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Six Sigma Approach to Effective Communication to Improve Patient Safety and Satisfaction
 

Six Sigma Approach to Effective Communication to Improve Patient Safety and Satisfaction

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    Six Sigma Approach to Effective Communication to Improve Patient Safety and Satisfaction Six Sigma Approach to Effective Communication to Improve Patient Safety and Satisfaction Presentation Transcript

    • Six Sigma Approach to Effective Communication to ImprovePatient Safety and Satisfaction Lois Yingling, RN, MSN, CPHQ Patient Safety Officer, Florida Hospital Winter Park Memorial HospitalWCBF’s 9th Annual Lean Six Sigma and Process Improvement Healthcare Summit May 12, 2010
    • 2008 Florida Hospital Orlando1908 Florida Sanitarium
    • • Founded by Seven-day Adventist Church in1908• Faith based health system committed to providing whole person care• 2188 acute care beds on seven campuses in tri-county area – Children’s Hospital under construction will be 8th hospital• Over 16,000 employees• Over 1900 physicians on staff• Over 2900 volunteers
    • The Hospital That Winter Park Built• Civic minded citizens shared a vision for a community hospital• 1951 non-profit Memorial Trust Organization incorporated to accept donations• Fifty-eight bed WPMH opened in 1955 at a cost of $660,000• One-hundred beds added in 1960
    • The Hospital That Winter Park Built• Medicare Participation 1966• Columbia partnership 1994 to 2000• Purchase by FH in 2000• Dr. Phillips Baby Place opened June 2007• New tower for Dr. Phillips Baby Place due to open Mother’s Day 2010
    • Current State 2010• 330 beds after May 2010• 225 physicians on staff• 1,428 employees• 215 Volunteers• 15,872 annual admissions• 39,319 annual ED visits• 9,109 annual surgeries• 2,377 annual deliveries
    • DMAIC Define
    • Opportunity Statement:• The Top Box Winter Park Nurse Communication Score for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in September 2009 is 71% (25th percentile).• The Top Box for Willingness to recommend is 65% (40th percentile)*Top Box = Always
    • Goal:• Improve *Top Box Nurse Communication to 80% (80th Percentile)• Improve *Top Box Willingness to Recommend to 69% (50th Percentile)*Top Box = Always
    • Why is focus on communication?• Communication root cause of 66% of all Sentinel events (The Joint Commission)• Sentinel Event unexpected occurrence causing death or harm or the risk thereof signaling need for immediate investigation
    • Why is communication important?• Improve Safety for all patients• Nurse communication is perceived as a key driver of “Willingness to Recommend” in our organization• “Willingness to Recommend key accountability
    • Scope:• 50% of eligible patients randomly selected to receive a survey in the mail• Metrics limited to patients who respond to the survey in the designated time frame (window is 8 weeks)• Response rate is 31 to 33%
    • HCAHPS:• Standardized survey designed & tested by AHRQ & DHHS to measure patient perceptions of hospital care for comparison to other hospitals in 2002• Endorsed by NQF in 2005• Implemented by CMS in 2006
    • HCAHPS:• Public reporting 2008• Hospital submission voluntary• Medicare payment reduced by 2 percentage points if choose not to submit
    • HCAHPS Aspects of Care:• *Communication with nurses & physicians• Responsiveness of staff• Cleanliness & quietness• *Communication about medication• *Discharge information• Overall rating• Willingness to recommend* Communication Metrics in control of nursing
    • D MAIC Measure
    • TOP Box Nurse Communication Linear Trend Model S ource: HCAHPS February through S eptember 2009 0.72 Variab le A ctual F its 0.70 A ccuracy M easuresNurse Communication MA PE 3.66600 0.68 MA D 0.02390 M SD 0.00072 0.66 0.64 0.62 0.60 February March April May June July August September
    • Trend Analysis Plot for Percentile Nurse Communication Linear Trend Model S ource: HCAHPS February through S eptember 2009 Variab le 0.25 A ctual F its A ccuracy M easures 0.20 MA PE 42.5704 MA D 0.0455 M SD 0.0025Percentile 0.15 0.10 0.05 February March April May June July August September
    • Top Box Willingness to Recommend Linear Trend Model S ource: HCAHPS February through S eptember 2009 Variab le 0.65 A ctu al F its 0.64Willingness to Recommend A ccu racy M easu res 0.63 MA PE 3.64435 MA D 0.02205 0.62 MSD 0.00058 0.61 0.60 0.59 0.58 0.57 0.56 February March A pril May June July A ugust September
    • Trend Analysis Plot for Percentile Willingness to Recommend Linear Trend Model S ource: HCAHPS February through S eptember 2009 Variable 0.40 A ctual F its A ccuracy Measures 0.35 MA P E 20.5667 MA D 0.0516 MSD 0.0035Percentile 0.30 0.25 0.20 February March April May June July August September
    • Top Box Medication Communication Linear Trend Model S ource: HCAPS February through S eptember 2009 Variab le 0.62 A ctual F its 0.60Medication Communication A ccuracy M easures MA PE 5.10400 0.58 MA D 0.02708 M SD 0.00094 0.56 0.54 0.52 0.50 0.48 0.46 February March April May June July August September
    • Top Box Discharge Information Information Linear Trend Model Source: HCAHPS February through September 2009 0.82 Variable A ctual F its 0.80 A ccuracy Measures MA PE 4.82035 0.78 MA D 0.03562DC Information MSD 0.00177 0.76 0.74 0.72 0.70 February March April May June July August September
    • AICDM Analyze
    • Stake Holder Analysis Minimal Modest Moderately StronglyStake Holder Engagement Engagment Neutral Engaged Engaged Influence strategy Intentional Rounding byAdministration X Administration Accountability to administration for Assigned Intentional Rounding byClinical Directors X Clinical Directors Accountability to administration for Assigned Intentional Rounding by Non-Non-Clinical Directors X Clinical Directors Accountability to Directors for Daily IntentionalNurse Mangaers X Rounding on units Accountability to NMs for Daily IntentionalAssistant Nurse Managers X Rounding on units Accountability to NMs & ANMs for Intentional BestFront line staff X Practice Behaviors X = current state = level of commitment to succeed Key Words: Accountability & Intentional
    • Bar r ie r s to P atie nt S atis fa ctionM is c e lla n e o u s S t a ff M e a s u re m e n t s l a ck o f p e r so n a l m a i l e d su r ve y fo o d a cco u n ta b i l i ty r e sp o n d e r ( p a ti e n t/ fa m i l y) l a ck o f a cco u n ta b i l i ty to vi si to r s su p e r vi so r 5 0 % o f e l i g i b l e p a ti e n ts w r o n g p e r so n o n th e b u s sa m p l e si ze va r i e s r o o m m a te s p e r ce p ti o n th a t o l d b u i l d i n g i s d r i ve r r e tu r n r a te ca p a ci ty sl o w r e sp o n se ti m e P atien t cl e a n l i n e ss D is- S atisfier s n i g h t n o i se o ld be ds co n str u cti o n n e w to we r o n e p h o n e l i n e fo r 2 p a ti e n ts l a ck o f a l l i n o n e s a l l r o o m s o n e TV fo r 2 p a ti e n ts m a y n o t h a ve sh o we r i n r o o m sm a l l b a th r o o m s E MR d e tr a cto r m o st r o o m s S P old building Eq u ip m e n t En v ir o n m e n t
    • ? Control•Noise In Control:•SP Out of ControlRooms •Personal Accountability •Age of•Visitors •Accountability to supervisor building•Rm Mate •Intentionality •Room/BR size•EMR •Scriptingdetractor •Construction •People: Right people on the •Survey•PhoneLines bus process•Food •Response time •TVs•All inones•Equip
    • Boxplot 85.00% 80.00% 75.00% 70.00%Data 65.00% 60.00% 55.00% 50.00% d n n n en at io at io at io m ic ic m m un un or e co m m nf R m m I to Co Co DC e ss r se io n gn Nu icat n illi ed W M
    • IDMA C Improve
    • Multi-Modal Strategies for ChangeThe Patient Experience• Clinical Excellence – National Patient Safety Goals – Clinical competence – Sacred Trust• Customer Service – Treating the patient with respect & dignity – Common courtesy• Clinical Excellence + Customer Service = Patient Experience
    • Multi-Modal Strategies for ChangeAppreciative Inquiry (October 2009)• Pays special attention to “the best of the past & present” in order to “ignite the collective imagination of what might be” Dr. David Cooperrider• Leverage strengths in an organization to make change• Appreciative inquiry questions for staff (personal responsibility)
    • Multi-Modal Strategies for ChangeAppreciative Inquiry Example questions• What can I personally do to improve our Patient Service scores?• What do I like best about my job?• What can I do to promote positive employee attitudes on my unit?• What have I done to recognize a co-worker this week?• How do I deal with a difficult “unloveable” patient?
    • Multi-Modal Strategies for ChangeCall Backs (October 2009Intentional Rounding by Administrative Team (November 2009)• Administrators assigned to specific units• Currently Monday through Friday – Currently day shift
    • Multi-Modal Strategies for ChangeDaily Communication to Nurse Managers• HCAHPS Scores• Accolades• Feed back loop specific to issues not addressed at unit level• Scores & accolades – Communicated daily to staff – Posted on units
    • Multi-Modal Strategies for ChangeIntentional Rounding by Nurse Managers (December 2009)• Mentoring by Directors• Currently Monday through Friday – Currently day shift – All new patients on all units – Service recovery• Immediate follow-up with staff – Positive feed back – Opportunities for improvement
    • Multi-Modal Strategies for ChangeIntentional Rounding by Assistant Nurse Managers (January 2010)• Mentoring by Directors & Nurse Managers• Every patient – Every day – Every shift• Immediate follow-up with staff – Positive feed back – Opportunities for improvement
    • Multi-Modal Strategies for ChangeDaily Communication to Patient by Frontline Staff (January 2010)• Today’s Plan (Plan of Care) – Automatic computer printout from electronic medical record• Frontline staff nurse reviews with patient – Nurse can add additional information (time a procedure might be done)• Encourage patient to write down questions for the physician
    • Multi-Modal Strategies for ChangeIntroductions at shift change (January 2010)• Departing nurse at end of shift – It has been my pleasure to care for you during my shift – This is “Anne” who will be caring for you after I leave • Anne is one of our best nurses• Oncoming nurse – I am pleased to meet you – Writes phone number on white board
    • Multi-Modal Strategies for ChangeTransition to all RN Model (January 2010)• First Unit transitions to all RN model – 21 bed progressive care unit – All semi-private rooms with exception of one private room – Oldest part of building – Space constraints – New manager
    • Multi-Modal Strategies for ChangeScripting (February 2010)• Welcome Mr. Jones, we’ve been expecting you.• Mrs. Jones, Can I do anything else for you before I leave?• Thank you for allowing us to care for you today, Miss Jackson.• Would you like me to pray with you?
    • CDMAI Control
    • Top Box Nurse Communication Linear Trend Model S ource: HCAHPS February 2009 through 2010 0.74 Variable A ctual 0.72 F itsNurse Communication A ccuracy Measures 0.70 MA PE 3.74163 MA D 0.02493 0.68 MSD 0.00085 0.66 0.64 0.62 0.60 y h il y e ly st er er er e r a r y a r y rc h u a r a rc A pr Ma J un J u gu m b tob m b m b u r r u Ma eb M Au pte Oc v e c e Jan eb F Se No De F
    • Top Box Willingness to Recommend Linear Trend Model S ource: HCAHPS February 2009 through March 2010 0.675 Variab le A ctu al 0.650Willingness to Recommend F its 0.625 A ccuracy M easu res MA PE 5.30697 0.600 MA D 0.03054 MSD 0.00177 0.575 0.550 0.525 0.500 y h il y e ly t r r r r y y h a r a r c Apr M a J un J u gu s be o b e be be ua r ua r a r c ru M m t m m r eb Au pte Oc n ve e ce J a F e b M F o D Se N
    • Boxplot of W illingness to R ecommend, N urse Communication 75.00% 70.00% 65.00%Data 60.00% 55.00% 50.00% W illingness to Recom m end Nurse C om m unication
    • Top Box Medication Communication Linear Trend Model S ource: HCAHPS February 2009 through March 2010 0.65 Variable A ctualMedication Communication F its A ccuracy Measures 0.60 MA P E 5.02837 MA D 0.02807 MSD 0.00130 0.55 0.50 y h il y e ly st er er er e r a r y a r y rc h u a r a rc A pr M a J un J u gu m b tob m b m b u r r u Ma eb M Au pte Oc v e c e Jan eb F Se No De F
    • Boxplot of Willingness to Recommend, Medication Communication 65.00% 60.00%Data 55.00% 50.00% Willingness to Recommend Medication Communication
    • Top Box Discharge Information Linear Trend Model S ource: HCAHPS February 2009 through March 2010 0.82 Variable A ctual 0.80 F its A ccuracy Measures 0.78DC Information MA PE 4.23569 MA D 0.03158 0.76 MSD 0.00133 0.74 0.72 0.70 y h il y e ly st er er er e r a r y a r y rc h u a r a rc A pr Ma J un J u gu m b tob m b m b u r r u Ma eb M Au pte Oc v e c e Jan eb F Se No De F
    • Boxplot of Willingness to Recommend, DC Information 85.00% 80.00% 75.00% 70.00%Data 65.00% 60.00% 55.00% 50.00% W illingness to Recommend DC Information
    • Lessons Learned• Clinical Excellence & the Patient Experience is a journey not a destination• Culture change – Awareness & accountability• Process – Standardized – Intentional• Right people on the team
    • Lessons Learned• Construction night noise especially disruptive• Families able to respond for patient• Early service training does not yield success• Embed accountability & process improvement before service training• Innovation is copying a good idea
    • Lessons Learned HCAHPS Department 2009 4th QT 2009 1st QT 2010 WP Hospital 59% 58% 65% Ortho (1960) 67% 66% 73% Womens (2620) 51% 50% 58% SCU (4010) 53% 55% 46% MSU (4040) 51% 46% 50% SPCU (4050) 56% 63% 51% SW 1 (4055) 48% 46% 76% MPCU (4070) 58% 58% 59% M/B (4090) 68% 59% 85% South 1 (9991) 50% 45% 56%Small tests of change are working and moving in the right direction
    • What makes Change Successful?The Effectiveness (E) of the Result Is Equal to the Quality (Q) of the Solution Times the Acceptance (A) of the Idea … Q x A x A = E = E “A” is Critical to Effectiveness 10 X 1 = 10 10 X 8 = 80 It takes time to gain acceptance by 1,428 employees
    • Jim Collins“I don’t care how hard this period is. Youhave to have the combination of believingthat you will prevail, that you will get out ofthis, but also not be the Pollyanna whoignores the brutal facts. You have to say thatwe will be in this for a long time and we willturn it into a defining event, a big catalyst tomake ourselves a much stronger enterprise.”
    • Thank You