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Patient Experience Case Study - University of Iowa Health Care
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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. If you have a case study to share please contact us.

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@Hawkeye Heaven: How University of Iowa Stead Family Children's Hospital Used Technology and Empathy to Improve Patient Experience

What was the opportunity, issue or challenge you were trying to address and in what setting?

When the concept of the UI Stead Family Children's Hospital was born, UIHC sought to improve its patient satisfaction for hospitalized pediatric patients as measured by the standardized Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) performance. (See pre-intervention scores Figures 4 through 8.)

The legacy pediatric unit was not designed around the needs of children, and patient-facing technology was limited to TVs with entertainment and some educational channels which provided programmed content, rather than patient-specific content. Inpatient education was a manual process, and content was paper-based.

With the introduction of a new children’s hospital facility and personalized technology for patients, UIHC sought to distinguish this new hospital as the destination in the state for children and families navigating health care experiences.

What process did you use to develop a solution?

UIHC engaged university leadership and the community—including the patient advisory council--to help define the priorities for this new Children’s Hospital. The vision for the Stead Family Children's Hospital was articulated in 2016: "Construct a new state-of-the art children’s hospital and incorporate sophisticated health information technology."

What outcomes were you looking to achieve?

UIHC sought to improve its overall experience for its pediatric patients and their families. In particular, UIHC needed to focus on empowering families with pediatric patients to return home successfully following their hospital encounter and reduce readmission.

What specific steps did you take to address the problem?

Technology

In 2016, University of Iowa entered into a vendor partnership to create a new personalized and immersive digital hospital experience for patients and families in their rooms . UIHC implemented computer tablets on bedside tables and installed large screen television displays at the footwall of each room. From the day the hospital opened its doors on February 25, 2017, Stead hospital patients described being favorably impressed by the bedside technology. By integrating with UIHC's RTLS badge system, patients and families could see, in real time, on their in-room screens, who was coming in and out of their rooms. (See Figure 1)

In addition to viewing entertainment, families could view evidence-based patient educational videos to learn more about their diagnoses and treatments. The in-room platform is integrated directly into nursing charting workflows to reduce double documentation/ duplicative charting efforts. Online Meal Ordering and room service empowered patients with choice of when, and what, to eat within medical diet order constraints. And as a tribute to a former pediatric patient, Stead designers gave its inpatients ability to use their bedside tablet to control the color in the room. This control, called “Drew’s Lamp” is used by patients to express and influence their mood.

Figure 1: In-Room Patient Platform on Television Showing an Alert when Nurse Enters the Room

Change Management and Training

UIHC embarked on a robust, and continuous, change-management program to implement the new patient engagement platform. UIHC began the workflow and training design for using the patient-engagement system six months prior to go live.

Starting in July 2016, UIHC piloted the patient-engagement system on an existing medical-surgical children’s floor. This was six months prior to the planned opening of the new facility. This day-in-the-life experience allowed some of the nurses and ancillary staff to become familiar with the bedside patient-engagement technology. The purpose of the pilot was to gain clinician buy in and work out any technology issues. This preparatory exercise allowed the staff to provide feedback and work with management to determine optimal workflows—for example, how to introduce the technology upon admission to patients. This early experience was incorporated into the training curriculum for all nurses and staff who would be working in the new hospital.

To successfully prepare their staff for work in the new hospital, UIHC invested in the construction of a mock-up center that included a representation of each type of patient room in the new building. Each staff member was required to complete eight-hours of hands on training in the mock-up center—including training on how to use the bedside patient engagement platform.

Community Connection and Empathy

The UI Stead Family Children’s Hospital was built on available land adjacent to the UI Medical Campus and overlooking the arena where the University of Iowa Hawkeyes play football--called Kinnick Stadium. Before the 2017 college football season began, a ticket holder with the Social Media handle “Hawkeye Heaven” posted the following on Facebook: "I think with the new U of I hospital addition open, Kinnick should hold a 'wave to the kids' minute during every game. Can you imagine how neat it would be to have all of those fans, players, & coaching staff look up at you sending a little extra inspiration?" (See Figure 2)

Figure 2: Social Media Post the Led to The Wave for the Kids

This post by “Hawkeye Heaven” generated a figurative and literal Wave. The “Wave for the Kids” has become amongst the greatest tradition in college football. At the end of the first quarter of every Kinnick Stadium home game, 68,000 fans, players, coaches, and officials all turn to look at the families at the windows of the UI Stead Family Children’s and wave for a full minute—acknowledging shared humanity, inspiration, and love. This unique expression of empathy has become part of the UI Stead Family Children’s Hospital culture—an expression of caring that persists well beyond football season. (See Figure 3.)

Figure 3: The Wave for the Kids

What measures did you establish to determine the success of this effort?

UIHC has measured the success of these programs by sequentially tracking data from the standardized HCAHPS. This survey, which is standard across all U.S. hospitals that report data to Centers for Medicare and Medicaid Services, asks discharged patients 32 questions about their recent hospital stay. UIHC has trended before and after implementation scores for four HCAHPS topics that relate to patient-experience: 1) Likelihood to Recommend to Others, 2) Received Instructions for Child Home Care, 3) Provided Condition/Treatment Info to Family, and 4) Felt Ready for Discharge.

What was the ultimate outcome of your effort?

All four patient-experience scores at UI Stead Family Children's Hospital have improved significantly.

Figure 4: HCAHPS Survey Question: Likelihood to Recommend to Others (Percentage of Patients)

Prior to the opening of the Stead Family Children's Hospital, families reported a mean likelihood to recommend inpatient pediatric services 74.8 percent (95% CI = 72.7 to 76.8) of the time. Since the opening of the new hospital, including the implementation of the bedside patient engagement platform, the mean satisfaction score has risen to 82.8 percent (95% CI 80.3 to 85.3).

Figure 5: HCAHPS Survey Question – Received Instructions for Child Home Care (Percentage of Patients)

Before go-live, a mean of 58.9 percent (95%CI = 53 to 64.9) of patients being discharged reported receiving Instructions for Child Home Care. Post go-live with patient engagement bedside technology that includes patient education, scores have consistently been higher with a mean of 68.9 percent (95%CI = 65.7 to 72.2).

Figure 6: HCAHPS Survey Question – Provided Condition/Treatment Info to Family (Percentage of Patients)

Families also more consistently report that they received condition/treatment-specific information. Prior to the implementation of bedside education, a mean of 59.1 percent (95% CI 52.9 to 65.3) of patients reported receiving this information. Post go-live a mean of 76.1 percent (95% CI 71.9 to 80.3) of patients report receiving condition/treatment specific education at UI Stead Family Children's Hospital.

Figure 7: HCAHPS Survey Question – Felt ready for discharge (Percentage of patients)

Overall, more patients reported feeling ready for discharge after the opening of the stand-alone children’s hospital and the introduction of the in-room patient-engagement platform. Prior to go-live, a mean of 61.2 percent (95% CI 54.6 to 67.7) of patients/families reported feeling ready for discharge. Post go-live, a mean of 73 percent (95% CI 70.7 to 75.2) reported feeling ready for discharge.

Figure 8: Summary of Patient Experience Findings *Note: None of the above Pre and Post Go-Live 95% Confidence Intervals Overlap

*Note: None of the above Pre and Post Go-Live 95% Confidence Intervals Overlap

What lessons did you learn you would share with others as they consider addressing a similar issue?

UIHC has learned that it is important to combine both high tech and high touch to improve patient and family experience.

Training all nurses in a mock-up room scenario improved the nursing staff’s ability to collaborate with patients on the in-room electronic platform (tablet and large screen display). Creating and sustaining change in practice when it comes to patient education is difficult and needs ongoing organizational focus and investment. Having a clinical champion to lead change management is critical. Inpatient education is valuable, important, and difficult to complete during a busy hospitalization. Integrating and automating the inpatient-education process facilitates beneficial outcomes.

High tech in-room patient engagement platforms support improvements in experience, education, and discharge preparedness. Authentic demonstrations of empathy, especially when they are unique to the individual or community, can honor families and improve the experience of being hospitalized.

1. https://uihc.org/basic-facts (Accessed June 4, 2018)
2. 
Charis-Carlson, Jeff. "UI Children's Hospital to be named after Stead family" Iowa City Press Citizen [Iowa City] Dec 2, 2015 https://www.press-citizen.com/story/news/education/university-of-iowa/2015/12/02/ui-childrens-hospital-named-after-stead-family/76661698/ (Accessed June 4, 2018)
3. Oneview Healthcare, Inc.
4. https://now.uiowa.edu/2017/02/will-kohn-6-first-patient-move-ui-stead-family-childrens-hospital-0 (Accessed June 4, 2018)
5. https://uichildrens.org/drew%E2%80%99s-lamp-brighten-rooms (Accessed June 4, 2018)
6. https://www.washingtonpost.com/news/early-lead/wp/2017/09/05/the-best-new-college-football-tradition-iowa-fans-waving-to-patients-in-a-childrens-hospital/?utm_term=.00e67d9ee6f3
7. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html

About University of Iowa Hospitals and Clinics

University of Iowa Health Care (UIHC) is a quaternary care center serving all Iowans across the state. UIHC has grown to serve yearly over 36,000 admissions, almost 60,000 Emergency Room visits, over 30,000 operative procedures, and more than 1 million ambulatory visits across its 300 geographically dispersed clinics. In 2014, University of Iowa received a donation from the Stead Foundation that enabled it to pursue constructing a free-standing hospital for Children and Families.

Case Study Authored by: Dr. Maia Hightower, Chief Medical Information Officer

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