Wednesday, August 1, 2012

Striving for excellent patient care

On 700 East, PCAs Megan Cloyd and CJ Rogers respond to a call light above the door to a patient room. Many areas will soon add “no pass” zones, which remind all staff members to respond to call lights in person, regardless of their role on the unit. 

Yvette Williams has worked closely with CoxHealth's Experience Excellence team to research the best tactics for providing great service. In this column from CoxHealth Connection, she details a few ways we're working to offer patients the best service:

Thinking about CoxHealth’s stroke care, two words come to mind: compliance and consistency.
Earning national recognition as a Joint Commission accredited Primary Stroke Center and becoming one of only 91 health systems in the nation to earn the Stroke Gold Plus Performance Achievement Award doesn’t happen by accident. It requires every single person who works with patients to have a high degree of consistency and compliance with a set of evidence-based practices. The goal for our stroke care is zero defects, which means providing the same high standard of care to every patient, every time. 

We can apply the same formula of compliance and consistency as we strive for excellence in service. Given CoxHealth’s strategic goal to be in the top 10 percent nationally in HCAHPS patient perception survey scores and that survey’s emphasis on the Top Box score of “Always,” the goal once again is zero defects. 

Reaching and sustaining our service goals will require everyone’s compliance with a set of behaviors and attitudes found in the delivery of excellent customer service and everyone’s consistency with those behaviors with every patient and family member, every time. 

How can we successfully shape patient perceptions of our care? The HCAHPS survey is behavior based, asking patients how often certain behaviors were performed and CoxHealth’s goal is to have the answer be “always.” Meeting that goal means the emphasis will be on us, our words, actions and behaviors. This will definitely take a team effort, which is exactly the direction Dr. John Duff, CoxHealth senior vice president and chief hospital officer, gave to a group of Experience Excellence team members. 

The group was asked to research best practice behaviors that have been shown to improve patient perceptions around certain HCAHPS dimensions, focusing first on two key areas – responsiveness and quietness. An education program was developed that included two videos, one for each dimension. The videos feature staff members in skits that demonstrate the six responsiveness tactics and five quietness tactics we identified. 

This spring, 300 nursing, ancillary and support services leaders were trained on these tactics. Then, leaders were asked to hold staff meetings to introduce them to employees and begin to monitor their use. Later this year, more educational programs will be developed to focus on the other key HCAHPS dimensions. 

Fortunately, these tactics are not new to CoxHealth. As you’ll see, these behaviors have already been implemented to some degree in several areas of our hospital services. The key now is to apply these tactics consistently among the entire patient care team. 

During a shift change in the Emergency Department at Cox North, nurses Tiffany Schneider and Nick Osborn talk with Hugh Harvey and his daughter, Devannie. Staff members in the North ED are now conducting bedside shift handoffs so patients can meet their new nurse and ask any questions they may have. 

Patients equate quality care in part with our responsiveness and courtesy. How quickly staff members respond to patient requests and needs throughout the hospital stay is one of the top predictors of overall patient satisfaction. An emphasis on improving responsiveness is already under way in several hospital units. 

Tactic No. 1 – Face-to-face response to call lights. One way of making responses more personal for the patient is to respond directly to a patient’s room to turn off the call light instead of answering the call light at the nurses’ station. 

400 West put this tactic into practice earlier this year. Donna Miller, unit secretary, says the change was difficult at first, but staff now see how this tactic is making a difference in the unit’s responsiveness. 

“We’d find that sometimes we’d answer the phone and then on the way to the room, we’d get sidetracked by another patient need,” says Miller. “Now we’re more responsive and able to respond to all our patients’ needs much faster.” 

Tactic No. 2 – No pass zones. All hospital units will become no pass zones where everyone on the floor is asked to respond to call light needs without passing by a room except when isolation or security reasons exist. Patient care assistant Sherri Elkins says a version of this tactic is already in use on 700 East. 

“We really look out for each other,” says Elkins. “If we see call lights going off and it’s not ours and we’re passing by, we just stop and answer it, that way we help each other out. We’re a team up here.”
To deploy this tactic, staff from ancillary and support services departments will be asked to respond to call lights. Phlebotomist Jamie Mast says she already responds when she’s on the way out of a unit. 

“I just walk in and introduce myself and turn off the call light. Then I ask the patient what they need. Usually it’s something I can take care of but if not, I tell the patient I have to get the nurse or PCA. I always come back and tell the patient what I did and that help is on the way,” says Mast. 

For those of you who might be uncomfortable answering call lights, it’s important to know that research shows 80 percent of the call light needs can be taken care of by anyone. Phlebotomist Rowena Hull finds this to be true. When she’s finished drawing blood, she asks if there’s anything else she can do. 

“Sometimes they have something little they want, like they can’t reach their tray, or their cell phone has fallen on the floor or they can’t reach their phone or their menu,” says Hull. 

Ancillary and support services staff should respond to call lights only after taking care of the patient they were helping originally. You can tell when a call light has been activated when the white light on the top of the light bank above a patient’s door is on. 

Tactic No. 3 – Caring rounds. This tactic is Nursing’s hourly rounding protocol. Consistent use of hourly rounding can actually reduce call lights. 

Coby Smith, nurse at the Meyer Orthopedic Center, says his goal through caring rounds is to keep patients informed. “I introduce myself and tell them a little bit about myself to make them feel comfortable. I tell them what they can expect for the day and about the time frames. I always ask them what else I can do for them in that moment, whether it’s bathroom, position, pain needs or just to find out if they have a concern about anything. It usually puts them at ease and shows that I do care.” 

Tactic No. 4 – Key words. Smith uses another tactic during his caring rounds: key words at key times and the AIDET method of communication, which stands for Acknowledge, Introduce, Duration, Explanation and Thank you. 

Key words are verbal signals of actions being taken for the patient that explain what you are doing and why. CCU/MICU nurse manager Lenny Shepard says his staff is getting into the habit of using AIDET in critical care, where families generally experience anxiety related to not knowing what the machines and monitors do or what the alarms mean. 

After acknowledging the patient and the family and introducing themselves, staff members are describing and explaining what they are doing and how long an intervention should take. They also encourage questions. Our consistency with key words and explanation can positively influence patient perceptions. 

“I just had the wife of one of our patients stop me to tell me how wonderful and how at ease she has been since all the nursing staff has explained everything happening and every medication they are giving,” says Shepard. “I have witnessed AIDET throughout the unit and I’m very excited about the success.” 

Tactic No. 5 – Check before you go. This tactic asks staff to assess a patient’s bathroom needs before leaving the room or before transporting a patient to another area. 

Tactic No. 6 – Bedside shift report. This tactic involves holding the shift handoff at the bedside to reassess and engage the patient regarding how well we’re responding to their needs. Staff members in the North Emergency Department were reluctant at first to use this tactic, but patient care manager Rachel Wells says they now see the value in it. 

“It forces us to have more face time with the patient and then the patient knows who to ask for as soon as the switch is made,” says Wells. “Patients seem to like it because they’re more informed.”

Rest is an important part of a patient’s recovery, but hospitals can be noisy places. Patients who can’t sleep due to noise or bright lights may be more irritable and anxious, which may negatively affect healing and a patient’s overall experience. Several departments have already deployed these tactics and others to promote a healing environment. 

Tactic No. 1 – Close the doors. Unless a safety concern exists, staff should close doors to protect privacy and reduce noise. 

Tactic No. 2 – Bunch tasks when possible. When possible, staff should “bunch” certain nighttime tasks so they can be performed at the same time. Patients won’t have to be repeatedly disturbed and our care will appear more coordinated. 

Tactic No. 3 – Offer sleep kits. Sleep kits are available on hospital units and should be offered to patients routinely. These kits provide tools such as ear plugs and masks to help patients get better rest.
700 East nurse manager Kim Cash says after hearing about this tactic, staff began offering them to patients. “I’ve seen multiple patients on the floor with those sleep masks, so I’m excited to see them wearing them even in the afternoon!” 

Tactic No. 4 – Reduce staff noises. Sometimes the cause of the noise is us. Staff voices can be very loud, especially at night and we can play a major role in reducing noise by keeping voices down when speaking in patient care areas. Nurse manager Lorinda Rehagen says night staff members on 700 West do a good job of helping each other keep noise levels down. 

Tactic No. 5 - Key words at key times. This tactic can also help staff explain why we care about maintaining a quiet environment and why some activities must be performed at night. 

Some units aren’t stopping at these tactics to offer a quiet environment. Several hospital units offer nap times, when lights are dimmed and staff voices are subsequently lowered, during the day. In a pilot project, nurses on 700 East wear pagers that send specific instructions about patient needs to nursing staff without the use of overheard paging. This also im
proves responsiveness. On 900 West, new sound-masking machines are helping decrease noise. 

Just imagine what our patient care areas will look and feel like if everyone is practicing these same behaviors and tactics. Our patients will see and feel a consistency in our efforts to create an experience that emphasizes responsiveness and quietness, making it more likely that their perceptions will be that we always made these important factors in their care a priority.