involving patients in performance improvement march 26, 2014
TRANSCRIPT
Involving Patients in Performance Improvement
March 26, 2014
Panelists
• Downey Medical Center NICU: Trav Ichinose, member of parent advisory council, Sarah Koshy, management co-lead and Marnie Morales, labor co-lead
• San Diego Medical Center Direct Observation Unit: Sheryl Almendrez, management co-lead
• Largo, Maryland, Urgent Care: Donna Fraser, labor co-lead
Special Guest
Hannah King
Director
Unit-Based Teams Service Quality
A Few Logistics
• To minimize noise, attendees have been muted upon entry
• Please use the chat box at the lower left of your screen to type in questions and comments
• Link to slides and audio will be posted to the LMP website
• Link and resources will be emailed to today’s attendees later today
• Environment is not familiar, can be disorienting
• Older people frequentlyuse bathroom at night – its dark
Why Are Patients Falling? Most falls (86%) were from patients mobilizing unassisted
Pat helped us understand the underlying reasons “why”
• From independent to dependent
• Embarrassed to ask for help and wearing a gown
NICU UBT & Parent Advisory CouncilNICU UBT & Parent Advisory CouncilDowney Medical Center Downey Medical Center
UBT PARTNERING WITH NICU PARENT ADVISORY
COUNCIL
• MISSION: Improve care design by partnering with all caregivers and giving a voice to the premature baby and family– Communicate patient needs and concerns– Help review and design policies and
procedures– Encourage family involvement
and information seeking– Strengthen communication
Advisory Council Identified These Issues:
– process of shift change report varied greatly
– Staff-centered versus patient-centered
– Visiting hours excluded parents from shift change
– Concerns about HIPAA
TRADITIONAL NICU SHIFT CHANGE REPORT
• Designed and Role Played Shift Change Reports– Staff role played with UBT and Advisory
Council members and identified gaps• Participated in Video Ethnography
– Videos made discussing benefits of attending shift change, demonstrating what it would look like
– Used as staff education tool
NKE+ DESIGN AND IMPLEMENTATION
74
8184
86
50
55
60
65
70
75
80
85
90
95
100
3rd Quarter2012
4rth Quarter2012
1st Quarter2013
2nd Quarter2013
Combined Nurse Knowledge Exchange Results
NKE+ COMPOSITE TOP SERVICE SCORE
• Enhancing Patient and Family Focus• Influencing Perception of Quality Care• Customer Satisfaction• Continued Improvement
and Staff Empowerment• Collaboration and
Shared Commitment
QUALITY THROUGH PARENT PARTNERSHIPS
Urgent Care Department
Largo, Maryland (Mid-Atlantic States)
Largo and Camp Springs Urgent Care/Critical Decision Unit
Name Title/Classification/Union
Donna Fraser Labor Co-Lead, RN (lead)
Felina Cephas LPN
Abraham Abban RN, Clinical Operations Manager, Management Co-Lead
Abagail Nowlin Lead Nurse, RN
Maria Chiu Lead Nurse, RN
Paulette Harding UFCW Shop Steward/ RN
Gary Campbell Director, sponsor
Urgent Care projects needing member input
• Triage wait – Starts when member checks in
– Finishes when the first vital sign is entered
• Provider wait– Starts when vital signs are entered
– Finishes when provider opens the encounter
• From exam room to finish– Starts when provider opens the encounter
– Finishes when AVS is printed
– Varies greatly by whether patient requires lab or x-ray
A member as part of your UBT: What does it look like?
Together we can make things better!
Our Best Practices
• Team approach: one doctor, a nurse and an Urgent Care tech make up a team and work together to manage patients assigned to doctor
• Daily huddles: cycle time data was shared monthly with the entire UBT
• Cycle Time: keep below 100 minutes for Largo and Camp Springs Urgent Care centers
What are We Doing Now?Active Projects
Focus on Member Service: “Treat Every Patient Like Family”
•Shift “champions”•Proactive care: Mammos, Paps, blood sugar, LDL ordered or done in Urgent Care •Patient safety: Name bands on every patient
Definitive Observation Unit
San Diego Medical Center
Patient Involvement in Committees
• Patient/Family Care Council (PFCC) started in 2012.
• Service Excellence Team-Council members meet every 3rd Tuesday for two hours
• Wanted to know inpatient patient perspective and ways to improve our patient care experience.
– Improvements include discharge paperwork for patients and thank you cards
• Frank Hagg - Staff Nurse Council (PFCC representative)
• Susan Mahler, PhD - invited to Unit Based Teams (PFCC representative).
Patient Involvement in UBTs
•DOU UBT staff were very interested in inviting a committee member from PFCC to monthly meetings.
•UBT wanted to know how would staff would feel to hear the “Real Truth” (patient’s perspective of care experience)
•Everyone “thinks” they are doing okay. Patients have a different perspective.
•DOU UBT wanted to know ways to improve Patient Care Experience through the perception of the patient
•Question staff and UBT had for PFCC member: “What does Nurse Communication mean to you?”
•Answer: “Competency is expected. Quality Care is parallel to the courtesy and respect given to the patients during hospitalization.”
Current DOU UBT Projects
Current Projects with Susan Mahler, PhD.
Overall Score
•Staff to introduce themselves every time they enter the patient’s room.
Nurse Communication
•MD/RN Collaboration
•Commonly used medications in the DOU/Possible Side Effects
Staff Responsiveness
•Ask patients what “timely manner” means to them.
Pain Control
•During rounding, talk about pain control and what the patient does at home for pain.
Discussion
• Why did you want to involve a patient in your performance improvement effort?
• What barriers did you face? How did other UBT members react? How did you overcome these barriers?
• What results did you achieve?
• How do you think having a patient voice in the project affected what you came up with?
• What is your advice to other UBTs that would like to try this?
Special Guest
Hannah King
Director
Unit-Based Teams Service Quality