Posted By Martie L. Moore,
Sunday, November 1, 2015
Updated: Monday, November 2, 2015
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"The one thing all children have in common is their rights. Every child has the right to survive and thrive, to be educated, to be free from violence and abuse, to participate and to be heard.”1 - Secretary-General Ban Ki-moon
As a former pediatric nurse and expert witness for child protection services, I’ve spent a lot of time caring for children in the hospital and home setting. I know one of the greatest things I’ve learned is that we as caregivers can empower children during difficult situations. The need to support the wellbeing of children extends beyond healthcare: It is a universal initiative.
Universal Children’s Day on Nov. 20—unlike the traditional Mother’s Day or Father’s Day recognized in the United States— was established by the United Nations General Assembly in 1954. All countries are encouraged to promote not only mutual exchange and understanding among children, but also to initiate action to benefit and uphold the wellbeing of children around the world.
Children in the U.S. may not always face the same frightening conditions as elsewhere in the world. But this day helps us to remember that we as clinicians still have a responsibility to create an atmosphere that supports the children under our care. We know that the less stress and anxiety a child has, the better their ability to cope in a stressful situation. Hospitalization is one of the stressful situations that we can do something about.
Improving patient experience is already a major target for hospitals, and hospitals are measured and paid based on HCAHPS surveys completed by adult patients. In October 2014, the Agency for Healthcare Research and Quality posted a pediatric version of the HCAHPS survey. This pediatric survey is under review this year as a possible benchmark on which to base hospitals’ Medicaid and Children’s Health Insurance Program reimbursements, leading to the expectation that this pediatric HCAHPS survey will ultimately factor into reimbursement as the adult equivalent does now for Medicare.2
Now is the time to be thinking about how to address this special population. The ways you care for children in your facility can go a long way toward producing a positive experience for both the patient and their loved ones.
Make the Hospital A Safe Place for Children
We all know hospitals can be a very scary place for anyone, let alone children. A child doesn’t know what to expect, and is constantly meeting new strangers. He or she may not understand what’s happening to them. They could be experiencing pain from their illness, the treatment, or both.
So how do we make the hospital a place where a child can feel safe, participate, and be heard? You can make a big impact with small changes: Start with what they’re wearing. Pajamas are a great source of comfort, and while the child’s personal pajamas may not be an option, your facility can still stock pediatric gowns that promote comfort and modesty, have kid-friendly prints, and feel soft like the pajamas they may wear at home. Consider pediatric gowns with MRI-safe plastic snaps that negate multiple gown changes.
While using pediatric gowns that evoke the comforts of home, also be sure that a child’s hospital bed is a safe place. Avoid performing any painful treatments while they are in their hospital beds so that it remains a haven that they can trust.
You can also help by communicating directly with your patients. Talk to them, not at or above them, so they understand what is happening. Speak at their level, both intellectually and physically, crouching or sitting down to look them in the eye.
You may even choose to draw pictures to help demonstrate what is going on inside their bodies or a treatment they are about to experience. Many children "play nurse or doctor” at home; offer to let them participate in their care by holding the stethoscope, counting with you for their pulse or heartbeat, or perhaps picking a favorite color for a bandage or cast. Your conversation may also help distract them from their pain. The fun prints on their gown featuring friendly animals or characters could be a conversation starter in itself. Ask them about pets, sports, movies, or their funniest joke. A good belly laugh does wonders for the soul!
Good communication involves good listening. Take the time to hear what a child says to you. You could learn that something as simple as a special toy or a quick trip outside for some fresh air could make him or her feel better.
Listening and observing may also help you uncover any signs of abuse. If you observe these signs, stay calm and report the suspected abuse immediately per your facility protocols.
You Make a Difference
Every day, clinicians make a big difference in the lives of the children they care for. Make yours a good difference. Delivering extraordinary care to our children can change lives, helping them grow up to be healthy and successful adults who can protect the next generation of youth around the world.
1. Universal Children’s Day. Available at: http://www.un.org/en/events/childrenday/. Accessed October 15, 2015.
2. CMS may use new child HCAHPS to adjust Medicaid hospital pay. Available at: http://www.modernhealthcare.com/article/20150108/NEWS/301089948. Accessed October 15, 2015.
Martie L. Moore is chief nursing officer of Medline Industries, Inc. based in Mundelein, Ill, a leading provider of medical products and clinical solutions across the continuum of care. In this role, Moore provides nursing leadership for solution-driven clinical programs, delivers product development to enhance bedside practice and launches quality initiatives across the continuum of care. With what she learned during the nearly 30 years of clinical experience and extensive executive leadership, Moore now develops forward-thinking solutions and programs for those in the field today.
Posted By Paul Westbrook,
Thursday, June 4, 2015
Updated: Thursday, June 4, 2015
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The etymology of the word hospital indicates that it derives from two rather divergent concepts. The first is the Latin hospes, from which we get warm words like "hospice”, "host” and "hospitable.” The second, also from Latin, is hostis, the root for the rather alarming concepts like "hostile” and "hostage.” As the saying goes, "There’s a thin line between love and hate.” For us in the hospital profession, perhaps we also walk on a thin line.
In my work with a renowned healthcare system in Northern Virginia, I noticed that there are day-to-day elements surrounding us that seem both hospitable (hospes) and hostile (hostis) in the care environment. Hospitable concepts include ideals: emotional connection, welcome, compassion, service, intrinsic joy, extraordinary care, empathy and excellence. Seemingly hostile topics include realities such as: regulatory pressure, profit preoccupation, command and control, task driving, growth planning, provider centrism, compensation concerns, and too many patients and not enough time. Perhaps on any day, we might forgive ourselves when instead of acting as hosts, we catch ourselves treating our patients as hostages. When even small feelings of hostility supersede a spirit of hospice and warmth. Maybe and simply that’s the human nature inherent in the nature of care.
I came to healthcare from 27 years’ executive service with Ritz Carlton and the Marriott Corporation. In the hospitality industry, hospes should always prevail, yet often doesn’t. Again, human nature. Over the past three years, I’ve had the privilege of leading the transformation at Inova Health System in its desire to achieve patient experience excellence. The commitment, collaboration and the results are inspiring, yet have not been without their challenges.
Central in this transformation was our focus in examining 5 key work streams: Culture, Communication, Human Resources Process, Leadership Development and Service Excellence and inculcating these with hospitality principles. As noted, in our introspection, we found both hospitable and hostile elements, both the hospes and hostis.Again, human nature inherent in the nature of care.
Given the power of human nature and our propensities, especially under the many pressures that we face each day both on the business-side and the care-side of healthcare, how do we keep ourselves focused to "deliver the unexpected,” to provide "extraordinary care” and to experience transformation expressed in "service excellence?” At its base, perhaps such service requires a spirit of genuine intentionality, and if I can borrow a word from the hospitality industry, maybe it takes a spirit of "Concierge,” which etymologically means to act "with service.”
Hospitality and hospital share the same linguistic roots. Hospitality principles like making emotional connections, individualizing service, recognizing and celebrating success and striving for service excellence guided us at Inova in our transformation. Integrating these hospes ideals into our work streams helped us gain immediate and sustained patient experience success.
*This is the first piece of a special three-part guest blog series focusing on various components of patient experience excellence, including patient and family care, culture and leadership and employee engagement.
Paul is the Vice President of Patient Experience at Inova Health System. Prior to joining Inova, Paul began his service delivery consulting company, Westbrook Consulting, LLC, with the mission of transferring his 35 years of hospitality service in branding, strategic deployment, and operations to other service industries, to give back to his community and make a meaningful difference in peoples’ lives. Paul is also part of The Beryl Institute's Patient Experience Executive Board.
Posted By Suzanne Steidl,
Thursday, March 5, 2015
Updated: Thursday, March 5, 2015
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For patients and families, remembering hospital experiences can be like remembering relationships —we recall the good and forget the awful. If the food was surprisingly good and the nursing staff was especially nice then it was a good experience; the bad is forgiven and forgotten or not acknowledged at all. Our experience surveys always arrived while I was in the throes of managing my mother’s illnesses and recoveries at home: I didn’t have time to do them and mostly forgot the details anyway. I had bigger fish to fry. So when I see a billboard declaring that a hospital is #1 in patient satisfaction, I have to wonder.
I’m emerging from six years of caring for my mother who was frightened into quadruple bypass surgery at age 82 despite the fact that her Parkinson’s disease was advanced. In addition to infection that required readmission, the surgery and recovery accelerated her Parkinson’s progression. Given encouragement and time to talk with her far-flung children before agreeing to immediate surgery, she may have thought about how she preferred to live out the rest of her life and decide against it. But she didn’t and she extended her life eight years, uprooting me from my home 1,000 miles away and challenging me to endlessly figure out, mostly on my own, "what do I do now”? I’ve experienced the continuum of care all the way to more than a year of corporate hospice care—I don’t recommend it—and getting zero information about alternatives to nursing home placement. My mother died in August, incapacitated and demented.
I don’t know what I don’t know so I depend on the experts to create processes and materials to help me make good decisions and to maneuver this often incredibly frustrating, difficult and potentially dangerous system.
My mother couldn’t function without her Parkinson’s meds and, until I wised up, they did not follow her from hospital to rehab. Early on, no one ever told me that there would be a medication gap so it became my job to remember to provide them. At discharge, everyone is given the same instructions regardless of our ability to retain information or foresight to take notes. For some, it takes courage to question or ask the discharge planner to slow down and clarify. Others are functionally illiterate. There’s an awful lot to organize. And who really has time or the will to read brochures when caregiving demands consume us? Not me.
Then there’s the home medical equipment. The guy who drives the delivery truck quickly explains how to operate the equipment. He’s always in a big hurry and doesn’t have printed material. Once, an oxygen concentrator was delivered and I was not instructed to fill it with distilled, not tap water or clean the filter. Filter? The alarm sounded the first night, I didn’t know why. I could go on.
I should know better. That I do not really troubles me. If I were an 80 year-old tending an antibiotic infusion pump at home, I don’t know what I’d do.
Maybe some facilities consider discharge planning and home care to be part of the patient experience that’s tracked and enhanced. That’s not my experience but I surely wish it were.
Suzanne Steidl is the founder of Your Daughter’s In Town: Health Advocacy for Elders. She is an advisory board member of the Healthcare Technology Safety Institute (HTSI) of the Association for the Advancement of Medical Instrumentation (AAMI) and is working to simplify DME Instructions for Use and streamline hospital to home processes. She is a member of The Beryl Institute.
Continuum of Care
Posted By Joel High,
Thursday, September 18, 2014
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It’s on all of our minds. It keeps us up at night. HCAHPS scores are not improving (or at least not fast enough). Value Based Purchasing is becoming more and more established. The competitor across town just remodeled their patient rooms and are wooing our patients their way. Employee morale and engagement are stagnant or declining. To top it off, your board members and CEO are demanding action.
Is this a worst case scenario? Perhaps. However, improving patient experience tops the list of strategic priorities for many health care organizations around the country. Medical school, nursing school, nor business school has prepared today’s healthcare leaders to manage, much less improve, the patient experience. A common misconception is that improving patient experience is a huge and complex undertaking, but in reality, improving patient experience doesn’t have to be complicated. In fact, in many ways it’s simpler than you think.
During my years working across the continuum of healthcare including hospice, long-term, acute care and now as a Patient Experience Improvement Coach, I have seen some simple and inspiring ways that healthcare organizations have improved the experience for patients and their loved ones. I share two examples of easy to implement initiatives below.
Every Patient Is My Patient
At a community hospital where I served as the Patient Experience Lead, we implemented an innovative patient experience program called "Every Patient Is My Patient” in response to declining HCAHPS scores around staff responsiveness. The program hinged on the philosophy that every employee and volunteer has an impact on the patient experience. The ask: Employees and volunteers were expected to respond to call lights immediately if they noticed one illuminated. Although it was known that on occasion there would be needs that fell outside of the expertise of the responder, we believed that the impact of responding to the call light right away would be important to patients and would communicate that the organization cared about them.
What we found was that the "Every Patient Is My Patient” program reaped immediate and sustained improvement in the patient experience and an increased level of team member accountability. In less than 6 months, this simple initiative resulted in a 5% increase in HCAHPS scores around staff responsiveness.
Through The Voice of Our Veterans
By leveraging insights gleaned from real-time patient feedback and improvement coaching support, one of our Veterans Affairs partners found that Veterans were having a difficult time finding their way to their appointment, securing post-discharge assistance and basic post-visit transportation services. Faced with these issues impacting their patients, a Roaming Ambassador program was put into place. The Ambassadors main objective: seek out Veterans who appear to need assistance and offer to assist. This was contrary to the traditional approach of having Veterans looking for assistance. The Ambassadors assist Veterans through every aspect of the discharge process and ensure that the needs of each veteran are supported. Comprised of volunteers and work study students, the Roaming Ambassadors worked weekdays with a team of about 30 on rotating shifts. To make the Ambassadors more visible to Veterans and others visiting the facility, donated funds were used to purchase Navy blue vests which on the back read "The Price of Freedom is Visible Here.”
The result of the initiative paid off with Veterans raving about the great service of the Ambassadors. This simple approach has made a big difference in the patient experience at this medical center and has helped create a more warm and inviting atmosphere at the medical center.
Creating an exceptional Patient Experience in today’s healthcare marketplace is extremely important. Everyone within the organization should be focused and committed to delivering an exceptional patient experience. Similar to a rowing team, progress becomes easier when all of the team members are working together towards the same goal. It doesn’t have to be complicated. Quick wins that sustain are possible with focus and attention.
Joel High, MDiv, MBA is a Performance Improvement Coach with TruthPoint. Joel’s passion is in helping healthcare organizations to transform their culture and create patient centered processes and practices. Joel has been engaged in patient centered care and patient experience work at both locally and nationally for more than a decade.
Posted By Bernadette Brady,
Friday, May 24, 2013
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I know that the patient experience is about individuals as much as the organisation. I also
know that in some organisations there are individuals who come up with really
good ideas to improve the patient experience. Visiting a local hospital some
months ago I walked past an enclosure containing birds and lizards. The bird
song was piped into the corridor so as you walked along the corridor you could
hear the birds chirping. It made me smile. There were individuals standing at
the enclosure just having a quiet moment. Each time I visit there are people
just enjoying the difference this enclosure brings to the usual hospital helter
skelter. Often there are children there who are kept entertained while their
parents make phone calls.
This enclosure was the
brainchild of the gardener. He roped in the electrician to help. Together they
have built the enclosure, lobbied for financial assistance to stock it and feed
the occupants and continue to maintain it. They are very proud of their
Alastair is the gardener at Calvary Health Care in Canberra,
Australia. Calvary is a fully accredited 250 bed public hospital. Services on
this campus include emergency department, an intensive and coronary care unit,
medical and surgical wards, a maternity unity, a voluntary psychiatric ward and
ambulatory care and outreach facilities and services.
There are many visitors to this hospital each day, some of
whom are fearful for themselves, some of whom are fearful for people they love.
Hospitals are not somewhere we chose to go to.
Alastair has, over many years, tried to provide areas within
the grounds of the hospital that will allow people to smile, to linger, to
revive. His greatest venture to date though is an enclosure that is situated
adjacent to one of the hospital’s busy thoroughfares. This enclosure takes up
an open air space enclosed by three walls and the glassed corridor. Alastair
has turned this area into an aviary with fish and lizards in the undergrowth.
The aviary is evident to all who walk these corridors. It provides a focal point for all who walk
along the corridor.
Initially Alastair introduced some lizards, fish and a
couple of quail to the enclosure but the crows kept taking the fish. That was
when Alastair enlisted Eric’s assistance. Eric is the hospital electrician. He
helped Alastair to put a net over the enclosure to keep the crows out. This of
course meant they could keep birds in.
The Facilities Manager approved payment for the netting and
the social club provided $220 towards buying birds.
About this time Eric saw an ad in all classifieds for
finches for sale for $2 each. When he rang to say he would "take the lot” the
person selling the birds asked why so many. When he heard where the birds were
to go he donated "the lot”. Another man when he heard what they were doing
donated quails. One man was overwhelmed by the aviary. He donated lizards.
Alastair and Eric have
been impressed by the generosity of local businesses and the community in
supporting their project. One woman donated speakers, a microphone and
amplifier box so the bird song could be heard in the corridors. She then sent
her son to install the equipment.
Alastair gets joy from the
number of people who linger at the window. "There are always people standing
there I have many thank you notes, We get to know the people who are coming
into the hospital regularly. One particular lady who comes to chemo twice a
week told me that coming to chemo she has a smile on her face and on her way
out she has a triple smile, just listening to the birds.”
For Eric "it is about making it easier for the people who
have to come here or the staff who just need somewhere to go and reflect
sometimes. We love watching the reactions.”
one man’s desire to make a difference to patients a community has been formed
with a common goal – to improve the patient experience.
Bernadette Brady, member of The Beryl Institute, has 40 years experience in the Australian health sector as a registered nurse, manager and change agent. She now works with health facilities to improve their knowledge of the patient experience and partnering with patients.
Calvary Health Care