Follow Up on Bedside Reporting The call content prompted us to: Make concrete plans to move shift report to the bedside Actually run a test of doing shift report at the bedside Make revisions to the way we currently do shift report at the bedside Try out unit leadership rounds IHI Expedition Improving Your HCAHPS Scores Through Patient Centered Care Post Discharge Phone Calls 1 Kelly Briggs, MBA, RN, CNA-BC, is the nurse manager of a 33 bed Acute Elder Care Unit at Hackensack University Medical Center. Ms. Briggs earned her MBA from Seton Hall University, BSN from Fairleigh Dickinson University and well as a BS in Biology from Manhattan College. Ms. Briggs has been a leader in the field of gerontological nursing for over years. Ms. Briggs is ANCC certified in Gerontology and Nursing Administration. She was instrumental in developing the fall reduction program at HUMC and designed the video monitoring system to achieve a % reduction in patient falls on her unit. She has presented at national conferences on the topic of fall reduction and pain management initiatives. Nina Setia currently serves as the Administrative Director of Service Excellence at Hackensack University Medical Center in northern NJ. In her role, she is primarily responsible for all service-oriented market research activities while driving and monitoring improvement initiatives throughout the organization. Her focus is on total customer satisfaction which includes patients, employees and physicians. Nina has been with the Medical Center for most of the last 14 years and during this time has presented successful initiatives at four Press Ganey National Conferences and two What s Right in Healthcare Studer Group National Conferences. She recently published an article in JONA (Journal of Nursing Administration) on discharge calls and leader rounding on patients, and has contributed to several other books, including Planetree s Putting Patients First. Nina s creative and innovative measurement strategies have enhanced the way the organization looks at patient, physician and employee satisfaction results. Nina received her BS in Broadcast Journalism/Communications from Syracuse University and her MS in Advertising Strategy/Communications from Virginia Commonwealth University. She also possesses a private pilot license. For fun, she spends time with her two Yorkshire terriers, Kahlua and Martini. Today s Topics Bundling the Value of Discharge Phone Calls and Leader Rounding on Patients Nina Setia, MS Administrative Director Service Excellence Kelly Briggs, MBA, RN, CNA-BC Nurse Manager Acute Care Elder Unit, 4 St. John Learn how Hackensack University Medical Center implemented a Discharge phone call program Measuring success Case Study operationalizing the program on one unit Bundling discharge calls with leader rounding on patients Where we are now 1
Hackensack University Medical Center Driven by Quality One of America s Best Hospitals: Top One Percent in the Nation THREE Consecutive Years Occupancy Rate (% Med/Surg Occupancy) 94.3% 92.2% 93.3% 93.7% 95.4% 91.5% 88.3% With this recognition, we pledge to continue our mission to improve the delivery of healthcare here and in other institutions nationwide. -Robert C. Garrett President & CEO 3 4 5 6 7 8 9 Length of Stay What our patients were telling us: 5.2 All Medicare I was told very little. I was not told how to take care of myself when I left nor did I have a full understanding of what happened & what was on my discharge papers. 5.1 5. 4.9 4.8 4.7 4.6 4.5 4.4 3 6.3 6.2 6.1 6. 5.9 5.8 5.7 5.6 5.5 5.4 4 5.3 5.2 3 5 4 6 7 5 8 6 9 7 8 9 Don't think I was told enough about taking care post surgery at home. I was not given complete instructions regarding the care of my wound. I just learned how to dress my wound when I called up my physician & reviewing the instructions given upon discharge Needed more advice on home care. I was back at Dr.'s office a few days later w/problems and questions, was given little to no info on discharge. It took several hours to be discharged but I was okay w/ it I felt the home instructions part could have been a little more informative. There was no warning to my family before I was discharged & no advice as to what should happen afterwards. The last nurse I had was very rushed and didn't have time to explain anything. 2
What they were really telling us: High Occupancy + Decreasing Length of Stay = Patient s perception of feeling ready for discharge Patient Satisfaction: Inpatient 4Q5 85.1 86.8 78th 52nd Extent felt ready for discharge Mean Score Instructions for care at home Nat'l %-tile Rank 82. 49th Instructions given about baby care* 89.3 72nd Likelihood of recommending Patient Satisfaction: ED 4Q5.4 Mean Score th Information about home care 77.2 Nat'l %-tile Rank th Staff cared about you as a person.8 42nd Likelihood of recommending Rolling Out Discharge Calls CEO Directive: Implement discharge phone calls to increase patient satisfaction Response: Plan was developed and adopted by the Satisfaction Advisory Council (committee of Satisfaction Teams Chairs) Developed customized discharge follow up phone calls logs (based on form from Studer group toolkits) To be rolled out through Satisfaction Teams Strategy Discharge Call Form 3
Discharge Call Practice Who makes the calls? Initiative: Discharge Calls Mostly RN s Most Nurse Managers participate Varies by unit Per diems (if under budget) Based on staffing ratio s and # of discharges per day Assigned RN to discharge calls Each RN on unit making a few calls each, per day No method of reports other than patient satisfaction Patient s perception of feeling ready for discharge + Healthcare Research Not understanding discharge instructions is one of the top 8 dissatisfiers to patients. How the patient manages their recovery post discharge is vital to maximizing clinical outcomes = Need for measurement of this initiative Measuring Discharge Phone Calls: Added Question to the ED Survey Quality of calls... 87.4.3 88th "Information about home care" 27th National % tile Rank 99th 46th K+ Visit Peer Group Received call Did not receive call Source: Press Ganey Associates, 2Q6 Impacts overall perception of care... 84.4 78.9 93rd "Likelihood of Recommending" 73rd 37th National % tile Rank 57th K+ Visit Peer Group Received call Did not receive call Source: Press Ganey Associates, 2Q6 and success increases quantity. 2Q6 3Q6 2Q6 3Q6 4Q6 1Q7 2Q7 3Q7 4Q7 1Q8 2Q8 3Q8 4Q8 1Q9 4
Enhancing the practice of Discharge Phone Calls Show patients we cared about them and their well-being even after discharge Improve patient compliance with discharge instructions Involve leadership in making the calls Provide real time feedback Involve attending physicians in making the calls Discharge Calls Improves Physician Performance (January-December 8, Press Ganey National %tile rank) 95th 89th th Doctors Section 91st 86th th Likelihood of Recommending Doctors making calls Other calls being made No call Patient Comments: Physicians Making Discharge Phone Calls Special thanks go out to Dr. Feldmanfor his concern about me after discharge. Dr. Feldman called me early in the morning about my well being. Thanks again. The ER doctortook the time needed to explain everything and order necessary tests. Even took the time to make a follow-up call the next day! Dr. Hewitt-Follow-up call to my home was detailed, informative, answered all my questions and gave me valuable recommendations for follow-up care. Patient and professional. Not only did Dr. Nierenbergtreat me with top notch medical attention -he called my internist at my bedside to update him AND called after my visit to check up on me. Amazing! Reinforce Practice Through Results ED Information about your care at home (Press Ganey National %tile rank) 2Q6 91 27 3Q6 Received call Did not receive call 92 94 96 96 98 85 88 87 81 84 71 73 63 18 4Q6 37 1Q7 43 2Q7 14 3Q7 43 12 4Q7 27 1Q8 18 2Q8 36 3Q8 4Q8 17 1Q9 25 2Q9 15 14 3Q9 4Q9 42 Reinforce Practice Through Results ED Likelihood of recommending (Press Ganey National %tile rank) Added Question to the Inpatient Survey Received call Did not receive call 97 98 92 94 93 94 94 86 87 89 76 77 76 78 78 73 69 67 2Q6 43 41 3Q6 4Q6 1Q7 2Q7 47 3Q7 25 4Q7 38 1Q8 29 2Q8 3Q8 37 4Q8 33 1Q9 48 2Q9 3Q9 37 4Q9 5
Results: 4 th Quarter 6 Targeted measurement for initiative vs. Overall perception of care Drill Down by Unit/Specialty Example: Obstetrics Reach rate more than doubledin 3 months!?!? 4Q6 1Q7 Quality vs. Quantity Individual coaching opportunities through unitbased report cards Goal: stay on track with intended purpose of initiative Reinforce Practice through Results Patient Perception of Care Inpatient Likelihood of Recommending (Press Ganey National %tile rank) Received call Did not receive call 98 99 98 98 98 99 99 99 99 99 98 76 4Q6 59 1Q7 56 2Q7 59 3Q7 62 64 4Q7 1Q8 71 2Q8 61 61 62 3Q8 4Q8 1Q9 73 2Q9 93 65 3Q9 97 54 4Q9 Patient Comments Next Steps FYI: I also rec'd. a follow up phone call after discharge the next day - that was truly appreciated. I even received a follow-up phone call inquiring if all was well!! I really appreciate the follow up phone call I received from the nurses after I was home, 'great service!! I was very taken by the follow up call to my home the following day. Impressed by the follow up call to see how I was doing. Accelerate practice through discharge call manager software Simplifies the process Ongoing since Jun 7 Get real-time feedback Evaluate attempt and reach rates Evaluate impact of other initiative(s) Hourly Rounding Nurse Leader rounding on patients Apply bundle science concept to practices Jun 7 -Present Jun 7 -Present Implement measurement coaching track to increase awareness and accountability Ongoing since Nov 6 Implement peer coaching and validation tools to ensure alignment of knowledge and to reduce variance in practices Late 8 - Present 6
Clinical Call Evaluates Hourly Rounding Auto fill s name of caller Service Recovery & Recognition Goals % attempt rate all services 75% complete rate Inpatient % complete rate Emergency Services Monthly Progress Toward Goal: DCM Stats Quarterly Progress Toward Goal 7
Quarterly Audit Case Study: 4 St. John Acute Care Elder Unit 33 Bed geriatric unit RN staffing ratio 1:6 Discharge phone calls made by all RN s Charge RN ensures that calls are made daily Nurse Manager reviews DC phone call comments daily and rewards and recognizes and provides coaching as needed. Teamwork! Unit Discharge Call Dashboard (%) Month # Discharges % attempted Difference from % goal % completed Difference from 75% goals Oct-8 193 49.2 (.8).4 (34.6) Nov-8 163 22.1 (77.9) 14.1 (.9) Dec-8 198.5 (99.5). (75.) Jan-9 183.1 (39.9) 54.1 (.9) Feb-9 186. 91.9 16.9 Mar-9 1 99.5 (.5) 93.5 18.5 Apr-9 2 98.1 (1.9) 89.1 14.1 May-9 191 89.5 (.5) 78.5 3.5 Jun-9 7 98.1 (1.9) 89.3 14.3 Jul-9 183 99.5 (.5) 81.4 6.4 Aug-9 1 98.2 (1.8).6 15.6 Sep-9 184 98.9 (1.1) 91.8 16.8 Oct-9 175 97.1 (2.9).9 15.9 Nov-9 181 99.5 (.5) 93.9 18.9 Dec-9 1 99.4 (.6) 91.7 16.7 % of Discharge Calls 2Q8 3Q8 4Q8 1Q9 2Q9 3Q9 4Q9 # Discharges 512 544 554 5 8 539 536 % attempted 42 22 24 87 95 99 99 % completed 29 17 18 85 87 92 Positive comments from our patients Irene was excellent. Everyone that took care of my mom was great. Kerry, Kelly, Ria, and Sherrie were all excellent nurses. Julia walked my mother each day to see my father who was a patient down hall. She was very nice. Sonny and Fran were excellent nurses. Leonor was very attentive. I loved everyone on 4 St John-the nurses and nursing assistants were wonderful. 8
Unit Patient Satisfaction 89 88 87 86 85 84 83 82 81 79 78 Mean score 81.9 84.7 85.6 86.3 85.2 87.8 86.8 National Rank w/in Geriatrics specialty 2Q8 3Q8 4Q8 1Q9 2Q9 3Q9 4Q9 35 52 64 76 74 74 74 Added Another Question to the Inpatient Survey Did a Nurse Manager Visit You During Your Stay? Source: Inpatient surveys received 4Q9 n=996 responses (67%=YES; 33%=NO) Did you receive a follow up phone call after your stay? Source: Inpatient surveys received 4Q9 n=15 responses (72%=YES; 28%=NO) National Percentile Ranking 96th 84th 92nd 16th 12th 8th Overall Extent Felt Instructions Yes No Ready for Discharge re: Care at Home 85th 7th Nurses Section 92nd 96th 37th 3rd Response to Likelihood to Concerns/ Recommend Complaints National Percentile Ranking Yes No 93rd 92nd 95th 17th Overall 12th Extent Felt Ready for Discharge 12th Instructions re: Care at Home 86th 19th Nurses Section 78th 8th Response to Concerns/ Complaints 97th 54th Likelihood to Recommend Bundle Approach: Did you receive a follow up phone call after your stay? + Did a Nurse Manager visit you during your stay? Source: Inpatient surveys received 4Q9 n=598 responses (76%=YES to both question, 24%=NO to both questions) Bundle Approach: Did you receive a follow up phone call after your stay? + Did a Nurse Manager visit you during your stay? Source: Inpatient surveys received 4Q9 n=598 responses (76%=YES to both question, 24%=NO to both questions) National Percentile Ranking 99th 98th 99th 97th 6th 4th 7th 7th Overall Extent Felt Instructions Nurses Ready for re: Care at Section Yes No Discharge Home 98th 99th th 1st Response to Likelihood to Concerns/ Recommend Complaints HUMC Mean Score 95 91. 89.7 89.5 85 81.1.6 81.8 75 Overall Extent Felt Instructions Ready for re: Care at Yes No Discharge Home 94.6 91.6 89.3 85.3 83.9 75.7 Nurses Response to Likelihood to Section Concerns/ Recommend Complaints 9
Quarterly Tracking Tools by Unit Measures effectiveness of practices Internal Coaching Model (as of Oct 8) Ability to leverage professionals within HUMC to serve as peer coaches, who were selected based on: Proven results Relationship with staff & understanding of the culture Vested Interest Demonstrated competency in key tactics Ability to role model and coach behaviors Pride in the organization and the delivery of quality patient care Implement Internal Peer Coaching model in Nursing Novice to expert coaching model using Expert Coaches as internal Subject Matter Experts 6 internal coaches selected To ensure standardization, all nursing leaders have been assigned a peer coach, regardless of their tenure, results or competency New tactics will be added in sequential manner to allow time for skills-building and implementation before adding other behaviors Peer Coaching Model Ref Benner, P. (1984). From Novice to Expert: Excellence and power in clinical nursing Those designated as Experts will use the following schedule for coaching or validation of competency on Key Initiatives 1) Have no experience in the behavior-must follow the "rules 2) New manager to HUMC - need to learn culture 3) Experienced nurse - new to management 1) Demonstrates acceptable performance after training 2)Tend to "think" they are doing it but no measurable results 3) They do the behavior when they have the time 1) Begins to see actions connected to goal attainment 2) Proactively correlate behavior to results (use logs) 3) Demonstrate skill and cognitive understanding the concept 1) Can adapt to nuances of the concept, are nimble and flexible 2) Perceive as part of the culture and can role model to others 3) Achieve measurable and sustained results 1) Have an intuitive grasp on the concept, "second nature" 2) Are firm believers and can coach, influence others 3) Can teach and verify competence in others Novice Meet with Coach every two weeks Advanced Beginner Meet with Coach Monthly Competent Meet with Coach Quarterly Proficient Meet with Coach every Six Months Expert Meet with Coaching Group Annually Sample Verification Tool Example: Discharge Call Practice Who makes the calls? End Goal/Result: Create a model for internal coaching that will hardwire the processes and sustain the behaviors long-term Raise the skill and confidence level of middle managers Help move a very good organization to a great one Past Mostly RN s Most Nurse Managers participate Varies by unit Per diems (if under budget) Based on staffing ratio s and # of discharges per day Assigned RN to discharge calls Each RN on unit making a few calls each, per day I.T. running reports Current & Future 6 coaches met with assigned Nurse Manager to identify current practice for efficiency and effectiveness Moving towards: Each RN on unit making a few calls each, per day Will identify supplemental staff to assist, i.e. ICU staff Nurse Manager runs own unit compliance
In Summary Instructions about your home care In Summary Overall Satisfaction 89 88 87th 76th 87 86 87th 74th Mean Score 87 86 51st 85 84 83 1Q6 2Q6 3Q6 4Q6 1Q7 2Q7 3Q7 4Q7 1Q8 2Q8 3Q8 4Q8 1Q9 2Q9 3Q9 4Q9 Mean Score National rank National Percentile Rank Mean Score 85 84 51st 83 82 1Q6 2Q6 3Q6 4Q6 1Q7 2Q7 3Q7 4Q7 1Q8 2Q8 3Q8 4Q8 1Q9 2Q9 3Q9 4Q9 Mean Score National rank National Percentile Rank Mean Score Started Discharge Calls 93 92 91 89 88 53rd 87 86 Measured discharge calls In Summary Likelihood of recommending Measurement Coaching Track Measured Nurse Leader rounding Measured Bundle Internal Coaches Attempt to call % of patients 93rd 87th National Percentile Rank A Final Thought It s interesting to know how patients think when they have had a chance to reflect on their experience with the hospital. If they feel comfortable when they get home about how to manage their care, felt cared about, and knew they were in good hands, they are more likely to perceive their care as better. 85 84 1Q6 2Q6 3Q6 4Q6 1Q7 2Q7 3Q7 4Q7 1Q8 2Q8 3Q8 4Q8 1Q9 2Q9 3Q9 4Q9 Thank you. Mean Score National rank Reference s Thank you. Your Challenge Before the Next Expedition Call. Develop a plan to test post-discharge phone calls for a subgroup of high-risk patients 66 11
Next Call: February 9 th 1:-2:pm ET Transform Care in Six Steps Delivering Exceptional Care Experiences by using the Patient and Family Centered Care (PFCC) Methodology and Practice Patty Embree Sr. Director, PFCC Project Management, Innovation Center University of Pittsburgh Medical Center 67 12