Patient Flow and Satisfaction: Navigating Through Systems

Transcription

1 Patient Flow and Satisfaction: Navigating Through Systems 1. The Impact of Improved Infusion Chair Utilization Laura Loninger RN, MA, OCN RN/SNC NYU Laura and Isaac Perlmutter Cancer Center 2. Navigation Programs Need Informatics Systems to Improve Patient Care, Measure Outcomes and Demonstrate Value Kris Blackley RN, BSN, OCN Director of Patient Navigation Levine Cancer Institute 3. Zooming in the Camera Lens on Oncology Infusion: Putting the Focus on Relationship-Based Care Jayme Cotter MS, RN, AOCNS, ACNS-BC Clinical Nurse Specialist Froedtert & the Medical College of Wisconsin 4. Bold Moves to Achieve Outstanding Inpatient Satisfaction : An NCI-designated Academic Cancer Hospital s Transformation Wendy Rowehl Miano DNP, RN, AOCN CNO/Director of Nursing University Hospitals Seidman Cancer Center wendy.miano@uhhospitals.org Patient Flow and Satisfaction: Navigating Through Systems Leadership Management Education Oncology Nursing Society 42nd Annual Congress May 4 7, 2017 Denver, CO 1

2 PERLMUTTER CANCER CENTER THE IMPACT OF IMPROVED INFUSION CHAIR UTILIZATION Roseanne DeRiso RN, MA, OCN Jessica Mayer RN, MA Joan Scagliola RN, MSN Laura Loninger RN, MA, OCN Joanne Staha RN, OCN Jacob Ramsey MPH, MHA Disclosures: Laura Loninger has nothing to disclose. Significance & Background At our NCI designated cancer center, even though hours of operation for the infusion center are 8:00AM to 7:30PM, a peak in patient appointment times was noted between the hours of 10:00AM and 1:00PM. As our volume of infusion visits increased, a cascade of increased patient wait times occurred. Leadership Management Education (L. Loninger) 1

3 Purpose Better distribute activity throughout the day in our infusion center in order to accommodate increase in volume Decrease wait time Increase patient and staff satisfaction 4 Challenges Location Tradition Space vs. Volume Scheduling 5 LOCATION 6 Leadership Management Education (L. Loninger) 2

4 7 TRADITION 8 We have always: Allowed office practice to schedule infusions Allowed patients to come at any time Provided all infusion related care in the infusion suite 9 Leadership Management Education (L. Loninger) 3

5 SPACE VS VOLUME 10 Infusion Encounters per year 34 th st + 38th st 29% total growth 69 total chairs for 34 th st and 38 th st 11 SCHEDULING 12 Leadership Management Education (L. Loninger) 4

6 Notes: Census numbers represent # of people on floor either in waiting room or in chair Monday Friday only 13 INTERVENTIONS Nursing, administrative and physician team leaders met to identify those patient groups who could safely be treated without a coordinated same day office visit with MD. 15 Leadership Management Education (L. Loninger) 5

7 Created a fast track unit to accommodate short visits: Vascular device access and blood draw Injections Pump disconnects Dressing changes Educate infusion schedulers: Identify non coordinated visits and schedule them at off peak times Identify fast track type appointments Provide scripted answers for explaining new process to patients PROGRESS TO DATE 18 Leadership Management Education (L. Loninger) 6

8 The # of patients seen before 10am increased by 92% Redistributed 48 hours of chair time per day to non-peak hours (before 10:00AM and/or after 2:00PM) by moving infusion appointments not linked to MD visit Opened fast track infusion unit resulting in 12 hours per day reduction of lab draws, injections, and pump disconnects per day off of the 5 th and 6 th floors 19 34th St Infusion Appt times July 2015 versus August % growth 34th St Infusion Appt times Week of N = th st Infusion Appt times Week of N = and 6 Fast track OPPORTUNITIES Require all orders to be signed prior to arrival at infusion center Structure the scheduling process to place treatments of 2 hours or less after 2:00PM Increase fast track availability to 5 days per week (currently open Monday through Thursday) Increase weekend staffing in order to accommodate additional volume on weekend days 21 Leadership Management Education (L. Loninger) 7

9 THANK YOU Leadership Management Education (L. Loninger) 8

10 Navigation Programs Need Informatics Systems to Improve Patient Care, Measure Outcomes, and Demonstrate Value Kris Blackley, RN, BSN, OCN ONS Congress May, 2017 Disclosures Kris Blackely has nothing to disclose. Levine Cancer Institute A Carolinas Healthcare Facility Academic, multi site, community based, cancer center 7 facilities within the CoC Network 12,000 new cancer patients annually 26 navigators across CoC Network Leadership Management Education (K. Blackley) 1

11 Navigation Ties it all Together Patient Navigation Role of patient navigator is to be a single point of contact for the patient throughout the patients cancer journey Support service to help with care coordination, education, identifies barriers to care, access to resources and aids communication with the multidisciplinary team Patient Navigation Leadership Management Education (K. Blackley) 2

12 Challenges Identified No standardized processes No documentation No way to track patients or collect information You Can t Manage What You Don t Measure Goals for Program Development Navigation program providing same quality at all facilities Facilitate communication across multiple facilities Assess quality and effectiveness of navigation Assess program from a management perspective Conduct Original Research on Navigation Leadership Management Education (K. Blackley) 3

13 Action Plan Develop IS systems to: Support standardized navigation practice and data collection across multiple facilities Help navigators manage large patient cohorts more effectively Capture metrics for management of rapidly growing multicenter navigation program Strength in Numbers Track volume Visit type Acuity Disease Navigator Barriers Referrals Time IS Tool within EMR Leadership Management Education (K. Blackley) 4

14 IS Tool for Patient Management Manage patients View appts Alert for ED Alert for admits Organization Research Outcomes Reduced 30 day readmissions for Navigated patients vs. Non Navigated patients Presented at ASPO Approximately 1 in 7 hospitalized patients is readmitted within 30 days of hospital discharge (rates vary due to several factors) The cost of readmissions to the healthcare system nationally are substantial roughly $30 billion/year for Medicare alone Non-Navigated patients were 52% more likely to have a 30 day all cause readmission than Navigated patient Tsai et al. N Engl J Med. 2013;369: Fed Regist. 2012;77(170): N Engl J Med. 2009;360(14): Research Outcomes Survival Benefit for Navigated vs. Non Navigated Patients presented at ASCO Improved overall survival at 12 months Survival benefit observed overall and across all subgroups measured Strongest benefit among: Black Medicaid Pancreatic Lung Leadership Management Education (K. Blackley) 5

15 3 Takeaways IS solutions provided necessary tools to build and deliver patient navigation services and improve care coordination. Standardized data capture was needed to evaluate patient outcomes and strategically address staffing and other operational requirements. These capabilities are essential to support patient navigation and demonstrate value of the program. Acknowledgements Collaborators and Special thanks to : Marc Kowalkowski, PhD Carol Farhangfar, PhD, MBA Derek Raghavan, MD, PhD Victoria Morris Andrea Bouronich John Green, MD Leadership Management Education (K. Blackley) 6

16 Zooming in the Camera Lens on Oncology Infusion: Putting the Focus on Relationship Based Care Jayme Cotter, MS, RN, ACNS BC, AOCNS Denise Portz, MSN, RN, ACNS BC, AOCNS Disclosures I have no relevant financial interests or relationships to disclose with commercial entities that produce, market, resell, or distribute health care products or services that are used by patients. Objectives Describe our trial of a sub specialized infusion area to promote the development of nurse patient relationships across the continuum of outpatient care. Articulate modifications to structures and processes related to scheduling to support this trial. Share outcomes of the project. Leadership Management Education (J. Cotter) 1

17 Who We Are Academic medical center in Milwaukee, WI 556 inpatient beds Clinical Cancer Center 238,309 outpatient visits in 2016 Cancer Center infusion area 32,284 patient encounters in 2016 Clinical Cancer Center: Big Picture Faith clinic Breast Care Center Courage Clinic Hope clinic Life clinic Grace clinic Outpatient Oncology Infusion Skin Cancer Center Nurse patient continuity challenges Suboptimal relationships between clinic and infusion staff Decentralized scheduling practices Non specific scheduling template Long patient wait times Zoom In OP BMT Program housed in infusion area Separate, dedicated space Reduced number of specialty trained RN staff Better continuity of care, relationship development OP BMT Leadership Management Education (J. Cotter) 2

18 Widening the Aperture Opportunity to trial a new model of care based on a partnership between infusion & a single clinic Emphasis on a specific population Malignant hematology & BMT Focus Comprehensive patient care Blood & Marrow Transplant Treatment Patient with hematological malignancy Transfusions by dedicated nurses in a devoted space. From Darkroom to Print Create new scheduling template Train Grace clinic schedulers in new process Dedicated nurses and space Creation of an RN education plan Begin patient care in new space Staff input: Daily work, process, charge RN, staffing calculation, process modification Malignant hematology infusion pod Phase 1: Development Phase 2: Pilot End Result: Integration into the Existing Structure Leadership Management Education (J. Cotter) 3

19 Framed and Matted: Patient Satisfaction Patient perception significantly impacted 1. Length of time spent waiting in chemotherapy waiting room 2. Appointment scheduling simplicity No items showed a negative impact Voice of the customer interviews completed Overwhelmingly positive Framed and Matted: Nurse Data Number of nurses caring for a patient throughout treatment Pre intervention Post intervention % reduction Framed and Matted: Objective Wait Times Leadership Management Education (J. Cotter) 4

20 Framed and Matted: Staff Communication Wallet Size A schedule that considers both treatment start time and duration positively impacts actual wait times. Centralized, in clinic scheduling allows patients to leave with a complete list of future appointments and contributes to patients perceptions of simplicity. Limiting the number of nurses a patient interacts with during their course of care allows the nurse to: Better know the individual patient More easily notice changes in the patient over time Provide a support system allowing for relationship development and improved follow through Life is like a camera. Focus on what s important, Capture the good times, Develop from the negatives. And if things don t work out, Take another shot. ~ Ziad K. Abdelnour Leadership Management Education (J. Cotter) 5

21 Questions? Contact information: Jayme Cotter, MS, RN, AOCNS, ACNS BC Clinical Nurse Specialist Phone: Acknowledgement: Lynn Czaplewski, MS, RN, ACNS BC, CRNI, AOCNS Leadership Management Education (J. Cotter) 6

22 Bold Moves to Achieve Outstanding Inpatient Satisfaction An NCIdesignated Academic Cancer Hospital s Transformation Wendy Rowehl Miano, DNP, RN, AOCN Deborah Liedtke, MSN Karen Hess, BSN Vickie Thomas-Januska, BSN, MBA, NE-BC Sara Scott, BSN, OCN Oncology Nursing Society 42 nd Congress May 4, 2017 DISCLOSURES No disclosures 2 UH Seidman Cancer Center Who are we? Part of the Case Comprehensive Cancer Center, one of 47 National Cancer Center Comprehensive Cancer Centers One of 29 members of the National Comprehensive Cancer Network Member of American Association of Cancer Institutes Major affiliate of Case Western Reserve University, Cleveland, Ohio 3 Leadership Management Education (W. Miano) 1

23 Bold Moves to Improve HCAHPS Inpatient Satisfaction Scores 4 Why is it so difficult to improve patient satisfaction scores? PROVIDERS & STAFF A variety of approaches has been tried across the US Empathy & emotional connection Clarity of expectations & accountability Scripting Specific required behaviors Feedback & reward 5 How will we achieve these goals? 1. Education & engagement of all employees 2. Clarity of expectations for employees & patients 3. Leadership engagement & visibility 4. Manager evaluations based on expected behaviors 5. Measure compliance with key process measures 6. Celebrate & reward our successes 7. Continuous input, feedback, process improvement 6 Leadership Management Education (W. Miano) 2

24 Education & Engagement of All Employees Letter from UH Seidman Cancer Center President UH Seidman Cancer Center Experience for new employees ~ establishing patient and family centered care and pivotal role of every employee in providing exceptional patient experience 7 Clarity of Expectations Ideal behavior cards specific to employee/md role Admission & discharge processes Upon admission, educate patients/families about our service commitments and call light response time standards Encourage patients/families to complete H-CAHPS survey 8 Implementation Details Ideal Behavior Cards 9 Leadership Management Education (W. Miano) 3

25 Clarity of Expectations Tell us if we are meeting your needs My room is clean and orderly My room is quiet If I experience any pain, I will partner with my caregivers to manage it My nurse checks on me every hour I understand my medications when I go home When I ask for help, I receive it quickly Clarity of Expectations My Request for Assistance Urgent medical need Respond to my call light by intercom Urgent toileting need Machine is beeping Non urgent question or other need Seidman Cancer Center Service Standard Less than one minute Less than one minute 2 minutes 10 minutes 10 minutes Leadership Engagement & Visibility Daily rounding upon admission & discharge Admission focus: Service standard commitments Discharge focus: Readiness for discharge and encourage completion of HCAHPS survey Weekly meetings with Hospital President, VP Operations, Director of Nursing, and RN managers Inpatient RN Manager and Medical Director partnership 12 Leadership Management Education (W. Miano) 4

26 Measure Compliance with Key Process Measures Process Purposeful Patient Hourly Rounds Environmental Services Daily Clean & Turn Down Post Discharge RN Phone Calls Weekly Meeting SCC Sr. Leadership & Inpatient Mgrs. Physician Specific Scorecard Every Manager Educates Employees & Assures Compliance with Ideal Behavior Cards Measurement Compliance Target UH Leader Responsible for Process Compliance & Scorecard Maintenance Scorecard 100% Miano Scorecard 100% Edwards Scorecard 100% Miano Scorecard 100% Levitan/Miano Scorecard SCC Leadership Rounds Distribution Quarterly Kim 100% Miano/Mangosh 13 Response of Hospital Staff Hourly Rounds Scorecard 100 Patient Hourly Rounding by Month: YTD Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16 Jul 16 Aug 16 Sep 16 Oct 16 Nov 16 Dec Celebrate & Reward Our Successes Celebration on Inpatient Divisions achieving All Green (both Month to Date and Year to Date) Leverage UH Achieves program to recognize every team member on division, including support services 15 Leadership Management Education (W. Miano) 5

27 UH Seidman Cancer Center Everyone I met smiled a genuine smile Never needed to use the call button. Nurses were constantly checking on me Doctor made me feel like he really cared with his genuine smile, caring handshake University Hospital is by far the most professional and well organized hospital 16 How Do Our Inpatients Rate Their Care? Overall Rating How Do Our Inpatients Rate Their Care? Room Clean Room Quiet 2016 through December Nurses Doctors Call Pain Medication Discharge Transition Light Control Teaching Goal: Goal: 80.3 Goal: 82.2 Goal: Goal: Goal: 66.1 Goal: 66.1 Goal: Goal: Goal: Continuous Input, Feedback, Process Improvement Ongoing input from Patient and Family Advisory Council & SCC Managers Continuous Performance Improvement UH Cleveland Medical Center Management Forum 18 Leadership Management Education (W. Miano) 6

28 Response of Hospital Staff Where is the greatest opportunity? Response of Hospital Staff SCC 2016 Overall Overall 62% Toileting How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted? 58% Response to call light After you pressed the call button, how often did you get help as soon as you wanted it? 62% 19 Responsiveness of Hospital Staff Action Plan Current Interventions Owner Metric Focus on toileting and pain on purposeful rounds using proactive approach RN Manager & Medical Director weekly leadership rounds Bedside RN bedside report & purposeful rounds Miano Miano/Hardacre Miano Weekly Call Light Data by Division Documentation tool 100% Staff completion January Take Home Messages Leadership matters o Modeling service standards o Accountability o Engagement o Recognition Publish Key Performance and behavior indicators Collaborate with and reward staff 21 Leadership Management Education (W. Miano) 7