HXR 2016: Human Focused Innovation in a Clinical Setting -Jennie Kung, UCLA Health
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This section of the agenda will feature leaders in innovation, patient experience, and design within a clinical setting. Each panelist will present the current state of experiential innovation at their organization, what successes they have seen, what situations they have learned from, and what their challenges and obstacles are, and where they would like to see things head in the future. Then Amy Cueva will guide the group in a discussion around strategy, measurement, culture change, and other important topics relevant to delivering phenomenal experiences.
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HXR 2016: Human Focused Innovation in a Clinical Setting -Jennie Kung, UCLA Health
- 4. FOCUS AREA CLUSTERSPATIENT AND EXPERT TAKEAWAYSTRANSCRIBED DATA Patient 01 Patient 02 SME 01 SME 02 Focus Area 3 Focus Area 2 Focus Area 1 Opportunity 3 Opportunity 2 Opportunity 1 OPPORTUNITY RECOGNITIONRAW DATA OUTCOMES Interview Notes Workgroup Minutes Observations Opportunities Ideas Patient Journey Patient Journey QDM/HCAHPS/Grievance s
- 5. Patient & SME Interviews 1 2 3 4 5 6 7 8 9
- 7. The cystectomy journey seems simple when viewed as a series of touch points at which patients interact directly with UCLA.
- 10. Cancer Toll SUPPORT (PATIENT- FACING) reluctance, guilt, fear, essential, family, friends NEOBLADDE R leakage, tubes, maintenance, satisfaction STOMA body image, odor, leakage, lifestyle change, support, education (timing/duration/qua lity), appliance, supplies CAREGIVER ROLES coach, advocate, nurse, coordinator, cheerleader, teacher, head of house CAREGIVER BURDEN housing, full time, cost, worry, fear, eased by others, assumed roles RECOVERY home support, function, independence, hobbies, weight, nutrition, sexual function, energy, family, job, mood DISCHARGE timing, information, point of contact HOME NURSE variability, stoma, invested, immediate MEDICAL CARE variation, evidence- based, expert, thorough, consistent, cancer control, appropriate, CHEMOTHERAP Y benefit vs. toxicity, delivery, stigma COMPLICATIONS bowel, anemia, infection, informed, dx / tx, setback, ER, readmission MOBILITY delayed, PT, resources, orders PAIN control, NG, epidural vs. IV, side effects, non-narcotic CARE ENVIRONMENT chaotic, disruptive, alarms, sleep trouble, PACU hold, limited resources, computer time, work arounds NURSING efficiency, empathy, competence, stoma comfort, turnover, handoffs, morale STAFF timeliness, variability in CICARE, PHYSICIANS coach, advocate, nurse, coordinator, cheerleader, teacher, head of house CARE COORDINATION point of contact, connectedness, MD access, myUCLAhealth, confidence in UCLA, thorough, convenience, timeliness, fragmentation, duplication UCLA BRAND research, trust, academic, personalized KNOWLEDGE GAPS nutrition, “prehab”, recovery, neobladder, stoma, risks, lifestyle impact INFORMATION accuracy, timeline, goals, expectations, completeness, decision- making, regret, stickiness, honest, relatable EDUCATION type, source, perspective, accessibility
- 11. empowering through education Cancer Toll coordinating care across the journey fostering a healing environment preparing patients for lifestyle change accelerating functional recovery bolstering patient support mechanisms
- 12. 12
- 13. 13frogThink © 2013 frog. Confidential & Proprietary. Opportunity to Idea
- 15. Contests & Culture Building
- 18. I don’t eat all that other stuff… I thought I was only supposed to eat lettuce and tomatoes… Elderly LEP patient
- 19. ‘intoxicado’ = $71 million
- 20. 8Bedside RNs Subject Matter Experts 3NPs 4 Cardiologist 4 Fellows 10 Residents 6Medical Student, Clinical & industrial psychologist, Social Worker, Care Partners, Patient Expert
- 21. Cardiac Observation Unit (COU) General Internal Medicine & Health Services Research Cardiac Care Unit (CCU) Bilingual Cultural Initiative Medical Psychology Assessment Center at Semel Institute for Neuroscience and Human Behavior Cardiology UCLA Innovation in Health Interpreter Services ValU/Quality Nursing Department Leadership Performance Excellence
- 23. Pediatric Voice
- 24. I have to tell my parents that I’m not getting any better… I don’t want to be reminded of my disease… 16 year old patient
- 25. Mother of a hospitalized infant, who is a nurse herself, stated that she “loves bedside rounds” but the nurse was present on rounds only about half of the time. Mother of 6 year old child hospitalized for leukemia had concerns that her child kept getting woken up in the night for trash being removed from the room. Mother of 6 year old admitted multiple times with leukemia, who is unclear of the roles of the medical students/doctors on the team.
- 31. Innovation Shark Tank 2016
- 32. “The Patient Voice project changed how I view the care I deliver on a routine basis… Our Department discovered a spectrum of actions we could take to enhance the value of care we deliver to our patients… It all started with asking them about their care.” Christopher Saigal MD, MPH
Editor's Notes
- UCLA Health aims to rank among the best‐performing programs for care nationally and internationally. Value projects help to achieve this aim by analyzing program performance from all perspectives – cost, quality, and patient experience – to gain a deep understanding of the value embedded in the care pathway, and by using this understanding to make improvements that yield greater value on all fronts. The Patient Voice Toolkit is part of this broader Value initiative that seeks to match financial and outcome measures to what UCLA patients are really seeking in their care. It facilitates deep learning of the current state of care through heavy patient engagement and input, thus providing insights from the patient perspective. The Patient Voice focuses on the patient journey, both from the patient perspective and the care team perspective. Initially, the process relies heavily on interviews with patients and providers to provide helpful data that is used to uncover themes and, finally, possible interventions to improve the care pathway.
- UCLA Health aims to rank among the best‐performing programs for care nationally and internationally. Value projects help to achieve this aim by analyzing program performance from all perspectives – cost, quality, and patient experience – to gain a deep understanding of the value embedded in the care pathway, and by using this understanding to make improvements that yield greater value on all fronts. The Patient Voice Toolkit is part of this broader Value initiative that seeks to match financial and outcome measures to what UCLA patients are really seeking in their care. It facilitates deep learning of the current state of care through heavy patient engagement and input, thus providing insights from the patient perspective. The Patient Voice focuses on the patient journey, both from the patient perspective and the care team perspective. Initially, the process relies heavily on interviews with patients and providers to provide helpful data that is used to uncover themes and, finally, possible interventions to improve the care pathway.
- UCLA Health aims to rank among the best‐performing programs for care nationally and internationally. Value projects help to achieve this aim by analyzing program performance from all perspectives – cost, quality, and patient experience – to gain a deep understanding of the value embedded in the care pathway, and by using this understanding to make improvements that yield greater value on all fronts. The Patient Voice Toolkit is part of this broader Value initiative that seeks to match financial and outcome measures to what UCLA patients are really seeking in their care. It facilitates deep learning of the current state of care through heavy patient engagement and input, thus providing insights from the patient perspective. The Patient Voice focuses on the patient journey, both from the patient perspective and the care team perspective. Initially, the process relies heavily on interviews with patients and providers to provide helpful data that is used to uncover themes and, finally, possible interventions to improve the care pathway.
- Idea Generation
- Idea Prioritization
- The “Yo Entiendo” Patient Voice project was designed to help us better understand health literacy and cultural barriers faced by the Spanish-speaking heart failure patients in 7N/7CCU.
- I want to share with you another project… One that used the Patient Voice to better understand the needs of our Limited English Proficient patients…
- An elderly Chinese speaking man having chest pain was transferred from a community based hospital over the weekend to UCLA for an emergent left heart cath. He came with his English speaking daughter who agreed with the outside hospital for her father to have an emergent cath. When they arrived to the cath lab at UCLA, as they were rolling the patient into the procedure room, he yelled and screamed waiving his hands in the air. UCLA staff weren’t sure what was happening. They called the interpreter services number only to find out that the patient did not want to have the procedure. How did this happen? 1. The daughter spoke/interpreted on behalf of the patient Inaccurate language preference documentation
- In 1984, a 22 y/o Spanish speaking male told his girlfriend he felt ‘intoxicado’ and collapsed. When she repeated the term, hospital personnel took it to mean intoxicated, though the intended meaning was ‘nauseated.’ His brain clot was misdiagnosed as a drug overdose. A jury later awarded a $71 million malpractice settlement against the hospital. [Shutts, S. (Feb 25 2008) Ohio medical students train with interpreters to improve minority care.]
- 8 Bedside RNs 3 NPs 2 Care Partners 1 Social Worker 1 Patient Expert 4 Cardiologist 4 Fellows 10 Residents 1 Medical Student 1 Clinical and industrial psychologist
- Collaborators
- Malka Sierra- Senior Multicultural Director American Heart Association “Caring for Your Heart: Living Well with Heart Failure” – Developers: San Francisco General Hospital; University of North Carolina; Northwestern University Feinberg School of Medicine
- The American Academy of Pediatrics endorses bedside rounds, with the family present, as the standard of care. At Mattel Children’s Hospital UCLA, inpatient teams round on their patients at the bedside. Family centered bedside rounds with the nurse present improves family satisfaction. We have room to improve our family satisfaction data, especially focusing on doctor communication. We had the honor of listening to the voices of our hospitalized children and their families to find out how we could improve the bedside rounding experience, and improve overall communication at Mattel Children’s Hospital UCLA.
- 16 year old patient admitted to the pediatric floor. She speaks English and Spanish, and her parents speak Spanish only. She told us that she is “often” used as the translator for medical information during rounds, and throughout her stay. This causes her “stress” because she “doesn’t want to be reminded of her disease.” Every time she has to translate, she is reminded of how sick she is. Her mother added “nobody wants to be reminded of their disease.” Spanish Speaking Families – Unfortunately, we are using hospitalized children as translators often on rounds due to lack of regularly-available in-person translators. Our family that had been inpatient for months had never seen an in-person interpreter prior to this project. The family also said that the translator phone service “glitches” and “cuts out.”
- RN joining bedside rounds on all patients. This is complicated because multiple teams round at the same time and RN’s are often busy in isolation rooms and cannot answer the phone or participate in rounds. RN will have specific role on rounds – reading vitals, I/O’s, nursing plan of care. Could we bring in a relief nurse during morning rounds who could free up the bedside nurse if he/she is busy during rounds? Families not understanding the roles of the medical team. Doctors to have role on ID badge – similar to flu badge – (resident, fellow, attending) Distribute a welcome packet which explains the roles of the medical team to all inpatients. Role of families on bedside rounds Door hanger – Give families choice of “I do / do not want to join rounds. Please wake /do not wake me for rounds. Please round inside/outside the room. I speak English/Spanish/Other.”
- Nearly 4,000 children are admitted to inpatient pediatrics at Mattel Children’s Hospital UCLA and Santa Monica UCLA each year. It is exceedingly difficult for patients and their families to achieve the amount and quality of sleep needed during this period of illness and stress. It has been known that critically ill patients experience poor sleep quality with severe sleep fragmentation and disruption of sleep architecture. Poor sleep while hospitalized is one of the most common complaints of patients who survive severe illness. Phase 1: children slept for a longer amount of time sleep scores improved Everyone benefits from a good night’s rest, but sleep is especially important in healing and strengthening children in the pediatric intensive care unit (PICU) at Mattel Children’s Hospital UCLA. Unfortunately, catching some Z’s at a hospital that operates 24/7 isn’t always easy. “We knew from talking to parents that their children’s slumber here wasn’t restful,” says Myke Federman, MD, medical director of the cardiothoracic PICU. “It seemed counterproductive that we were providing a high level of medical care to these children, yet we weren’t addressing something as fundamentally important as sleep. We wanted to see what we could do to improve the patient and family experience by providing a more comforting and quiet place to rest.” Thanks to a patient-experience award from the UCLA Institute for Innovation in Health, Dr. Federman, along with PICU physician Yonca Bulut, MD, and PICU clinical nurse specialist Theresa Kirkpatrick, CCRN, launched a sleep-hygiene initiative in March 2015 called Supporting Sleep for Health and Healing (SSHH). “We began by surveying nurses and parents to pinpoint the biggest sleep stealers in the unit and worked with day- and night-time staff to make certain improvements,” says Dr. Bulut. “We had to educate the staff about the unique sleep needs of infants, children and teens because a teen’s sleep needs and patterns are going to be different than a toddler’s, so it’s important to take these into account.” Since these sleep hygiene steps were imple-mented, PICU patients and their parents are resting easier. “Before this initiative, parents reported that their kids were averaging about six hours of nightly sleep in the hospital,” says Dr. Federman. “Our PICU kids today get an average of 7.5 hours of sleep every night. We hope that the extra rest will translate into better health outcomes for them.” Thanks to another award from the UCLA Institute for Innovation in Health, the team is expanding the SSHH initiative to all of Mattel Children’s Hospital UCLA, as well as the pediatrics unit at UCLA Medical Center, Santa Monica. “We believe adult patients could benefit from this program as well,” says Dr. Bulut. “One day we hope to see SSHH in place throughout UCLA Health. After all, everyone feels better after a good night’s rest.”
- Improvements for a Good Night’s Rest: Creating and displaying signage that designates the unit as a sleep-friendly zone. Implementing a 10 pm lights-out policy. Lubing squeaky wheels on medical carts. Placing silencers on the doors to the PICU so they don’t bang shut. Equipping each patient room with a white-noise machine. Supplying foam earplugs and eye masks to patients and their families. Installing a noise detector that flashes yellow or red when sound levels in the unit exceed set noise limits. Creating signs for parents to hang on their children’s doors that let staff know to come back later because a child is resting, or to enter because a child is awake. Combining nighttime medical procedures when possible. Silencing the ice makers that nurses use to store bloodwork.
- $10K: The team will use new technology to reduce multiple needle sticks often required to obtain IV access due to poor vein visibility.
- So we think that in order for our hypothesis to hold true, the thinking needs to change around lean and around innovation. Read quote