|Patient Experience Case Study - Barnes-Jewish Hospital|
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Improving Responsiveness to Meet Patient's Needs
What was the challenge, opportunity or issue faced?
The responsiveness initiative began as a part of the Goal Deployment Process at Barnes-Jewish Hospital. Responsiveness was one of the HCAHPS areas in need of serious improvement. One of the goals chosen by the executive team was to better our overall response to our patient needs by improving the HCAHPS domain Responsiveness. Specifically we wanted to improve call light and bathroom help on HCAHPS. In short, we were not always meeting our patient’s requests in a timely manner. We had been working on purposeful hourly rounding (PHR) for many years and needed to "hardwire” the process and gain staff understanding and buy in of the process. We wanted to cascade the goal to the staff in a manner in which they could positively impact our responsiveness.
What did you do to address it?
A responsiveness committee was formed in January 2014. The goal was to improve the HCAHPS responsiveness domain by 5 points. Best practice review showed PHR had a huge impact not only on responsiveness but on the PX in general. The committee began by doing a blitz assessment of hourly rounding on the various service lines (neuro, medicine, surgery and oncology). An assessment of how team members performed purposeful hourly rounding was done by accompanying them as they rounded. The shadowing showed that rounding practices were inconsistent across the house and team members lacked knowledge on how to perform PHR. An assessment of our manager rounding showed we were not consistently validating team member’s performance to assess if patients needs were met proactively when possible.
Our call light system was also upgraded allowing for notification and escalation of calls. Prior to this upgrade the approach on some areas was to alert the nurse to the patient need when Unit Secretary (US) saw them or a single page to the nurse which was sometimes lost in the shuffle if a second reminder was not set. This was quite a culture change and many staff resisted having the second and third call lights come to their paging device if the call was not answered. The next step in the process was to build accountability around the practice of the secretaries answering the call lights and setting a service reminder. Reports were available to managers regarding compliance. Managers could then work one on one with the US if problems arose. Goals were set and tracked by the manager about how many service lights would be set during the US shift. 90% was the agreed upon number the secretaries were able to set during a shift.
Once it became the norm to set the service lights, we worked on eliminating second and third call outs from the patients. Managers and Directors were having the call lights escalated to them if there was a third call out. This enabled them to dialogue with the staff to see why they were unable to answer lights and how the manager could help with this situation.
We also began our refresh of hourly rounding. In order to gain staff buy in we talked to some hourly rounding champions and did a man on the street video to enable staff to hear from peers. The champions talked about all of the following:
To validate that PHR was happening more consistently, managers began rounding to validate. Some of the managers took it one step further and began accompanying team members while they rounded to validate their performance and provide feedback and recognition as appropriate. Additionally, we began seeing frequent comments from our patients on our vendor survey about people checking on them hourly and being proactive about their needs.
What were the outcomes?
We improved our HCAHPS Responsiveness % Always from 58.30 to 62.46 from 2013 –end of 2014 which is significant change but did not meet the 5 point goal. We were able to maintain our % Always in 2015 despite some significant staffing challenges. The outcomes achieved were processes and technology being put in place in order to accurately measure responsiveness, team member performance and knowledge around PHR.
Our goal in 2016 is a 2 point increase in % Always on HCAHPS responsiveness with a 4 point stretch goal. In January of 2016 we began onboarding our new staff with the importance of proactively rounding on their patients. A majority of staff hired is new grads and they are being taught the importance of being proactive by meeting their patient needs and decreasing the number of calls they receive. We have done a refresh with all other staff and team members.
While we continue our refresh and immersion of the staff to PHR, we are working on additional measures as well. For example, two units trialed a phone which is answered directly by the team member when the patient calls. If they are unable to answer, the phone will be elevated to another team member, Lead Charge nurse or the front desk. The team’s trialing this phone provided input on how to enhance the phone and fine tune the process of answering the calls. The team’s trialing the phones have seen a marked increase not only in their responsiveness and HCAHPS scores, but in their overall quality of care scores. Due to the success of this program, we will be rolling out the phones house wide in the summer of 2016.
About Barnes Jewish Hospital
Barnes Jewish Hospital (BJH) is part of BJC Healthcare located in the St. Louis Metropolitan area. With 1,365 licensed beds, it is the largest academic teaching hospital in Missouri and has an academic partnership with Washington University School of Medicine. BJH has 9,620 employees including 3,347 RN’s and 838 Resident Physician and Fellows. It is ANCC Magnet certified as well as listed on the honor roll of best hospital on US News & World Report for 23 consecutive years.