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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.
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Changing Our Culture, One Moment at a Time
What was the opportunity, issue or challenge you were trying to address and in what setting?
We looked at our HCAHPS data, comments, complaints and conducted patient focus groups and learned that our patients were frustrated with our overall patient flow in regards to triage, admission and how they transitioned throughout the maternity service. They were also upset at the lack of team work, caring, excitement, communication and perceived judgement from the staff in regards to their individual parenting choices.
A specific example of this is described when one of our focus group patients said our team confronted her when she asked for her baby to be brought to the nursery and supplement her feeding with formula. She said the team suggested she wasn’t going to be a “good mother” because she wasn’t doing the “right” thing for her baby by exclusively breastfeeding and having the baby with her at all times.
What process did you use to develop a solution?
We hired an outside consultant who had no affiliation with the hospital and conducted two patient and family focus groups at different day/times for all new parents that had delivered within the last four months. We then conducted focus groups with current patients that had delivered 24-48 hours ago. We wanted to compare and see if there were any differences among these two groups.
We then conducted both physician and staff focus groups. The same moderator facilitated these, and they were separated by pediatricians, obstetricians and then all of patient care services (RN, PCA, Tech, Clerks, etc…). This was done to ensure each group felt safe to address their concerns among their peers. No leadership was present at any of the focus groups. These were all done within two weeks of one another as we wanted to ensure everyone was able to share their concerns during the same time frame.
What outcomes were you looking to achieve?
The outcomes we were focused on were our HCAHPS data in regards to overall likelihood to recommend, (from the 17th in 2017 to 57th in 2018 YTD percentile) nurse communication, (19th to 58th percentile) doctor communication (73rd to 83rd percentile) and responsiveness, (28th to 57th percentile) as well as the patient comments on the survey.
The team felt we were not meeting our patients’ expectations in regards to consistently communicating their care plan, providing support during breastfeeding and lactation along with treating all patients with courtesy and respecting their individual care choices.
What specific steps did you take to address the problem?
The team designed a full day off site retreat for the entire staff including our voluntary physicians and ancillary partners. The idea for the retreat came from the redesign team as a result of MCH leadership and patient experience walking the team through what our HCHAPS scores and patient comments really meant and understanding our patients' experience. They felt that their entire team needed this education and awareness, and the idea for the retreat was born.
Another key takeaway after reviewing our data was a clear lack of teamwork, communication and respect creating a negative culture among the team that our patients felt. The redesign team spent 6 two-hour sessions discussing and planning the retreat and what components we should focus on. They felt having patient speakers would have the largest impact on understanding the experience our patients were having and then wanted to provide the team with the necessary tools to fix our largest challenges and bring them back to the reason they went into their profession - communication, team work, respect, re-igniting their passion.
We conducted 2 full day off site retreats (view the retreat agenda), back to back with one scheduled during 9am - 5pm and the other scheduled between 12pm - 8pm. This was done to cover both shifts as our team is comprised of over 300 people. We also conducted one session at our hospital for anyone we may have missed or who was out during that time. We did the retreat on our traditionally slower volume days and partnered with both our employed and voluntary doctors as they attended the retreat and weren’t performing scheduled C-sections or inductions on these days. We also brought in per diem and part time staff to help cover shifts during this time.
The messaging and conversation all came from our redesign team. The group created a flyer and presented this to the entire maternity service during huddles and at team meetings. The retreat was time away from the hospital for everyone to get together, address our current culture and patients’ experience and then align on the 5 hospitality promises the redesign team was asking their colleagues to make.
Top 5 Service Standards
- Include “Welcome” in our hello.
- Always positively introduce the next team member.
- At discharge we say “Thank you for sharing this moment with us”.
- Acknowledge everyone in the room. (Family, friends, visitors, etc…)
- Know your patients name.
What resources, if any, did you engage – either internally or externally – to address the problem?
We felt it was very important to have senior leadership support from both administration and our physicians. Both groups contributed the funds needed to host the retreat off site which helped create a very special feeling for our team. Having our redesign team lead the retreat was another key component. We facilitated time for them to meet every week off the unit to discuss the retreat and make all of the arrangements.
In terms of the activities and trainings, everything was done with limited resources in mind. The conflict resolution training came from real examples on the unit, the improvisation exercises came from our patient experience team and the scavenger hunt was free and built by the team and used social media
What measures did you establish to determine the success of this effort?
With the help of the facility’s AV team, we asked two patients from our focus groups to come and speak at the retreat to share their experience (both positive and negative) and asked the patient who left us a voicemail if we could share her comments as a way of learning among our team.
In terms of our videos, we created both locally at the hospital utilizing individual team members skills and used Mac/iMovie programs free on Macs to produce the content.
What was the ultimate outcome of your effort?
At the end of the retreat all team members filled out an evaluation form allowing them to provide real feedback about the day and how this will impact their practice moving forward. We complied the feedback from both days and shared the feedback with the entire team during our huddles. We now share our HCAHPS data, patient comments and letters every week during our team huddle and host quarterly recognition events for team members who have been recognized by patients for going above and beyond.
We have made a significant effort in sharing our data both positive and negative with the team on a regular basis. Our redesign team still meets every week to continue to discuss any issues, challenges or suggestions in improving our patients experience. We had the entire team sign our five hospitality promises and hung the poster on our unit as a reminder.
The redesign team was formed in January 2017, and we started planning the retreat in July 2017 and then hosted the retreat in September 2017. We have seen our improvements continue since October 2017.
We experienced the improvements the next month (October 2017) and they have continued until today (as of June 6, 2018)
To help with sustainment of our achievements, we host weekly huddles on the unit to keep the momentum going along with our redesign weekly meetings and quarterly recognition events. Along with this, we are in the midst of planning our 2018 retreat as we believe that a yearly gathering of the team is critical to continuing our journey.
What lessons did you learn you would share with others as they consider addressing a similar issue?
Given the size of our team, we have never had a meeting that included all of our staff members. The retreat was meaningful because for the first time, the entire team was together, hearing the same message at the same time. This allowed everyone to have a better understanding of our current state, goals, vision and the expectations moving forward. Another key component was that it was staff led, designed and hosted off-site.
The structure and format of the culture retreat can be transferred to any other service line or facility as it combines both qualitative and quantitative data to tell your patients story. The multifaceted approach is ideal for different environments and uses different learning techniques such as:
- Role playing
- Patient testimonials
- Team activities
- Breakout sessions
- Peer lead conversations
You should never assume that your team understands your patients voice and how it’s measured in your surveys. We also found that the best team to create and design a solution is the team that is facing the issue and engage them in the beginning of every project, as they are your champions.
About Lenox Hill Hospital
Lenox Hill Hospital is a 652-bed, acute care hospital located on Manhattan's Upper East Side. A staple in the community for more than 160 years, our hospital has earned a national reputation for outstanding patient care and innovative medical and surgical treatments. Our mission is to deliver outstanding healthcare with compassion and respect, to promote wellness in our communities, and to advance the field of medicine through education and research. Every moment matters.
Case Study Authored by: Joe Leggio, MBA, Senior Director, Patient Experience and Amy Marshall, MSN, RN, Director, Maternity & Newborn Services