|On the Road - Medical Center Arlington|
A Change is Gonna Come…
Creating the Foundation for Improving the Patient Experience at Medical Center Arlington
Jason A. Wolf
She started with focusing on simple weekly messages on the facility’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and patient satisfaction performance. The discovery was that most of the staff members were not fully aware of the scores, so there was not a sense of the challenges they faced or opportunities they had. By beginning to share the data in small, understandable chunks awareness spread across the organization, at first slowly, but then with increasing momentum. The reality for the team was not that they were incapable of better performance, but that many were unaware of where they stood.
The communication boards have been (and still are being) phased in throughout the facility. They provide a clear template for how all staff will communicate with patients and families. They also are monitored on the numerous layers of leadership rounding now in place (see below) and have become a focal point for consistent and reinforcing communication. The communications teams also recognized the need to specialize these boards for some of the departments with unique needs as exemplified in the picture of a board for the Emergency Department design to address anticipated time spent in the ED.
The story of the communication boards is not simply one of mounting nice white boards on the wall. Rather it exemplifies the thoughtfulness of the PPET and PI process at Arlington. Christi Nguyen, currently the Director of Risk Management for the medical center explained how the communication boards were not pulled from a standard catalogue. The team gathered the input from staff across departments in the hospital as well as patient focus groups to know what was important to them. Prior to deployment of these new tools, the team observed the current usage of existing white boards and provided training on usage and expectations before the new boards were mounted. Audits were done on the use of existing boards to ensure consistency before the new boards ever arrived. This intentional effort and building of a new practice was supported by an infrastructure of accountability.
The interdisciplinary rounding logs serve as a means for all staff that enter and leave a patient room to acknowledge and identify their interactions. These forms include information touching nursing, environmental services and food service and are required to be posted near the door of each room so they are easy to locate (and as Christi added, easy to audit). As Juan and I toured a few of the units we were able to see these forms in use. They were powerful communication tools and also a means to ensure key elements of the experience were being considered in every visit by any staff member to a room. The challenges that remain are consistent use and placement of the form, but are part of the ongoing reinforcement included in the rounding process and process improvement discussions.
It is also important to recognize the overall work of the PPET members themselves. As Juan Luna stressed, "It is the members themselves of the PI Teams, that are driving much of the change here at Medical Center Arlington.” Team members are actively engaged in efforts such as On-The-Spot recognition where members of the Cleanliness team recognize positive actionsor by being a part of the New Employee Orientation presentation (PI Team members are invited to share what it was like to be part of the teams and they engage in staff-to-staff discussion about patient experience being everyone’s accountability).Juan added, "We need to recognize that along with the leadership, it is important to have fire starters throughout the organization to build excitement and awareness around this. The members of our PPET do just that for us.”
This statement exemplifies how moving the needle for Arlington came down to a structure of engagement and accountability. From the engagement of staff in the work of the PPET, additional features for ensuring accountability were also implemented. These efforts included consistent executive rounding, director rounding and role modeling from leadership at all levels and ultimately led to a reinforcement of the expectations for all members of the Medical Center Arlington community.
Setting Expectations of Performance – Rounding and Walking the Talk
An important part of the Arlington story has been their ability to take simple concepts and effectively move them to action. While these tools and processes may be in place at many healthcare facilities, the unique and inclusive design process, the shared accountability and ownership that was created and then ultimately the engagement of leadership in reinforcing both action and outcomes have been the "perfect storm” of efforts to support success. Executive rounding was the starting place for this effort.
Executive rounding at Arlington, while not unlike rounding we see elsewhere, had an interesting twist – a rigorous and public accountability structure. Executive leaders complete and submit rounding logs and the progress of these round is reported weekly. The executive leadership team not only reviews the scores, but they actually see everyone else’s rounding progress. The power of this was palpable for Linda as she shared an interesting story. When reporting on one week’s score to the executive team, a significant number of questions arose as to why the scores were dipping. Questions of how this could be happening, where were we missing our efforts and other inquiries were posed. Linda then switched to the slide showing the tracking of rounding that week…the discovery being that the team had fallen off that week in their rounding efforts and the scores reflected this loud and clear.
"This was an ah-ha moment for all of us as leaders,” Linda stated. "If we can’t do this, how do we expect our directors or staff to do it consistently”. The team recognized that it was in their willingness to hold themselves accountable for this important effort that they not only had a great impact on scores, but they modeled the behavior expected across the organization.
The public display of rounding logs is a powerful commitment that is part of the growing director level rounding efforts being implemented as well. Transparency at Arlington is not simply about scores, but about a shared commitment to doing the simple and fundamental things well in order to ensure the best experience possible for patients. This is when what could be seen as the ordinary, can, and has in Arlington started to become the extraordinary.
Another addition to the leadership effort put in place pulls all of these initial efforts together. The leadership team now comes "ready to work” the last Friday of every month. Ready to work means they dress appropriately for the unit they will be supporting that day, from assisting nurses in the ICU to the CEO himself serving as a transporter in the Emergency Department. The leadership team works with staff in their roles, gets a sense of the day-to-day work, and engages directly in the most effective way of understanding the patient experience, by being at their side.
These leadership efforts provide an opportunity for leadership to walk the talk and show their commitment of the expectation that Medical Center Arlington be a place that provides unparalleled care and unwavering service to patients, their families and the growing region they serve. The efforts in combination with the initial steps outlined above do not represent taking on major culture change or driving an extensive patient experience effort by title. They have identified the fundamental pieces that needed to be put in place first to ensure a foundation for a greater patient experience and on which future plans can be built.
Laying the Groundwork for the Future
The power of the Medical Center Arlington effort may be the very simplicity mentioned at the outset. It also includes the rigorous commitment this new team has taken on to ensure a great place for care, a great experience for patients and a great place to work for staff at all levels. Arlington represents the many facilities asking themselves where to start and while their exact path may not be the one every facility need follow, the process represents an opportunity for serious consideration.
The efforts at Medical Center Arlington exemplify how focused action can lead to positive outcomes. In the short period of time since starting these efforts, Arlington is already seeing results. Their "top-box” (percent ‘always’) scores around their major efforts have all seen improvements from the end of 3rd Quarter of 2010 to today, almost 9 months later. Communication has increased from 75% to 79%; pain management has moved from 74% to 78%; and cleanliness has jumped from 66% to 78%.
So what foundations can your facility (or is your facility willing to) put in place on which to build your patient experience efforts? The tactics may be different, but the fundamentals should not be. It is about aligning leadership and people, establishing clear expectations and living to them at all levels. It is about transparency and ownership, consistent communication and accountability. With that, what was exemplified in this visit is that while simple in concept, it is not always easy. As in building new muscles there is pain and at times it is easier to stop than push through. Our patients deserve only the later…that we push through. Medical Center Arlington, while still early in their journey, is showing a great commitment to do just that.
As we wrapped up the day in Juan Luna’s office I looked up at his white board laying out their patient experience plan and saw the words "A Change is Gonna Come”, the title of the song by Sam Cooke. This was powerful as it represents a common theme that is continuing to emerge from my visits. Improving patient experience is not necessarily about large change efforts, but instead is about unearthing the passion that brings people to this work. When we do the things we know are right we can be assured that change is gonna come.
As Sam Cooke so eloquently wrote:
There been times that I thought I couldn't last for long
But now I think I'm able to carry on
It's been a long, a long time coming
But I know a change gonna come…
Change is definitely happening at Medical Center Arlington.
My greatest of thanks to the team at Medical Center Arlington for both their time and hospitality. I appreciate their willingness to share the early stages of their process and I hope this will inspire others to tell their "getting started” stories. It is through this sharing that we will make our efforts stronger and easier and continue to improve the patient experience together.
For more information on the efforts at Medical Center Arlington, you can contact:
Manager Guest Services
Medical Center of Arlington