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Patient Experience Case Study - Maple Grove Hospital
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Improving Pain Management through a Process and Culture Change

What was the challenge, opportunity or issue faced?

In 2011, Maple Grove Hospital’s (MGH) Director Team challenged the hospital leadership to improve performance of the Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) scores around pain management. With monetary incentives tied to HCHAPS through Value Based Purchasing and the increasing consumer awareness and transparency of patient satisfaction, organizations must dedicate time and resources to improve scores. Leadership chose to address pain management through a process of hardwiring pain assessment and culturally through engagement of staff in thinking of the comfort in each patient and family’s experience at MGH.

What did you do to address it?

Process
Traditionally, pain management has been considered a clinical focus and had process improvement initiatives around pharmacological interventions and nursing practice. With this in mind, a Pain Management Team was created to address pain management with an understanding that each and every patient has a right to the assessment and management of pain. The team developed policies and procedures which address the organization’s expectations of pain management, introduced new PCA and PCEA pumps and began to think about holistic approaches to pain all in support of their mission and philosophy of care.

A key driver in improving pain management has been the creation of a nursing checklist for real time evaluation of a patient’s pain. The checklists require that every patient admitted to the medical-surgical unit at MGH establish a comfort goal. This goal is discussed at shift report and daily team care rounds. Nurses at the bedside are asked to document interventions (pharmacologic and integrative) to close the gap between current pain scores and comfort goals. Current alternative interventions include dim lighting, positioning, hot and cold compress, and other therapies. Pain scores, comfort goals and interventions are documented at every shift throughout a patient’s stay all with the hope to close the gap between the pain the patient is experiencing and the comfort he/she wishes to feel. The tool has created a sense of accountability and created opportunities for great conversations between physicians, nurses, patients and families.

Analysis of the checklists is done by the hospital’s Clinical Effectiveness department and reported to the pain management team at monthly meetings. Since the implementation of the checklists overall gap scores have been reduced by close to 50%.

Culture
In 2010, Maple Grove Hospital launched the Patient Experience Advisory Team (PEAT). PEAT is a multidisciplinary team that seeks to create the best experience for every single patient and family and cultivate a workplace where everyone knows they have a role in patient experience. This is a unique opportunity for frontline staff, leadership, physicians and patient representatives to see the impact that every individual has on the patient and family experience.

PEAT members were asked to think about the pain management innovatively and as a patient experience measure. The team used the HCAHPS composite scores to drive the initial conversations of pain management: "During this hospital stay, how well was your pain well controlled” and "During this hospital stay, how often did staff do everything they could to help you with your pain.” This team of materials management, guest services, respiratory therapy, housekeeping and others were challenged to seek solutions and innovations that keep patients and families involved and at the center of care delivery.

Through several break-out sessions, conversation shifted toward thinking about pain a measure of reduced anxiety and comfort. A member of the environmental services noted she always asked the patient if there is anything else they needed after cleaning the room, and asked if they were comfortable. From this discussion, a new awareness surfaced that every single patient and staff encounter should end with, "Are you comfortable?” The campaign began to become engrained into the fabric of the culture and is known to staff as "RUC.”

What were the outcomes?

Since February 2011, the team has thought about pain in a new ways and as a true measure of comfort, asking every patient, at every encounter, "are you comfortable?” At subsequent meetings, the team explored comfort in other industries (hotel, airline, business) to understand what a comfortable and healing environment meant to the patient. The team recognized that comfort means something different for every person. For someone in the emergency care center it may mean a warm blanket and dim lighting, for a mother in labor it may mean calming music or a different position and for a surgical patient it may be a cold compress.

The PEAT members, Pain Management Team and leadership have infused RUC throughout the organization. Each staff was given a "RUC” button to wear. It has become a part of the uniform. Many patients and families ask, "What is RUC?" Seeing individuals completely removed from bedside care, such as security, be engaged in the project, recognizing that offering someone a wheelchair, or calming an anxious family member, contributes to the comfort of the patient care experience has been a remarkable experience for the organization.

As a hospital, Maple Grove has raised its HCHAPS pain management composite score from 66.5 in February 2011 to 76.5 in November 2011 and currently are at 79.6 September 2013. This is a remarkable improvement. "RUC” was a product of the innovative thinking of engaged and enthusiastic staff and had led to tremendous success. It was the combination of the cultural embrace of comfort and the dedicated attention to the process of pain management that has made the program successful at Maple Grove.

Watch the employees talk about the culture at Maple Grove Hospital.


About Maple Grove Hospital
Maple Grove Hospital opened in 2009 with 90 beds and has increased to 130 beds to meet the growing needs of the community. Through partnerships with North Memorial and Fairview, Maple Grove Hospital has created a new approach to health care – where patients and families are at the center of not only what we do but how we do it.

At Maple Grove Hospital, we inspire each other to give our patients and their families’ compassionate, remarkable care. Together, delivering health care as it ought to be is our vision and helps us to consistently strive to provide the best quality of care in a safe and healing environment.

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