Decreasing Noise to Increase Our HCAHPS Joanne Muzzey, RN MS Director of Patient Advocacy and Planetree Karin Block, RN Relationship-Based Care Coordinator
Agenda Introductions Awareness activity Elmhurst Memorial Healthcare overview Kaizen event Rest and relaxation hour Outcomes Lessons learned Next steps
Elmhurst Memorial Hospital Suburban Community Based Hospital established in 1926 275 beds 66% private rooms Model of Care Relationship-Based Care Shared Governance Planetree Affiliation 2007
Elmhurst Memorial Hospital Today Transitioned to a new replacement Hospital on June 25, 2011 259 private rooms
Awareness for Change - 2008 HCAHPS first released for EMH Quiet at Night 47.2% 1% of HealthStream database One unit as low as 17.1% Planetree Progress Assessment Feedback
Initial Interventions Work Life Council Silenced portable phones Planetree Steering Committee Healing Environment Team Organization awareness Unit Councils Unit specific noise Practice Council Sleep Standard
Reasons for Organization Wide Approach Minimal improvement in HCAHPS Feedback from our Patient Family Advisory Council Initial efforts were not coordinated and ineffective A culture change was needed
Assessment Kaizen event held on June 30, 2009 Multi disciplinary focus included staff members from all areas, volunteers and members of Patient Family Advisory Council Organizational noise assessment Data collected Decibel readings Observation of workflow
Assessment 46 tasks were identified and categorized Environment and equipment Processes People
Accomplishments from Kaizen Quiet at Night Standard Elevator use Standard Standardized call light system and telephone ring tone volumes across all units Keypads silenced Tube stations padded Cushioned tops of laundry hampers IV pole inventory Rest & Relaxation Time
Rest and Relaxation time objective Create an environment conducive to healing by offering our patients one hour in the afternoon to rest without interruptions 80% of the time, through the coordination of patient care and support services.
Rest and Relaxation Planning Multidisciplinary task force developed 31 areas/departments represented Senior leadership support Staff-level team leaders Members: clinical/nonclinical Emergency Department Cardiovascular unit Critical care unit Progressive care unit Oncology unit Medical unit Surgical unit Food Service Family Birthing Center Housekeeping Respiratory care Transitional care unit Pediatrics Ambulatory surgery unit Central Admissions Area Diagnostics Physical Therapy
Planning: Initial meeting Senior leader message Awareness activity Overview of project Everyday Creativity Defined the scope Set timeline for implementation Initial discussion of unit hours
Planning: Everyday Creativity Reframe the problem into an opportunity Change the group s perspective Seek the next right answer Create passion
Planning: LEAN process Defined scope In scope: inpatients Out of scope: new admissions, outpatients (ED, Ambulatory Surgery), Transitional Care Center, behavioral health unit, stat and emergency care Decision making activities
Picture Frame Scope of Project New Admission Behavioral Health Unit Inpatient Nursing Units Bedside handoff process Verbal/written report tools In-patient areas Admitted patients(including OBSV and SPO s) Content of report Outpatient to inpatient areas Transitional Care Center Stat and Emergency Care Outpatient Areas: ED & Ambulatory Surgery
Planning: Timeline 6 months from Kaizen to Implementation Kaizen June 30, 2009 Initial task force meeting November 23, 2009 Rest and relaxation hour February 1, 2010 phase one Hours by department/floor 1 2p.m. Third floor: medical, oncology, Family Birthing Center, Pediatrics 2 3 p.m. Second floor: cardiovascular, progressive care, critical care 4 5 p.m. Fourth floor: surgical
Implementation Phases Phase one Inform patient and family Rounding to prep patients Close patients doors as desired Dim hallway lighting Lower voices Phase two Decrease/eliminate environmental noise at the unit level Phase three Coordinate patient s schedule to support rest time 80% of the time
Outcomes Decibel reading Unit observation Hall lights dimmed Patient doors closed Staff activity Patient interviews Are you aware of rest and relaxation time? Was the environment suitable to allow you to rest?
Decibel Readings Unit Before After Change 3N 54.7 54.5 CVC 54.5 51.2 PCU 51.8 48.3 2% reduction 32% reduction 33% reduction
Timeline Initial HCAHPS Report Council projects Rest and Relaxation hour New Campus opens 2008 2009 2010 2011 2012 Steering Committee initiatives Kaizen New Campus training 75.9%
Quietness of area around room at night September 2008 47.2% September 2009 51.6% March 2010 55.9% September 2010 60.1% March 2011 60.6% September 2011 75.5% December 2012 75.9% March 2013 78.5% December 2013 73.9% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% New campus
New Hospital Quiet by Design Sound absorbing materials Room darkening shades Decentralized work stations Onstage / Off stage work and patient flow
New Hospital Quiet by Culture Uncluttered Quiet equipment Staff awareness and ownership of the environment
Implementing R&R in our new environment Individualized to patient preference Patient Centered Scheduling Multidisciplinary approach
Lessons Learned Need a department champion Feedback is essential Share department best practices Keep the momentum Monthly check in meetings
New Hospital Decibel Scores Average Sound Levels (db) New Hospital October 2011 New Hospital September 2013 Unit Daytime Levels (6:00 am 10:00 pm) Night-time Levels (10:00 pm 6:00 am) Medical 5SW* 2011 2013 2011 2013 50.9 52.7 23% increase 48.1 48.2 1% increase Surgical 4W Oncology 4SE Cardiovascular 3SW 54.5 57.3 38% increase 54.5 56.6 27% increase 53.5 56.1 34% increase 47.9 55.0 126% increase 48.9 52.2 49% increase 49.9 52.8 40% increase Progressive Care Unit 53.8 55.7 24% increase 50.2 50.6 5% increase Family Birthing Post Partum NA 52.0 NA 46.4 Average 53.5 55.3 29.2% increase 49.0 51.4 44.2% increase
Next Steps for EMH Awareness Patient Experience Team Relationship-Based Care Kaizen Always events expectations
Questions?