Flex Program: MBQIP Improvement

Transcription

1 Flex Program: MBQIP Improvement HCAHPS Q9 Quietness of Hospital Environment Presented by: Rochelle Schultz Spinarski August 23, 2016 California, Wyoming, and Illinois Flex Programs

2 Housekeeping All lines are muted. Please use the discussion box for any questions. Lines will be open for discussion the last 15 minutes of the webinar. Webinar materials will be posted at Resources tab. A post webinar survey will follow. Please complete the survey. Upcoming Webinars: EDTC 1 Dates TBD EDTC 5 Dates TBD WY QI Roundtable: Sept 8, 10 11am CA QHi and MBQIP Roundtable: October 11, 10 11am

3 Agenda CAH Performance: What do our patients think? Noise: Why does it matter? Noise: Where is it? Noise: How can we decrease it? Noise: How do we know we re making a difference? Noise: Tools and Resources Discussion

4 Webinar Participants CA SORH WY SORH IL CAH Network CAHS: California 34 Wyoming 16 Illinois 51

5 Key Sources HCAHPS and the Metrics of Patient Experience: A Guide for Hospitals and Hospitalists, Hospital Medical Practice The Hospital Noise Project: The Beryl Institute Noise reduction project in 241 hospitals Addressing Quietness on Units Best Practice Implementation Guide, Massachusetts General Hospital

6 What do our patients think? Quiet?

7 CA, IL, WY, All CAHs &US: Q9 Quietness of Hospital Environment FMT, content/uploads/2016/02/hcahps national trends.pdf & Hospital Compare

8 CAH Performance: HCAHPS Q9 Quietness of Hospital Environment WY: HCAHPS 9, Quietness All Hospitals A C D E G H I J K L M N State National 2Q2014 3Q2014 4Q2014 1Q2015 2Q2015 3Q2015 4Q2015

9 CAH Performance: HCAHPS Q9: Quietness of Hospital Environment All Hospitals

10 Noise Whether inadvertent, unavoidable, or accidental, noise is one of the most invasive aspects of the hospital environment. (Joseph, 2006) Press Ganey has found that patients complain about noise two times more often than about anything else in a hospital, including the food. (Fick and Vance, 2000) According to patient satisfaction surveys, the quality of the healthcare experience is often evaluated according to the hospital s dynamic environment, those circumstantial and changeable components that are caused and impacted by people, change throughout the day, and are within the control of the staff. Susan Mazer

11 Ahhhhh Our hospitals and patients are HERE Not here

12 Noise: Why Does It Matter? The cost of a noisy environment is high and the cost to fix it is relatively low. Sleep is a biological necessity. Disturbed sleep is associated with health problems and delays healing. Hidden Costs: Increased patient agitation, aggression and delirium Increased pain & less effective pain management Slower healing Violations of privacy Sleep deprivation Increased falls Increased risk of medical and nursing errors Nursing fatigue

13 Noise: Where is it? Noise has layers Noise floor, aka ground zero Heating, ventilation, ice machines, walls and floors that amplify noise Things that move Carts, vacuum cleaners, floor waxers Things outside Lawn mowers, construction, cars/alarms Alarms People People Moving Walking, talking Communication Equipment Paging systems, phones, cell phones, personal pagers Patients Walking, talking, televisions, Visitors Walking, talking, televisions

14 How can we decrease noise? There are many approaches. All of them require buy in from leadership and staff hospital wide, staff time, a commitment to improvement, and feedback from patients and families. Plan on addressing layers of noise by improving the whole healing environment over time.

15 Getting Started Organize Leadership Team Enthusiasm is good Structure Flexible Process Documented but not burdensome Strategy Set a goal and timeline Education/training Communication and reporting Measurement Who? How? Often!

16 Assessment Initial Assessment Real time assessment Follow up assessment Assessment How noisy is it? Engage everyone Start by having all staff complete the HCAHPS survey based on their knowledge of the hospital Use lean and other tools to identify challenges and needs Hospital wide Each unit Quiet committee who are eyes and ears Secret shoppers looking for opportunities for improvement Patient at Night Hear and understand patient experience Patient engagement committee topic area

17 Creating a diagram that includes cause and effect. Lower level caus can often be what you want to tackle.

18 Priority Matrix Location Source: People Source: Equipment Reception (A) ED (B) Outpatient Dept (C) Inpatient Halls (D) Nursing Station (E) Cafeteria (F) Laundry (G) Source: Environment

19 Noise Stratification By Time Observations or noise meter readings 7a 9a 9a 11a 11a 1p 1p 3p 3p 5p 5p 7p 7p 9p 9p 11p 11p 7a A B C D E F G

20 Where to Focus Areas Most Focused Nursing stations (81.3%) Patient rooms (71.7%) Corridors (61%) ICU (36.9%) Whole hospital (30.5%) ED (18.2%) Lobbies and waiting rooms (12.3%) Operating rooms (5.3%) Primary Sources of Noise Equipment (55%) monitors, tanks, pumps, carts.. Talking (51%) staff, patients, visitors General activity (41%) coming and going, activities Alarms (25%) Overhead paging (19%) Shared rooms (15%) Other (slamming doors, cleaning, nurse calls, construction, elevators Source: Beryl Institute

21 Top 3 Challenges to Reduce Noise 1) Behavior and Culture Accountability Compliance Awareness Buy in/ownership 2) Environment Semi private rooms Building layout Size/space constraints Carpet, ceiling tiles 3) Miscellaneous Equipment/alarms Paging Costs/budget Lack of focus/fatigue/higher priorities

22 How do we address noise?

23 Examples of Noise Reduction Efforts Noise committee/champion all shifts Shhh campaign Leaders working night shifts Communication/reminders between staff Daytime rounding Quiet hours (daytime and nighttime) Signage, postage, flyers Replaced wheels on carts Limited visiting hours Limited paging Sound monitoring devices (Yacker Tracker) Flashlights used at night instead of overhead lights Relaxation/healing channel on TV Dimming lights at certain times Comfort/quiet kits with ear plugs, masks Allowing patients to close their doors and post do not disturb signs Headphones for TVs/TV viewing policy Sound absorbing materials on floors, ceilings, and/or walls Scheduling no nighttime maintenance/housekeeping Patient room phones with volume adjustment New HVAC systems Installing ambient white noise machines Communicate with patients about waking them up during quiet hours (when and what) Coordinate with treatment team to bundle night time tasks Communicate any night time projects (e.g., cleaning) that may disturb sleep and offer to close door, ear plugs

24 Implementing Quiet Times What are quiet times? How are quiet times structured? What happens during quiet times? How are staff, patients, and families notified of quiet hours?

25 Quiet Time Signage

26 Communication with Patients Convey to the patients that the goal is make them comfortable and to create a quiet environment. Use key words at key times: We ALWAYS want to keep your room quiet at night so you can rest would you like us to close your door? We will be in to check on you approximately every two hours throughout the night. Sometimes our voices seem louder at night, so please let us know if we are bothering you or if you cannot sleep.

27 Communication with Families and Visitors We want to provide the best healing environment for all our patients. Would you mind lowering your noise level to help our other patients get the rest they need? To ensure your roommate gets the rest they need, would you mind lowering the TV volume?

28 Yacker Tracker: Tahoe Forest Health System, Truckee, CA Jim Sturtevant, MS, RN, CCRN, Admin Director of Acute Care and Extended Care Introduced Yacker Tracker in ICU Rotated every month to new unit Questions about noise in daily rounding (M F) Changed wheels & new carts Partnering with patients Staff permission to remind one another to be quiet Team effort Awareness

29 The Kick Off/Go Live/Commit Forever All staff should be educated about noise, goals, plans, process and strategies Information should be fresh Consider having an event, announce to all staff via , newsletter, team meetings etc.

30 Monitoring Improvement Rapid Tests of Change Track progress Hourly, shift or daily huddles Establish quiet specialists for each shift, throughout the hospital Evaluation Real time Noise audits or observations In room patient surveys Tracking noise levels Acknowledge people doing the right thing Timely, friendly conversations when people are not doing the right thing Periodic HCAHPS reports do not give you the information you need.

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33 Patient & Family Feedback MA General Hospital, QUIETNESS.pdf

34 A few additional points to consider How do patients make noise stop? Create a real time reporting and remediation system. Noise hotline? How do staff make a noise stop? Create a reporting and remediation system. Noise tickets? There are good sounds and bad noises. Give patients the knowledge, tools, and environment to control sounds.

35 Celebrate Successes Display charts and graphs Report to all staff Acknowledge people doing the right thing Hold events, special activities Keep moving forward and create a healing environment!

36 Resources & Tools Contact Flex Program Staff Technical assistance Connecting with other CAHs Funding to support improvement? On site lean support (CA) SHIP grants

37 Sources Addressing Quietness on Units Best Practice Implementation Guide, QUIETNESS.pdf Beckers Hospital Review, ways to reduce hospital noise.html Beryl Institute, _noise_webinar.pdf HCAHPS and the Metrics of Patient Experience: A Guide for Hospitals and Hospitalists, Hospital Medical Practice, content/uploads/0615 H Patient Satisfaction.pdf Hospital Noise and the Patient Experience, Hospitals and Health Networks, runaway noise in the hospital Hospital Quality Institute, Reducing Noise, Improving Experience, Promoting Healing: Exemplary Efforts in CA Hospitals, Webinar, noise improving experience promoting healingexemplary efforts california hospitals and Quality Improvement Implementation Guide and Toolkit for CAHs, implementation guide and toolkit critical access hospitals Reduce and Optimize Hospital Noise with Six Sigma Tools, optimize hospital noise six sigma tools/ World Health Organization, data/assets/pdf_file/0017/43316/e92845.pdf YouTube

38 Our aim is not silence, rather it s a healing and patient centered culture & environment

39 Thank you Rochelle Schultz Spinarski 651/