Rounding in the Emergency Department What goes around comes around: Excellence Starts with You! Jamie E. Hendrix, RN, BSN Director of Emergency Services Beaver Dam Community Hospitals, INC. (Beaver Dam, WI) Richard Tovar, MD, FACEP, DBAMT Infinity Health Care Medical Director Beaver Dam Community Hospitals, INC. (Beaver Dam, WI) Presentation Objectives 1. Participants will learn how they can leverage themselves and their teams to achieve customer service excellence. 2. Participants will learn the essential steps to take in transforming their department and to get desired results. 3. Participants will learn how implementing essential tactics such as patient and staff rounding will help them to achieve desired results in customer and staff satisfaction. 2 1 2008 Studer Group
Beaver Dam Community Hospitals, INC. 3 Beaver Dam Community Hospitals, INC. 4 2 2008 Studer Group
It s Not About Us, It s About the Patients. 5 Our Charge: Overhaul the ER. Conduct an image campaign. 6 3 2008 Studer Group
How Do You Start? 7 Beaver Dam Community Hospitals, INC. Emergency Services Department Vision The ED will be a Center of Excellence for urgent and emergent care. High Quality Clinical Care Prompt and High Quality Service Personalized Care Non-judgmental 8 4 2008 Studer Group
It Starts with You What goes around comes around. What does this mean anyway? To make a complete change or reform. (idiomatic) To complete a cycle of transition, returning to the point of origin. 9 It Starts with You It begins with self reflection!! Ask yourself: Do I make customer service my first priority? Do I role model what I expect of others? How would I like to work for me? What kind of leader am I? Am I a winner or a whiner? Am I an owner or a renter? 10 5 2008 Studer Group
Making the Vision Reality Staff Ownership/Accountability Accepting the past and looking to the future. Owning your part of the past. Accept don t defend. Being willing to change. Asking yourself, Have I been more in to me than the patients/customers? 11 It s Not About You, It s About the Patient... 12 6 2008 Studer Group
Making the Vision Reality Transparency Be open and honest about current state, assessments, expectations, and actions needed for improvement. 13 Making the Vision Reality Perception is Reality... Is the lady pictured old or young? 14 7 2008 Studer Group
Don t be too Quick to Judge Others.. Your assessment may be way off! Your assessment may be way off! Click here to play video clip 15 Moving Forward Complete the past and move forward. If you keep one foot in the past and one in the future you will never move forward. 16 8 2008 Studer Group
Making the Vision Reality Shared Vision & Goals Goals related to Customer Satisfaction, Turnaround Times, and Volumes established. Clear Expectations Patient Rounding is required every 30 minutes Technical/Clinical Skills It is not about us, it is about the patients. Patients are the center of all we do, it because of our patients that we are employed. Customer Service Skills Teamwork/Communication 17 Making the Vision Reality Teamwork 18 9 2008 Studer Group
Making the Vision Reality Essential Components of Management Team: Shared goals Collaboration Partnership Trust Respect Support Open Communication Managing up 19 Making the Vision Reality You can do anything with the right amount of TEAMWORK! 20 10 2008 Studer Group
Making the Vision Reality Teamwork Teamwork established with other departments Partnership with Medical Staff By working together and focusing on the patients not ourselves, we created a pull verses a push effect. Behavioral standards established and enforced. 21 Making the Vision a Reality Teamwork We clearly defined the 3 aspects we were looking for in each team member. Clinical /Technical Teamwork/Communication Customer Service 22 11 2008 Studer Group
Making the Vision Reality 23 Making the Vision Reality Make sure you have the right people on your team. 24 12 2008 Studer Group
BDCH ES Team Members 25 BDCH ES Team Members 26 13 2008 Studer Group
Making the Vision Reality Accountability Hold staff accountable for expectations related to care, service, teamwork and communication. Use feedback from customer concerns, patient satisfaction surveys, and clinical documentation including timelines. 27 Making the Vision Reality Accepting Change If you want to get what you have always gotten, then keep on doing what you have always done. You can t control what happens to you. You can however, control your response or attitude toward what happens to you. When you control your response, then you will be mastering change verses letting it master you. 28 14 2008 Studer Group
Changing the Way We Do Things... Tradition Just because we have been doing things this way for years, doesn t mean it makes sense. 29 Making the Vision Reality The best way to know how you are doing, and what needs to improve... Measure, Measure, Measure!!! 30 15 2008 Studer Group
Making the Vision Reality Measurement We measured and analyzed the following feedback on a monthly basis. All information gathered was used to make and evaluate process changes. - Customer satisfaction ratings *Individual provider *Shift *Department - Direct customer feedback - Turnaround times/metrics - Volumes 31 Change- It Starts With YOU Leaders establish the vision for the future and set the strategy for getting there; they cause change. They motivate and inspire others to go in the right direction and they along with everyone else, sacrifice to get there. John Kotter 32 16 2008 Studer Group
Leading Change 33 Making the Vision Reality Thoughts on Change: You can change anything if you do following: 1. You clearly decide what it is that you're absolutely committed to achieving 2. You are willing to take massive action 3. You notice what is working and what is not. 4. You continue to change your approach until you achieve whatever life gives you along the way. - Anthony Robbins 34 17 2008 Studer Group
Making the Vision Reality Communication 35 Making the Vision Reality Communication 36 18 2008 Studer Group
Making the Vision Reality Communication Share the results of your efforts with members of the team. -consistency -transparently -acknowledge positive -change processes as needed 37 Rounding 38 19 2008 Studer Group
Rounding Physician style Rounding is performed on patients for 3 reasons: Customer service/guest relations Quality improvement Enhanced reimbursement 39 Rounding Physician style Physician Electronic Medical Record (EMR) Order entry/chart documentation Requires a minimum of 3 separate rounding times with the patient/family Initial contact Update on ED throughput Discharge 40 20 2008 Studer Group
Rounding Physician style Initial contact: Patient is greeted by the physician/physician extender Initial exam performed Diagnostic and treatment plan explained Emphasis on estimated waiting time for throughput presented if possible 41 Rounding Physician style Update: Any delay in diagnostic tests, consultations, etc., given as update to patient AND family Partial results shared with patient and family Reassessment of throughput time 42 21 2008 Studer Group
Rounding Physician style Snap shot of EMR serial exam documentation: Repeat exam time snap shot Serial exam for abdominal pain snap shot 43 Rounding Physician style ED Observation 44 22 2008 Studer Group
Rounding Physician style Serial Exams 45 Rounding Physician style Discharge: Summary of diagnostics/treatment Estimated time to discharge or admission Always ask any other questions or concerns?? at the termination of visit 46 23 2008 Studer Group
Rounding Physician style ED Course 47 Rounding Physician style Feedback to all physicians and physician extenders on a monthly basis Positive and negative customer service and quality benchmarks are shared with each provider on an ongoing basis Several physicians have increased their guest relation scores with feedback With positive results, renters become owners 48 24 2008 Studer Group
Rounding-Physician Style Press Ganey Rounding Scores Doctors courtesy Doctor took Time to Listen Doctor informative Re: treatment Doctors concern for comfort 90 80 70 74 69 75 74 82 81 83 82 60 50 40 30 20 20 16 15 17 10 0 2006-2007 1st 6 months of rounding 1st Quarter 2008 49 Rounding Physician style Average Turn Around Times for MD 70 66.25 60 53.5 50 Minutes 40 30 20 12.75 10 0 Provider "X" In Bed / Initial Contact Initial Contact / Care Complete In Bed / Care Complete 50 25 2008 Studer Group
Rounding-Nurse style 51 Rounding-Nurse style 52 26 2008 Studer Group
Rounding-Nurse Style What is nurse rounding? Nurses spend more time at bedside. Patient knows who the nurse is. Questions are answered. Patient and family informed of delays. Comfort needs are met. Rounding is documented. 53 Rounding-Nurse style Each patient is seen by the nursing staff every at least 30 minutes. Nursing staff use the AIDET format when rounding. 54 27 2008 Studer Group
AIDET A- Acknowledge Address patient by name. Make the patient feel welcome and as though you expected them. Use eye contact. Use welcoming and positive body language. 55 AIDET I- Introduce Tell the patient your name, title, and credentials. As you get more comfortable with rounding, share more information such as: Skills, experience, certifications Manage up coworkers and other departments 56 28 2008 Studer Group
AIDET D- Duration How long is the expected wait? How long will test, or procedure take? How long will results take? When will the doctor or next caregiver come in? 57 AIDET E- Explain Tests/procedures Discharge and medication instructions What you are doing, why, and what your thought processes are Answer questions 58 29 2008 Studer Group
AIDET T- Thank Remember that HealthCare is consumer driven. Patients have choice and they have chosen to come to your hospital. Thank them for choosing you. 59 Rounding How to start: Provide facts about current state. Make expectations clear. -every patient -every day -every time Find a way to measure results. Follow up on noncompliance. 60 30 2008 Studer Group
Nurse Rounding Results 100 90 80 Press Ganey Rounding Scores By Percentile Ranking 83 85 86 82 83 Nurse took time to Listen Nurses attention to your needs Nurses informative re treatment Informed about delays 90 87 93 70 60 58 56 55 54 50 40 30 20 10 0 2006-2007 1st 6 months of rounding 1st Quarter 2008 61 BDCH Outcomes Stakeholder Satisfaction Quality People Performance Growth Community 62 31 2008 Studer Group
Stakeholder Satisfaction Emergency Room Press Ganey Overall Percentile Scores 100 90 80 70 60 50 40 Standard Overall Standard Nurses Standard MD's 30 20 10 0 2006 July 2, 2007 - Dec 31,2007 4th Quarter 2007 1st Quarter 2008 63 Stakeholder Satisfaction Patient Satisfaction by Volume 89 88 87 86 85 84 88.5 National Average BDCH Average 83 82 83.7 81 National Average for ED's with 20,000-29,999 visits per year BDCH ER AND UC with 24,261 visits 64 32 2008 Studer Group
Stakeholder Satisfaction Beaver Dam Community Hospital, Inc. Press Ganey - Emergency Services 2006-2008 100 90 Percentile Ranking 80 70 60 50 40 30 86.4 85.7 88 85 80.9 81.7 78.6 73.1 83 2006 2007 Jan1 - June 2008 20 10 0 Overall Facility Rating Overall Rating of Care Likelihood of Recommending 65 People New ER Physician Group hired. ER RN Vacancy Rate reduced from 33.03% in 2007 to current rate of 3.13 YTD%. Charge Nurse and Tech. positions added for evening and weekend (high volume) hours. Clinical Nurse Manager hired to increase the skill level of nursing staff. 66 33 2008 Studer Group
Performance Average Turn Around Times Arrival to Discharge Emergency Department 160 140 141 136 131 135 120 GOAL-120 100 80 60 June 2006-June 2007 July 2, 2007- Dec. 31, 2007 4th Quarter 07 1st Quarter 2008 40 June 2006-June 2007 July 2, 2007- Dec. 31, 2007 4th Quarter 07 1st Quarter 2008 67 Performance Beaver Dam Community Hospital Med Flight Ground Times 70 64 60 50 40 30 24 24 32 2006 2007 20 19 17 10 0 Regional ER to Med Flight Call Med Flight Ground Time Med Flight Call to Arrival at UWHC 68 34 2008 Studer Group
Performance 300 250 200 Average Time Spent in US Emergency Departments Arrival to Discharge 2007-2008 Nat. Average TAT Wisconsin Average TAT 150 BDCH Average TAT 100 50 0 In Minutes National average TAT 240 Wisconsin average TAT 182 BDCH average TAT 130 69 Growth Number of Emergency Services Visits 30000 25000 22405 24261 20000 15000 13487 15002 2006 10000 8918 9259 2007 5000 0 Urgent Care Emergency Department Accumulative 70 35 2008 Studer Group
Excellence Starts With You! 71 What s Right Emergency in Health Care SM Evidence to Services Outcomes 72 36 2008 Studer Group
Conclusion 73 37 2008 Studer Group
Thank You! Jamie E. Hendrix, RN, BSN Director of Emergency Services Beaver Dam Community Hospitals, INC. (Beaver Dam, WI) Richard Tovar, MD, FACEP, DBAMT Infinity Health Care Medical Director Beaver Dam Community Hospitals, INC. (Beaver Dam, WI) 38 2008 Studer Group