Session Seven Connections: Cleanliness Kelly McCutcheon Adams, MSW, - PDF document

4/5/2012 Session Seven Connections: Cleanliness Kelly McCutcheon Adams, MSW, LICSW, IHI Director Barbara Balik, RN, EdD, IHI Faculty April 4, 2012 2:00 – 3:00pm EST David Kim David Kim , Institute for Healthcare Improvement (IHI), is responsible for managing and coordinating a variety of programs based on Key Processes on the IHI Improvement Map. Mr. Kim is a graduate of Boston University. He has been with the IHI for 2 years. He enjoys sports, food, and travel. 2 1

4/5/2012 WebEx Quick Reference • Welcome to today’s session! • Please use Chat to “All Raise your hand Participants” for questions • For technology issues only, please Chat to “Host” • WebEx Technical Support: 866-569-3239 • Dial-in Info: Communicate / Join Teleconference (in menu) Select Chat recipient Enter Text 3 When Chatting… Please send your message to All Participants 4 2

4/5/2012 Kelly McCutcheon Adams, MSW, LICSW Kelly McCutcheon Adams, MSW, LICSW, Director, Institute for Healthcare Improvement (IHI), has served in this capacity for eight years for a variety of IHI Collaboratives and programs, particularly those focused on critical care. She is a medical social worker with experience in hospice, nursing home, sub-acute rehabilitation, emergency department, and ICU settings. She has also served as faculty for the US Department of Health and Human Services Organ Donation Collaborative and for the Gift of Life Institute. 5 Barbara Balik, RN, EdD Barbara Balik, RN, EdD, Principal, Common Fire Healthcare Consulting, is also Senior Faculty at the Institute of Healthcare Improvement. Her areas of expertise include leadership and systems for a culture of quality and safety, including patient- and family- centered care, patient experience, systems to improve transitions in care, and transforming care prior to or with optimization of an electronic health record implementation. She works with leaders to develop adaptive systems to excel and innovate in complex organizations, and to ensure sustained improvement and innovation every day. Ms. Balik's publications include the book, The Heart of Leadership , and the IHI white paper on “Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care,” among others. Previously, she served in senior leadership roles at Allina Hospitals and Clinics, United Hospital, and Minneapolis Children's Medical Center. 6 3

4/5/2012 Overall Objectives At the end of this program, participants would be able to: • Articulate key foundational elements in support of all domains of patient experience improvement • Share specific testable ideas for improving nurse communication, pain management, and cleanliness • Plan small tests of change to try during the Expedition 7 Session Agenda • Homework – We did you learn? • Patient Experience Change Package ─ Our focus today • Perspectives from the Field: ─ Kendall Regional Medical Center ─ Regional Medical Center of Bayonet Point • Time for Q&A • Close of Expedition 8 4

4/5/2012 Homework from prior session • Identify 1 lesson from the field in Pain Management to test in the next 5 days • Share what you learned from the test at the next session 9 Pain Management Key Change Concepts Pain Management and Connections • Introductions and Understanding Patient Comfort Definitions ─ Process to understand patient definition of comfort preferences including light, heat, noise. Create reliable system for these definitions and preferences being shared across shifts and disciplines • Pain Management ─ Mutually develop comfort goals that include pain management, medications, environment, and activity level for hospital stay and for self-management post-hospitalization. • Shared Care Plan ─ Consider the care plan a shared document. Assure opportunities for patient input into the plan and review the care plan together • Pain Management Expertise ─ Develop or identify a specialized expert resource to consult with staff and care team regarding difficult pain management issues and train staff on current methods • Pain Management Escalation Pathway ─ Develop a policy or procedure for staff to follow when a patient has difficult pain management. Develop staff understanding of role of personal bias in addressing challenging pain issues with patients. 5

4/5/2012 Patient Experience Change Package: Overview Key areas for improving specific domains of patient experience: Nurse Communication, Today’s Session Cleanliness, and Pain Management Staff and Physicians Connection Patient and Family Improvement/ Leadership Engagement Infrastructure Foundational Elements for Improving Patient Experience Our Focus Today • Why the Connection? ─ Cycle of Communication between all staff and physicians and patients/families is core to patient experience ─ Examples of where Connection shows up in HCAHPS results:  Nursing Communication  Cleanliness  Pain Management 12 6

4/5/2012 Patients and Families as Detectives • Clinical: The what of service ─ Technical quality; competence of providers; reliability; coordination; pain • Relationships: How interactions occur ─ Respect; empathy; address emotional needs ─ Nurse/Team Communication • Environmental: Physical aspects of how the service is provided ─ Cause stress or offer calm and healing ─ Cleanliness » Berry and Seltman, Management Lessons from Mayo Clinic Cleanliness Key Change Concepts • Cleanliness Process Standardization ─ Make the cleaning process reliable and standardized. Consider checklists, posting cleaning schedule, and random audits. • Cleanliness Inspection ─ Reliably and frequently inspect all patient rooms for cleanliness, clutter, and needed improvements. Use this as an opportunity to talk to patients about their needs and expectations. Eliminate items that are not needed and are not used. • Introductions and Understanding Patient Comfort Definitions ─ Begin process of understanding comfort preferences around issues like light, heat, noise, and patient definition of cleanliness. • Leadership Rounding ─ Regular leadership rounding with patients and families, staff and physicians, and other leaders for the purpose of information gathering (to understand what the daily work is really like), coaching, recognizing, correcting, role-modeling, and providing real-time service recovery when needed. • Patient Activated Communication ─ Develop processes for patients and families to be able to directly access assistance when needed (Environmental Services, Nutritional Services, Rapid Response Team) 7

4/5/2012 Lessons from the Field • Kendall Regional Medical Center • Regional Medical Center Bayonet Point 15 Kendall HCAHPS data: Top Box answers for Room and Bath Cleanliness 16 8

4/5/2012 Regional Medical Center Bayonet Point HCAHPS data: Top Box answers for Room and Bath Cleanliness 17 Kendall dall Regiona nal l Medi dica cal l Center Miami, i, Florida ida From Cleanliness to a Healing Environment HCA Patien ent Experienc ience e Collabora aborative ive 9

4/5/2012  Daily huddles in EVS Department (each shift) ◦ Focused education on AIDET ◦ Supervisor/employee rounds focused on patient interaction  New Uniforms for EVS Staff  Welcome Card  Unit Leader/Nurse Rounding ◦ Ask patient to validate room cleanliness • Random Focused Inspections • On each shift • Immediate feedback directly to housekeepers • Result of nursing & management rounding • Any area that has a low score requires immediate repeat cleaning of area • Results of Focused Inspections are used as part of Annual Performance Appraisal 10

4/5/2012 Bayonet Point Hospital Cleanliness Scores Where we are now- Last Quarter 64% Current Score 74% How we achieved 74% 1. Scripting of staff, business cards in patients room, setting cleaning expectations for patient when they arrive, turndown service, patient visitation. 2. Updated equipment-Two Boost machine to improve productivity, one riding burnisher, one riding scrubber to reduce the time on corridor floor care. 3. Painting patient rooms and de-cluttering the walls 4. Refurbishing the patient room chairs total cost $32,092 verses over $200.000 in replacement cost (this figure Includes some bed replacement) GOALS 2011 Focus attention on 2 Central’s Cleanliness score to bring their score up from 64% to 82% (This week 2 Central’s score is 95%) Provide 24 Hour coverage in the Emergency Department 2012 Achieve the Top box 50 quartile by the end of the first quarter for all units and work with the Nursing Directors in improving the Hospitals overall satisfaction score. Suggestion: Cleanliness Program Accountability for 2012 Through Leadership support promote a sense of accountability of cleanliness for all hospital staff whenever they are in the presence of a patient. Use rounding as a means of measure. 11