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Patient Experience Case Study - Rush University Medical Center
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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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Improved Patient Communication with Systematic Whiteboard Use

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

A general medicine unit was identified for having lower than facility average patient satisfaction scores. Research has shown the positive impact a well-designed and utilized whiteboard can have on the patient experience. We undertook an intervention to improve the use of the whiteboards on that unit. Prior to implementation, there was no standard format for filling in information on the whiteboard or training in its use provided to staff. Further, use of the whiteboard was not monitored for timeliness or accuracy.

A patient and staff needs assessment found that over 80% of both groups found the whiteboards useful, but the layout of the whiteboards made their use challenging. Additionally, we found a lack of consistency in monitoring and updating the whiteboard on a daily basis. As a result, we undertook an initiative to redesign our board, train staff in the utility of a whiteboard, its usefulness to staff, patients and family, and began a routinized audit of its use for timeliness and accuracy.

What process did you use to develop a solution?

Physician, nurse and unit leaders were identified to lead the change effort. Unit staff were invited to participate in focus groups and feedback sessions to learn more about the utility of whiteboard use, and offer suggestions for improvement efforts. Prior patient experience survey results were shared, along with audit data on whiteboard use.

What outcomes were you looking to achieve?

Similar to previous research that has shown an effect on patient experience metrics, we looked at Press Ganey and HCAPHS scores as a measure of success regarding our efforts. To that end, we identified 8 questions from Press Ganey and HCAPHS that keyed in on communication, in addition to the overall HCAHPS rating question. Patient experience outcomes focused on top box scores from both surveys on to the following 9 items:

What specific steps did you take to address the problem?

Staff education and awareness about whiteboard usage began through an initial training session, with subsequent reminders during shift change, staff meetings, new employee/resident orientation and updates from the project team. Our intervention also included unit staff training on the use of a whiteboard, a re-design of the board based on patient and staff feedback, routine audits on use, and routinized feedback to unit staff on whiteboard use and impact we were seeing on patient satisfaction scores.

A cross-walk between the old whiteboard and the newly redesigned whiteboard, highlighting the changes made is provided below:

What resources, if any, did you engage – either internally or externally – to address the problem?

Resources engaged included the redesign of existing whiteboards as well as Press Ganey and HCAHPS patient experience data.

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

A single general medicine inpatient unit was selected for our intervention and audit. Two other general medicine units, where there was no whiteboard initiative, served as control groups. Additionally, we were able to track changes in patient experience over time, pre and post intervention, through Press Ganey and HCAHPS survey results for the 9 survey items detailed above. Our sample included patients discharged between 6/6/2014- 3/17/2017. Training was done in the month prior to June of 2016, with a roll-out date of mid-June 2016. Patient experience data were available for 1183 patients; 565 in the pre-intervention control group and 280 in the pre-intervention experimental group, 240 in the post-intervention control group and 98 from the post-intervention experimental group.

What was the ultimate outcome of your effort?

The percentage of patients in the post-initiative experimental group who gave each question a top box score increased for all nine selected survey questions when compared to those patients discharged prior to our intervention. We observed the largest percentage increase on the item regarding doctor’s explanation, which went up 12.6 percentage points in the post-intervention period compared to the pre-intervention period for our intervention group. No consistent change was observed for our control groups over time. 

*Indicates a statistically significant association (p-value < .05)

Our audit data on the accuracy and timeliness of information on the whiteboard found that 85% to 98% of white-boards audited were up-to-date and accurate over time. Information about staff was accurate over 85% of the time. Looking at the patient fields, 62.7% had accurate discharge goals and planned discharge date, 71.6% had correct patient goals listed and 74% had correct “Plan of Day” information.

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

Initial successes seen with this study show how simple, low-cost and patient-centered change initiatives can have a positive effect on the patient experience. Our efforts examined how training, along with an improved and standardized whiteboard and simple audits, can improve the patient experience.

About Rush University Medical Center

Rush is a not-for-profit health care, education and research enterprise comprising Rush University Medical Center, Rush University, Rush Oak Park Hospital, Rush Copley, and Rush Health. Rush University is home to one of the first medical colleges in the Midwest and includes one of the nation's top-ranked nursing colleges, as well as graduate programs in allied health, health systems management and biomedical research. Rush also offers more than 70 residency and fellowship programs in medical and surgical specialties and subspecialties. Rush is the largest non-governmental employer on Chicago's West Side and is the 20th largest private sector employer in Chicago, with more than 7,100 employees.

Rush University Medical Center is an academic medical center located in Chicago, Illinois. We are a 664-bed hospital that serves adults and children and includes the Johnston R. Bowman Health Center, which provides medical and rehabilitative care to older adults and people with short- and long-term disabilities. The Medical Center is the hub of our patient care and is closely connected to Rush University; in fact, all of the university’s programs are taught by physicians, nurses and other faculty and staff from the Medical Center.

Case Study Authored by:
Michael Drunasky, MS-HSM Associate Consultant, Sg2.
W. Jeffrey Canar, Ph.D. Assistant Professor, Dept. of Health Systems Management College of Health Sciences, Rush University Medical Center
Francis Adams Fullam, MA Assistant Professor, Dept. of Health Systems Management College of Health Sciences, Rush University Medical Center
Shobha L. Rao, MD Assistant Professor in Internal Medicine College of Medicine, Rush University Medical Center
Irwin Press, Ph.D. Adjunct Faculty, Dept. of Health Systems Management College of Health Sciences, Rush University Medical Center

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