Defining and Measuring Excellence in Quality, Safety, and Patient Experience

Transcription

1 CONSUMER ENGAGEMENT Defining and Measuring Excellence in Quality, Safety, and Patient Experience Featuring Cape Fear Valley Health System and Parham Doctors Hospital (HCA Capital Division)

2 Road Map Attaining Quality and Safety Excellence at Cape Fear Valley Health System 3 Achieving Exceptional Patient Experience at Parham Doctors Hospital Live Q&A

3 3 Introducing Cape Fear Valley Health System Cape Fear Valley Health System Jana Stonestreet Former Senior Vice President and Chief Nursing Executive Darcie Brady Education Coordinator 765-bed regional health system in southeastern North Carolina Private, not-for-profit system, serving a six-county region Serves more than 1 million inpatients and outpatients annually TJC disease-specific certifications: hip, knee, heart failure, advanced stroke, AMI, pneumonia, wound care; chest pain accreditation; bariatric surgery

4 4 Organizational Issues Targeted for Improvement ORGANIZATIONAL GOAL CHALLENGE(S) LIMITING SUCCESS iround-driven IMPROVEMENTS Improve Functional Integration: Individual departmental monitoring, especially of interrelated services Measures may be isolated and used independently; loss of shared utility and collaborative impact on services Integrated, transparent findings; benefits across disciplines and functions Streamline Leadership Workflow: Reviewing, interrelating, assessing, documenting operational workflow Rounding / auditing and documentation is often sequential; workflow is inefficient and draws leader away from operations to submit findings Seamless rounding and documentation; increased leader presence; increased leader efficiency More Effectively Use Information: Data compilation, analysis, reporting Data often extracted and reviewed independently; determinations made regarding formulation of reports on an as needed basis may be inconsistent and/or varied System standard analytics; automated data flow to predefined custom reports Improve Accountability: Using audit results to increase transparency Lack of immediate transparency and inconsistent reporting led to inconsistent auditing and use of results Full, immediate transparency of audits by individuals and results for each unit/department

5 5 iround by the Numbers 59 30,410 Audit & Rounding Forms Rounding Forms & Audits Audit & Rounding Completions to Date 1 Paper-based Pre-iRound Manual and varied process for auditing Lacked standardized data capture of the findings Lack of real-time transparency Cumbersome and ambiguous reporting processes; administrative burden Inconsistent analysis and reporting Post-iRound Streamlined workflow for all hospital audits improves auditor efficiency Standardized questions allow leaders to compare results across units and across the system More granular insights into details of findings and exceptions One, easily accessible source for all audit data Full and immediate transparency into audit compliance and results 1) As of mid-september 2015

6 6 Establishing the Foundation for Success Vision CNO direction Executive buy-in Clear communication of goals and expectations Efficient, transparent process Culture of sustainability 2 1 Execution Automated quality and safety audits Patient safety focus Professional development Visibility into excellence Creating and sustaining process improvements

7 7 Organization-wide Commitment to Excellence Ensuring Commitment to Success at All Levels of the Organization Improving Processes Based on Increased Transparency and Real-Time Staff Feedback Selling the vision to the CEO/Senior leaders to secure the necessary resources Utilizing iround to facilitate organizational goals Elevating quality and safety practices through continual internal and external oversight Training and development staff redefine training and provide coaching when necessary Employee feedback utilized to refine training curriculum Friendly competition among staff to improve performance and identify best practices, and to improve the practice itself The iround technology enables our leaders and staff to keep their finger on the pulse of their performance on the myriad of clinical processes designed to provide excellence in clinical care. Jana Stonestreet, CFVHS

8 8 Identifying and Implementing Process Improvements Example of Audit/Rounding Process 1 z 2 3 Collect data by observation and chart audits using iround Identify real-time coaching opportunities Analyze data in weekly meetings; compare internal vs. external audit results Iterative process; repeated as needed 6 5 z 4 Review processes and training curriculum ; implement changes as needed Take recommendations to appropriate committees Shift focus based on audit results; target areas needing improvement

9 9 Internal vs. External Auditing Activity Ensuring Patient Safety Procedures are Being Followed Internal Audits: Bedside Report Rounding Daily Order Review Daily Weights ED Admission Order Fulfillment Indwelling Urinary Catheter Removal Medication Pass Observation Audit Skin Breakdown Prevention and Wound Care Protocol Telemetry 23,238 External audit completions 1,135 Internal audit completions

10 10 Streamlined Reporting Across Audits Brings all Data Together in One Easy-to-Access Dashboard Click into UBIC reports to see a list of all UBIC audits

11 11 Easy Identification of Specific Audit Reports Select specific UBIC audit to review data/reports

12 12 Audit Drill-Down for Detailed Performance Review Auditspecific dashboards for drilled down data analysis

13 13 UBIC Report of Reports

14 14 Summarizing Best Practices 1 Ensure executive buy-in and support. 2 Clearly define roles and responsibilities. 3 Empower employees to be a part of the solution. Have a clear vision. Be able to communicate benefits to the organization while gaining executive buy-in to the overall process. Establish a structure in which the data can be utilized. Identify those responsible for reviewing the data and communicate the expectations that come with real-time visibility into issues. Utilize employee feedback from training courses and auditing procedures. Be willing to adapt both to accommodate staff needs and enable them to better perform their jobs.

15 Road Map Attaining Quality and Safety Excellence at Cape Fear Valley Health System 3 Achieving Exceptional Patient Experience at Parham Doctors Hospital Live Q&A

16 16 Introducing Parham Doctors Hospital Parham Doctors Hospital Brenda Woodcock Chief Nursing Officer, Parham Doctors Hospital Angela Katis Division Director of Service Excellence, HCA Capital Division 200-bed acute care facility located in Richmond, VA HCA s Capital Division Healthgrades Top 50 Hospitals (nine years in a row) Healthgrades Top 10 percent for Joint Replacement Joint Commission Gold Seal of Approval for hip and knee replacement, and spinal fusion

17 17 iround s Purpose at Parham Doctors Hospital Aligning Our Approach to Improve Patient Care Leveraging iround to Further Patient Experience Initiatives through Nurse Leader Rounding Offering Short-Term and Long-Term Gains Increase Rounding Compliance Meaningful Patient Interactions Improved Patient Experience Focused Employee Recognition CNO presence/coaching Build in additional rounding blocks Decrease number of meetings to allow rounding focus Unit Leader Presence Real-time Visibility And Accountability Consistent Rounding Practices Decreased Roundable No Responses Use Observation and critical thinking skills Involve family members Identify root causes with data

18 18 Setting Nurse Leader Rounding Expectations Defining the Role of a Nurse Leader Nurse Leader Rounding should be performed by Nursing Unit Directors. The goal for Nurse Leader Rounding in the inpatient setting is to round on 90% -100% of patients on the unit every day. Directors should only delegate up to 25% of Leader Rounding. Delegation should be restricted to Clinical Coordinators, Charge Nurses, Supervisors, Managers or other role that has been trained and found competent in Nurse Leader Rounding (i.e., Educator or CNO). Purposeful Leader Rounds should take 3-5 min/patient and contain 2-3 focus areas bed units = 1.5 hours on average bed units = 2-3 hours on average Nurse Leaders should round by nurse assignment and deliver recognition and coaching IMMEDIATELY following Leader Rounds on that assignment. Always give positive recognition first followed by coaching area for success. Coaching should be conducted in the most private area possible lean in and lower tone of voice if hallway conversation is necessary.

19 19 The Perfect Storm Creates Leadership Opportunity Limited Resources During Critical Implementation Stage Executive Contribution to Maintain Patient Satisfaction 30-bed unit experienced tremendous movement leading to very lean staff Loss of leadership threatened the loss of momentum with key patient experience initiatives CNO present on the unit; rounding on patients to maintain implementation momentum New tool developed to encourage increased CNO presence with patients and unit leaders (CNO Observation Form) CNO presence in the HCA Capital Division is viewed as a critical success factor. Coaching of new and existing nurse leaders is a key component to successful purposeful rounding. - Brenda Woodcock, CNO, Parham Doctors Hospital

20 20 CNO Observation Form Recognition and coaching opportunities identified during observation

21 21 Establishing a Foundation for Purposeful Rounding Essential Components of Purposeful Rounding PROCESS No Cherry Picking This is not about who is getting an HCAHPS survey, it s about the leader truly listening to every voice on their unit every day; All patients deserve to be heard, not just the happy ones Efficient but Purposeful Leader Rounding Balancing rounding compliance goals with meaningful patient interactions Focused Team Recognition Front line staff appreciate seeing their leader present and engaged on the unit; The physical presence of the leader validates the care staff provides and the value they bring to the team BEHAVIOR Be Prepared Communicate with unit nurses and be knowledgeable of the patient s condition before rounding; Take a census report with you and add the nurse assigned to each pt in the margins; Round by nurse assignment Discuss not Interview Take the time to actively listen, then gather honest feedback by digging deeper into hesitation; If you are finished and sense hesitation, ask What s most important to you today? Be an Empathetic Leader (not a task checker) Focus on the patient s experience making eye contact and providing undivided attention

22 22 Structuring the Rounding Process for Success Patient Rounding Process 1 z 2 3 Iterative process Unit leaders round on patients on their unit; deliver recognition and coaching immediately following the round Identify real-time trends, service recovery and patient experience improvement opportunities Analyze data daily; share weekly summaries with executive team, nursing directors, and staff 6 5 z 4 Closely monitor HCAHPS improvements over time Perform unit-by-unit comparisons to benchmark best practices Organization-wide trends are reviewed by service excellence committee

23 23 Communicating Results through Weekly Reports Press Ganey Scores Support Early Signs of Improvement 1 Average 12% improvement in Press Ganey question Nursing staff check on you responses from January to February 2015 for early units. Overall responses to these questions higher for units utilizing iround than those not yet deployed. Press Ganey scores received in early March indicate that units showing greatest improvement were from the six facilities who had deployed iround to date. 1) For the Capital Division, as reported to The Advisory Board by Division leadership

24 24 Providing Targeted Performance Summaries Henrico CNO s, Some notes on iround for last week: EXCERPT Forest: Very strong week for both units in compliance to census. The only thing I would watch for is a sig drop in Explain Side Effects at 48% for 63 patients on 3N. Any insight into that and what the nurse leaders are focusing on differently? It appears to be a pattern and did not increase after we noted it last week. May need a new plan there for that. Parham: 5E is still going backward in compliance any idea what it will take to turn this one around? I will be coming in to do some coaching and leader rounding in the next 2 weeks any thoughts beforehand would help. Retreat: We are definitely seeing a drop again on both units I have plans to spend time here as well in the next 2 weeks. What else can we do to support you in the meantime? Is it staffing or other challenges that would explain? Side effect recall is also low on 4E at only 25%. I know this is time consuming to stay on top of this, but without the consistency in leadership here, the HCAHPS scores will not sustain long term.

25 25 Sharing Results Among Teams Nurse leaders share rounding results and with their staff through s, newsletters, unit postings, and daily huddles. Communications include: Employee recognition Best practice sharing Patient comments (Voice of the patient queries) Performance trends Coaching opportunities

26 26 Parham Doctors Hospital: 2 East Significantly Decreasing the Percentage of Roundable = No Period Rounds Census % Attempted % Rounded Roundable - Yes Roundable - No March % 28% April % 53% May % 30% June % 22% July % 38% August % 54% Total 1,141 1,731 66% 35%

27 27 Parham Doctors Hospital: 2 East Using iround to Identify Obstacles to Performing Full Patient Rounds 48% of all attempted rounds resulted in a Roundable No response N = 1,141 50% of Roundable No responses included Confused and Other as primary reasons unable to round on patient N = 547 Other Confused Discharged Sleeping Off Unit Provider in Room Non-Verbal Pt Refused 9 Roundable - Yes Roundable - No Bathroom Bathing 3 1

28 28 Performance Improvement Trends: 2 East Using iround to Identify Obstacles to Performing Full Patient Rounds 53% of all attempted rounds resulted in a Roundable Yes response March 1 May 31, 2015 N = % of all attempted rounds resulted in a Roundable Yes response June 1 July 31, 2015 N = % of all attempted rounds resulted in a Roundable Yes response Aug 1 Sept 30, 2015 N = Roundable - Yes Roundable - No Roundable - Yes Roundable - No Roundable - Yes Roundable - No

29 29 Parham Doctors Hospital: 5 East Significantly Decreasing the Percentage of Roundable = No Period Rounds Census % Attempted % Rounded Roundable - Yes Roundable - No March % 17% April % 31% May % 29% June % 35% July % 29% August % 70% Total 948 1,650 57% 31%

30 30 Parham Doctors Hospital: 5 East Using iround to Identify Obstacles to Performing Full Patient Rounds 47% of all attempted rounds resulted in a Roundable No response N = % of Roundable No responses included Confused and Other as primary reasons unable to round on patient N = 445 Other Confused 99 Discharged Sleeping Off Unit Provider in Room Non-Verbal Pt Refused 10 Roundable - Yes Roundable - No Bathroom Bathing 1 1

31 31 Performance Improvement Trends: 5 East Using iround to Identify Obstacles to Performing Full Patient Rounds 46% of all attempted rounds resulted in a Roundable Yes response March 1 May 31, 2015 N = % of all attempted rounds resulted in a Roundable Yes response June 1 July 31, 2015 N = % of all attempted rounds resulted in a Roundable Yes response Aug 1 Sept 30, 2015 N = Roundable - Yes Roundable - No Roundable - Yes Roundable - No Roundable - Yes Roundable - No

32 32 Facilitating More Purposeful Rounds Additional scripting to prompt greater patient feedback I want to ask you a few questions about your time with us on this unit. Your stay here Is important to us, a nurse leader will visit you every day of your stay PSYCH/CONFUSED PATIENT SCRIPTING How is our team doing supporting you in your healing with medication? Are we helping you control your pain and explaining side effects of new medication to you? I know that a hospital stay can be difficult, I wanted to talk with you to make sure my team is supporting you in the best way possible while you are here. Is there anything else we should know about you that could help us support you better today?

33 33 HCA s Patient Rounding Question Library Core Questions (Required to be present for all facilities & units) Responsiveness Care Plan Communication Pain Management Communication Board Observation Environmental Observation Menu of Optional Question (Inclusion to be determined by facility and unit) Hourly Rounding Log Explanation Hourly Rounding Log Observation Call Light Utilization New Medication Explanation Side Effects Explanation Bedside Shift Report Communication Board Review All Items within Reach Observation

34 34 Tracking HCAHPS Improvements Over Time Overall Hospital HCAHPS Satisfaction

35 35 Summarizing Best Practices 1 Ensure executive buy-in and support 2 Communicate results with entire team 3 Provide feedback immediately Establish the patient experience priority and commitment with the executive team. Translate the priority into goals for nurse leaders Description of best practice. Utilize the data to identify trends; share the information in a timely fashion so that process improvements can be implemented to impact future performance. Following each leader round, recognize exceptional service from staff and provide coaching when necessary.

36 Road Map Attaining Quality and Safety Excellence at Cape Fear Valley Health System 3 Achieving Exceptional Patient Experience at Parham Doctors Hospital Live Q&A