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Using Point of Care Real Time Surveying Across a Large System
What was the challenge, opportunity or issue faced?
Baylor Scott & White Health (BSWH) recognized a need for real-time data to inform efforts to improve the experience of patients and team members in hospitals. We adopted a point-of-care data gathering tool to a) gather consistent data on patient concerns, improvement ideas and opportunities to recognize staff and b) trigger actions for remediation of concerns.
What did you do to address it?
An advisory team selected an electronic web based point-of-care platform and piloted the tool in seven hospitals to evaluate whether the platform met the goals of the initiative. A governance committee established guidelines for adoption of the platform and standard questions to be used across sites. Sites selected their own surveys, including the standard questions established by the governance committee (6) plus up to 3 additional questions to meet their local objectives. To participate in the pilot, sites were required to have established rounding workflows and existing processes where data could be incorporated and used (e.g., huddles, coaching programs).
Sites used an implementation checklist to guide the set-up and use of the tool. The checklist included technical requirements (e.g., hardware, wireless network), survey setup guidance (e.g., question selection, access rights), and questions about how and where data would be incorporated into current processes to ensure use. The checklist prepared sites to leverage the platform in ways that met their needs. For example, some sites wanted to identify who was rounding in order to measure rounding compliance. Other sites chose to use the tool to measure specific process-improvement initiatives or recognition opportunities.
What were the outcomes?
Standardizing a core set of questions allowed comparison between facilities and between units at facilities. A core set of questions also supported consistent meaningful conversations during rounding. Staff could focus on the conversation with the patient, and less on the task of rounding. Questions were specific enough to focus a conversation, but allowed enough topic variation to gather meaningful feedback. The standard set of six questions included:
- Have you been given assistance in a timely manner when you have requested it?
- Is your room clean to your satisfaction?
- Do you feel the staff are actively listening to your needs?
- Has our team been keeping you informed of what is happening?
- Please share with us how we can improve. (Type data in box)
Changes in selected HCAHPS domains were evaluated for sites participating in the pilot evaluation of the tool. Performance was compared across three periods: a) 6-months before implementation, b) 6-months after implementation, and c) Quarter 1 of 2016. Three hospitals used the platform in part to focus on improving medication communication. Among those three hospitals, all saw some improvement on the HCAHPS Communication About Medicines domain. The hospital that saw the most dramatic improvement moved from the 62nd to the 93rd percentile rank by using the tool to identify and respond to patients with medication questions while also applying continuous process improvement strategies to attain their goals. When a patient was identified as having questions about medications, questions were addressed by the person who identified the question or escalated to a manager to discuss with the patient before discharge. Improvement was less dramatic for hospitals that gathered data without also having a robust process for responding when patient questions were identified.
Four hospitals focused their point-of-care data collection on improving perceptions of nurse communication. Two of four hospitals saw consistent improvement in performance on an HCAHPS question about nurse listening. Sites that saw the most improvement used the point-of-care tool as an opportunity to focus rounding on having meaningful discussions with patients rather than only transactional tasks. The questions in the platform prompted topical conversations, which helped personalize rounding discussions.
The capacity of the platform to capture both data and feedback, in ways that made rounding more purposeful, was a strength of the tool seen at all sites. Teams that participated in the pilot found value in the tool’s reporting dashboard. Electronic real-time reports were used in daily huddles to recognize team members, escalate concerns, and increase awareness of real-time patient experiences. Run charts and comments were available easily and quickly to leaders as needed. Leaders also appreciated that they could implement a process improvement initiative and see the impact quickly in the point-of-care data, even before post-discharge patient experience surveys.
Since completion of the pilot, the platform has been widely adopted across Baylor Scott & White Health in hospitals, Emergency Rooms, clinics and other areas to gather information where traditional patient experience surveys are either unavailable, are not practical to evaluate short-term initiatives, or do not address specific improvement efforts.
About Baylor Scott & White Health
Baylor Scott & White Health (BSWH) is the largest not-for-profit system in Texas with:
- 49 Hospitals, 5,250 + Licensed Beds
- 140 Satellite Outpatient Facilities
- 30 Ambulatory Surgery Centers
- 4 Senior Health Centers
- 155 Primary Care Clinics
- 476 Specialty Care Clinics
- 4 Urgent Care Centers
- 24 Retail Pharmacies
- 5+ Million Annual Patient Encounters
6,600+ Affiliated Physicians
- 40,000 Employees