounding System

Donor Nephrectomy Patients –

Deluxe Meal Tray Service

Patient Satisfaction Survey (Nursing Care)

Improving the Patient Experience (Current)

CSMC House-Wide Handbook (Current)


Vitality & TeamworkEmployee Recognition Program

MD-RN Collaboration

Monthly 8South “Success” Celebration

8 South Medication Room & Nursing Station Renovation Input

Staff Vitality Surveys


Safe & Reliable CareSafety Star Program

Condition H Orchestrated TOC

Value-Added Care ProcessesEarly Discharges

Van Go Service

Post Discharge Survey (Readiness)

Patient Focus GroupsPatient Focus Groups Formed in Fall 2006 as a result of low scores on Patient Satisfaction

surveys conducted by Picker Goals:

— Identify and isolate the problem areas — Come up with specific solutions to each problem

Groups formed in the following categories:— Pediatrics— Women’s Health— Adult Medical— Labor & Delivery— Adult Surgical

Planning for the FuturePlanning for the Future Patients and family members to play increasingly important role

in organization’s improvement initiatives

— Continue to invite current and previous patients to attend weekly TCAB meetings

— Patient representatives as members of hospital-wide committees (Patient Satisfaction, TCAB, Improving the Patient Experience)

Improving the Patient Experience: Categories of Need

DATA NEEDED TO DETERMINE

PRIORITIES 1. Comments from Picker Survey 2. Complaint Data 3. Feedback from Patient Relations 4. Feedback from focus groups (including videos of

January groups) 5. Feedback from employees & st aff 6. “Secret Shopper (i.e. patient)”

SUCCESSFUL ACQUISITION AND

DISTRIBUTION OF DATA Responsible Committee

Members

INTERPERSONAL COM M UNICATIONS 1. Telephone etiquette for EVERYONE – Use consistent script throughout all of CSMC

2. Communication skills a. Verbal b. Non Verbal – eye contact

c. Attentive listening

SUCCESSFUL TEST(S) OF CHANGE

WHICH WORK

Responsible Committee Members

Bernie Mendiondo David Esquith Allison Rotter

Barbara Leanse

M ANAGING PATIENTS ’ EXPERIENCE 1. Waits / Delays 2. Rights / Respons ibilities 3. Service Recovery 4. Complaints 5. Information Provided a. Verbal /Oral

b Written c.White Board


WHICH WORK Responsible Committee

Members Eskedar Gobeze Marlene Clark

M OTIVATION & ACCOUNTABILITY 1. Holding Staff Accou ntable 2. Recognition 3. Inspiring Culture Change


WHICH WORK

Responsible Committee Members Flora Haus

David Esquith Allison Rotter

TOOLS & SUPPORT NEEDED FOR

STAFF 1. Scripts

a. Telephone b. Meeting / Greeting people c. Dealing with diffic ult people d. What are basic comfort measures to offer visitors e. Code of conduct -employees f . Anger management

2. Classes a. Respect for persons b. Listening c. Communication d. Cultural competence

3. Resources for Support a. Nursing Liaison b. Work -n-Life Matters c. Peer Su pport


WHICH WORK

Responsible Committee Members

Bernie Mendiondo

Improving the Patient Experience: Categories of NeedImproving the Patient Experience: Categories of Need

Q & AQ & ASessionSession

Open Open DiscussionDiscussion

ReferencesReferencesPatient and Family Perspectives: Engaging Your Customers

In Quality Improvement Initiatives

Cahill, J. (1998). Patient participation – a review of the literature. Journal of Clinical Nursing, 7(2), 119-128.

Jeske, L., Kolmer, V., Muth, M., Cerns, s., Moldenaur, S., & Hook. M. (2006). Partnering with patients and families in designing visual cues to prevent falls in hospitalized elders. Journal of Nursing Care Quality, 21(3), 236-241.

Larrabee, J.H., & Bolden, L.V. (2001). Defining patient-perceived quality of nursing care. Journal of Nursing Care Quality, 16(1), 34-60.

Tutton, E. M. (2005). Patient participation on a ward for frail older people. Journal for Advanced Nursing, 50(2), 143-152.

Webb, B., & Benstead, R. (2002). Patient panel: an ongoing learning process. Nursing Standard, 16(20), 39-42.

Documents

Patient and Family Perspectives: Engaging Your Customers In Quality Improvement Initiatives July 31, 2007 Vernon Henderson, BA, Patient & Family Care Volunteer