Experience Innovation Outcomes San Francisco Health Plan March 18 2014 Quality Culture Series 1 Examine and Build from Drivers of an ideal healthcare workplace experience Using your organizations Pulse Survey results to design high impact always events that return empl ID: 599903
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Slide1
Improving Workforce Experience
Experience. Innovation. Outcomes.
San Francisco Health Plan
| March 18, 2014
Quality Culture Series
1Slide2
Examine and Build from:
Drivers of an ideal healthcare workplace experienceUsing your organization’s Pulse Survey results to design high impact “always events” that return employees to
purposeProven practices and toolkits for improving staff empowerment, resilience, and
relationshipsStrategies to minimize initiative fatigue and align improvement efforts
2
Welcome and Program ObjectivesSlide3
Page 3
Your SherpasAteret HaselkornSolutions Development Director
Kim PettyManaging DirectorSlide4
Page 4
Experience Innovation Network in Brief
Our Passion
Humanize the Healthcare Experience.
About
Us
Founded by Dr. Bridget Duffy, the first Chief Experience Officer at the Cleveland Clinic and in the nation.
ExperiaHealth accelerates the discovery and adoption of innovations that restore the human connection in healthcare.
Our Results
Guided experience strategy, transformation and improvements at more than 50 hospitals and health systems, consistently delivering measureable results.
Select Partners on the Experience Journey Slide5
Restoring Joy to Medicine
M. Bridget Duffy, MD
Chief Medical Officer, Vocera
Co-founder, Experience Innovation Network Slide6
“We must focus on innovations that improve humanity.”
– Earl
Bakken
Founder of MedtronicInventor of the PacemakerSlide7
“
Entered to care,
lost my soul”
Frontline 6 Word StoriesSlide8
Joy
Quadruple Aim Slide9
Employee WellbeingSlide10
The science
of finding focus in a stressed-out, multitasking culture
MindfulnessSlide11
Impact of Burnout and FatigueSlide12
“Primary care physician burnout threatens the quality of patient care, access, and cost containment within the U.S. health care system.”
In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices,”
Sinsky
, CA, et al. (2013) Annals of Family Medicine, 11(3): 272-278.
In Search of Joy in Practice Slide13
Medical
School
Adapted from
Hojat
, M.,
Mangione
, S.
Nasca
, T.J. &.
Gonnella
, J.S. (2005). Empathy scores in medical school and ratings of empathic behavior 3 years later.
Journal of Social Psychology
, 145 (6), 663-672.
Practicing
Nearing Retirement
Medical
School
Practicing
Nearing Retirement
Physician Empathy CurveSlide14
ExhaustionSlide15
© 2011
Thomas G. Murphy, M.D.
Is Technology Making Us Less Human?Slide16
20
Day Stay 2001
212 Pages
14
Day Stay 2011770 Pages
Meaningless Use Slide17
“If the cows are happy, the milk is supreme!”
Meaningful RelationshipsSlide18
Human
Experience=
Loyalty
and Growth
Empathy
+
Communication, Relationship, Emotions
Experience Mapping
=
Efficiency
Quality, Safety, Flow
Lean
+
The Key to the Ideal ExperienceSlide19
Reconnect
people to purpose
.
Improve physician and nurse communication
.
Enable peak performance
.
Create a relationship-based culture
.
Address emotional
and spiritual needs
.
Wellbeing ChecklistSlide20
Case Study 1: Sacred MomentSlide21
Case Study 1: Sacred Moment
95
th % Physician Satisfaction
“We benefit from the Sacred Moment as much as the patient.”
-Twin Rivers Employee
117% Increase in Patient SatisfactionSlide22
Case Study 2:
Staff Resiliency
Chief Morale OfficerSlide23
Resiliency Program
Assessment
Self Awareness
Mindfulness Based
Stres
s Reduction
Practice of Gratitude
Social Support
Measured pre/post staff emotional exhaustion.
Chief Morale Officer
90%
of program participants saw reduction in burnout
Case Study 2: Staff ResiliencySlide24
“I enjoyed this and am looking forward to bringing it to the clinic and taking time to honor our soul/spirit in our work.”
“Thank you. This class is helping me to relax a little bit and be more accepting.”
“I am very grateful that I attended this workshop, it helps me to focus to take care of myself.
Case Study 2: Staff ResiliencySlide25
Case Study 3: Code Lavender™Slide26
Percent of staff who
“do not feel supported” decreased from 24% to 2.7%
163% increase in staff’s likelihood to recommend
“The
lavender alert has
changed the energy on the unit
in a huge way. Our manager is more compassionate during stressful times, and we recognize each others burdens better than we did before. The palliative care team, and others that have supported us in various lavender alerts are
wonderful
and
amazing
!”
-
ICU Employee
June 2013
December 2013
Case Study 3: Code Lavender™Slide27
The secret to caring for the
patient and family is in caring for the care providers.
-Francis Peabody, 1925Slide28
“True Innovation Improves the Human Experience.”
– Alexander BlassSlide29
Contact
M. Bridget Duffy, MD
Chief Medical Officer, Vocera
www.vocera.com
Twitter: @
DuffyCXOSlide30
Agenda – Experience Design and Mapping
Page
30Slide31
Page 31
“For sale,
baby shoes,never worn”Slide32
Page 32
Your 6-Word Stories“[Insert Stories]”
how would you describe the current staff experience at your organization?
So, in 6 words…Slide33
Page 33
6 Word Stories“Who knows my dad’s whole story?”
“Too many doctors, too little health.”
“Needed hope, entered hospital, lost soul.”“I hear voices, never my own.”
“Eyes averted, too busy, can wait.”
“Discharged, that means I go home now?”
“Where are you taking me? Will it Hurt?”
From Patients & Families
“Entered to care, lost my soul.”
“
Caring chaos, frustration, treadmill
”
“Tired of saying, ‘I am sorry.’”
“Time constraints, few resources, still care.”
“Organized chaos, with moments of caring”
“Pulled by heart, pushed by utilization”
“Throw them over the wall, splat.”
From the Front Lines Slide34
Page
34
Walk in Their ShoesSlide35
Page 35
Restoring the Human Connection in HealthcareSlide36
Jessica McIninch, PsyD, Andersen Valley Health Center Jessica Moore, FNP, Petaluma Health Center
Page 36Guest SpeakersSlide37
“Together, We Create a Healthy Community”
Jessica McIninch,
Psy. D.Mark Apfel, MD
37Slide38
Our Journey
- Our Approach-
- The Outcomes-
38Slide39
Our Solution
Our Clinic staff members have begun a daily practice of proven stress reducing methods to improve our health, well-being and happiness.
We
hope to help staff members balance the stress, burnout, and emotional
exhaustion that can come from the daily work of caring for the
patients we serve
.
We are emphasizing the use of mindfulness
to skillfully
focus our attention to our
present moment
experience in an open
and nonjudgmental
manner.
- Our Approach-
Step 1: Administer Self Assessment to establish baseline
Step 2: Initiate 30 day Mindfulness/Gratitude program
2 Training Sessions Weekly Homework The Challenge: Share 1 gratitude each day via e-mail, picture, leaving a message on work-lineStep 3: Re-administer Self Assessment
- Project Goals -
- The Premise -
You’ll Never Guess What Happened
39Slide40
Our Outcomes
- Our Wellness Room -
- Pulse Survey Results-
“I really enjoy coming into work
knowing that my colleagues appreciate
me and the work I do.” – Staff Member
- Mindfulness Pilot-
89%
Increase in Gratitude scores
81%
Increase in “Observe” Scores
94%
Increase in “Non React” Scores
100%
Reduction in “
Burnout” Scores
“You can really tell, there’s a difference,
people are friendlier in the halls, it makes iteasier to work together and get things done.” - Staff Member
40Slide41
Seeking Satisfaction:
PHC’s Journey Toward Improved Provider and Staff SatisfactionSlide42
Identify the Problem
Annual Surveys: All StaffReviewsTeam MeetingsMonthly All Provider MeetingExit InterviewsSlide43
Major Drivers of Disatisfaction at PHC
Undefined WorkInadequate Support Poor Communication/Lack of FeedbackPoor CompensationDisconnect Between Personal Values and Day-to-Day WorkSlide44
Defined Work
Empaneled ProvidersStandard Hours for Providers & StaffClear Operational and Quality AimsConsistent Message around Strategic GoalsSlide45
Expanded Team Model
Robust HuddleSmaller PodsAccessible LeadershipSupport To Accomplish WorkSlide46
Monthly Team/Provider Clinical QualityWeekly Operational Data
Quarterly Provider ReviewsWeekly Case Review and Mentorship for New ProvidersFrequent FeedbackSlide47
Compensation AnalysisTransparency around Compensation
Incentive Pay Structure for ProvidersProvider Input around Incentive StructureFair CompensationSlide48
Lunch & Learn for StaffStaff Massage
Staff MeditationFitness Class DiscountsExclusive Fitness Offerings for Staff Gym Membership DiscountsAnnual Provider Camping TripPotlucksHalloween CompetitionWinter Gala
Summer PicnicMonthly Finding Meaning In Medicine Support Group (FMM)Community Building/WellnessSlide49
Find deeper satisfaction and meaning in day-to-day work lives
Strengthen original sense of callingForm Authentic Community with colleaguesLearn tools of self care
Renew their commitment to themselves, their patients, and medicineFMM ObjectivesSlide50
5-10 Participants
Monthly meetings at a colleague’s home1 ½ HoursEveryone comes prepared to share on the month’s topic
Group StructureSlide51
Improved provider retention/decreased turnoverImproved staff satisfaction
Improved patient satisfactionImproved sense of meaning and community among providersDid it work?Slide52
How has your journey impacted your organization’s culture? What has been most eye-opening about your experience?
Panel Discussion 52Slide53
Page 53
Relax, Restore, Re-caffeinateSlide54
Page 54
Idea Exchange Slide55
Speed Dating FormatSlide56
5 Conversations for 5 Minutes Each
Pick one or two questions below or create your own question to kick off your conversation: To drive workforce experience:What’s the most exciting innovation you’ve seen?What program has been the most successful?
What new approaches are you piloting or considering?How do you define success?
Page 56Conversation Starter QuestionsSlide57
Time
Remaining:
5:00
4:45
4:30
4:15
4:00
3:45
3:30
3:15
3:00
2:45
2:30
2:15
2:00
1:45
1:30
1:15
1:00
0:45
0:30
0:15
0:10
0:05
0
:00
Click Here to Begin Timer
Experience Observation Simulation
5 Minute Simulation
Idea Exchange Timer
5 Minute CountdownSlide58
Page 58
Building a Baseline
Review of PULSE Survey Findings
Preliminary Opportunity IdentificationSlide59
Page 59
Building A Baseline
Administer.
Analyze.Communicate.
Introduce.
Pulse SurveySlide60
60
Why Measure Staff Loyalty?
Profitable, sustainable, organic growth
Are more enthusiastic about their work
Provide better customer experiences
Influence other employees
Provide feedback and ideas
Buy more
Stay longer
Refer friends
Provide feedback and ideas
Engaged Employees = Loyal PatientsSlide61
Survey designed to measure loyalty,
by asking staff and providers to answer questions on a 0-10 point scale (0-Highly Unlikely to 10-Extremely Likely) Page 61
What is the Pulse survey?
Baseline Questions
How likely are you to recommend this clinic as a
place to work
to a friend or relative?
What would it take for you to rate us a “10” or to maintain your rating ?
How likely are you to recommend this clinic as a
place to come for care
to a friend or relative?
What would it take for you to rate us a “10” or to maintain your rating of “10”?
Optional Questions
What would you do to improve the patient and family experience?
What would you do to improve the provider and staff experience ?Slide62
Page 62
“Satisfaction” vs. “Loyalty”Definitions from
The American Heritage Dictionary of the English Language, New College Ed, Boston
Satisfaction (noun). The fulfillment or gratification of a desire or need
“The
patient is
always right”
Working Harder
Not Correlated to Growth
“The
patient is
our partner”
Working Smarter
Correlated to Growth
Loyalty
(noun)
.
Feelings of
devoted attachment
and affection
Focus of Net Promoter MethodologySlide63
10
9
8
7
6
5
4
3
2
1
0
Not at all likely
Neutral
Extremely
Likely
Detractors
Passives
Promoters
How likely are you to recommend a colleague or friend?
Explore
%
Promoters
(9s and 10s)
%
Detractors
(0 through 6)
% Net promoters
=
-
Calculating NPS
Celebrate
63
What does NPS tell us?Slide64
The Value of the Pulse Survey
Simple way to capture,
analyze and act on staff voice.
Heard
Supported
Engaged
Activated
Motivated
Empowered
Accountable
Leading to staff
who
feel:
64Slide65
Demonstrated to Have an Impact
Page
65Slide66
66
Driving Improvement with the Pulse Survey*NPS range across over 30 healthcare facilities (includes hospitals and clinics)
Category
AveragePlace to Work
NPS Place to Work Range
-73%
to 89
%
Place to Work Average
7.84
Place to Work
Range
4.04- 9.2
Come for Care
NPS Come for Care Range
-58%
to 88%Come for Care Average
7.17Come for Care Range
4.34 - 9.44
Establish a Baseline
– Create a measurable starting point for improvement and an understanding of the current employee experience and employee perceptions of the patient and family experience.
Identify Opportunities
- Identify specific, actionable improvement opportunities and potential solution based on verbatim comments.
Take Action
– The greatest value in establishing a baseline and collecting feedback is in the ability to act on the feedback and communicate back to survey participants what was done as a result their feedback.
Measure Results
– Organizations can administer the “pulse survey” at the beginning and end of an Experience Improvement project to gauge the impact in improving the experience in their hospitals.
*BenchmarkingSlide67
Our Pulse Results
Page
67Slide68
From the front line…
68
“Most people try to help each other as much as possible.
”
Communication
“[There is a] bit of a disconnect between different departments. Some portions could benefit from
better communications
from the other
depts
to provide a better overall workflow for the clinic.”
“Efficiency, stronger leader ship, TEAM WORK...... management and staff all pulling together
to make
it a better place "clinic" Not only directing traffic but being in it to help your team!... that
way no
one would have resentments... working together....”
“ We need to
treat every patient and family member as if they really do matter
….This might be the only opportunity they have to get health care…”
Camaraderie
“I feel fortunate in my life for the last 26 yrs. that I've been working here. I'm happy with myself
I share
these happiness with my co-workers and our patients. When there are turmoil’s I know
they will
pass. Nothing is forever.…”
“More support and communication”
“That individual departments meet more than once a month, even if it is temporary. this may help
with the communication issue that has been a problem for a longtime.”
Teamwork
“More morale and team-building
events.”
“More gathering outside of work with different department.”
(
with / from
leadership)Slide69
Page
69Experience Hierarchy
Needs Met = DifferentiationSlide70
Page 70
Pulse Survey Break-outStep 1 – 15 Mins: Team Pulse Survey ReviewWhat was your greatest insight while reviewing the verbatims?What are your ‘quick wins’?
Step 2 - 15 Mins: Report Out and DiscussionSlide71
Page 71
Preparing to Prosper
Creating a Culture of Experience Excellence
ExperiaHealth’s Experience Improvement FrameworkSlide72
Page 72Slide73
Page 73
The Key to the Optimal Experience
Efficiency
Remove Waste
Process Improvement
Empathy
+
Human Connection
Experience Improvement
Healing Experience
=
Loyalty for LifeSlide74
Page 74
6 Steps to Experience TransformationMake Experience Transformation a Unifying, Strategic Priority
Engage Providers to Lead in Partnership with AdministrationEngage Associates in Transforming Patient & Staff Experience
Design and Implement ‘Always Events’ that Improve ExperiencePilot and Spread Always Events (PDSA)Measure and Monitor ResultsSlide75
Page 75
1. Experience = Top Strategic Priority
Foundational Elements
Competitive Differentiation
Strategy:
Clearly articulated; well disseminated
Governance:
Well-defined chain of command; integration between experience, process, and quality/safety improvement
Culture:
Alignment of hiring, acculturation, and rewards structures
Voice of the Employee and Patient:
Qualitative and quantitative; action focused
Co-Design Processes:
Frontline-led
adaptation and implementation of known best practices; driving towards sustainability and accountability
Measurement:
Linking experience, clinical, and quality outcomes
Innovation: Designing new models of care; identifying Always Events; restoring human connections and joy to medicine; hardwiring change through technology and process changeSlide76
Page 76
2. Provider-Administration Partnership
Shared goals, vision and accountability
Collaborative decision makingFrequent and clear communication
May debate in private, but publically speaks with one voiceSlide77
Page 77
3. Engage Team in Experience Transformation Slide78
Page 78
4. Design Always Events
Empathy Arrival (or Pre-Arrival)
The Four C’sConnect – “Hello Mr. Smith. I’m [Name]. Welcome to the clinic. Are there any questions that I can answer for you prior to your visit?” Or “Is there anything else you would like me to share with your care team?”
Compassion
– “You must be frustrated.” “I can imagine how that must be upsetting.” “You must be worried.”
Communicate
– “[MA Name], your provider’s medical assistant, will be out soon to escort you back to the exam room.”
Comfort
– “Please make yourself comfortable” – offer water, coffee, or other comfort measures as appropriate.
Note information to help the MA identify the patient in the waiting area.Slide79
Page 79
5. PDSA Pilot, Refine, ImproveSlide80
Page 80
6. Measure and Monitor ResultsSlide81
Organizations with Higher Patient Satisfaction Data Transparency Have Higher Scores
6. Data Transparency = Improved Results
Source: Poster presented at the 2010 AcademyHealth Annual Research Meeting, held June 27-29, 2010 in Boston, MA.; The relationship between transparency and quality performance in urban safety net hospitalsSlide82
Page 82
Eat, Drink, Mingle – Lunch!Slide83
Page 83
The Road Ahead – Afternoon Agenda! Slide84
Page 84
Before we Proceed!
What is your greatest insight or learning thus far?Slide85
Page 85
Proven Solutions in Team Experience
Review of Evidence Based SolutionsSlide86
Page 86
Key Empowerment DriversSlide87
Resiliency / Code LavenderConnected Communication
No Excuses Teams Page 87
Key Workforce Experience SolutionsSlide88
Page 88
Prevalence of Burnout and StressUp to 60% of physicians report symptoms of burnout*50% 3rd yr med students report burnout**40% of hospital nurses have increased levels of burnout***
26% of nurses who leave the field report stress as the cause****57% of nurses reported stress****
*JAMA 2002;288(12):1447-1450.**Mayo Clin Proc. 2006; 81(11): 1435-1442.***JAMA 2002; 288(16): 1987-1993.
****Nursing Economics 2005;23(1):25-30.; Carol Reineck; Antonio
Furino
;
Nursing Career Fulfillment: Statistics and Statements From Registered NursesSlide89
Reduced Satisfaction
Increased Medical Errors
Increased Malpractice Risk
Increased
Mortality
Rates
Burnout and Emotional Exhaustion
Reduced Capacity for Empathy
*Journal of Nursing Care Quality April 1996 - Volume 10 - Issue 3 Dugan et al.
Stressful nurses: the effect on patient outcomes
.
** Journal of Applied Psychology,
Vol
73(4), Nov 1988, 727-735 Jones et al
Stress and medical malpractice: Organizational risk assessment and intervention.
***Stress and Health Volume 22, Issue 2, pages 131–137, April 2006,
A proposed physician–patient cycle model
****AHRQ May 2003, David H
Hickam
, MD, MPH ,
The Effect of Health Care Working Conditions on Patient Safety
Why Resiliency in Healthcare
Matters
89
LESS IP FOCUS BUT BROADER – FOR THE BRIEF – E.G., JOB ROLES INVOLVEDSlide90
The Stress Spectrum
90Slide91
Page
91
Code Lavender™
91Slide92
Code Lavender™
Percent of staff who
“do not feel supported” decreased from
24% to 2.7%“The lavender alert has changed the energy on the unit in a huge way. Our manager is more compassionate during stressful times, and we recognize each others burdens better than we did before. The palliative care team, and others that have supported us in various lavender alerts are wonderful and amazing!”
-ICU Employee
During stressful times in the ICU, I feel acknowledged and supported
by:
June 2013
December 2013
Page
92Slide93
Calling a Lavender Alert
93Slide94
Page 94
Elements of Resiliency Programs
Mindfulness
Self Awareness
The Practice of Gratitude
Social Support
1. Self-regulation
2. Intentionality
3. Self-validation
4. Social Support
5. Self-care
Source: BJC Compassion Fatigue Innovation Showcase, ExperiaHealth CXO Roundtable, April
25
, 2012
Fostering acceptance
Finding meaning in life
Gratitude
Spirituality
Retraining your attention
Source:
http://www.mayoclinic.org/resilience-training/
3 Gratitudes
JournalingExercise (self-care)
Meditation (Mindfulness)Random Acts of Kindness
Source: http://www.ted.com/talks/shawn_achor_the_happy_secret_to_better_work.htmlSlide95
Resiliency Program Results
Pre-Program 64% of participants showed signs of burnout as measured by “Emotional Exhaustion”6 Weeks Post Intervention (N=21):
90% of participants improved results on the “Emotional Exhaustion” scale8 Months Post Intervention (N=17):
82% still showed sustained improvement on the “Emotional Exhaustion” scale
Page
95Slide96
Page 96
Drivers: Communication, Teamwork, Connection and Relationship
Source: Ascension Health
Communication
Connection
Teamwork
Relationship
Inpatient
Correlation
Emergency
Department
Correlation
Outpatient
Correlation
Overall
Quality of Care
.809
Overall
Quality of Care
.698
Overall
Quality of Care
.526
Level
of
Safety
Y
ou
F
elt
.791
Staff
Met Your Individual
Needs
.654
Teamwork
between
Doctors
Nurses
& Staff
.481
Staff
Met Your Individual
Needs
.791
Teamwork
between
Doctors
Nurses
& Staff
.642
Responsiveness
to
Concerns &
Complaints
.465
Teamwork
between
Doctors
Nurses
&
Staff
.788
Responsiveness
to
Concerns & Complaints
.636
Respect
for Privacy
.452
Courtesy & Friendliness
Shown
by Staff
.736
Staff
Communication
.627
Doctors
Understanding
and
Caring
.449
Nurses
responsiveness to
needs
and requests
.736
Staff
met Emotional
Needs
.620
Courtesy
and
Friendliness
of all Staff
.446
Sensitivity
to Spirituality
.735
Sensitivity
to Spirituality
.614
Sensitivity
to Spirituality
.443
Responsiveness
to
Concerns
and Complaints
.728
Overall
Quality of Doctor
Care
.613
Staff
Informing about
Waits
and Delays
.429
Rate the nurses'
Understanding
and Caring
.721
Courtesy
and Friendliness
Shown
by Staff
.607
Nurses
Understanding
and
Caring
.428
Correlations Between Experience Elements And Loyalty (willingness to recommend) Across Care SettingsSlide97
“I entered the room focused on me and left focused on others.”
- Tiffany Rodery, TRRMC
Page
97Connected CommunicationSlide98
Page 98
The Connected Communication ModelSlide99
Page 99
Guiding Principles – Connected Communication
Build a Connection – Discuss Fears and ConcernsIdentify and Engage Loved Ones (e.g., family members, caregivers, etc.)
Address Spiritual NeedsIdentify Language
Preferences
Capture Comfort PreferencesSlide100
Page 100
5. Connected Communication Impact
23%
Increase
Patient Satisfaction
17%
Increase
Pulse Survey ResultsSlide101
Page 101
No Excuses TeamsNo. Excuse. Team.
@ Twin Rivers Regional Medical Center
Empower Staff to Lead ChangeSlide102
Page 102
Tap into the Wisdom of the Team
No Excuses Team (NET): empowers a multi-disciplinary group of staff and managers to eliminate the culture of learned helplessness that had become rampant at TRRMC.Slide103
Page 103
No Excuses Team in Action!
Employee of the Month Parking
Associate Appreciation
Fixing 3S Printer
Clocks in Patient Rooms
Patient Welcome Packages
Pediatric Crash Cart
16 Wins implemented in two days… !!Slide104
Page 104
Benefits to Date – The Rising Tide
Top Box – Overall Hospital Rating
117% Increase in Patient Satisfaction
Interventions
Staff and MD Pulse Survey
Town Hall Communication Series
Lightening Rounds
No Excuses Team (NET)
“Sacred Moment” at Admission (Healing Handoff)
95
th
%
Physician Satisfaction
in Press Ganey DatabaseSlide105
105Operationalizing “No Excuses” with Experience Huddles
Who’s Involved:
2 leaders (1 clinical, 1 non-clinical)
Where:
Each clinic or Department
How Often
:
Twice a Week
Duration
:
10-15 minutes min/department
Common Practice:
Tools and questions to guide huddle are provided and will focus on patient experience, the work environment, healthcare excellence and performance improvement.
Key Components
“We do a great job talking with each other about our cares and concerns. We don’t let miscommunication fester.”
-Post-partum nurse
Which of our values do we live well, what could we do a better?
What are you worried about that I should be worried about?
Sample Questions
Goal:
Connect leadership and frontline staff
around organizational prioritiesSlide106
106
Results – Maple Grove Hospital
+14%Workplace Dynamics Employee Survey
+11%+10%
Results based on 500 responses (757 invited)
HCAHPS Overall Willingness to Recommend
90
th
%ile
Engaged Employees Delivering Exceptional ExperienceSlide107
Page 107
Relax, Restore, Re-caffeinateSlide108
Page 108
Aligning to Deliver
Team Breakout SessionsSlide109
PIP Timeline
PIP = Practice Improvement Program
Page 109Slide110
How could these Always Events benefit the workforce at our facility or clinic?
Would one be more beneficial than the other? What would this look like for our clinic? What would make or break a successful adoption? What would be measure or monitor as an outcome?
Are there other Always Events that we should examine? Page
110With your teamSlide111
Building a Better Workplace
Supports Practice Improvement Program (PIP) measure
PE 1: Staff Satisfaction Improvement Strategies
Page 111Slide112
Page 112
Accelerating Execution
Experience Transformation RoadmapWorkshop Recap and EvaluationSlide113
Page 113
Your Action PlanFinalize appropriate intervention for adoption
Schedule and observe care at your clinic for 2 hours (step outside of your day to day role)Host clinic-based town hall meeting to share results of observation and Pulse
Brainstorm ideas for improvement Introduce and modify intervention to be adopted
Run a PDSA of your interventionSlide114
Page 114
Ask yourself - Why?! Why?! Why?! Why?! Why?!
With fresh eyes, step into the role of a family member with a loved one to observe the experience and identify the “Moments of Truth”
across four dimensions.
Did the patients, families, staff, and providers receive the right information at the right time?
How did the patients, families, staff, and providers perceive the quality of care?
Did the physical environment support the patients, families, staff, and providers needs?
Were the patients, families, staff, and providers emotional needs met? Slide115
115Slide116
Page 116
The PDSA ModelPlan – What is your objective and how will you achieve it
Do - “Just do it” (i.e. do the plan)Study - What did you learn?
Act - What will you do with the knowledge you learned?
A
P
S
DSlide117
117
Implementing Always Events
A
P
S
D
DATA
A
P
S
D
A
P
S
D
A
P
S
D
A
P
S
D
PDSA Fits HereSlide118
Introduce Written Action Plans
Routine use of Action Plan for Better Self-Management
A
P
S
D
DATA
Cycle 1:
Test with 1 provider/1 patient
Cycle 2:
Revise and test with 2 provider and 6 patients
Cycle 3:
Revise and test with 3 providers including patients from different cultural preferences
Cycle 4:
Train for Implementation
Cycle 5:
Monitor
continued
use by providers
Aim:
Routine use of Action Plans
Measure:
% of patients with documented action plans
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118
Start Small, Then Scale
A
P
S
D
A
P
S
D
A
P
S
D
A
P
S
DSlide119
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Start with a Small Test of ChangeConduct the initial test with…
one clinicone office
one docone patient
1Slide120
Plan:
Do
: Describe what actually happened when you ran the test
Check
:
Describe the measured results and how they compared to the predictions
Act
:
Describe what modifications to the plan will be made for the next cycle from what you learned
List the tasks needed to set up this test of change
Who?
When?
Where?
Predict what will happen when the test is carried out
Measures to determine if prediction succeeds
Planning 1 PDSA Cycle
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Additional Resources
Common ChallengesTactics and Tool-kits
How do we best observe our clinic?
Toolkit – Observation GuideHow to we encourage
staff and family members to participate?
Communication:
Informing the staff that the goal is to improve the experience for patients, families, and
staff.
Formal Invitation:
Consider a formal letter of invitation from senior leadership
Incentives:
Consider incentivizing staff with gift cards or a team lunch.
How
do we summarize our findings?
Toolkit -
Preliminary Findings TemplateHow do we create a project plan for implementation?PDSA Template Slide122
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Parting Thoughts
“What I’d like to see change? In
the long-term we aren’t billed around patient experience, but that is the way the world is going. It is what is important. It is exciting to be involved at this time. The human things are what is missed and falls outside of job descriptions now. I hope that this project will help us to look at how we can make a culture change to meet people where they are and be human
.”
- One of you!Slide123
Next Steps
Baseline: February 2014Final
: November 2014Webinar: Feb 18, 2014QCS Workshop
: March 18, 2014EIN Webinar: Showcasing Early Wins, May 15, 2014 Best Practice Sharing: September 2014, Quality Culture Series
EIN Coaching Call
#1
:
Embarking on the Path to Improvement (Apr/May)
EIN Coaching Call
#2
:
Capturing Stories (July/August)
EIN Coaching Call
#3
: Reviewing Wave #2 Survey Results (
Nov/Dec)
Pulse Survey to be administered by CEPC
EIN = Experience Innovation Network Page 123Slide124
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124
The Experience Innovation Network supported by Vocera Communications and the Stanford Clinical Excellence Research Center fosters partnerships across organizations to revolutionize healthcare experience and outcomes. Founded by Dr. Bridget Duffy, the first Chief Experience Officer in the nation, this network of healthcare pioneers is accelerating the discovery and adoption of innovations that restore the human connection in healthcare that ultimately improves clinical outcomes, increases patient and staff satisfaction, drives physician loyalty, and creates market differentiation in an uncertain healthcare environment.
For more information, please visit
www.experiahealth.com
and follow-us on Twitter at @ExperiaHealth.
About the Experience Innovation Network