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Case Studies provide real stories of current efforts, including programs being initiated, practices being implemented, and outcomes being targeted and/or achieved. Case studies are presented as both an opportunity for learning from others as well as a spark for further ideas on how we work to improve the patient experience. If you have a case study to share please contact us.
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Teamwork, Communication, Safety Culture and the Patient Experience: What’s the Connection?
What was the challenge, opportunity or issue faced?
In 2010, Elmhurst Memorial leaders made a commitment to improve their teamwork and communication performance among their providers and staff in their Emergency Department (ED). The hospital was preparing to move to a new facility in 2011 and believed that ineffective teamwork and communication was negatively impacting efficiency, quality, patient safety and patient satisfaction.
What did you do to address it?
Elmhurst leadership partnered with HTT in September 2010 to discover opportunities to improve teamwork and communication that would result in a culture of safety, patient engagement, staff engagement and patient satisfaction. Elmhurst formed a change team consisting of multi-disciplinary leaders from within the ED with the Chief Nursing Officer (CNO) serving as the executive sponsor. The change team developed a comprehensive, system-wide long term improvement and sustainment plan that would guide the organization through implementation and build the organization’s internal capacity to sustain and continuously improve their team performance.
HTT conducted an in-depth needs analysis and correlated all available ED data including patient culture surveys, patient satisfaction and quality measures. Coupled with an intensive on-site assessment, observations and focused interviews of staff and patients, HTT identified opportunities for improvement in environmental conditions, measurement and evaluation of related metrics, staff engagement, patient engagement, leadership, teamwork and communication.
Although many organizations may view improvement in patient satisfaction, quality and patient safety as disparate or unrelated, new evidence between safety culture and the patient experience of care measures indicates a strong relationship (Sorra, et al., 2012). In fact, the strongest connections exist between staff perceptions of ‘teamwork within units’ and the patient’s perception of care related to the ‘responsive of staff’. This suggests that patients are able to recognize good teamwork or the lack of it.
This evidence indicates that a positive change in safety culture leads to a positive change in the patient experience of care related to the HCAHPS survey. Change the culture; change the patient experience. Immediate goals for the change team included the development of their own leadership skills, engaging all staff in improvement efforts and establishing a new climate within the organization including:
- Team centered, collaborative care
- A work environment that is collegial, supportive and appreciative; where trust is valued
- Acknowledgment that all providers and staff are important members of the healthcare team
- A common language for effective teamwork and communication
- Transparency and timeliness in the sharing of critical information across the team
And a new pledge to patients that included:
- Engaging patients and families with practices that foster enhanced communication and patient-centered care and care coordination
- Improving patient satisfaction by timeliness, sensitivity to personal privacy and attention to patient comfort.
- Engaging all patients and families in a professional and courteous manner at all times.
HTT then worked with leadership to design and implement a staff driven improvement model as follows:
- Implemented a unit change team structure within the organization that supports transparency of information, accountability and tangible support from senior leadership. This is accomplished by determining unit specific goals, developing and prioritizing actions, monitoring improvements, reward and recognition and sharing successes.
- Interpreted baseline assessment data to focus and prioritize improvement objectives including the identification of key competencies and behaviors required to achieve improvement aims.
- Utilized a train-the-trainer/train-the-coach model to provide all staff with the core teamwork and communication skills needed to transfer new behaviors to the frontline of care. HTT used the evidence-based, public domain TeamSTEPPS® – Strategies and Tools to Enhance Performance and Patient Safety curricula to drive the change. Additional tools like the ‘3Ws’ were leveraged to encourage patients and families to become integral members of their care team (Perez, 2008). The 3Ws include: Who I am; What I’m doing; and Why I care; to promote structured patient engagement.
- Provided coaching to the change team to develop confidence and competency in change management, process improvement, simulation, coaching and reflection with their staff.
- Developed and implemented story-based simulations to ensure learning transfer, innovation, real-time application of new tools and processes and a culture of continuous improvement using the StoryCare® online system (www.storycare.com). Stories have been shown to enhance the learning experience and improve retention of key concepts.
- Collaborated with the change team to create and implement methods and processes required to evaluate critical success measures.
Elmhurst ED Director Kathleen Delapaz reported that the use of stories with the frontline team at regular huddles resulted in rapid changes in behaviors. "At the time we presented the StoryCare® medication story at a team huddle, I was receiving multiple emails a day from pharmacy regarding staff removing medication under the wrong patient name from the Pyxis. Before StoryCare®, I had routinely been receiving three emails a day; now I am receiving three emails a week at most. I now have weeks where I receive NO emails from pharmacy. It is tangible evidence that we are able to quantify the impact of using stories to improve performance.”
What were the outcomes?
As a result of this work, the Elmhurst team transformed their capacity to change not just to train; making improvement continuous and sustainable in 15 months. The following is a list of improvements attributed to the intervention:
- 80% reduction in medication related patient safety events
- Observed patient engagement team performance improved by 25%
- Observed TeamSTEPPS® skills improved by 23%
- Statistically significant improvement in Safety Culture in 11 of 12 composites
- Improvement in handoffs and transitions of care by 18%
- Length of Stay reduced by 30 minutes as a result of cross-team coordinating huddles
- Outperformed ED averages for patient satisfaction during facility transition
About Elmhurst Memorial
Elmhurst Memorial Hospital, located in Elmhurst, IL, is a 340 bed not-for-profit corporation that has been serving Chicago’s western suburbs since 1926. Elmhurst Memorial is an acute-care hospital that annually admits 15,300 patients, performs 12,000 surgical procedures, 1,500 deliveries and has over 43,000 Emergency Room annual visits. There are over 2,000 employees at Elmhurst Memorial Hospital, including 72 affiliated physicians.
Since 2004, Healthcare Team Training (HTT) has provided patient-centric improvement services and products to civilian, government and military healthcare clients in 17 countries. HTT has provided implementation support for the TeamSTEPPS® program to over 450 clients to improve patient safety, quality and patient satisfaction. HTT supported the development and delivery of TeamSTEPPS® with the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense Military Health System from 2005 – 2011. HTT developed the web-based StoryCare® system with IDEAS – The Innovation Studio of Orlando, FL. StoryCare® is an easy-to-use, team simulation system designed to drive rapid and sustainable organizational change and innovation at the frontline of care using the power to storytelling.
1. Sorra, et al. (2012). Exploring Relationships between Patient Safety Culture and Patients’ Assessments of Hospital Care. Journal of Patient Safety, 8(3), pp. 131-139. Accessed September 21, 2012 at http://journals.lww.com/journalpatientsafety/pages/default.aspx.
2. Perez, O. (2009). The Patient Experience – A Guide to Creating Meaningful Patient Experiences in Every Healing Encounter. Florida Hospital. Orlando, Florida.
3. McDrury, J. et al. (2002). Learning through Storytelling in Higher Education: Using Reflection & Experience to Improve Learning. Dunmore Press Limited. London.
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Related Body of Knowledge courses: Organizational Effectiveness.