Improving Communication Openness in BWHC Ambulatory: Update

Improving Communication Openness in BWHC Ambulatory: Update

Patient Safety Culture Survey Fall 2012 administered AHRQ Patient Safety Culture Survey to all hospital employees for the first time Spring 2013 results received and data analysis begun Fall 2013 announcement that the hospital would focus on improving Communication Openness and Non-punitive response to error in response to the results Communication Openness Non-punitive response to error

Improving Communication Openness: The Ambulatory Approach Defining: What is Communication Openness? Patient Safety Culture Survey Assessment of Communication Openness Providers in this office are open to staff ideas about how to improve office processes. Staff are encouraged to express alternative viewpoints in this office. Staff are afraid to ask questions when something does not seem right. It is difficult to voice disagreement in this office. Individual Empowerment Positive Error Reporting Interdisciplinary Team Work

Improving Communication Openness: The Ambulatory Approach WHAT? Interdisciplinary team work Individual empowerment Positive Error reporting HOW? Reach everyone Scalable Economical Impactful

The Life of a 10 Minute Idea

Staff member has an idea Staff members submit idea via web form Ambulatory Services receives the idea Idea received Any type of improvement idea which impacts safety, improves the patient experience or improves the work environment Could also submit ideas already successfully in place at the local level Staff member specifies whether he/she would like to be involved in the evaluation of this idea.

Ambulatory Services discusses which practice should evaluate the idea Ambulatory Services sends idea to practice leadership Practice leadership assigns idea to Workgroup Triad (team comprised of 3 different roles) Ambulatory Services IDEA Practice Leadership IDEA Practice Leadership Workgroup Triad Ideas are assigned to different areas where possible to promote community wide problem solving Workgroup triad: - 1 Physician plus - Nurse, LPN, MA, Practice Assistant, etc. Leaders identify a new triad for every idea to involve as many staff as possible

Workgroup triad completes 10 Minute Idea Worksheet to evaluate idea Workgroup triad submits completed worksheet to Ambulatory Services Ambulatory Services follows up with the submitter of the idea and posts the completed worksheet on the intranet Practice Leadership Work Sheet Ambulatory Services Feedback Idea Sharing Promotes multidisciplinary communication and team building Worksheet takes 10 minutes to complete quick and easy Triad decides whether to recommend for a local and/or global pilot Ideas suggested for global implementation may be piloted in other areas Staff member feels that idea was valued and seriously considered Other areas benefit from the process no need to reinvent the wheel

The Progression of Each Idea Will be Tracked on PikeNotes Idea Submitted Idea assigned to ABC Practice 10 Minute Idea Worksheet Completed Submitted for pilot grant Click to read the idea Click to read the completed worksheet Each idea will be posted on PikeNotes Staff will be able to track the progress of the idea in real time Promotes a sense of community across the ambulatory enterprise Staff can see that their ideas are taken seriously

Progression of each Idea Visible on Intranet Site Submitted Assigned Analyzed Feedback Posted Staff able to track the progress of their ideas in real time helps them feel that their feedback is taken seriously Promotes a sense of community across a large, diverse, and geographically dispersed Ambulatory campus Fun to read everyone s ideas!

Soliciting Ideas Encouraged submissions through a kick-off contest in Nov-Dec 2012 Continued outreach in Jan-Feb Post-it notes for all employees Posters Business Cards Mass emails weekly

Idea Submissions Dec 2013-March 2014 Over 220 ideas from 62 practices across 21 depts Ideas submitted by all practice roles: Role % Role % Practice Assistant 23% Radiology Tech 5% RN 16% Administrative Assistant 4% Admin-Other 9% Clinical-Other 4% Blank/Unknown 9% Physician s Assistant 3% MD 8% Nurse Practitioner 2% Practice Manager 8% Social Worker 2% LPN 5%

Idea Submissions Dec 2013-March 2014 Categories of ideas included: Category % Patient Experience 28% Safety 21% Employee Experience 16% Operational Efficiency 14% IT 11% Access/Ease of Scheduling 6% Revenue Cycle 2% Environmental 2% Other 1%

Sample Ideas Employee Experience C.A.R.E. Cards (including Employee Appreciation Event) Staff Awards Nominated by Patients (including Employee Appreciation Event) Employee Fitness Program Fit Bit Grant Employee Appreciation Event Patient Experience Patient Tablet Surveys at Point of Service - Pilot Wall of Wisdom at the Weiner Center Seed Money for Text Message Appointment Reminders Enhanced Wayfinding Program Pilot Safety Ambulatory Rapid Response Team Abnormal Lab Results VNA Training Yellow Dot It Other Ambulatory Float Pool Best Practice, Best Contact Less Waste Initiative Collecting Co- Pays Up Front

Feasibility Analysis April-May 2014 Assigned two ideas to every practice to evaluate feasibility 20% of the ideas were assigned to the practice that submitted them (based on submitter request) Remaining 80% were spread to outside areas able to understand the situation/problem addressed by the idea

Grant Contest June 2014 Chose frontrunners with the help of Ambulatory leadership groups (Reduced from 16-8 semifinalists) Criteria Multiple submissions (2 15+) Ability to scale Aligned with Institutional priorities Voting for top 8 semifinalists was open to the entire Ambulatory community

Grant Contest Results Received 803 total votes top 3 winners: Text Message Appointment Reminders Employee Fitness Program Less Waste Initiative

Feedback from Practice Leaders It s wonderful for staff to have an outlet to express their ideas. Even if it isn t something we can implement in our practice, maybe someone else could benefit from it. I tell them, You should submit that as a 10 Minute Idea and I think they feel more appreciated. The staff met in 2 groups this morning and had a very enjoyable time working out these 2 ideas. Both are close to our hearts as many patients come to us [with similar issues.] One group had lots of feedback. We were actually considering implementing [a similar idea] here, so [assessing the idea will] be helpful to our practice.

Lessons Learned Without ideas, you have no program - Key to actively and consistently promote/encourage idea submissions Don t focus so much on submissions that people forget about the analysis phase Transparent, real-time posting is important, but requires either a high degree of manual effort or investment in a technological solution

Update and Next Steps The Patient Safety Culture Survey was administered again in Fall 2014 Preliminary results indicate the Communication Openness and Non-punitive response to error scores increased Institution planning to continue to focus on these elements in order to further solidify improvements Considering running the 10 Minute Idea again perhaps with patient ideas

Improving Communication Openness in BWHC Ambulatory: Update