Decreasing Noise to IncreaseOur HCAHPS

Joanne Muzzey, RN MSDirector of Patient Advocacy and Planetree

Karin Block, RNRelationship-Based Care Coordinator

Agenda

• Introductions

• Awareness activity

• Elmhurst Memorial Healthcare overview

• Kaizen event

• Rest and relaxation hour

• Outcomes

• Lessons learned

• Next steps

Elmhurst Memorial Hospital

• Suburban Community Based Hospital established in 1926

– 275 beds

• 66% private rooms

– Model of Care

• Relationship-Based Care

• Shared Governance

• Planetree Affiliation 2007

Elmhurst Memorial Hospital Today

• Transitioned to a new replacementHospital on June 25, 2011

– 259 private rooms

Awareness for Change - 2008

• HCAHPS first released for EMH

– Quiet at Night 47.2%

• 1% of HealthStream database

• One unit as low as 17.1%

• Planetree Progress Assessment Feedback

Initial Interventions

• Work Life Council

– Silenced portable phones

• Planetree Steering Committee

– Healing Environment Team

• Organization awareness

• Unit Councils

– Unit specific noise

• Practice Council

– Sleep Standard

• Minimal improvement in HCAHPS

• Feedback from our Patient Family Advisory Council

• Initial efforts were not coordinated and ineffective

• A culture change was needed

Reasons for Organization Wide Approach

Assessment

• Kaizen event held on June 30, 2009

– Multi disciplinary focus included staff members from all areas, volunteers and members of Patient Family Advisory Council

– Organizational noise assessment

• Data collected

– Decibel readings

• Observation of workflow

Assessment

• 46 tasks were identified and categorized

– Environment and equipment

– Processes

– People

Accomplishments from Kaizen

• Quiet at Night Standard

• Elevator use Standard

• Standardized call light system and telephone ring tone volumes across all units

• Keypads silenced

• Tube stations padded

• Cushioned tops of laundry hampers

• IV pole inventory

• Rest & Relaxation Time

Rest and Relaxation time objective

Create an environment conducive to healing by offering our patients one hour in the afternoon to rest without interruptions 80% of the time, through the coordination of patient care and support services.

Rest and Relaxation Planning

• Multidisciplinary task force developed

– 31 areas/departments represented

– Senior leadership support

– Staff-level team leaders

• Members: clinical/nonclinical

– Emergency Department– Cardiovascular unit– Critical care unit– Progressive care unit– Oncology unit– Medical unit– Surgical unit– Food Service

–Family Birthing Center– Housekeeping –Respiratory care –Transitional care unit–Pediatrics– Ambulatory surgery unit– Central Admissions Area– Diagnostics

–Physical Therapy

Planning: Initial meeting

• Senior leader message

• Awareness activity

• Overview of project

• Everyday Creativity

• Defined the scope

• Set timeline for implementation

• Initial discussion of unit hours

Planning: Everyday Creativity

• Reframe the problem into an opportunity

• Change the group’s perspective

• Seek the next right answer

• Create passion

Planning: LEAN process

• Defined scope

– In scope: inpatients

– Out of scope: new admissions, outpatients (ED, Ambulatory Surgery), Transitional Care Center, behavioral health unit, stat and emergency care

• Decision making activities

Bedside handoff process

Verbal/written report tools

In-patient areas

Admitted patients(including OBSV and SPO’s)

Content of report

Outpatient to inpatient areas

Picture Frame Scope of Project

New

Admission Inpatient Nursing Units

Transitional Care Center

Outpatient

Areas:

ED &

Ambulatory

Surgery

Behavioral

Health Unit

Stat and

Emergency

Care

Planning: Timeline

• 6 months from Kaizen to Implementation

– Kaizen June 30, 2009

– Initial task force meeting November 23, 2009

– Rest and relaxation hour February 1, 2010

phase one

• Hours by department/floor

• 1– 2p.m. Third floor: medical, oncology, Family Birthing

Center, Pediatrics

• 2 – 3 p.m. Second floor: cardiovascular, progressive

care, critical care

• 4 – 5 p.m. Fourth floor: surgical

Implementation Phases

• Phase one

– Inform patient and family

– Rounding to prep patients

– Close patients’ doors as desired

– Dim hallway lighting

– Lower voices

• Phase two

– Decrease/eliminate environmental noise at the unit level

• Phase three

– Coordinate patient’s schedule to support rest time 80% of the time

Outcomes

• Decibel reading

• Unit observation

– Hall lights dimmed

– Patient doors closed

– Staff activity

• Patient interviews

– Are you aware of rest and relaxation time?

– Was the environment suitable to allow you to rest?

Decibel Readings

Unit Before After Change

3N 54.7 54.52%

reduction

CVC 54.5 51.232%

reduction

PCU 51.8 48.333%

reduction

2008 2009 2010 2011 2012

Timeline

InitialHCAHPSReport

Steering Committee initiatives

Council projects

Kaizen

Rest and Relaxation

hour

New Campusopens

New Campus training

75.9%

Quietness of area around room at night

• September 2008 47.2%

• September 2009 51.6%

• March 2010 55.9%

• September 2010 60.1%

• March 2011 60.6%

• September 2011 75.5%

• December 2012 75.9%

• March 2013 78.5%

• December 2013 73.9%

0%10%20%30%40%50%60%70%80%90%

New campus

New Hospital

Quiet by Design

Decentralized work stations

Onstage / Off stagework and patient flow

Sound absorbing materials

Room darkening shades

New Hospital

• Quiet by Culture

– Uncluttered

– Quiet equipment

– Staff awareness and ownership of the environment

Implementing R&R in our new environment

• Individualized to patient preference

• Patient Centered Scheduling

• Multidisciplinary approach

Lessons Learned

• Need a department champion

• Feedback is essential

– Share department best practices

• Keep the momentum

– Monthly check in meetings

New Hospital Decibel Scores

Average Sound Levels (dB)

New Hospital October 2011

New Hospital September 2013

Unit Daytime Levels

(6:00 am – 10:00 pm)

Night-time Levels

(10:00 pm – 6:00 am)

2011 2013 2011 2013

Medical

5SW*

50.9 52.723% increase

48.1 48.21%

increase

Surgical

4W

54.5 57.338%

increase

47.9 55.0126%

increase

Oncology

4SE

54.5 56.627%

increase

48.9 52.249%

increase

Cardiovascular

3SW

53.5 56.134%

increase

49.9 52.840%

increase

Progressive Care

Unit

53.8 55.724%

increase

50.2 50.65%

increase

Family Birthing

Post Partum

NA 52.0 NA 46.4

Average 53.5 55.329.2%

increase

49.0 51.444.2%

increase

Next Steps for EMH

• Awareness

• Patient Experience Team

• Relationship-Based Care Kaizen

– Always events expectations

Questions?