Flex Program: MBQIP Improvement
HCAHPS – Q9 – Quietness of Hospital EnvironmentPresented by: Rochelle Schultz Spinarski
August 23, 2016California, Wyoming, and Illinois Flex Programs
All lines are muted. Please use the discussion box for any questions. Lines will be open for discussion the last 15 minutes of the webinar.Webinar materials will be posted at www.wyqim.com, Resources tab.A post webinar survey will follow. Please complete the survey.
Housekeeping
Upcoming Webinars: EDTC – 1 – Dates TBD EDTC – 5 – Dates TBD WY QI Roundtable: Sept 8,
10‐11am CA QHi and MBQIP
Roundtable: October 11, 10‐11am
CAH Performance: What do our patients think?
Noise: Why does it matter? Noise: Where is it? Noise: How can we decrease it? Noise: How do we know we’re making a difference?
Noise: Tools and Resources Discussion
Agenda
Webinar Participants
CAHS:California – 34Wyoming – 16Illinois ‐ 51
CA SORHWY SORHIL CAH Network
HCAHPS and the Metrics of Patient Experience: A Guide for Hospitals and Hospitalists, Hospital Medical Practice
The Hospital Noise Project: The Beryl Institute Noise reduction project in 241 hospitals
Addressing Quietness on Units Best Practice Implementation Guide, Massachusetts General Hospital
Key Sources
What do our patients think?
Quiet?
CA, IL, WY, All CAHs &US: Q9 –Quietness of Hospital Environment
FMT, http://www.flexmonitoring.org/wp‐content/uploads/2016/02/HCAHPS‐national‐trends.pdf & Hospital Compare
CAH Performance: HCAHPS Q9 Quietness of Hospital Environment
0
10
20
30
40
50
60
70
80
90
100
A C D E G H I J K L M N State National
WY: HCAHPS 9, Quietness
2Q2014 3Q2014 4Q2014 1Q2015 2Q2015 3Q2015 4Q2015
All Hospitals
CAH Performance: HCAHPS Q9: Quietness of Hospital Environment
All Hospitals
Noise
Whether inadvertent, unavoidable, or accidental, noise is one of the most invasive aspects of the hospital environment. (Joseph, 2006)
Press‐Ganey has found that patients complain about noise two times more often than about anything else in a hospital, including the food. (Fick and Vance, 2000)
“According to patient satisfaction surveys, the quality of the healthcare experience is often evaluated according to the hospital’s dynamic environment, those circumstantial
and changeable components that are caused and impacted by people, change throughout the day, and are within the control of the staff.” ‐ Susan Mazer
Ahhhhh
Our hospitals and patients are HERE Not here
The cost of a noisy environment is high and the cost to fix it is relatively low.
Noise: Why Does It Matter?
Sleep is a biological necessity. Disturbed sleep is associated with health problems and delays healing. Hidden Costs:
Increased patient agitation, aggression and delirium
Increased pain & less effective pain management
Slower healing Violations of privacy Sleep deprivation Increased falls Increased risk of medical and
nursing errors Nursing fatigue
Noise: Where is it?
Noise has layers Noise floor, aka “ground
zero” Heating, ventilation, ice
machines, walls and floors that amplify noise
Things that move Carts, vacuum cleaners,
floor waxers Things outside
Lawn mowers, construction, cars/alarms
Alarms
People People Moving
Walking, talking Communication Equipment
Paging systems, phones, cell phones, personal pagers
Patients Walking, talking,
televisions, Visitors
Walking, talking, televisions
There are many approaches. All of them require buy‐in from leadership and staff hospital‐wide, staff time, a commitment to improvement, and feedback from patients and families.Plan on addressing layers of noise by improving the whole healing environment over time.
How can we decrease noise?
Getting Started
Organize Leadership Team
Enthusiasm is good Structure
Flexible Process
Documented but not burdensome Strategy Set a goal and timeline Education/training Communication and reporting Measurement
Who? How? Often!
Assessment
Initial Assessment Real‐time assessment Follow‐up assessment Hospital‐wide
Each unit Quiet committee who are eyes
and ears Secret shoppers – looking for
opportunities for improvement Patient at Night – Hear and
understand patient experience Patient engagement
committee topic area
Assessment – How noisy is it? Engage everyone
Start by having all staff complete the HCAHPS survey based on their knowledge of the hospital
Use lean and other tools to identify challenges and needs
Creating a diagram that includes cause and effect. Lower level causcan often be what you want to tackle.
Location Source: People Source: Equipment
Source: Environment
Reception (A)
ED (B)
Outpatient Dept(C)
Inpatient Halls (D)
Nursing Station (E)
Cafeteria (F)
Laundry (G)
Priority Matrix
A B C D E F G
7a‐9a
9a‐11a
11a‐1p
1p‐3p
3p‐5p
5p‐7p
7p‐9p
9p‐11p
11p‐7a
Noise Stratification By Time
Observations or noise meter readings
Where to Focus
Areas Most Focused
Nursing stations (81.3%) Patient rooms (71.7%) Corridors (61%) ICU (36.9%) Whole hospital (30.5%) ED (18.2%) Lobbies and waiting rooms
(12.3%) Operating rooms (5.3%)
Primary Sources of Noise
Equipment (55%) – monitors, tanks, pumps, carts..
Talking (51%) – staff, patients, visitors General activity (41%) – coming and
going, activities Alarms (25%) Overhead paging (19%) Shared rooms (15%) Other (slamming doors, cleaning,
nurse calls, construction, elevators
Source: Beryl Institute
Top 3 Challenges to Reduce Noise
1) Behavior and Culture
Accountability Compliance Awareness Buy‐in/Ownership
2) Environment
Semi‐private rooms Building layout Size/space constraints Carpet, ceiling tiles
3) Miscellaneous
Equipment/alarms Paging Costs/budget Lack of focus/fatigue/higher priorities
How do we address noise?
Examples of Noise Reduction Efforts
Noise committee/champion all shifts Shhh campaign Leaders working night shifts Communication/reminders between
staff Daytime rounding Quiet hours (daytime and nighttime) Signage, postage, flyers Replaced wheels on carts Limited visiting hours Limited paging Sound monitoring devices (Yacker
Tracker) Flashlights used at night instead of
overhead lights
Relaxation/healing channel on TV Dimming lights at certain times Comfort/quiet kits with ear plugs, masks Allowing patients to close their doors and post
do not disturb signs Headphones for TVs/TV viewing policy Sound absorbing materials on floors, ceilings,
and/or walls Scheduling – no nighttime
maintenance/housekeeping Patient room phones with volume adjustment New HVAC systems Installing ambient white noise machines Communicate with patients about waking them
up during quiet hours (when and what) Coordinate with treatment team to bundle night
time tasks Communicate any night time projects (e.g.,
cleaning) that may disturb sleep and offer to close door, ear plugs
Implementing Quiet Times
What are quiet times? How are quiet times structured?
What happens during quiet times?
How are staff, patients, and families notified of quiet hours?
Quiet Time Signage
Communication with Patients
Use key words at key times: “We ALWAYS want to keep
your room quiet at night so you can rest – would you like us to close your door? We will be in to check on you approximately every two hours throughout the night.”
“Sometimes our voices seem louder at night, so please let us know if we are bothering you or if you cannot sleep.”
Convey to the patients that the goal is make them comfortableand to create a quiet environment.
Communication with Families and Visitors
“We want to provide the best healing environment for all our patients. Would you mind lowering your noise level to help our other patients get the rest they need?”
“To ensure your roommate gets the rest they need, would you mind lowering the TV volume?”
Yacker Tracker: Tahoe Forest Health System, Truckee, CA
Introduced Yacker Tracker in ICU
Rotated every month to new unit
Questions about noise in daily rounding (M‐F)
Changed wheels & new carts Partnering with patients Staff permission to remind one
another to be quiet Team effort Awareness
Jim Sturtevant, MS, RN, CCRN, Admin Director of Acute Care and Extended Care
The Kick Off/Go‐Live/Commit Forever
All staff should be educated about noise, goals, plans, process and strategies
Information should be fresh Consider having an event,
announce to all staff via email, newsletter, team meetings etc.
Monitoring Improvement
Rapid Tests of Change
Track progress Hourly, shift or daily huddles Establish quiet specialists for
each shift, throughout the hospital
Evaluation Real time Noise audits or observations In‐room patient surveys Tracking noise levels Acknowledge people doing the
right thing Timely, friendly conversations
when people are not doing the right thing
Periodic HCAHPS reports do not give you the information you need.
Patient & Family Feedback
MA General Hospital, http://www.mghpcs.org/eed_portal/Documents/PatExp/ADDRESSING‐QUIETNESS.pdf
How do patients make noise stop? Create a real‐time reporting and remediation system.
Noise hotline? How do staff make a noise stop? Create a reporting and remediation system. Noise
tickets? There are good sounds and bad noises. Give patients the knowledge, tools, and environment to control sounds.
A few additional points to consider
Celebrate SuccessesDisplay charts and graphsReport to all staffAcknowledge people doing the right thingHold events, special activities
Keep moving forward and create a healing environment!
Resources & ToolsContact Flex Program Staff• Technical assistance
Connecting with other CAHsFunding to support improvement?On‐site lean support (CA)SHIP grants
Addressing Quietness on Units Best Practice Implementation Guide, http://www.mghpcs.org/eed_portal/Documents/PatExp/ADDRESSING‐QUIETNESS.pdf
Beckers Hospital Review, http://www.beckershospitalreview.com/quality/13‐ways‐to‐reduce‐hospital‐noise.html Beryl Institute, http://c.ymcdn.com/sites/www.theberylinstitute.org/resource/resmgr/webinar_pdf/final_‐
_noise_webinar.pdf HCAHPS and the Metrics of Patient Experience: A Guide for Hospitals and Hospitalists, Hospital Medical Practice,
http://healthcarecommunication.info/wp‐content/uploads/0615‐H‐Patient‐Satisfaction.pdf Hospital Noise and the Patient Experience,
http://www.healinghealth.com/images/uploads/files/hhs_hospital_noise_whitepaper.pdf Hospitals and Health Networks, http://www.hhnmag.com/articles/4138‐runaway‐noise‐in‐the‐hospital Hospital Quality Institute, Reducing Noise, Improving Experience, Promoting Healing: Exemplary Efforts in CA
Hospitals, Webinar, http://www.hqinstitute.org/post/reducing‐noise‐improving‐experience‐promoting‐healing‐exemplary‐efforts‐california‐hospitals and www.hqinstitute.org
Quality Improvement Implementation Guide and Toolkit for CAHs, https://www.ruralcenter.org/tasc/resources/quality‐improvement‐implementation‐guide‐and‐toolkit‐critical‐access‐hospitals
Reduce and Optimize Hospital Noise with Six Sigma Tools, https://www.isixsigma.com/industries/healthcare/reduce‐and‐optimize‐hospital‐noise‐six‐sigma‐tools/
World Health Organization, http://www.euro.who.int/__data/assets/pdf_file/0017/43316/E92845.pdf YouTube
Sources
Our aim is not silence, rather it’s a healing and patient‐centered culture
& environment
Thank youRochelle Schultz Spinarski
651/731‐[email protected]