See the opportunities and challenges organizations face in addressing the patient experience.
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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Patient & Family Connections in a No Touch World
Proactive supportive calls to families were key in facilitating human connections and addressing concerns in a timely manner
Keeping patients occupied during down times helped distract them from feelings of loneliness and perceived isolation under a no-visitor policy
Experience Framework Alignment
What was the opportunity, issue or challenge you were trying to address and in what setting?
This case study provides a description of programming options developed to respond to a public health crisis. Specific interventions are identified along with preliminary outcomes. It also discusses the disruption of human connection and patient isolation during the COVID-19 pandemic.
The patient experience is more than the technical care and services provided; it is about recognizing and respecting patient and family connections that are critical to healing and recovery. Collaboration with patients and their families is a key goal to facilitate understanding, education and communication which positively impacts the patient experience.
Marianjoy Rehabilitation Hospital, an acute inpatient rehabilitation hospital in the Midwest, began caring for COVID patients following their acute hospital stay. A typical patient’s average length of stay in acute rehabilitation was two-weeks, which was in addition to the two to three weeks COVID patients were spending in acute care hospitals without access to visitors. Patients were missing face-to-face connections with their supportive family members and friends. They also had more downtime, which left many patients feeling isolated and bored. Additionally, nursing staff were receiving many calls daily from families wanting to know how their loved ones were doing, which was taking nursing away from direct patient care. Marianjoy recognized what patient connection and caring needed to look like in this new environment and set out to make enhancements in these areas.
What process did you use to develop a solution?
Patients relations, patient engagement, spiritual care, and occupational therapy members met to discuss needs and to develop and implement a plan to address patient and family connections to reduce feelings of isolation and boredom. The program was to start with conducting proactive Family Support Calls. The team engaged a Process Improvement Department team member as well for support in development of resources. It was determined that Microsoft Teams would house the information on this program, and key resources were identified and developed.
What outcomes were you looking to achieve?
Through focused discussions, feedback was obtained from patients, families and caregivers allowing Marianjoy to identify specific interventions to address the issues. For patients, we aimed to address loneliness and feelings of isolation and to meaningfully fill the additional downtime they faced without visitors. For family members, we sought to ease their concerns about the quarantine of their loved one. Our efforts addressed caregiver concerns as well through assistance that helped balance the communication needs of the families and the need to continue to provide excellent patient care.
What specific steps did you take to address the problem?
Family Support Calls
Labor pool staff accessed the patient’s medical record to locate the Communications Sheet to determine the patient’s designated person to whom we could communicate. If no communication sheet was in the medical record, staff would consider the “person to notify” in the medical record as the person to contact. Staff then checked with nursing before proceeding to assure there were no nursing/clinical issues or concerns. If not, a staff member would visit the patient (except for COVID positive patients) to share their role and ask permission to contact their designated family member.
Next step was to call the family member using scripting from a Program Facilitator Guide to provide a supportive call or leave a message if no answer. The Program Facilitator Guide outlined what message to leave to ensure HIPAA compliance.
Staff members would triage and refer any questions as appropriate to the physician, nursing, case management, patient relations, patient engagement, spiritual care or new work stream developed to address patient/family video call connection and downtime
activities. Staff members documented on a log and sent the log sheets daily to patient relations, spiritual care and patient engagement, highlighting any additional follow-up needed.
Occupational therapists were trained to provide support for patients during their downtime. This support included assisting patients with their own phones to make video calls with family or utilizing iPads downloaded with various video technology if patients did not have a smart phone or other device of their own. A mobile cart was created that included books, games, puzzles, cards, paper labyrinths and colored pencils and iPads to round on patients in the early evening.
What resources, if any, did you engage - either internally or externally - to address the problem?
The first document developed was a tracking log that captured the date, patient name and room number, family member contacted and comments including follow-up needed (Appendix A). A Program Facilitator Guide was created for training and as a reference tool (Appendix B). The team produced an orientation PowerPoint for training (Appendix C). The program included a communication tool to introduce the designated family support call members to the nursing unit staff. (Appendix D).
Position requirements were developed, and a request was submitted to the labor pool to staff these positions. Seven outpatient therapists were identified from the labor pool* for this program and assigned to nursing units.
(*The labor pool contained staff not able to work in their regular role due to outpatient services closures.)
What measures did you establish to determine the success of this effort?
We based our metrics on data from the first six weeks of admissions starting at the end of March. During this period, 278 patients were served. 195 family check-in calls were completed, 136 video calls facilitated with family members and 244 social patient visits occurred.
We aimed at improving our scores around Likelihood to Recommend (LTR). We were successful in this endeavor with the LTR (by discharge date) from 9/1/24-3/24/20 at 85.8% top box (target 87% top box). The LTR (by discharge date) from the program’s inception 3/24-5/10/20 was 96.7% top box.
We also monitored patient comments, which were positive, including:
“Being able to connect with my Dad by video made all the difference.”
“I felt that everyone really cared about my husband and myself.”
“They called and followed up and very nice and courteous.”
What was the ultimate outcome of your effort?
The greatest achievement was the normalization of relationships that occurred through our video call connections. Additionally, nursing staff reported fewer family calls to nursing units with this program in place. Nursing staff also expressed feeling supported with the overwhelming needs of the families during this time of no visitors. Employees working these roles outside of their primary work settings expressed feeling they were doing meaningful work; however, we do not have any current employee engagement data for this time period.
What lessons did you learn would that would share with others as they consider addressing a similar issue?
After the public health event is over, some patients will still experience loneliness and isolation for various reasons and many may continue to have non-productive time requiring activities to engage them; therefore, program modification and enhancement of these best practices would be beneficial in an ongoing capacity. Organizations need to identify what is needed for sustainability of these interventions.
About Marianjoy Rehabilitation Hospital, part of Northwestern Medicine:
Marianjoy Rehabilitation Hospital, part of Northwestern Medicine, provides intensive physical medicine and rehabilitation to individuals who have experienced an illness or injury. We have more than 40 years of expertise in treating a wide variety of medical conditions, including specialty programs focused on stroke, spinal cord injury, brain injury, pediatric, orthopaedic/musculoskeletal and neuromuscular disorders. Physical medicine and rehabilitation use a medically based, multidisciplinary approach for the treatment of acute and chronic conditions. Our comprehensive care teams of physicians, therapists, nurses and support staff are trained and certified in the latest and most-effective practices available, simultaneously contributing to the field with innovations through research and education.
Marianjoy Rehabilitation Hospital offers customized levels of care at various locations based on individual patient needs and goals, including:
- Acute inpatient rehabilitation
- Subacute inpatient rehabilitation
- Outpatient therapy and day rehabilitation
- Physician clinics
Utilizing state-of-the-art technology, clinicians deliver innovative, evidence-based treatment, maximizing recovery and promoting independence for patients. The Marianjoy Assistive Rehabilitation Technology Institute (MARTI) and Tellabs Center for Neurorehabilitation and Neuroplasticity (TCNN) provides patients with the unique experience to work with therapists in the most advanced and effective therapeutic equipment in the field.
Our award-winning environment has everything you need for your rehabilitation journey: medical expertise, state-of-the-art technology, a peaceful setting. We are here to provide rehabilitation, restore hope and rebuild lifestyles.
Appendix A. Example of tracking log
Appendix B. Program Facilitator Guide
Appendix C. Orientation Training Powerpoint Presentation
Appendix D. Communication Tool for Family Support Calls
For more information contact:
Marianjoy Rehabilitation Hospital, Northwestern Medicine,
Wheaton, Illinois, United States
Kim Pedersen, Director Patient Relations