1) Two hospitals implemented regular hourly rounding programs to improve patient experience.
2) Rounding involves checking on patients' needs, pain levels, comfort and safety every 1-2 hours.
3) Early results show reductions in falls and improvements in HCAHPS scores for nursing communication and responsiveness.
Annette Bartley: Making it happen - Intentional RoundingThe King's Fund
Annette Bartley, Independent Healthcare Consultant, The Health Foundation, highlights the key findings of the CQC report on the State of Care and discusses the benefits of Intentional Rounding for patients.
University of Utah Surgical Unit Improves Response to Call LightsUniversity of Utah
University of Utah's Kathy Schumann, RN, CCTN, provides an overview of how a nursing intervention to improve response to call lights improved pain management outcomes, increased patient satisfaction, quality outcomes and patient safety.
Annette Bartley: Making it happen - Intentional RoundingThe King's Fund
Annette Bartley, Independent Healthcare Consultant, The Health Foundation, highlights the key findings of the CQC report on the State of Care and discusses the benefits of Intentional Rounding for patients.
University of Utah Surgical Unit Improves Response to Call LightsUniversity of Utah
University of Utah's Kathy Schumann, RN, CCTN, provides an overview of how a nursing intervention to improve response to call lights improved pain management outcomes, increased patient satisfaction, quality outcomes and patient safety.
Presented at the George Washington University 1st GME Retreat. Includes overview of handoff function and content, pitfalls for handoffs, and strategies for safe and effective communication during handoffs, and how to use process improvement techniques to make handoffs safer. Handout includes handoff menu of educational tools to be used by faculty teaching.
University of Utah Health: Wellness Champion Poster Session 2017University of Utah
Improving Wellness: 40 Champions, 20 Projects and 12-months of Progress: The Wellness and Integrative Health’s Resiliency Center, Accelerate, and the Spencer S. Eccles Health Sciences Library presented a Faculty Wellness Poster Session. Each department in the School of Medicine highlighted the past year’s Wellness Champion projects, which are focused on personal resilience, burden reduction, and team work. The poster session demonstrates work completed so far as the Wellness Champion program is expanded to faculty and staff across U of U Health.
Measuring “Culture of Safety” Tawam’s Experience
Discovery:
Tawam Hospital’s Executive leadership realized the need to establish a “Culture of Safety” within the organization and implemented the Johns Hopkins Medicine “Comprehensive Unit based Safety Program” (CUSP). CUSP was introduced as a pilot project in the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NNU) and Paediatric Oncology Unit (Peds Onc).
Prior to implementation the leadership decided to measure staff perception of safety using evidence based tool.
Solution:
Tawam partnered with Pascal Metrics to implement the Safety Attitude Questionnaire survey. The SAQ was administered to all Tawam Hospital staff in three phases (2008, 2010 and 2011). In 2010 the pilot CUSP units were also resurveyed to determine the status of safety culture since its introduction in 2008.
An email from the CEO was sent to the participants encouraging them to participate in the SAQ survey.
Physicians, nurses, ward-clerks; respiratory therapist, physiotherapist, dieticians etc were included in the survey.
Those who spent at least 50% of their time in the identified units were only included to participate in the survey.
Survey was administered during departmental meetings to increase response rate.
Conducted separate sessions of physicians.
Staff dropped the completed surveys in an envelope.
82% of staff in the patient care areas of the whole hospital participated in the overall 3 phases of SAQ Survey.
The three CUSP pilot units were re-surveyed in 2010.
Anonymity, privacy and confidentiality were maintained from the beginning till the end.
Outcome:
The survey results were graded against percentage positive responses. Responses that were less than 60% mark were graded in the danger zone and anything above the 80% mark were graded in the goal zone. Teamwork climate and Safety climate scale scores are considered to be primary dependent variables, because they are important in preventing patient harm.
The overall hospital score on all the domain scores were in the danger zone, less than 60%. 20 clinical locations in 2010 and 7 clinical locations in 2011 had less than 60% scores in the primary dependent variables.
The SAQ results were disseminated department wise in the presence of a hospital Senior Executive. Every department did an action plan using the SAQ de-briefer tool. The hospital administrators to bring about the change played a facilitators role and helped the departments to come up with their actionable plans.
The hospital leadership in their pursuit to continuing the culture of safety journey, identified six more units for CUSP implementation based on the Phase 2 SAQ scores of 2010. Accordingly the Medical 1, Medical 2, Surgical 1, Surgical 2, Day Case and OBGYN Units were identified for the CUSP roll out. Senior Executive leaders were assigned to each of these new CUSP units to ensure leadership commi
A dissertation report on analysis of patient satisfaction max polyclinic by ...Mohammed Yaser Hussain
Hospitals are increasingly becoming sensitive to the needs of the patients as will the community. It is no longer the sellers [providers] market. Except for the totally free service provided by the Government run hospitals and a few hospitals run by the civic hospitals.
According to Dona Bedian
“Patient satisfaction may be considered to be one of the desired outcomes of care, even on element of health status itself” and that “information about patient satisfaction should be as indispensable to assessment of quality as to the design and management of health care system.
During the recent years the use of patient satisfaction surveys has increased in health care industry due in part to the belief that perception of quality is an important factor in demand for services and that survey result may have significant effect on provider behaviour. According to Ware “patient satisfaction is a determinant of a healthcare provider or system. Use of services complaints and malpractice suits”.
Use of patient satisfaction survey as a tool for quality improvement has become extensive in almost all western countries. Most hospital have a system of obtaining routine feedback from all the discharge patients. The quality improvement task force of the joint commission of accreditation of the health care organization in USA is also encouraging hospitals to mandate surveys are conducted in private hospitals.
Abstract
To assess the patient satisfaction level in emergency
department of a level 1Trauma Centre in India.
Shallu Chauhan, Dr.Deepak AgrawaL.
JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi-110029, India
Introduction
Patient satisfaction is an important indicator of the quality of care and service delivery in the
emergency department (ED). The objective of this study was to evaluate patient satisfaction
level in the E.D. of a level 1 Trauma Centre,AIIMS,New Delhi.To determine the effects of
actual waiting time,perception of waiting time,information delivery and expressive quality on
patient satisfaction.
Methods
This study was carried out for 2 months during all shifts mostly for those patients who triaged
as green.We made two groups:1) control group{ not explained anything to the patient} and
2) test group{patient explained for time management & treatment}. Patients/relatives were
asked to complete the questionnaire prior to discharge. For the first month, eight questions
were based on descripitve information were distributed to the control group { questions
including explanation of procedures to the patient,communication of staffs,problems faced
by patient/relatives, and overall patient satisfaction level}.Then, following second month
another study questionnaire included 11 questions based on a Likert scale concerning
waiting time{ie,overall time management,waiting for X-ray or C.T,scan,review by doctor, for
discharge & treatment},promptness & behaviour of staff and cleaniness of hospital given to
the test group.
Observation
Ninety patients who attended our ED were included in this study.The perception that waiting
times for placebo injection & T/t were less than expected was associated with a positive
overall satisfaction rating for the ED encounter[p is 0.033] as compared to actual waiting
time.Actual waiting time were not predictive of overall patient satisfaction. The highest
satisfaction rates were observed in cleaniness of hospital in both the groups and most of them
rated it as very good. For overall treatment, in control group 34% rated as poor & fair and
67% rated as good and very good,whereas in test group only 22% rated as poor and fair
but78% rated as very good and excellent.At the same time,both the groups were rated as
good for overall time management but they were not satisfy with the time taken by doctor
to review the reports and 33% rated as fair in control group and 22% rated as fair in test
goup.The assigned waiting time for particular physician to review a report was 60minutes
but average time taken to consult a particular physician was >60mins which mostly occur
in control group.The overall satisfaction rate was dependent on the mean waiting time. The
highest waiting time for a low rate of satisfaction of patient was 180minutes and for very
good level of satisfaction was just 15minutes. In control group,30% and 17% of patients
rated as fair and poor
Stratified pathways of care...from concept to innovationNHS Improvement
NHS Improvement is working in partnership with patients, clinical teams, the Department of Health (DH) and voluntary organisations to improve the effectiveness and quality of service delivery for those living with and beyond cancer. This is a summary report of this year’s work and includes pathways for breast, colorectal and prostate cancer.
Satisfactions Among Admitted Patient of Tertiary Level Hospital in Dhaka City.DR. S A HAMIDI
I am Dr. Saleh Ahmed Hamidi, successfully Conducted a dissertation & also presented by me (08/01/2016) about patient satisfaction level in tertiary level hospital.
How Disease Management, Case Management And Corporate Health Programs Can Sup...The HR Observer
This seminar will explain the paradigm shift in health care from acute diseases to chronic conditions. Based on this understanding the importance and potential of disease and case management programs as well as corporate health programs will be described. The role of self-management and the tremendous impact of HR on health and disease related costs will be highlighted. The relationship of patients to physicians is no longer the unique interaction in health care, but health coaches and HR interventions play a more and more important and effective role. At the end of the seminar HR representatives will be able
• To understand what is a Disease Management and Case management program
• To know how preventive Corporate Health Programs add value to HR functions
• To evaluate which programs may support HR in controlling health insurance premium
This presentation was used at HR Summit and Expo 2013 www.hrsummitexpo.com
How one Hospital Shaved Off 88 Minutes from their ALOSEmCare
With goals of getting the right processes and staffing in place, the administration and staff at LewisGale Medical Center in Salem, Virginia put a priority on patient-centered process improvements that would shorten wait times and length of stay in the emergency department (E.D.). Here’s how they improved metrics including decreasing the ED ALOS by 45 percent.
Presented at the George Washington University 1st GME Retreat. Includes overview of handoff function and content, pitfalls for handoffs, and strategies for safe and effective communication during handoffs, and how to use process improvement techniques to make handoffs safer. Handout includes handoff menu of educational tools to be used by faculty teaching.
University of Utah Health: Wellness Champion Poster Session 2017University of Utah
Improving Wellness: 40 Champions, 20 Projects and 12-months of Progress: The Wellness and Integrative Health’s Resiliency Center, Accelerate, and the Spencer S. Eccles Health Sciences Library presented a Faculty Wellness Poster Session. Each department in the School of Medicine highlighted the past year’s Wellness Champion projects, which are focused on personal resilience, burden reduction, and team work. The poster session demonstrates work completed so far as the Wellness Champion program is expanded to faculty and staff across U of U Health.
Measuring “Culture of Safety” Tawam’s Experience
Discovery:
Tawam Hospital’s Executive leadership realized the need to establish a “Culture of Safety” within the organization and implemented the Johns Hopkins Medicine “Comprehensive Unit based Safety Program” (CUSP). CUSP was introduced as a pilot project in the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NNU) and Paediatric Oncology Unit (Peds Onc).
Prior to implementation the leadership decided to measure staff perception of safety using evidence based tool.
Solution:
Tawam partnered with Pascal Metrics to implement the Safety Attitude Questionnaire survey. The SAQ was administered to all Tawam Hospital staff in three phases (2008, 2010 and 2011). In 2010 the pilot CUSP units were also resurveyed to determine the status of safety culture since its introduction in 2008.
An email from the CEO was sent to the participants encouraging them to participate in the SAQ survey.
Physicians, nurses, ward-clerks; respiratory therapist, physiotherapist, dieticians etc were included in the survey.
Those who spent at least 50% of their time in the identified units were only included to participate in the survey.
Survey was administered during departmental meetings to increase response rate.
Conducted separate sessions of physicians.
Staff dropped the completed surveys in an envelope.
82% of staff in the patient care areas of the whole hospital participated in the overall 3 phases of SAQ Survey.
The three CUSP pilot units were re-surveyed in 2010.
Anonymity, privacy and confidentiality were maintained from the beginning till the end.
Outcome:
The survey results were graded against percentage positive responses. Responses that were less than 60% mark were graded in the danger zone and anything above the 80% mark were graded in the goal zone. Teamwork climate and Safety climate scale scores are considered to be primary dependent variables, because they are important in preventing patient harm.
The overall hospital score on all the domain scores were in the danger zone, less than 60%. 20 clinical locations in 2010 and 7 clinical locations in 2011 had less than 60% scores in the primary dependent variables.
The SAQ results were disseminated department wise in the presence of a hospital Senior Executive. Every department did an action plan using the SAQ de-briefer tool. The hospital administrators to bring about the change played a facilitators role and helped the departments to come up with their actionable plans.
The hospital leadership in their pursuit to continuing the culture of safety journey, identified six more units for CUSP implementation based on the Phase 2 SAQ scores of 2010. Accordingly the Medical 1, Medical 2, Surgical 1, Surgical 2, Day Case and OBGYN Units were identified for the CUSP roll out. Senior Executive leaders were assigned to each of these new CUSP units to ensure leadership commi
A dissertation report on analysis of patient satisfaction max polyclinic by ...Mohammed Yaser Hussain
Hospitals are increasingly becoming sensitive to the needs of the patients as will the community. It is no longer the sellers [providers] market. Except for the totally free service provided by the Government run hospitals and a few hospitals run by the civic hospitals.
According to Dona Bedian
“Patient satisfaction may be considered to be one of the desired outcomes of care, even on element of health status itself” and that “information about patient satisfaction should be as indispensable to assessment of quality as to the design and management of health care system.
During the recent years the use of patient satisfaction surveys has increased in health care industry due in part to the belief that perception of quality is an important factor in demand for services and that survey result may have significant effect on provider behaviour. According to Ware “patient satisfaction is a determinant of a healthcare provider or system. Use of services complaints and malpractice suits”.
Use of patient satisfaction survey as a tool for quality improvement has become extensive in almost all western countries. Most hospital have a system of obtaining routine feedback from all the discharge patients. The quality improvement task force of the joint commission of accreditation of the health care organization in USA is also encouraging hospitals to mandate surveys are conducted in private hospitals.
Abstract
To assess the patient satisfaction level in emergency
department of a level 1Trauma Centre in India.
Shallu Chauhan, Dr.Deepak AgrawaL.
JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi-110029, India
Introduction
Patient satisfaction is an important indicator of the quality of care and service delivery in the
emergency department (ED). The objective of this study was to evaluate patient satisfaction
level in the E.D. of a level 1 Trauma Centre,AIIMS,New Delhi.To determine the effects of
actual waiting time,perception of waiting time,information delivery and expressive quality on
patient satisfaction.
Methods
This study was carried out for 2 months during all shifts mostly for those patients who triaged
as green.We made two groups:1) control group{ not explained anything to the patient} and
2) test group{patient explained for time management & treatment}. Patients/relatives were
asked to complete the questionnaire prior to discharge. For the first month, eight questions
were based on descripitve information were distributed to the control group { questions
including explanation of procedures to the patient,communication of staffs,problems faced
by patient/relatives, and overall patient satisfaction level}.Then, following second month
another study questionnaire included 11 questions based on a Likert scale concerning
waiting time{ie,overall time management,waiting for X-ray or C.T,scan,review by doctor, for
discharge & treatment},promptness & behaviour of staff and cleaniness of hospital given to
the test group.
Observation
Ninety patients who attended our ED were included in this study.The perception that waiting
times for placebo injection & T/t were less than expected was associated with a positive
overall satisfaction rating for the ED encounter[p is 0.033] as compared to actual waiting
time.Actual waiting time were not predictive of overall patient satisfaction. The highest
satisfaction rates were observed in cleaniness of hospital in both the groups and most of them
rated it as very good. For overall treatment, in control group 34% rated as poor & fair and
67% rated as good and very good,whereas in test group only 22% rated as poor and fair
but78% rated as very good and excellent.At the same time,both the groups were rated as
good for overall time management but they were not satisfy with the time taken by doctor
to review the reports and 33% rated as fair in control group and 22% rated as fair in test
goup.The assigned waiting time for particular physician to review a report was 60minutes
but average time taken to consult a particular physician was >60mins which mostly occur
in control group.The overall satisfaction rate was dependent on the mean waiting time. The
highest waiting time for a low rate of satisfaction of patient was 180minutes and for very
good level of satisfaction was just 15minutes. In control group,30% and 17% of patients
rated as fair and poor
Stratified pathways of care...from concept to innovationNHS Improvement
NHS Improvement is working in partnership with patients, clinical teams, the Department of Health (DH) and voluntary organisations to improve the effectiveness and quality of service delivery for those living with and beyond cancer. This is a summary report of this year’s work and includes pathways for breast, colorectal and prostate cancer.
Satisfactions Among Admitted Patient of Tertiary Level Hospital in Dhaka City.DR. S A HAMIDI
I am Dr. Saleh Ahmed Hamidi, successfully Conducted a dissertation & also presented by me (08/01/2016) about patient satisfaction level in tertiary level hospital.
How Disease Management, Case Management And Corporate Health Programs Can Sup...The HR Observer
This seminar will explain the paradigm shift in health care from acute diseases to chronic conditions. Based on this understanding the importance and potential of disease and case management programs as well as corporate health programs will be described. The role of self-management and the tremendous impact of HR on health and disease related costs will be highlighted. The relationship of patients to physicians is no longer the unique interaction in health care, but health coaches and HR interventions play a more and more important and effective role. At the end of the seminar HR representatives will be able
• To understand what is a Disease Management and Case management program
• To know how preventive Corporate Health Programs add value to HR functions
• To evaluate which programs may support HR in controlling health insurance premium
This presentation was used at HR Summit and Expo 2013 www.hrsummitexpo.com
How one Hospital Shaved Off 88 Minutes from their ALOSEmCare
With goals of getting the right processes and staffing in place, the administration and staff at LewisGale Medical Center in Salem, Virginia put a priority on patient-centered process improvements that would shorten wait times and length of stay in the emergency department (E.D.). Here’s how they improved metrics including decreasing the ED ALOS by 45 percent.
In collaberation with Dr. Roberta A. Newton, PHD at Temple University, Visiting Angels has developed a Senior Fall Prevention Program. Falls are the 2nd leading cause of accidental deaths in the US, with 75% of these falls occurring in the senior population. It is our hope to reduce future incidence by providing this prevention program free of charge
While Android programming is based on Java, there are some important philosophical differences and Android-specific constructs to consider. Android for Java Developers is an action-packed, hands-on presentation that takes you through the anatomy of an Android application. The sample application includes most major Android building blocks (Activities, Intents, Services, Broadcast Receivers, Content Providers) to illustrate the philosophy of Android application development. It assumes basic Java knowledge.
Quality management in nursing professionSANJAY SIR
Quality improvement requires in any field to provide best services to the community in the health care system. it is uploaded to aware the the paramedics & nursing personnel to improve the quality care & helps educators to teach their students.
Clinical Assignment Quality Improvement Final Project GoalWilheminaRossi174
Clinical Assignment: Quality Improvement Final Project
Goal:
· Combine your Quality Improvement Project Part 1 through Part 3 and finalize the Quality Improvement Project.
· Compose a conclusion for your Quality Improvement Project.
Content Requirements:
1. A description of the clinical issue to be addressed in the project.
2. An assessment of clinical issue that is the focus of the quality improvement project.
3. A SWOT (strengths, weaknesses, opportunities, threats) analysis for the project. Analysis of the strengths, weaknesses, opportunities, and threats related to the quality improvement process.
4. An outline of the action plan for the project.
5. Discuss stakeholders and decision makers who need to be involved in the quality improvement project.
6. Discuss resources including budget, personnel and time needed for the quality improvement project.
7. Discuss potential strategies for implementation and evaluation.
8. Conclusion
Submission Instructions:
· Refine your Quality Improvement Project Part 1, Part 2, and Part 3 based on your instructor's feedback.
· The paper is to be clear and concise, and students will lose points for improper grammar, punctuation and misspelling.
· The final project is to be 8 - 12 pages in length and formatted per current APA, excluding the title, abstract and references page.
· Incorporate a minimum of 12 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.
· Journal articles and books should be referenced according to the current APA style (the library has a copy of the APA Manual).
Running Head: QUALITY IMPROVEMENT PROJECT 3
QUALITY IMPROVEMENT PROJECT
Part 3
June 20, 2021
Quality Improvement Project
Action Plan
Outline
-Defining the scope of the recruitment work plan, nursing residency enhancement, and career development projects.
-Allocation of responsibilities to stakeholders of the project departments.
-Estimate and create workable timelines and activities for each team.
-Note down the budget for the project.
The project involves an action plan to ensure quality improvement in the nursing profession. It is based on the fact that there is a significant shortage of nursing practitioners, which directly affects their quality of service. The action plan itself involves defining the nature of the recruitment work plan, which will be in connection to the newly graduated nurses with no experience and using their feedback on the job to determine if they will retain them. The work plan will involve questionnaire interviews, group sessions, and one-on-one interviews about the state of the job as the nurse continues.
The action plan will also include research on the state of nursing residency facilities at different medical institutions and later crafting proposals to the medical center and the government department involved in their nursing residency facilities with recommendations. Th ...
The Best Technology for Professional Learning - Chris GrafWileyProLearn
Presented by Chris Graf, as part of the Wiley Professional Learning seminar, 'Across the Professions'. For info visit http://wileyprolearning.wordpress.com or follow us @WileyProLearn
Email: cgraf [at] wiley.com
3 Strategies for Maximizing Service Line Efficiency, Quality and ProfitabilityWellbe
Maximizing service line efficiency, quality and profitability is a hot topic, particularly with rising patient care demands, changing reimbursement models, and estimated physician shortfalls. This webinar takes a look at three solutions beginning in the operating room and expanding to the entire patient care journey.
1st solution: A unique clinical and operational service model focused on the specialization of qualified, reimbursable clinical labor to optimize surgeon involvement and reduce OR costs.
2nd solution: Taking a holistic view of the service line through the patient care journey to produce a value stream map to understand the current state. Assisting staff with comparing this current state to the ideal future state, comparing national benchmarks and clinical best practices helps your staff innovate and co-create an individualized plan to get your service line to a higher level.
3rd solution: Utilizing dashboard metrics of the critical to success factors, to sustain and improve your service line.
As a participant, you will be able to:
• Identify key operational and clinical indicators of orthopedic service line efficiency
• Describe how Surgical First Assists can add value in the OR
• List the steps in developing and/or evaluating or building an orthopedic service line
• Describe how metrics/dashboards assist in sustaining change and improvement of orthopedic service line
About the Speaker:
Miki Patterson, PHD ONP, Senior Director of Orthopedics in Intelligent CareDesign at Intralign
Dr. Patterson is a certified orthopedic nurse practitioner and brings over 25 years of clinical experience in healthcare, consulting, direct advanced orthopedic patient care, teaching, NIH level, qualitative and quantitative research and publishing. She is a past president of the National Association of Orthopedic Nurses (NAON) and continues to be nationally recognized for leadership and advancing orthopedic care.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. 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
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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