Domain IV: Strategy Development and Execution (Bullet 3)

Lydia Elliott, Ed.D
Note by Lydia Elliott, Ed.D , updated more than 1 year ago
Lydia Elliott, Ed.D
Created by Lydia Elliott, Ed.D about 4 years ago


Action Recommendation: Identify and describe proven and emerging practices linked to patient experience and service excellence outcomes

Resource summary

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Domain IV: Proven and Emerging Practices

Identify and describe proven and emerging practices linked to patient experience and service excellence outcomes - Leadership rounding - Hourly nurse rounding - Bedside change of shift reporting - Patient and family advisory councils - Post-discharge phone calls - Project RED (ReEngineering hospital Discharge) - Sleep aids (e.g. headphones, ear plugs, soothing sound generators) - Patient-friendly daily medication schedule and teaching cards on common new medications - Communication tools for patients/families during their stay (e.g. notepads, white boards)

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Leader Rounding

1. Senior leader rounding—Senior leaders round throughout the hospital to support the unit leader and role model positive behaviors for employees.2. Unit leader rounding—Unit leaders round on staff to better develop these relationships; find out what is working well and address concerns about tools and systems. Unit leader rounding is the most important type of rounding.3. Support service rounding—Unit leaders round in the areas they serve to clarify expectations; celebrate accomplishments; identify what still needs attention and to build strong inter-departmental alliances.4. Rounding on patients—Nurses, physicians, and ancillary staff round on patients to ensure their comfort, safety, and satisfaction. They also round to keep them informed; manage up staff skill sets and harvest reward and recognition for what’s going well.Reference

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Hourly Nurse Rounding

Hourly nurse rounding requires minimally every patient rounded on once during there stay but best results are achieved by rounding every patient every day- Decreases falls by 50%- Decrease skin breakdown by 14%-Increase patient satisfaction 12 points-Reduces call light volume by 38%References (41 minutes)

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Bedside Change of Shift Reporting

Bedside Shift Report conversations help organizations avoid “dropping the baton “during one of the most critical patient care intervals and provide a standardized change-of-shift procedure for staff to embrace. They involve off-going nurses, oncoming nurses, and patients. Although the details of bedside shift reporting vary from facility to facility, a successful implementation provides a real-time exchange of information that increases patient safety, improves quality of care, increases accountability, and strengthens teamwork.For the Patient Patient’s perspective is valued as being most important -- it isn’t “about us,” our schedule or comfort zone. Our priority must be the patients as that is the reason why we are here. Patients will see – and hear – from the team of professionals who are providing their care. Patients will be reassured that everyone is getting all the necessary report about what is going on with them. Patients will feel more informed about their care thereby making them less anxious and more compliant with their care and treatments. Allow them to be involved in their care. Patients will be more satisfied because they know that things are being done and monitored throughout the shift. Patients will know who their nurse is on every shift. The process will reduce the “2 – 3 hour ‘alone’ time” during shift change. Many patients perceive the 2 – 3 hours around the change of shift to be a time when no one is around. Sentinel events also occur more often during this time. Bedside Report could help eliminate this. The process will aid in increasing communication. Communication issues are the root cause of about 30% of patient safety events and improved communication between caregivers greatly improves patient care and outcomes For the staff Improves the sharing of information between health care providers by utilizing a standardized method of communicating. If asked questions, you won’t have to say “I haven’t seen my patients yet” and therefore you will be more prepared. The off-going nurse can use “hands-on” to show the on-coming nurse how to operate special equipment or how special orders are being handled. Accountability will increase since each nurse will know his or her patients’ condition at the end of the shift. Keeps report to items related to patient condition and social status. Improves the nurses understanding of patient condition as you are able to visualize the patient. Gives you an orderly room and patient at the beginning of the shift. Overcomes differing communication styles. Bedside Shift Report might sound something like this:Introductions:Good morning, Mr. Jones. I am going home now, and Karen is going to be your nurse today. Karen has been with us for three years. She is excellent and I’m leaving you in good hands.Explain bedside handoff upon admissionI want to go over the information with Karen that you and I have experienced together today and how our plan of care is going so that she has all the information she needs to take care of you today. If I’ve left out anything important for Karen to know, please tell us.“Would you like me to ask the visitors to leave when we do the report since we will be discussing your private information? “I am going to ask your visitors to wait outside for just a few minutes….Safety:Mr. Jones, I am going to check you name band for your safety…. Use the teach back method (asking the patient to confirm their understanding by explaining it back to the practitioner) to keep the patient involved in the conversation. Use the report framework provided by your organization to standardize the report structure. SBAR is a frequently used framework for this and is referenced later in the suite toolsInformed:Let me update your whiteboard….I want to keep you informed, what questions can I answer?For organizations that have also implemented hourly rounds this is also the opportunity to do a round so completing the eight behaviors in the context of Bedside Shift Report is efficient for the oncoming nurse and ensures no gaps in patient needs being metAddress Three Ps: Pain, Potty and PositionHow is your pain?Are you comfortable?Do you need to go to the bathroom?Assess Environment:Let me make sure everything is in your reach….. Closing:Mr. Jones, do you have questions? Is there anything more that Karen needs to know in order to provide you with the best quality care today? I’m heading home now. Thank you for allowing me to be a part of your care.References Taken from Studer Group (2013).

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Patient and Family Advisory Councils

A Patient and Family Advisory Council (PFAC) partners patients and families with members of the healthcare team to provide guidance on how to improve the patient and family experience. As part of this PFAC process, patients and families are invited to serve on hospital committees to ensure that the consumer’s point of view, perspective, and experience are not only heard, but also integrated into the service and quality improvements that are engineered to ensure high-quality, customer-centered care. Through their unique perspectives, they give input on issues that impact care, ensuring that the next patient or family member’s journey is easier.

BENEFITS OF A PATIENT AND FAMILY ADVISORY COUNCIL For the Healthcare Organizations: Provide an effective mechanism for receiving and responding to consumer input. Result in more efficient planning to ensure that services really meet consumer needs and priorities. Lead to increased understanding and cooperation between patients, families and staff. Promote respectful, effective partnerships between patients, families and clinicians. Transform the culture toward patient-centered care. Develop programs and policies that are relevant to patient’s and families’ needs. Strengthen community relations. Recognize that collaboration with their providers through patient-centered care leads to better self-management of chronic conditions and improved adherence to medication regimens. For Patients and Families: Gain a better understanding of the healthcare system. Appreciate being listened to and having their opinions valued. Become advocates for the patient and family-centered healthcare in their community. Understand how to become an active participant in their own healthcare. Develop close relationships with other members on the council. Provide an opportunity to learn new skills (facilitating groups, listening skills, telling their story). ReferenceTaken from the following site:

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Post-Discharge Phone Calls

WhyPhysicians and nurses feel better when they know that patients understand and are executing accurately their discharge instructions. Unfortunately, research tells us this is often not the case. One study found that 81 percent of patients requiring assistance with basic functional needs failed to receive a home care referral, and 65 percent said no one at the hospital talked to them about managing their care at home. With readmissions reporting underway, we have now reached a critical juncture. Our industry is showing some improvement in HCAHPS and process of care measures, but we are certainly not “there” yet. The same is true of preventable readmissions: Progress does not happen overnight. It takes time and focused effort and that is why healthcare organizations need to strongly address this issue right now. 19.6 percent of Medicare patients readmitted within 30 days (That is 2 million patients!) 90 percent of the readmissions deemed unplanned Only 50 percent of those readmitted had seen their physician prior to readmission These readmissions estimated at $17.4 billion for one year (2004) Obviously, preventable readmissions are a critical issue with implications that go far beyond financial ones. Many patients are not even filling their prescriptions due to cost. After all, our patients are still our patients even after they are discharged. We naturally want to be confident they are receiving great care and continuing to heal outside the hospital walls. Yet, readmissions have been a persistent problem for a while now: As a nation we have shown little improvement in this critical patient care area. Data recently released by the Centers for Medicare & Medicaid Services (CMS) shows somewhat stagnant performance on hospital readmissions for heart attacks, heart failure, and pneumonia. Post-visit calls have always been about quality. We know they have an impact on HCAHPS and the patient overall perception of care. We find patients’ perception of their care is a byproduct of quality, and when their care is qualityand patient-centered, organizations achieve desired results and sustain the gains. Evidence proves consistently that when a patient receives a call post-discharge, we verify compliance and improve overall clinical outcomes. Patients also feel empathy from the hospital when they receive a touch point once they are home to ensure they are recovering safely. It also allows you to initiate service recovery if needed as well. Post visit calls, long proven to drive stronger transitions of care, are a proven tactic to improve clinical outcomes, impact the patient care experience, and reduce preventable readmissions. (Clark, Paul Alexander, et al. “Patient Perceptions of Quality in Discharge Instruction.” Patient Education and Counseling 59, no. 1 (2005): 56-68). POST-VISIT CALL BENEFITS Improves clinical efficacy Reconfirms discharge instructions Clarifies medication instructions Reduces patient anxiety Reduces complaints and claims Increases perception as a byproduct of high quality Improves Processes Increases revenue Harvests positive feedback of physician and staff for retention and recognition ReferenceTaken from

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Project RED (Re-Engineering hospital Discharge

The Project RED (Re-Engineered Discharge) training program was designed to help hospitals re-engineer their discharge process. Using the study modules and supporting materials, hospitals will become familiar with Project RED's processes and components, determine metrics for evaluating impact, and learn how to implement Project RED.

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Additional practices

Additional proven and emerging practices linked to patient experience and service excellence outcomes Sleep aids (e.g. headphones, ear plugs, soothing sound generators) Patient-friendly daily medication schedule and teaching cards on common new medications Communication tools for patients/families during their stay (e.g. notepads, white boards)

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