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PATIENT CONVERSATIONS. Capturing what our patients are trying to tell us. I thought we called this Patient Rounding…. We did, but what was our impact? - Did not visit outpatients, ED, or ambulatory surgery patients. - Did not visit patients who had been inpatients for more than one day.
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PATIENT CONVERSATIONS Capturing what our patients are trying to tell us
I thought we called this Patient Rounding… • We did, but what was our impact? - Did not visit outpatients, ED, or ambulatory surgery patients. - Did not visit patients who had been inpatients for more than one day. - Did not visit patients who had been here on the weekends. - Asked relatively “generic” questions. - Did little with the information we gathered.
What did we accomplish? • Results: no real long-term impact on patient satisfaction. • Conclusion: we had an ineffective (i.e., “broken”) process that wasn’t set up to achieve a clearly-defined purpose.
“DADLI” is born • Enough issues to mandate process re-design, but how? • Let’s try something new (very new) and design the process using “Define”, from DMAIC, and the Baldrige process evaluation concepts of Approach, Deploy, Learn, and Integrate (ADLI), so we get “DADLI.” • And, even better, let’s error proof the re-designed process using healthcare failure modes effects analysis (HFMEA) • So that’s DADLI, vetted by HFMEA! DADLI! DMAIC ADLI
Sharon Key Sherry Nance Lara Smith Jenni Marsh Sue Cumpston Janet Forrest Karen Gammons Sharon Mitchell Jennifer Taylor Kathy Ritch Martha Barham Gordon Prince Aaron Wall John Jeffries Gary Kollm Lee Penry Mike Pickels Eric Fletcher The Rapid Event Team
Patient Conversations: The Purpose • The purpose of the Patient Conversations process is: ‘to validate patient key requirements, and provide actionable information to be used in organizational learning and improvement relative to those key requirements’
After 4 days… the process! • Remember our problems? • Did not visit outpatients, ED, or ambulatory surgery patients. • Did not visit patients who had been inpatients for more than one day. • Did not visit patients who had been here on the weekends. • Asked relatively “generic” questions. • Did little with the information we gathered. • All problems addressed in the new process… thank you DADLI.
Never fear, there is no “process test”, just know… • the process is robust. • the information gleaned by you, from the process, will result in improvement. • the process has been tested. • with your feedback, the process itself will continue to improve.
The In-Person Pilot of Patient Conversations • Eight people in pairs rounded on the 7th floor twice a week for four weeks during the month of May. • Each pair had a window of 48 hours to complete the conversation assignment, which consisted of 21 questions related to the ED, and then 24 more questions related to inpatient care. • Each conversation took about 30 minutes and both patients and facilitators were irritated with the long and redundant process.
The Telephone Pilot of Patient Conversations • Cindy Tilley and Lisa Sink in the Contact Center have been calling as many patients as they can get in contact with – the goal is 10 per day. • They experienced a difficult time getting people on the phone. • They used an abbreviated version of the questions and found people were open to spending 10 minutes or less. But duplicate conversations and overlap of Press Ganey were discovered.
Learning From The Inpatient/ED Pilot – Hunches Confirmed • Working in pairs is helpful; • Using a 24-hour window of time to complete the conversation assignment worked well; • It is possible to gather valuable data about the ED experience even after the patient has moved to an inpatient unit.
Learning from the Pilot: “Ah Ha’s” • Even the pilot team could not maintain the integrity of the initial arduous questioning process; • The questions were MUCH too long; • The time we spend it the room was MUCH too long; • Not all patients understood the terms we used in the pilot survey; • There is a tendency to design the system for ease of tallying information to be yes/no or scaled answers, but more individualized feedback better meets the purpose of the program; • It is helpful to have the patient’s family present, so we redefined “alone.”
Pilot Process Outcomes • Pairs of people with defined roles will conduct Patient Conversations – The Facilitator and the Scribe. • There will be eight questions that help us get to the “actionable data” described in the purpose statement. • Information about the ED and the unit experience can be gathered simultaneously. • The Conversations will be conducted throughout the inpatient units, with assignments going out on Mondays and Thursdays. The Scribes will be expected to enter the response data by the end of that 48 hour window.
The Role of Facilitator • Role #1: To assist with the accomplishment of the Patient Conversation purpose (understand our performance related to key patient requirements and obtain actionable data that will be used for organizational learning and improvement) by leading the conversation and effectively drilling down to the actionable data. • Role #2: To maintain the integrity of the process, being mindful that each Scribe is learning. Facilitators should be providing a consistent learning experience.
The Role of the Scribe • Role #1: To learn from the conversation through observation of the facilitator. • Role #2: To assist with the accomplishment of the Patient Conversation purpose (understand our performance related to key patient requirements and obtain actionable data that will be used for organizational learning and improvement) by capturing the information in writing and submitting it to Business Intelligence in a timely manner.
(click) Main Menu
(click) Question Batch Selection Screen Patient Responses • 5 North Patient Questions • 8 South Patient Questions
(click) Question Selection Screen Patient Responses 5 North Patient Questions Selected question batch: • How was the temperature of your room? • Were you satisfied with the selection of meals?
Patient Response Entry Screen Patient Responses Enter patient account #: Enter conversation date: Selected question: How was the temperature of your room? Patient’s response:
Receiving your assignment • Quarterly you will receive your assignments for the following three months. • You will receive an assignment reminder on Friday if your assignment falls on Monday, or on Wednesday if you have a Thursday assignment.
Coordinating the Conversation • Assignments will be assigned for Mondays and Thursdays. The pair will have 48 hours to complete the conversations and report back to Business Intelligence. • The Facilitator will complete a busy search of the Scribe’s GroupWise calendar and request a time that appears available.
Selecting the Patient • Facilitator and Scribe meet on the unit and WASH HANDS • On Mondays, start at the lowest room number • On Thursdays, start at the highest room number • When selecting a patient, look for the five A’s: • Alert • Awake • Agreeable • Alone (without members of the HPRHS workforce) • A-okay…. Not on isolation or contact precautions
Why not ask members of the workforce which patients we should talk with? • They may steer us away from displeased patients; • They may steer us towards patients that they think will be “good” for our process; • They may negatively impact the random selection in the process.
The Conversation • The Facilitator will lead the conversation and the Scribe will document verbal and nonverbal communication. • Neither the Facilitator nor the Scribe should add or delete steps in the Patient Conversations process.
What If ??????????????????? • The patient seemed to meet the 5 A’s but does not once you are in the room? • Is very, very, very upset and prefers to discuss the problems, not your silly ole questions? • Can’t understand you because they speak Spanish or Urdu or Vietnamese or …? • Can’t understand you for another reason?
Service Recovery / Star Performer • Service recovery cards will still be used and will be in your notebook. • Report use of a Service Recovery card to ext. 6999, along with the number on the card. • Peter Dansie’s number is 878-6391 and should be used for more significant issues. If you hear of a Star Performer during your conversation, try to obtain enough information for the Scribe to complete the card and pass it along to the Star Performer.
Remember, it’s all about the purpose! The purpose of the Patient Conversations process is to understand our performance related to key patient requirements and obtain actionable data that will be used for organizational learning and improvement.
