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On the Road - MacNeal Hospital
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Investing in the Patient Experience by Investing in People


On the Road with MacNeal Hospital

Deanna Frings and Stacy Palmer
May 2013

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When we arrived at MacNeal Hospital for the latest On the Road with The Beryl Institute, we were greeted by a huge banner on the side of the building reading "Our Hospital is a Magnet for Excellence in Caring.” MacNeal had recently received Magnet status, the highest honor from the American Nurses Credentialing Center. As we began our day at McNeal, it quickly became apparent how much their Magnet Journey of five years influenced their patient experience culture. The successful Magnet process resulted in a more aligned commitment to patient centered care and a deep awareness by both leadership and staff that it really is all about the patient.

MacNeal is one of four hospitals making up Unity Health Chicago, part of Vanguard Health System. MacNeal provides a great example of the value in creating a focus on patient experience which has been implemented at the other facilities in the Chicago market – Weiss Memorial Hospital, West Suburban Hospital, Westlake Community Hospital and River Forest Medical Campus.

Sue Murphy and Julie LinkOur gracious hosts for the visit were Sue Murphy RN BSN MS, Market Vice President of the Patient Experience for Unity Health Chicago and Julie Link RN MSN MBA CNOR, Director of Patient Experience at MacNeal Hospital. Both demonstrated deep passion for addressing patient and staff satisfaction and an understanding that creating a culture of caring goes far beyond implementing tactics, and requires unwavering support from leadership. They feel honored and blessed to do the work they do and to have the ability to impact staff, patients and the community. As Murphy stated, "It’s what I love doing. The patient experience journey is worthwhile work that touches many."

That pride also showed through from Link as she opened our day by sharing a program MacNeal recently implemented called Care for the Caregiver. The program, launched with the help of a Seven Pillars Grant, provides support to help second victims, members of the front-line health care team involved in or exposed to an adverse outcome with a patient. The program trains staff to confidentially reach out to those who may have been emotionally traumatized after an event and simply check on them – make sure they are eating and sleeping, and see if they need a listening ear. As Carol Hafeman, MacNeal’s Director of Safety and Risk Management, stated, "I love this program because it shows our commitment to taking care of employees so they can better take care of patients.”

The MacNeal team first learned about Care for the Caregiver at an Institute for Healthcare Improvement Conference, and was inspired to bring it to their facilities. It’s a wonderful reminder of the importance of taking care of staff emotionally, and was a fitting introduction to the values and priorities of this team.

Leadership Support Critical to Success

The commitment from the top was also evident right away at MacNeal, and Murphy gives much credit to the executive leadership team who supports the consistent message and processes to interject the strategy of constantly asking – "what would the patient think, what does it look like from the patient’s perspective?”

Unity Health Chicago CEO and President William T . Foley also has a vision for the Chicago market and a commitment to making sure a dedicated role for patient experience existed. This is Murphy’s role. The teams embraced the concepts of shared decision making with a strong belief that to change the culture you need to include the people delivering care. That focus on engaging front line staff was prominent throughout MacNeal and rest of Unity Health Chicago and remains a guiding principle today. It was an evolution to show employees how very much even the small things matter.

Engaging Staff at all Levels

Murphy admits it took some trial and error to learn how to fully engage staff and change the culture, "We tried telling staff ‘do this,’ we tried telling staff ‘others say we should do it’ and then we learned we must include them in the decision making process and help them understand ‘why’ we should do it.”

It is also about consistency. We met with Kathleen Benjamin MSN RN NE-BC, MacNeal’s Chief Nursing Officer and a firm believer that setting a tone of service within a culture requires constant reinforcement. "We must interject the importance of service at every opportunity. That includes having our CEO speak about it at orientation, making it a part of daily huddles and supporting Julie’s visibility within the organization,” said Benjamin.

Benjamin also acknowledges that middle managers are key. They must be provided with the tools and support to perform their roles and effectively lead their teams. They need to understand staff engagement and be passionate about spreading its importance.

Another example of staff engagement is the multi-disciplinary council MacNeal implemented that went beyond nursing to help define what a culture of excellence looks like. The council participated in a mind mapping exercise to brainstorm what patient experience is and what it takes from the staff to achieve. Note: this collaborative practice was also implemented by Unity Health Chicago’s parent company, Vanguard Health, when its CEO, Charlie Martin, engaged front line staff to develop its company vision – One Vanguard. By bringing together a cross-functional team for a 2 ½ hour session of creative thinking, mind mapping, and bonding, he engaged staff at all levels in creating and supporting Vanguard’s corporate vision.

The system also embraces a transformational leadership model reinforcing to staff that "YOU” are in the middle. The model is reinforced by a leadership development program now in place at all four facilities and including 292 leaders, directors and above. It follows the samed shared governance process of the Magnet program that was successful with nursing, but spreads it through all departments. The program ‘widens the net’ so the entire leadership team hears about service, increasing accountability and engagement. It is executed by Human Resources and other key leaders and reinforces the shift from giving information to truly training leaders. Initial focuses included helping leaders to engage their staff in the ‘why’ of what they do and training them to find champions in their departments to help spread the desired culture.

Another way MacNeal engages cross-functional teams for input and ideas is with its Patient Experience Committee. The group, started by Murphy and now led by Link, is currently working on noise reduction efforts. In a wonderful example of how simple and cost-effective an impactful idea can be, the committee is in the process of providing noise kits to all floors within the hospital. Equipped with such things as WD-40, pen lights and quiet signs, the kit helps each floor realize the simple actions they can take to reduce noise for patients and their families.

Unity Health Chicago also realizes the importance of creating fun, engaging places for employees to work. Afterall, working in healthcare can be emotionally and physically draining at times. Having some light-hearted, friendly activities to enjoy can help bond teams and refresh and recharge all staff. A simple, yet powerful example of an employee engagement activity was Unity Health Chicago’s ‘Spring Fling’. It shows that it doesn’t take a large budget to make big strides. Employees were encouraged to decorate their areas around spring baseball. Management passed out pizza, peanuts and prizes. Departments also shared patient experience stories, giving them a chance to share their successes and be motivated by others.

Evidence-based Tactics

Murphy acknolwedges that patient experience success ‘is about much more than tools.’ Creating a culture of service supported by leadership is critical. Then, pairing specific, proven tactics with the engagement of employees makes for a solid foundation. Some evidence-based tactics proven valuable at Unity Health Chicago include:

  • Bedside Handover
    We had an opportunity to walk through several patient floors while at MacNeal and to interact with multiple staff members. We were especially excited to hear one nurse rave about the bedside handover process. She stated, "I can tell patients feel safer when we do this. It shows we care about them and their transition. They appreciate hearing me talk to the person who’s taking responosibility for their care right in front of them. They know we are communicating and that reassures them.”

  • Hourly Rounding
    Nurses are taught to not only tell patients (and family members) they will check on them every hour, but to also explain why. They reinforce, "I care about you and I want to be sure you are safe.”

    Leaders have learned not to simply ask, "Are you rounding every hour?” but to dig deeper and focus on what nurses and patient care techs are doing when in the patient rooms. Are they asking the deliberate questions? As MacNeal Director of Education, Chris Carsten commented, "So much can be picked-up through causal conversation when our team knows how to appropriately follow-up with additional questions.”

  • Nurse Leader Rounding using iPads
    All Vanguard hospitals recently partnered with Customer Feedback Systems to implement nurse leader rounding utilizing iPads. Prior to using the iPads, the staff used a paper system to guide and document their rounding efforts. Although the team at MacNeal admits it was a little slow to get all leaders comfortable with the new technology and beyond the mindset that it was simply ‘another thing to do’, the transition has been very positive. It has dramatically increased compliance and accountability and offers the ability to receive daily, weekly and monthly reports on rounding results. The reports go out daily to Murphy, Link and Benjamin to track. They also generate an alert if there is an issue that needs to be addressed right away. Leaders quickly came to value quality time with patients and the ability to better understand how patients are being cared for.

  • Post Discharge Calls
    Patients receive an automated call following their discharge asking specific questions, facilitated by National Research Corporation’s Illuminate service. Certain responses trigger a notification back to the hospital where their nursing team will follow-up for more details and/or to answer any questions or resolve confusion.

  • Satisfaction Surveys
    They have requested that their survey vendor, Press Ganey, only use HCHAPS questions plus a few additional questions about rounding – specifically to see if the patient was rounded on ‘hourly’ or ‘frequently.’ Interestingly, Murphy points out that those who say yes to regular, hourly rounding scored in the 90-95th percentiles overall, while those answering ‘no’ drop to the 40th percentile overall, even if the patient acknowledged ‘frequent’ rounding.

    Results from the surveys are reviewed regularly at Benjamin’s Weekly Service Meeting. Staff members recognized by name in surveys are acknowledged in those meetings – a testament to MacNeal’s efforts to shift to reward wins rather than focusing on losses.

Special Touches to Ensure Excellent Patient Experience

Most of the tactics mentioned above are often considered best practices in today’s healthcare environment, though we commend MacNeal along with the rest of Unity Health Chicago’s ability to make them a consistent priority among all facilities. They have also developed several best practices of their own. One of our favorites while touring the MacNeal floors was the use of Nurse Identification Cards at each patient’s doorway. These are meant to help physicians, patients and family members quickly identify who is caring for that patient at any time. Unit Secretaries are respolsible for updating the cards at each shift change.

We also fell in love with the idea of ‘Dora.’ A bi-lingual, peri-operative liasion, she meets patients and their family members before they go into surgery to establish a relationship and updates family throughout procedures. Each family is even given a card providing Dora’s contact information and a message reassuring them that she is available to assit the loved ones while the rest of the staff is caring for the patient. As Teresa Sworsky RN, MacNeal’s Patient Experience Champion, Operating Room, explained, "In the operating room we have a short time to make a big impact, and Dora’s preseance – her desk is right off the elevator – is a huge comfort to patients and family.” The operating staff also makes it a regular practice to ensure positive dialogue among staff, acknowledging that the hospital walls are thin and patients can eaily overhear (and possibly misconstrue) conversations.

In Conclusion

It was a pleasure to spend a day at MacNeal Hospital learning how its patient experience journey has impacted the hard-working community living in this Chicago suburb. It was also inspiring to hear how its patient experience learnings are cascading into the other three Unity Health Chicago facilities. We appreciate the recognition that patient experience success is about engaging employees including sharing stories, and involving them in the process and decisions.

At The Beryl Institute we are proud to be a community of practice sharing patient experience successes and learnings. We believe this On the Road offers both a reinforcement of accepted practices and new ideas to spur action.We commend Murphy, Link and the rest of the team on their efforts to date and wish them well on the continued journey.

To learn more about the patient experience efforts at Unity Health Chicago, please contact:
Sue Murphy
Market Vice President of the Patient Experience

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