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