A Rapid Team Approach: Service Recovery Team (SRT)

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1 Complaint Management A Rapid Team Approach: Service Recovery Team (SRT) Vicki Tiller RN MSN Glenbrook Hospital NorthShore University HealthSystem

2 We Have a Need Defining The Problem Increased number of complex patient complaints Challenging behaviors Need for multi-disciplinary response Repeat patients/rotation of caregivers Limited staff time to intervene Need for staff support for rapid resolution Capture/resolve complaints before discharge

A Brief History The RRT 1990s Failures in planning (including assessments, treatments and goals), breakdown of communication between patients and staff or between staff and other staff, failure to

3 A Brief History The RRT 1990s Failures in planning (including assessments, treatments and goals), breakdown of communication between patients and staff or between staff and other staff, failure to recognize early signs of deterioration in a patient s condition Rapid response to any clinical need Without negative repercussions for staff Enacted on fact or instinct Less than an arrest team, more than a second nurse Team members: ICU MD, RT, NC Empowered to treat or transfer

4 Premise Current SRT Failures in planning (including assessments, treatments and goals), breakdown of communication between patients and staff or between staff and other staff, failure to recognize early signs of deterioration in a patient s condition Rapid response to any care need Without negative repercussions for staff Enacted on fact or instinct Targeted multi-resource response Team members: By need and expertise Empowered to investigate and resolve

5 Background Very few models Similar in mental health environment None for complaint resolution None found for non-clinical emergencies Obstruction of discharge by family Evolution of complex personal needs Moral/ethical challenges Patient/Hospital Rights

6 The Goal Elevate the patient experience Role model to empower staff Use resources more effectively Accelerate the organizational response Unify and organize communication Make use of experts Aim for proactive positive outcomes Affect patient/staff satisfaction levels Support physicians in challenging situations

Align the Team with the Need Event types and volume drove team membership Identified largest number of in-house complaints Defined common themes

7 Align the Team with the Need Event types and volume drove team membership Identified largest number of in-house complaints Defined common themes Repetitive problems with all patients vs. one patient Identified departments for greatest benefit Necessary skill sets Experience, seasoning of members

8 Invited to the Table Who and Why and What Matters Experts Accessible Limited time frame Multi-dimensional resources beyond themselves Full administrative support Accountable Willing to experiment Flexible within reason

benefits departments Builds strengths, trust, cohesiveness Focus on

9 Benefits For Team Members Increased awareness of scope of patient challenges Opportunity to improve processes Problem resolution that benefits departments Builds strengths, trust, cohesiveness Focus on better outcomes for all Success measured in outcomes, staff satisfaction

10 Process Planning Who came to the party? Risk Social Work Vice President Hospital Services Vice President Nursing Services Nurse Managers from ED, ICU, Med/Surg Chaplain Manager Concierge Services Hospitalist Admin Ethics Committee

11 Key Strengths Or why did we include them? Risk: Liability review Social Work: V.P. Hospital: V.P. Nursing: Chaplain: Discharge arrangements High level authorizations Nursing care issues Psych/spiritual conflicts Concierge: Facilitator, Documentation Hospitalist Admin: Intervention, MD guidance Ethics member: Moral/ethical conflict, end-of life

12 Making it Happen Determined course; revised along the way Point person Communication pathway Steps in the process Required Team member response Ad hoc member response Documentation/EMR Response types Educating the staff Implementation

13 The SRT Admin VP Nursing VP SW Manager Concierge Manager Risk Manager Hospitalist s Manager

14 Ad hoc Members ED Manager Chaplain Resource Team Manager Ethics Committee Member Financial Counselor And anyone else we need

15 Defining Roles Point Person First contact Receives brief summary from CNM or designee Meets on unit within 10 minutes Meets pt/family others, for additional detail prn Contacts appropriate SRT members Optional huddle Documents SRT

16 Pathway Decisions made and changed Separate pager id Everyone huddles Time expectation (obligations) Flexibility Addressing unavailability Origin of "the story

17 Steps Recognition of need by staff Time commitment Interruption to other care Higher level of intervention Clarification with Manager Unit resolution vs. SRT Contact Point Person

18 Next Steps Request SRT Point person fact finding Identify expertise needed Communicate Resolve Document

19 Responsiveness Team contact, a page away Required Designees In-person response or not Dedicated point person Ad hoc contacts SRT

20 Template Demographics Type of SRT Requested Reason for Contact: Medical Hospitalist/Other Physician Nursing Social Work/COC Discharge, CMS, Obs Financial Risk Privacy Ethical Issue Behavioral Concierge Other Patient Rights i.e. (POAH): Other: Members activated Brief factual summary Recommendations Plan/Outcome Other staff contacted for executing plan

21 How does everyone know? SRT scanned in to chart Scanned document property in EMR Elevated to BPOC Alerts in banners

22 Documentation Progress note, why not? Immediate access Availability for repeat admissions Not linked with Event Reporting Discoverable?

23 Sample Document Brief factual summary from Manager or designee: Refusing care/discharge stating we are violating her rights as a disabled person. Patient has auditory impairment. Patient admitted from ED, abusive behavior, non-compliant with medical treatment and social solutions, inappropriate comments to staff, uncooperative in ED, multiple admissions, negative and abusive behavior towards unit staff and medical team. Splits the team creating conflict in plan of care Recommendations: Assemble resources and medical providers to meet in conference with the patient in her room Set plan of care for safe discharge, with patient agreement. Re-state plan Identify that the ADA was contacted in Washington; clarification on patient rights Sign-language interpreter present in room

24 Complex Plan Plan/Outcome Med assessment completed with interpreter present. Plan of care for tests outlined, explained, and accepted by the patient. Specific discussion of inappropriate patient behaviors and expectations completed. Staff/patient interaction clarified and agreed to. SW to work on shelter placement, obtaining subsidized meds if possible from outside sources post discharge. Clinic appointment made pending outcome of testing. SW also preparing housing options and transportation. Per ADA, TTY phone, lip reading, writing, and the interpretive teleconference meet the patient s need. We will provide live interpreters for complex conversations when they are necessary and available to the best of our ability, as described by the Dept. of Justice, auxiliary aids and services at hyperlink If the service is unavailable work with our alternative means to provide acceptable services, meeting ADA guidelines. This information was obtained by direct contact with the Washington D.C. office for the ADA.

25 Staff Education In-patient vs. Out-patient Unit/Department based Empowerment Hospitalists Gate keeper: CNM Successful education trends

26 After 1700 Continuity Process maintained Shift in resources Access Hand-off

27 SRT Process Discussion with Nurse Manager (NM) or DH Factual summary prepared Staff recognizes problem Requiring additional services Discussion with Nurse Manager (NM) or DH Additional resources needed Contact SRT point person Point person responds in-person to the dept. Within 10 minutes Point person Huddles with staff/nm Patient/family interview Chart review if needed Unit level response With resolution Point person contacts Additional resources For resolution Solutions, explanations Developed Shared with pt and staff Accomplish response And resolution Complete and Scan SRT doc into patient record Enter Event Report as appropriate Review for process Improvement at quarterly SRT meeting

28 Outcomes Called for complex service issues only March 2013 to present Staff empowerment/satisfaction increased Qualitative data staff response SRT vs. Behavioral Plan of Care Behavioral Plan of care Extension of SRT Really works!

29 Complex Problems Need Thoughtful Solutions Customer Service: Please give me the one at the bottom.

30 Questions The wise person will act only after evaluating all the options and designing the wisest solution anonymous

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