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UHC, Patient Satisfaction Collaborative
 

UHC, Patient Satisfaction Collaborative

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Rounding at Robert Wood Johnson University Hospital

Rounding at Robert Wood Johnson University Hospital

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    UHC, Patient Satisfaction Collaborative UHC, Patient Satisfaction Collaborative Document Transcript

    • Improvement Collaborative Patient Experience 2009 Field Brief BENCHMARKING & IMPROVEMENT SERVICES SUCCESSFUL STRATEGIES Implementing Rounding Enhancing the Role of Leadership in Service Excellence Building Staff Competencies Creating a Service Excellence Program THE POWER OF COLLABORATION
    • Patient Experience Improvement Inside Introduction to the Collaborative.........................3 Collaborative Participants About the Collaborative ...................................3 Successful Strategies............................................5 Clarian Health Partners: Methodist Hospital of Indiana Implementing Rounding ...................................5 Enhancing the Role of Leadership Denver Health in Service Excellence .........................................8 Harborview Medical Center Building Staff Competencies ...........................10 Creating a Service Excellence Program .............10 Hennepin County Medical Center Publication Summary ........................................14 Oregon Health & Science University Robert Wood Johnson University Hospital Stanford Hospital & Clinics Stony Brook University Medical Center Thomas Jefferson University Hospital UC Davis Medical Center UC Irvine Medical Center University Health Systems of Eastern Carolina (Pitt County Memorial Hospital) University Hospital of the SUNY Upstate Medical University For links to UHC’s Patient Experience resources, including the benchmarking project field book, University Medical Center of Southern Nevada member presentations and Web conference recordings, survey results, and innovative strate- University of Michigan Hospitals & Health Centers gies, log in to the UHC Web site at www.uhc.edu and go to the Benchmarking & Improvement Services area under Improve Performance. University of North Carolina Hospitals University of Utah Hospitals and Clinics University of Virginia Health System (University of VA Medical Center) University of Washington Medical Center For more information about UHC’s Patient Experience initiatives or to be added to the Patient Virginia Commonwealth University Health System Experience Improvement Collaborative listserver, (MCV Hospital) contact the project manager, Deb McElroy, at (630) 954-2782 or mcelroy@uhc.edu. Yale-New Haven Hospital University HealthSystem Consortium 2001 Spring Road, Suite 700 Oak Brook, IL 60523-1890 (630) 954-1700 Fax: (630) 954-4730 www.uhc.edu 2
    • Introduction to the Collaborative Introduction to the Collaborative An excellent health care organization produces • Accountability and performance expectations an excellent patient experience. For each • Communication of progress and success patient, the quality of a health care experience is based on the answers to these and other In several instances, the collaborative provided similar questions: Was my pain level regularly an incentive to begin organizational improve- assessed? Did the nurses ask if I had questions ment; in others, the collaborative acted as about my care plan? Was the identity of the support for an ongoing organizational effort. physician in charge of my care made clear The collaborative also helped participants to me? Moreover, while many personnel overcome the barriers to success identified in contribute to the patient experience, the the benchmarking project, such as competing true excellence of a patient’s experience lies priorities, a lack of personal accountability, in the perception of the patient and the a blame-oriented culture, and the challenges patient’s family members—and no one else. inherent in sustaining efforts over time. Rationale for the The steering committee for the UHC Patient Several key benchmarking project findings1 Improvement Experience 2008 Benchmarking Project felt it also guided collaborative participants’ efforts: Collaborative was important to define “excellent patient expe- • Patient experience programs with greater The challenge: Members rience” as a point of reference for the collection longevity have better performance on patient asked for support after of project data. The following definition was satisfaction measures, and that performance benchmarking projects used for the project1: improves as the program becomes more because making significant changes can be overwhelming. An excellent patient experience, as comprehensive. perceived by patients and their families, • Including patient satisfaction measures in The solution: UHC Bench- evolves from care that is respectful of marking & Improvement performance evaluation expectations results Services offers improvement and responsive to individual patient in an improved patient experience. collaboratives to help mem- preferences, needs, and values, ensuring • There is a relationship between incentive bers implement change that patients’ values and safe practices compensation and better performance, and through structured support, inform all decisions affecting their care. the type of compensation may affect results. networking, and sharing of best practices among mem- The benchmarking project identified successful • Analysis of the project data demonstrated no bers with the same focus. practices that sustain an improved patient expe- statistical variation related to case mix index, rience and helped participants identify areas of gender, or Medicare or Medicaid status of the strength and opportunities for improvement. patient population. Twenty-one organizations enrolled in the About the Collaborative improvement collaborative; participation in Because making significant organizational the original benchmarking project was not changes can be overwhelming, UHC offered a requirement for joining the collaborative. the Patient Experience 2009 Improvement Participants first completed a gap analysis Collaborative to help participants implement and worksheet to define their intended per- the benchmarking project’s critical success formance improvement initiatives, goals, met- factors1: rics, and team. (Examples of their initiatives are in Figure 1.) Between December 2008 and • Institutional commitment to service excellence May 2009, they participated in monthly collab- • Organization-wide education and support orative conference calls to network, share advice and tips, and report progress. 1 Patient Experience Benchmarking Project 2008 Field Book. Oak Brook, IL: University HealthSystem Consortium; 2009. https://www.uhc.edu/docs/003731569_PtExp2008FieldBook.pdf. Accessed August 26, 2009. UHC Patient Experience Improvement Collaborative 2009 Field Brief 3
    • Introduction to the Collaborative Two work groups focused on initiatives related conference calls took place separately from to education, organizational support, com- the collaborative calls and offered additional munication, and accountability. Work group opportunities for discussion and networking. Examples of Patient Experience Improvement Initiatives Organization Initiativea Oregon Health & • Improve nursing and physician communication Science University • Reduce number of falls and pressure ulcers Robert Wood Johnson • Hardwire and enhance “every 2 hours” rounding University Hospital Stanford Hospital & • Expand the service team to coach units/clinics on patient satisfaction scores Clinics • Enhance hourly nurse rounding • Develop support service report cards University Medical • Implement a system that allows patient activation of the rapid response Center of Southern action team Nevada University of Michigan • Implement a policy on calling patients 24 hours after discharge Hospitals & Health • Improve awareness and visibility of patient- and family-centered care, Centers including psychosocial and spiritual components • Involve family members in root cause analyses of adverse events in the pediatric intensive care unit University of Utah • Create unit-based action plans to improve the patient experience Hospitals and Clinics • Create patient experience incentives and evaluations for all leaders and faculty University of Washington • Include patient satisfaction measures in performance evaluation expectations Medical Center Virginia Commonwealth • Organize nursing leaders of selected units to develop scripts for individual University Health System roles in units • Implement scripts with an “every 2 hours” rounding program • Have nurse managers round on all new patients Figure 1 – Source: UHC Patient Experience Improvement Collaborative participants a Not an inclusive list. For More Information To find these resources for the Patient Experience projects, log in to the UHC Web site at www.uhc.edu and go to the Benchmarking & Improvement Services area under Improve Performance. Resources available include: • Benchmarking project field book • Action plan • Knowledge transfer meeting presentations and Web conference recordings • Strategy map • Survey results • Innovative strategies • Sample Performance Opportunity Scorecard • Internal improvement project planning checklist • UHC’s Patient Experience Improvement Collaborative listserver 4 UHC Benchmarking & Improvement Services
    • Successful Strategies Successful Strategies Implementing Rounding our union staff,” said Mansfield. Union staff were concerned that if they signed the state- Performing regular, thorough, and efficient ment, it could be used against them in a puni- patient rounds was a successful initiative for tive manner. With the support of union leaders, 2 collaborative participants: Robert Wood the committee convinced Johnson University Hospital (RWJ) and the concerned staff mem- All RWJ nurses now round every 2 hours from Virginia Commonwealth University Health bers that the statement 10:00 AM to 6:00 PM, carrying a small refer- System (VCU). Although the rounding of commitment was program details varied, each organization ence card that summarizes rounding procedures. intended as nothing more discovered that rounding is a valuable tool than a behavioral expectation. In retrospect, the for improving the patient experience. committeee members realized that they should Robert Wood Johnson University Hospital. have involved union leaders from the start. RWJ’s past efforts at rounding were less than Nevertheless, all staff members signed the promising. In an attempt to improve patients’ statement without further pushback. perception of staff responsiveness, better Two types of rounding were implemented: manage patient pain, prevent falls, and en- nursing and leadership. All RWJ nurses now hance nurses’ working plans, the organization round every 2 hours from 10:00 AM to piloted rounding in 1 unit in September 6:00 PM, carrying a small reference card 2008 before implementing “every 2 hours” that summarizes rounding procedures rounding house-wide. Unfortunately, lack of (see Figure 2 for rounding competencies): accountability and staff buy-in prevented the initiative from succeeding. “If rounding wasn’t • Introduce yourself done, that just seemed to be okay,” said Laura • Use the whiteboard at the patient’s bedside Mansfield, RNC, MSN, director, Patient to write down the care plan for the day Satisfaction. Other barriers included unit-to- • Address the 4 P ’s: pain, position, potty, unit variation in approaches to rounding as personal needs well as resistance from unit leaders, nursing • Perform scheduled tasks RWJ formed a grassroots committee of directors, and other staff. representatives from every nursing area to • Communicate when you Reflecting on that first attempt at rounding, will return examine the proposed rounding process and Mansfield said, “We knew we needed a formal • Ask if you can do anything assist in its implementation. process to be successful.” After joining the else for the patient UHC collaborative, the organization re- grouped by forming a grassroots committee • Document the round in the daily log of high-performing nursing staff representa- In addition, a special rounding Post-it note is tives from every nursing area to examine the available in all units for use when the patient is proposed rounding process and assist in its sleeping. The note tells the patient the time the implementation. rounding nurse stopped by and the time that The committee developed a pamphlet with a the rounding nurse will return. Elderly patients step-by-step explanation of RWJ’s rounding ini- in particular feel comforted to know that some- tiative; the pamphlet included a statement of one is checking on them while they sleep, commitment that staff were asked to sign. “We Mansfield noted. initially had some tremendous pushback from UHC Patient Experience Improvement Collaborative 2009 Field Brief 5
    • Successful Strategies Rounding Competency Checklist at Robert Wood Johnson University Hospital DATE NAME DEPARTMENT EVALUATOR SELF ASSESS EVALUATOR COMMENTS YES NO YES NO INTRODUCTIONS Knock on door prior to entering — ask permission Manage up your skill or that of your co-worker Use good eye contact EXPLAIN HOURLY ROUNDING UPON ADMISSION Explain the purpose of hourly rounding (initial visit) Use key words “very good” care Describe rounding schedule (6am-10pm q2hr) UPDATE WHITE BOARDS Place name on white board Update nursing plan of care/goals for patient ADDRESS 4 P’S PAIN-POSITION-POTT Y-PERSONAL NEEDS How is your pain? Are you comfortable? Do you need to go to the bathroom? Personal needs ASSESS ENVIRONMENT Move items within reach (table, call bell, phone, water) PERFORM SCHEDULED TASKS Complete MD-ordered treatments, procedures Complete nursing care as needed Administer scheduled medications CLOSING We will round again in about 2 hours Is there anything else that I can do for you? I have the time Document your round on rounding log Figure 2 – Source: Mansfield LJ, Omabegho M. Rounding at Robert Wood Johnson University Hospital. Presented at: UHC Patient Experience Improvement Collaborative Knowledge Transfer Web Conference; June 8, 2009. 6 UHC Benchmarking & Improvement Services
    • Successful Strategies Leadership rounds follow a different proce- particularly by decreasing the number of dure. Organizational leaders round twice a patient falls. Around-the-clock hourly rounds day, 7 days a week. In the morning, the leader were rolled out in 2 acute care units (ortho- checks the patient’s environment, introduces pedic surgery and surgery) himself or herself, acknowledges any family in first quarter 2009. “The VCU implemented hourly rounding not only to members who may be present, asks about the two units were similar in enhance the quality of the patient experience quality of the nursing care the patient has what they wanted to do, received, asks if a nurse has checked on the but they rolled it out but also to improve patient safety, particularly patient every 2 hours, and asks if he or she can slightly differently, and by decreasing the number of patient falls. do anything for the patient. Evening rounds, they were dealing with a which are much briefer, consist of follow-up very different physical layout,” said Mary Kay questions and information about the identity Beasley, clinical administrator. The orthopedic of that evening’s charge nurse. Some leaders unit features a pod design with a mix of semi- leave their business cards for patients as well. private and private rooms and a central nursing station, while the surgery unit has all private Since implementing a formal rounding rooms and a large, state-of-the-art decentralized program, RWJ has seen improvement on nursing station design. several measures. RWJ’s Hospital Consumer Assessment of Healthcare Providers and In the orthopedic unit, rounding is alternately Systems (HCAHPS) nursing score has performed by registered nurses and care part- increased from 71% to 73%, and its respon- ners. Staff members who perform rounding siveness score has increased from 56% to carry a cue card with reminders of rounding 58%. Several of RWJ’s Press Ganey scores procedures: have also improved: “response to concerns • Assess pain level and offer pain medication and complaints” increased from the 33rd • Ask if the patient needs help going to the to the 46th percentile, “staff work together” bathroom increased from the 44th to the 59th per- centile, and “promptness to call bell” • Assess the patient’s comfort increased from the 43rd to the 66th per- • Place the call bell, telephone, and TV centile. The organization’s fall rate has seen remote within reach improvement as well, decreasing from an • Make sure the bedside table, tissues, water, average of 3.3 falls per month in fourth and trash can are next to the bed quarter 2008 to an average of 3.06 per • Ask if the patient needs anything else month in first quarter 2009. • Tell the patient that staff will return in According to Mansfield, organizations consid- an hour ering their own rounding initiatives should resist the urge to rush implementation, “A key question that seems to really elicit focusing instead on helping staff understand replies from the patients is ‘Is there anything and accept the process. else I can do for you before I leave the room?’” said Beasley. For more information about RWJ’s experience, contact Laura Mansfield, director, Patient Surgery rounding at VCU differs slightly from Satisfaction, at (732) 828-3000 or orthopedic rounding because it is performed laura.mansfield@rwjuh.edu. only by licensed staff members. However, the surgery unit uses a laminated cue card very Virginia Commonwealth University Health similar to the one used in the orthopedic unit. System. VCU implemented hourly rounding In addition, the surgery cue card features the not only to improve the quality of the patient ACT (ask, check, and tidy up) rubric (Figure 3). experience but also to increase patient safety, UHC Patient Experience Improvement Collaborative 2009 Field Brief 7
    • Successful Strategies Surgery Rounding Cue Card at Virginia Commonwealth University Health System Front Back SMILE Remember . . . Tell the patient you are doing rounds A: ASK Identify self • Bathroom • Change positions Make eye contact • Pain • Anything I can do Ask: “Is there anything else I can do for you before C: CHECK I leave the room?” • Call bell and phone • Bed low, top rail up A good attitude is contagious! • ID band on • Trash can beside bed • Water and cup within reach T: TIDY UP • Floor clear to bathroom • Bedside table within reach • Assist in setting up tray • Keep room neat Figure 3 – Source: Beasley MK. UHC Patient Experience Improvement Collaborative. Presented at: UHC Patient Experience Improvement Collaborative Knowledge Transfer Web Conference; June 30, 2009. VCU began to see success with its new A major success was the surgery unit’s signifi- rounding protocols as early as the end of the cant decrease in the number of patient falls, quarter in which they were implemented. In which dropped from an average of 7.38 per a Professional Research Consultants (PRC) quarter in fourth quarter 2008 to 2.41 in first loyalty study, the orthopedics unit saw a spike quarter 2009. “What this data does not pull in “excellent” responses (from 56% to 62%) out is that surgery actually did not start the to the question “How would you rate nurses’ hourly rounds until the end of February,” caring for you or your said Beasley. “At the end of March, there were family member when 0 falls. Once the project was fully rolled out, “We don’t call this an initiative, because an it was actually almost a 6-week period without needed?” The surgery initiative sounds time-limited. This is a culture unit’s performance on falls. Our fall committee is going to be looking change.” the same measure in particular at their way of doing rounds and – Chrissy Daniels, director, Exceptional decreased slightly, from what it contributed to this.” Hourly rounding Patient Experience, University of Utah 100% to 97.6%, pos- is now being rolled out in every unit at VCU. Hospitals and Clinics sibly because it had just For more information about VCU’s experience, completed a geographic contact Mary Kay Beasley, clinical administrator, move within the hos- at (804) 828-6392 or mbeasley2@mcvh-vcu.edu. pital, according to Beasley. On the question “What is the likelihood that you would recom- mend VCUHS to friends and relatives?” the Enhancing the Role of Leadership in Service Excellence percentage of “excellent” responses jumped from 50% to 73% for the surgery unit and University of Utah Hospitals and Clinics. stayed at 60% for the orthopedic unit. Mean- In 2008, Utah held the Exceptional Patient while, on the unit customer indicator PRC Experience Retreat to answer the question satisfaction dashboard, the surgery unit’s per- “Why are we unable to consistently provide formance increased from 60% to 65.8%, and an exceptional experience for each of our the orthopedic unit’s performance increased patients?” It was the first time that the organi- from 40% to 50%. zation had conducted a leadership develop- ment program about the patient experience. 8 UHC Benchmarking & Improvement Services
    • Successful Strategies “We were all out of our comfort zones, but videos of patients describing what made their that’s sometimes a good place to be,” said experiences exceptional,” said Daniels. “Staff Chrissy Daniels, director, Exceptional Patient being able to hear the senior vice president’s Experience. A root cause analysis revealed personal message has been one of the most a lack of an effective decision-making process, transforming things.” a lack of accountability, care that was not Local efforts were also launched. Physician patient-focused, and a mission conflict: Was initiatives included physician introduction Utah’s purpose research or patient care? cards, faculty behavioral standards, and bi- Several action steps emerged from that retreat. annual individual physician reviews, while Utah’s mission, vision, and values were vali- hospital initiatives included retreats, learning dated, with an emphasis on having a single mis- sessions, and “we were here” housekeeping cards. sion with multiple ways to achieve it: patient The results of these culture-change efforts care, education, and research. Principles for have been gratifying. Press Ganey has recog- decision making and patient-focused care were nized Utah as a top decile improver, with a also developed. Finally, the performance evalua- 1.6 mean improvement in the third quarter of tion process was modified to include the patient fiscal year 2009. In overall patient satisfaction, experience. “We don’t call this an initiative, inpatient psychiatry rose to the 90th per- because an initiative sounds time-limited,” centile, inpatient oncology to the 98th per- said Daniels. “This is a culture change.” centile, ophthalmology to the 70th percentile, A follow-up retreat in February 2009 celebrated and the family medicine network to the 85th successes and moved the culture-change process percentile. Slower but still improving is the to the next level. Implementation plans were University of Utah Hospital, with a 1.2 mean developed for value-based employment and improvement in the third quarter of fiscal retention, reward and recognition, unit-based year 2009. action plans, leadership roles and responsibili- Utah’s chief recommendation to other organiza- ties, and communication. tions that are seeking to improve their patients’ As a result of these retreats, the Utah faculty experience is to create an physician practice’s executive medical director environment that supports The Utah faculty physician practice’s executive and the hospital’s chief executive officer aligned this goal. “[We want to] medical director and the hospital’s chief execu- goals, measurement tools, and processes and listen to what our patients say and hear what they tell tive officer aligned goals, measurement tools, attended leadership development opportunities related to an exceptional patient experience. us,” said Daniels. “It’s not and processes and attended leadership devel- Leaders also spent 2 to 6 hours shadowing knowing the answers; it’s opment opportunities related to an exceptional someone in the part of the organization with asking the right questions. patient experience. which they were least familiar. That experience It’s digging deep enough to resulted in, among other changes, new remotes find root causes, not applying superficial fixes.” for televisions in patient rooms. To that end, organizations should provide a safe platform for open and frank discussion so that To maintain the organizational focus on the problems can be identified, celebrate successes, patient experience, Utah implemented weekly and make sure that staff members hold each scorecards, monthly learning sessions, ways to other accountable. reward and recognize individuals and teams (such as a personal letter from the chief oper- For more information about Utah’s experience, ating officer to any staff member named on a contact Chrissy Daniels, director, Exceptional patient survey), and employee forums to review Patient Experience, at (801) 581-2423 or progress and share experiences. “In addition, chrissy.daniels@hsc.utah.edu. our senior vice president has made a series of UHC Patient Experience Improvement Collaborative 2009 Field Brief 9
    • Successful Strategies Building Staff Competencies work environment and include patients and family members in actively seeking University of Washington Medical Center. ways to eliminate the risk of patient injury Before joining the UHC improvement collab- to maximize the delivery of quality care. orative, University of Washington Medical This includes reviewing the pertinent poli- Center (UWMC) created a Rehabilitation cies and procedures as well as understanding Services Patient and Family Advisory Council all aspects of the work environment. All (PFAC) that included 10 patient and family staff are required to indicate when there advisers, a unit medical director, an occupa- is a patient safety concern and elevate issues tional therapy manager, and 4 direct-care staff. to the appropriate leadership. The council’s goal was to bring patient- and family-centered care (PFCC) principles into During annual evaluations, feedback about the direct patient care through the staff competen- new competencies was solicited. New compe- cies used in annual performance evaluations. tencies were distributed to areas representing various hospital services—inpatient, outpatient, To accomplish that goal, the Rehabilitation and ancillary—and were given directly to staff Services PFAC took several steps. The occupa- to solicit more feedback. Competencies were tional therapy II position job description also reviewed by key organizational leaders and summary were revised, and technical from compliance, quality improvement/patient competencies were rewritten to include safety, and human resources areas. Currently, PFCC language and principles. The Institute UWMC is using the hospital-wide feedback to for Family-Centered Care’s “Templates— revise the competencies; the revised compen- Philosophy of Care Statements, Definitions tencies and recommendations will then be pre- of Quality, and Position Descriptions” was a sented to executive leaders. valuable resource. The revised job descriptions were reviewed with staff and council members, For more information about UWMC’s experience, who drafted a final version that did not address contact Ann Buzaid, nurse manager, at organization-wide behavioral competencies. (206) 598-3054 or abuzaid@u.washington.edu or Jennifer Herrman, nurse manager, at After joining the UHC collaboration, UWMC (206) 598-3004 or jherrman@u.washington.edu. decided to expand the effort by revising the organization-wide competencies. Standardized Creating a Service Excellence Program competencies were revised on every staff member’s job description, using guidelines Stanford Hospital & Clinics. At Stanford, the developed by the Rehabilitation Services PFAC. journey to improve the patient experience Patient representatives were recruited from each began about 2 years ago when the organiza- of 7 PFACs, and UWMC tion developed a service excellence workshop. Competencies for UWMC staff were revised to staff representatives were It was felt that the organization already pos- increase readability, infused with new language recruited from key areas sessed the key to a successful service excellence that supports PFCC principles, and sorted to such as inpatient care program—an engaged and skilled manage- reflect PFCC values. services, ambulatory care ment team. The workshop’s goal was to focus services, organizational on service quality while addressing multiple development and training, human resources, imperatives: Epic electronic medical records, and patient relations. expense reduction, quality and patient safety, and regulatory compliance. Competencies for UWMC staff were revised to increase readability, infused with new lan- At the workshop, “overall rating of care” was guage that supports PFCC principles, and selected as the principal measurement of patient sorted to reflect PFCC values. For example, satisfaction. Since that measure was so broad, the competency previously titled “HIPAA workshop participants examined 2 years of his- Compliance” was retitled “Patient Privacy.” torical data to see what was driving that overall In addition, patient safety was included as rating in the inpatient areas, the emergency a new competency: department, and the clinics. Patient safety is a priority of everyone at Key inpatient drivers included whether patients UWMC. Staff consistently review their had trust and confidence in the nurses and 10 UHC Benchmarking & Improvement Services
    • Successful Strategies doctors treating them, felt that they were of feedback, support service report cards, treated by the nurses with courtesy and respect, enables inpatient units and clinics to give con- and felt that doctors listened carefully to them. tinuous feedback on their level of satisfaction Stanford decided to aim for increasing inpatient with support services. The cards include basic service excellence from the 75th to the 80th questions about the general services area, such percentile in fiscal year 2009. Key drivers in the as how quickly transport emegency department were whether patients staff arrived when called. A closed-loop same-day feedback program was felt that they had to wait too long to see a Stanford also implemented developed to give Stanford nursing and general doctor and how highly they would rate the services teams access to real-time feedback executive walk rounds, in courtesy of emergency department staff. The which executives ask spe- about concerns that can be resolved during a goal in this area was to increase service excel- cific questions of key patient’s hospital stay. lence from the 28th to the 75th percentile in stakeholders—leaders, fiscal year 2009. Finally, key drivers in the employees, physicians, and patients—to obtain clinics were how well organized the office was actionable service information. A closed-loop perceived to be by patients, how they rated the same-day feedback program was developed to courtesy of the office staff and of their doctors, give Stanford nursing and general services and whether they felt that the main reason teams access to real-time feedback about con- for the visit was addressed to their satisfaction. cerns that can be resolved during a patient’s The goal was to increase the service excellence hospital stay. The program’s goal is to improve average score from 93.78% to 95% in fiscal the patient experience by allowing for imme- year 2009. diate service recovery. An analyst goes to Between January and June 2009, several new select units and passes out feedback cards with best practices were introduced in the inpatient, 5 open-ended questions to patients and fami- clinic, and support services settings. Among lies. The analyst then collects the cards, identi- the first to be implemented was the AIDET fies any immediate issues, communicates the (acknowledge, introduce, duration, explanation, issues to the appropriate nurse managers and thank you) communication framework, which enters them into a database, and generates a represents the 5 dimensions of patient-centered daily report that is e-mailed to nurse managers. communication and which was held to be the Several best practices were introduced in the most effective practice for improving patient emergency department in early 2009. A satisfaction in the inpatient setting. new holding room was designed to reduce Implemented around the same time was the the number of hours that patients spend in best practice of transferring trust, which entails hallway beds, increase the using “the right words at the right time” to number of patient beds Support service report cards enable inpatient transfer trust to the next health care provider. available, and improve units and clinics to give continuous feedback on For example, when a physician is finished door-to-physician wait examining a patient, he or she could say, “Just times. Stanford also imple- their level of satisfaction with support services. proceed to check-out, and Sally, who is our mented a quick-triage medical assistant, will make sure you get the model to improve door-to-triage end time and referrals you need.” coached physicians and staff on service behav- iors to improve patients’ perception of care New recognition mechanisms include “WOW! provider courtesy. cards,” a way to spontaneously recognize, affirm, and show appreciation for employees In addition, Stanford has developed several whose performance and actions model their physician-specific initiatives, such as integrating personal commitment to excellent care and individual physician scores into quarterly superior service. Anyone can fill out a card and quality scorecards, recognizing physicians with submit it to the employee’s immediate manager, “WOW!” cards and monthly learning break- who recognizes that employee with a certificate fasts with the chief executive officer and chief and a small gift card for coffee. Another form UHC Patient Experience Improvement Collaborative 2009 Field Brief 11
    • Successful Strategies operating officer, launching the Service Alert The other pilot project is a physician-patient e-newsletter, and designing a broader internal communication framework known as GIIFT and external communications campaign. (greet patient and family, introduce yourself, information sharing, feedback, transfer of care). Two other physician initiatives are currently The pilot was launched in May 2009 for being piloted: team cards and a communication medicine unit (cardiology) physicians, with the framework. Team cards are business cards with goals of implementing a consistent physician- photographs that are given to every patient. patient communication standard for all patients The patient places the team cards into plastic in the unit and improving patients’ under- sleeves distributed by unit/nursing staff. This standing of who their physicians are. The team pilot began in March 2009 for more than in charge of the pilot developed this physician- 100 physicians and medical students on the specific script based on AIDET principles. See internal medicine service, with the goal of Figure 4 for more details about the GIIFT improving physician-patient interactions as framework. well as patients’ understanding of who is on their primary care team. Prior to this pilot For more information about Stanford’s experience, program, for example, many patients did contact Asha Viswanathan, project manager, not understand that residents and interns are Service Excellence, at (650) 721-6266 or doctors, and these patients left the hospital aviswanathan@stanfordmed.org or Deepti thinking that a physician had never seen them. Randhava, program manager, Process Excellence, at (650) 736-4211 or drandhava@stanford.org. GIIFT Communication Framework at Stanford Hospital & Clinics G Greet patient and family Knock on the door, make eye contact, and say hello. I Introduce yourself State your role and whether you are on the primary or consulting team taking care of the patient. I Information sharing Get information from the patient such as history, medications taken at home, and symptoms, and give information such as tests ordered and when to expect results. F Feedback Ask the patient and family what questions or concerns they have. T Transfer of care “I will be your doctor until [state day and time], and Dr. Smith will take over from me at [state day and time].” Figure 4 – Source: Randhava D, Viswanathan A. Service excellence program: improving the patient centered care experience at Stanford Hospital. Presented at: UHC Patient Experience Improvement Collaborative Knowledge Transfer Web Conference; June 30, 2009. 12 UHC Benchmarking & Improvement Services
    • Successful Strategies The Next Step Is Yours Collaborative participants continue to move forward with their improvement initiatives. Meanwhile, the information provided in this field brief can help you develop strategies for designing and carrying out your own patient expe- rience improvement projects. Ongoing networking is available through the Patient Experience Improvement Collaborative listserver. For links to UHC’s Patient Experience resources, including the benchmarking project field book, member presentations and Web conference recordings, survey results, and innovative strategies, log in to the UHC Web site at www.uhc.edu and go to the Benchmarking & Improvement Services area under Improve Performance. For more information about UHC’s Patient Experience initiatives or to be added to the listserver, contact the project manager, Deb McElroy, at (630) 954-2782 or mcelroy@uhc.edu. For More Information To find these resources for the Patient Experience projects, log in to the UHC Web site at www.uhc.edu and go to the Benchmarking & Improvement Services area under Improve Performance. Resources available include: • Benchmarking project field book • Action plan • Knowledge transfer meeting presentations and Web conference recordings • Strategy map • Survey results • Innovative strategies • Sample Performance Opportunity Scorecard • Internal improvement project planning checklist • UHC’s Patient Experience Improvement Collaborative listserver UHC Patient Experience Improvement Collaborative 2009 Field Brief 13
    • Publication Summary Publication Summary To find these and other resources for the Patient Experience initiatives, log in to the UHC Web site at www.uhc.edu and go to the Benchmarking & Improvement Services area under Improve Performance. Field Book—A comprehensive overview of the most significant findings and recommendations of the benchmarking project. This project guide will help you make the best use of performance assessments and other tools to improve the patient experience. It is available in both softcover and electronic formats. Action Plan—A detailed list of successful strategies and tactics in an action plan template to guide your improvement initiatives. Knowledge Transfer Meeting Presentation and Web Conference Recordings—Presentations on the benchmarking project findings and how to use them, member presentations, and record- ings of the projects’ Web conferences. Strategy Map—An outline of the tactics that better-performing organizations have used to improve the patient experience. Survey Results—Comprehensive results of all data collected for the benchmarking project. The data give a clear idea of how all participants compare across the full range of performance measures. Innovative Strategies—Specific tactics that benchmarking project participants have used to improve performance. Sample Performance Opportunity Scorecard—A self-assessment tool that can be used to iden- tify specific strategies to pursue. Internal Improvement Project Planning Checklist—A checklist designed to stimulate discus- sion and help you begin an improvement initiative. Field Brief—A summary of the lessons learned from the improvement collaborative and the improvement initiatives of the participants. Project Manager For more information about UHC’s Patient Experience initiatives or to be added to the Patient Experience Improvement Collaborative listserver, contact the project manager, Deb McElroy, at (630) 954-2782 or mcelroy@uhc.edu. 14 UHC Benchmarking & Improvement Services
    • University HealthSystem Consortium 2001 Spring Road, Suite 700 Oak Brook, IL 60523-1890 (630) 954-1700 Fax: (630) 954-4730 www.uhc.edu © 2009 University HealthSystem Consortium. All rights reserved. The reproduction or use of this document in any form or in any information storage and retrieval system is forbidden without the express, written permission of UHC; however, participants in UHC’s Benchmarking & Improvement Services program may copy portions of the document for internal use only at any time. 9/09 1000 OI0709