georgia tech healthcare management practicum

Patient Experience in Cardiac Services

Georgia Tech Healthcare Management Practicum10 April 2019

Children’s Healthcare of Atlanta

Table of Contents

I. Team/Project Introduction

II. Journey Mapping

III. Observations

IV. Recommendations

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Our 10-person student team brought a diverse range of perspectives to this project

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Vikram VaradarajanMajor: BME

Minor: Pre-med

Taylor SpuhlerMajor: Business

Focus: Supply Chain

Shannon OwensMajor: BusinessFocus: Strategy

Bridget BallardMajor: Business

Focus: IT Management

Jenny ChoiMajor: Business

Focus: Strategy & Innovation

Rachel FrattMajor: Business

Focus: Marketing

Brady BoveMajor: BME

Minor: Leadership Studies

Maggie MartinMajor: Business Focus: Pre-Law

John WagnerMajor: BusinessFocus: Finance

Noah PerryMajor: BME

Focus: Research


Team Background

• All members spent the previous semester completing coursework in areas such as:– Public Health– Health Information Systems – Health Insurance and Finance– Patient Experience – Future Trends in Healthcare

• Course was focused around a speaker series and case study analysis

• Our team was chosen to participate in a practicum course in partnership with the Children’s Patient Experience team led by Sam Hosokawa

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Our task: understand pain points for patients and families at Children’s through journey mapping

• Understand care experiences for patients and families in Cardiology

• Georgia Tech students must identify and prioritize gaps to inform future improvement initiatives for Children’s Healthcare of Atlanta

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We conducted 15+ interviews with staff and families

• Interviewed the following staff to understand their pain points and goals

• Interviewed patients and families to assess their time spent at Children’s and any unaddressed needs

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We broke down the patient journey into five steps

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Intake & Referral

Pre-OpDay of

Surgery

Post-Op (ICU & Step

Down)Discharge

Observations

Children’s Healthcare of Atlanta 9

Intake & Referral: Rescheduling throws off parents’ planned hotels/flights

Family Experience

“We had to wait 9 hrs before going into a planned surgery only because there was an emergency that came up, but it was understandable.”Rescheduling

Issues


Intake Processing Time

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Intake & Referral: Getting referred from their cardiologist can sometimes take a long time

Family Experience

“It took a couple weeks to get scheduled, then a couple longer before we were actually seen.”

“It took about a week to get an appointment mostly because they were waiting on UAB to send my records and referral over.”


Pre-Op: Long wait times tire out parents and kids

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Long Wait Times

Family Experience

“I felt that there was too much idle time - it was a very long day during what is already an emotionally exhausting time for parents and patient.”


Pre-Op: Families have a difficult time with all the tasks that need to be done on Pre-Op day

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UnclearExpectations

Family Experience

“It was a long day with a toddler who was cranky and hungry. I sometimes felt like we were being herded into places where they may or may not expect us to be there. It was not our smoothest experience with Children’s but it still wasn’t bad at all.”


Pre-Op: Parents fill out the same information in different places repeatedly

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Family Experience

While filling out paperwork during Pre-Op“What is your child here for? Tetralogy of Fallot. What other conditions does he have? None. It’s not like we already filled this out three times today.”Repetitive

Paperwork


Day of Surgery: Families would like more updates during the surgery

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Family Experiences

“Communication could have been more timely. If there is a delay we would like to know rather than sit and worry thinking procedures had already started.”

“Although apprehensive, receiving hourly phone calls was helpful for aiding parents in the process of their child’s surgery.”

Insufficient Updates


Day of Surgery: Staff sometimes are not well connected with parents during surgery

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Family Experiences

“We mainly waited in the large surgical waiting area out of fear of missing an update. It was a little tough being in such a large area with people who were facing totally different types of surgeries. Meeting other families was nice, but more privacy (without leaving the hospital) would have been welcome also.”

Disconnect Between Staff and

Parents


Post-Op: Families value providers who know them well, but there is a lot of information to share

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Staff Knowledge Transfer

Family Experiences

“Use repeat nurses when you can, especially on important days. Our son failed extubation 5 times. Having a new nurse on extubation day was stressful. We needed someone who knew him and us.”

“I think communication needs to get a little better even between the care team from day to day. The nurses do though make you feel very welcome to visit and really care.”


Post-Op: Staff doesn’t always know when or whether the family is at Children’s

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Unknown Family Location

Family Experiences

“You can’t pour from an empty cup. After 30+ total days with her being admitted we have learned that sometimes it’s ok to step away from the ICU and get rest.”


Post-Op: It’s difficult to break down surveys by step of care, and providers can’t

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Unclear Feedback Areas

Family Experience

“We loved Donna and Lidgy ... They were wonderful nurses in the cath lab. I think it was Tina who was also very good at working with out daughter through all the "ouchies" such as getting the IV out. Dr. Long and Dr. Kim along with the fellows were also very helpful!”


Discharge: Parents may be overwhelmed with the care they have to provide for their child

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Family Experiences

“Be patient with parents. Be patient when they don’t understand what you just said or have to listen to them ask the same questions ... We are exhausted and emotional and fighting for our child the best way we know how.”

Complex Parent Education


Discharge: Families who do not speak English or Spanish might have difficulties

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Language Barriers

Family Experiences

“I recall very little during that time. I was overwhelmed and anxious and relieved that the surgery went well.”


We identified 7 problems as high impact and low effort areas

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Language Barriers Unclear Feedback Areas

Rescheduling Issues

Unclear Expectations

Unknown Parent Location

Our Recommendations


Utilize volunteers throughout the process to address needs for families, patients, and staff

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PE

OP

LE

Rescheduling Issues Unclear Feedback Areas



• Expand volunteer program into two

segments: business & pre-med

• Utilize volunteers for both booking &

rescheduling family travel accommodations

• Hospitality-focused volunteer

opportunities

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PE

OP

LE



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PE

OP

LE

Rescheduling Issues Unclear Feedback Areas



• Expand volunteer program into two

segments: business & pre-med•

• Specify training for pre-med students to be

more involved in detailed surgery updates

• Exposure for future employees/doctors

• Collect in-person surveying data from

patients and families--business or pre-med

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PE

OP

LE


Employ detailed video training and indoor maps to set pre-op expectations and minimize complexities

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PR

OC

ES

S

Language Barriers




• Embed guideline prep videos within the Children’s app utilizing Seacrest Studios

• Add-on thorough step-by-step videos for parents unsure of pre-op, surgery, and post-op procedures

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PR

OC

ES

S



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PR

OC

ES

S

Language Barriers




• Customize indoor hospital maps for families based on their child’s course of care--ex: what to expect with a child who has tetralogy of fallot

• Set explicit journey expectations through personal accounts linked on the Children’s app (long-run)

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PR

OC

ES

S


Map Recommendation Mock-Up

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Map Recommendation Mock-Up

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Heart Murmur

Tetralogy of Fallot

Congestive Heart Failure

Cardiomyopathy

Pulmonary Hypertension

Ventricular Septal Defect

Indoor Map

Staff expected to see

Parent Guidelines

Training Videos

External Resources

Common FAQs



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PR

OC

ES

S

Language Barriers

Unclear ExpectationsComplex Parent Education



• Append other languages such as Chinese, Vietnamese, Korean, French, & Hindi to Children’s app indoor map & guideline

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PR

OC

ES

S


Incorporate card access and team collaboration tools to increase communication between staff and families

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TE

CH

NO

LO

GY





• Know where parents/guardians are -

hospitality perspective

• Know where parents/guardians are -

data collection and outcome perspective

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TE

CH

NO

LO

GY



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TE

CH

NO

LO

GY





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TE

CH

NO

LO

GY

• Staff to staff communication for informal

updates and flow of work day via current or

new technology

• Real time updates



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Channel Examples

Volunteer ExampleShift Change Example


Summary: Our Observations

• Rescheduling surgeries throws off family’s plans

• Clear family confusion during pre-op

• Difficult staff-staff communication

• Overwhelming discharge education

• Lack of translations for discharge instructions

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Summary: Our Recommendations

• Utilize volunteers even more--both business & pre-med

• Enhance the Children’s app with personalized course of care approaches and translations

• Give families card access

• Increase staff collaboration

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Children’s Healthcare of Atlanta 42

Thank you!

Supplemental Slides

Other recommendations for Children’s, and more information we gathered


Volunteer Positions: Potential Issues

• Infrastructure/Unreliability– If volunteers don’t show up for surgical shift, then the

existing call system can be the fallback • Patient Privacy

– Volunteers can be trained in HIPAA • Training

– Can shadow patient, attend a discharge class, and learn from nurses on how to give information

• Interest– There are a lot of motivated students

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Our Survey: Questions we asked to the cardiac family advisory council (Part 1)

1. What condition brought your child to Children’s Healthcare of Atlanta?

2. Please enter the date of your child's surgery (month/year). We 3. We are focusing on surgeries within the past 2 years (March 2017 through March 2019), but feedback on surgeries prior to 2017 will be considered as well.

4. Describe your experience during the referral process. When were you referred to Children’s and by whom? What went well and what could be improved based on your experience?

5. Was there a delay in between the referral and contact from Children’s? If so, how long?

6. Describe your experience in pre-op. What went well and what could be improved based on your experience?

7. Describe your experience during the surgery. What went well and what could be improved based on your experience?

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Our Survey: Questions we asked to the cardiac family advisory council (Part 2)

8. Describe your experience in post-op. What went well and what could be improved based on your experience?

9. What was the best piece of advice/knowledge given to you by your care team while at Children’s?

10. What were the updates like during surgery? Who gave them to you?

11. Describe the education you received during your child's hospital stay. What improvements could be made to the way your received this education?

12. If you had the opportunity to speak directly with the board of Children’s and you had the chance to provide input on how to make the experience better for another child, what would you recommend to them?

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Impact of Issue vs. Effort to Improve Matrix

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High Impact Low Impact

Low Effort

Rescheduling Issues



Complex Training

Language Barriers

Unclear Feedback Areas


Assistance with Lodging Information

High Effort

Repetitive Paperwork

Insufficient Updates

Intake Processing Time

Staff/Parent Disconnect


Pre-op Video Training: Potential Concerns

• Cost• Time• Inconsistencies

– There are a lot of conditions to care for and a lot of small variations that happen

– “The sutures used to close my son became infected. Dr. Shashidharan told us when we were readmitted for infection that she had just begun using that brand and had learned after his surgery that those stitches do not dissolve in very young babies.”

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Team Collaboration: Potential Concerns

• Training • Usefulness (will people actually check?)• Incorporating more technology

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Slack and Voalte are existing Team Collaboration tools which can be used in healthcare

Benefits

• The Enterprise version is HIPAA compliant

• Data encryption in transit and at rest

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Benefits

• Used at hospitals currently like Texas Children’s

• Integration with nurse calls and vitals monitoring

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