CARE TEAM COLLABORATION ACROSS THE CONTINUUM

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CONTENTS

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6 Success Story: Advocate Health Care: Optimizing clinical communications at Advocate Health Care

13 Success Story: Advocate Medical Group: Care team collaboration praised at Advocate Medical Group with Implementation of PerfectServe Synchrony™

16 Article: When Communications Work, Patients Win

19 Infographic: Solving the complexities of care team collaboration

20 Video: Streamlining clinical communication (Advocate Health Care)

21 Video: Reducing communication process waste among clinicians

Webinar: healthsystemCIO.com All Stars Panel: Care Team Collaboration — Let’s Talk IT and Clinical Strategies

Webinar: Healthcare trends and strategies: A C-suite perspective

Webinar: Solving the complexities of care team collaboration

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WEBINAR

healthsystemCIO.com All Stars Panel: Care Team Collaboration – Let’s Talk IT and Clinical Strategies This PerfectServe-sponsored healthsystemcio.com All Stars Panel round-table discussion features Alex Rodriguez, VP and CIO, St. Elizabeth Healthcare; Shahid Shah, co-founder and CEO, Netspective Communications; and Terry Edwards, president and CEO, PerfectServe, on the IT and clinical pieces that make up a successful care team, the evolution and the future of healthcare, and their own experiences and lessons learned.

Alex Rodriguez, vice president and chief information officer, St. Elizabeth Healthcare

Shahid Shah, co-founder and CEO, NetspectiveCommunications

Terry Edwards, president and CEO, PerfectServe

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healthsystemCIO.com All Stars Panel Care Team Collaboration — Let’s Talk IT

and Clinical Strategies

A Complimentary Webinar from healthsystemCIO.com

Sponsored by:

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WEBINAR

Healthcare trends and strategies: A C-suite perspectiveJoin Mark Dixon as he shares strategies to adjust to the trends impacting healthcare. Dixon has more than 25 years of strong, results-driven experience in developing and sustaining market-leading organizations.

Mark D. Dixon, RPh, MHA, FACHE, The Mark Dixon Group LLC

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Integrated Delivery Networks and Hospitals Trends and Strategies

A C-suite Perspective with Mark Dixon

Sponsored by:

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WEBINAR

Julie Mills, MBA, RNtechnical support manager, PerfectServe

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Solving the complexities of

Building a fast and effective communication process between care team members is an intricate undertaking. In this on-demand webinar, Julie Mills, who has helped hundreds of organizations manage workflows effectively, will walk you through the complexities and considerations of even the most challenging care team workflows.

Initiation

Key components of communication

Recipient Process

care team collaboration

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SUCCESS STORY

Optimizing clinical communications at Advocate Health CareAccurate, efficient and reliable clinical communications are essential to achieving clinical integration — a key step for improving healthcare quality and safety and a primary goal of healthcare reform. Today, many organizations are looking for ways to improve communications among the healthcare providers in their hospitals. Within large health systems, supporting effective communication between clinicians can be challenging — especially across member hospitals with differing needs.

Advocate Health Care is a 12-hospital integrated healthcare delivery system operating in Illinois. Widely acknowledged as a pioneer in clinical integration, the organization sought new technologies and services to foster improved communication among providers.

Specifically, Advocate leaders wanted to improve physician-to-physician and nurse-to-physician communication, thus promoting improved care quality and patient safety. This case study examines the goals and outcomes of four Advocate facilities that implemented PerfectServe as a tool to improve clinical communication.

PerfectServe Synchrony™ is a comprehensive and secure communications platform that routes voice, text, and web- and system-generated communications based on personalized algorithms, allowing physicians to control when and how they are contacted. The single-network platform and directory give staff easy access via voice search, web and mobile interfaces. The service also includes a 24/7 help center staffed with clinical communications experts.

View Story

Health system: Advocate Health Care

Location: Chicago

Number of hospitals in health system: 12

Medical staff: 6,000+

Recognized as one of the nation’s top 10 health systems

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CONTINUED: Optimizing clinical communications at Advocate Health Care

SUCCESS STORIESSUCCESS STORIESSUCCESS STORY

PerfectServe is one tool that definitely demonstrates to physicians that you are serious about improving their satisfaction. Not only that, it also has patient safety and nursing satisfaction benefits.

Lutheran General Hospital: Using PerfectServe to build relationships with physicians

Advocate Lutheran General Hospital is a 638-bed tertiary care teaching hospital outside of Chicago. Approximately 1,100 physicians practice at the hospital, which handles almost 30,000 admissions and nearly 58,000 emergency department visits each year. The hospital achieved Magnet® designation in 2005 and was awarded re-designation in 2010. The Magnet Recognition Program® of the American Nurses Credentialing Center recognizes hospitals with the highest level of professional nursing practice and patient care.

The organization implemented PerfectServe in 2011. Michael McKenna, MD, vice president of medical management, describes the hospital’s choice to use PerfectServe as a step in its journey to clinical integration, a focus of the organization for more than a decade. “Our pursuit of clinical integration is leading us to evolve into a high-reliability organization and develop the right care model that allows us to get the best outcomes possible,” he says. “Communication is the backbone of this evolution.”

With PerfectServe, reviewers can send quick, secure messages to physicians via a web-contact tool. Physicians reply to charting questions much more rapidly, according to Rebecca Hernandez, RN, BSN, the hospital’s documentation nurse supervisor. “The new system saves time and allows for rapid turnaround of chart reviews, which has helped us meet our goal of 24-hour turnaround time for discrepancy reviews.” Hernandez believes the system also will allow the hospital to more easily deal with coding changes in the future, such as those in ICD-10.

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SUCCESS STORIESSUCCESS STORIESSUCCESS STORY

Trinity Hospital: Fostering nurse-physician teamwork

Located in southeastern Chicago, Trinity Hospital serves more than 90,000 patients annually. More than 300 physicians, representing 50 medical specialties, practice at the 250-bed hospital. Like Lutheran General, Trinity Hospital has prioritized quality improvement as a top initiative. The organization implemented PerfectServe in 2011.

A long-term goal of the hospital, according to Michelle Gaskill, RN, BSN, MHA, vice president of nursing and clinical operations, is achieving ANCC Magnet designation. A key step in the process is improving teamwork and nurse-physician relationships. An equally important goal of the hospital is improving efficiency and eliminating unnecessary delays in care.

Gaskill and Jon Bruss, the hospital’s president, learned of PerfectServe at a presentation convened by Rance Clouser, vice president of information systems support services and communications at Advocate. Gaskill and Bruss saw the potential for PerfectServe to help with both organizational goals.

Their hypothesis has proved correct. Says Gaskill, “PerfectServe speeds up the communication process so we can exchange information faster, improve the quality of handoffs and reduce delays. It helps with health outcomes by allowing staff to get the right information about the right patient at the right time.”

PerfectServe has also helped improve nurse-physician relationships by eliminating a significant source of frustration: difficulties with timely communication. In the past, nurses would waste valuable time trying to reach physicians through the wrong mode of communication; for example, when a surgeon turned off his pager and informed the answering service to call his cell phone but the nurse dialed his pager directly, or the nurse searched through multiple call schedules to identify the appropriate physician to contact. The frustration involved in communication was a deterrent to teamwork.

CONTINUED: Optimizing clinical communications at Advocate Health Care

Staff can contact a physician right away...PerfectServe enhances communication incredibly.Sakhawat Hussain, MDMedical director of clinical informaticsAdvocate Trinity Hospital

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CONTINUED: Optimizing clinical communications at Advocate Health Care

SUCCESS STORIESSUCCESS STORIESSUCCESS STORY

“Clinical teams must be collaborative,” says Gaskill. “The frustration related to communication was causing a deterioration of nurse-physician relationships. PerfectServe centralizes communication and removes these obstacles.” Because floor nurses carry portable phones, physicians can call back directly and quickly reach the nurse needing to speak with them, removing the need for unit secretary intervention and providing additional time for the nurse and the physician.

According to Gaskill, the change has been effective: “PerfectServe has absolutely made us more efficient.” Sakhawat Hussain, MD, medical director of clinical informatics at the hospital, concurs: “Physicians receive calls according to their requirements. Staff can contact a physician right away, a remarkable change for us. PerfectServe enhances communication incredibly.”

Christ Medical Center: Shoring up communication between physicians and nurses

Located in Oak Lawn, Illinois, Christ Medical Center is a 695-bed teaching hospital with nearly 1,300 affiliated physicians.

The medical center is one of the major referral hospitals in the Midwest for a number of specialties, including cardiovascular services, heart and kidney transplantation, and neurosciences. Christ Medical Center achieved ANCC Magnet designation in 2005.

The medical center decided to implement PerfectServe to address communication breakdowns between physicians and nurses.

Meg DeYoung, vice president of customer and support services at both Trinity Hospital and Christ Medical Center, encouraged leaders at Christ to consider selecting PerfectServe based on the excellent results achieved at Trinity. The hospital also received positive feedback from physicians who had replaced their answering services with PerfectServe.

The new system saves time and allows for rapid turnaround of chart reviews, which has helped us meet our goal of 24-hour turnaround time for discrepancy reviews.Rebecca Hernandez, RN, BSNDocumentation nurse supervisor Advocate Lutheran General Hospital

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SUCCESS STORY

CONTINUED: Optimizing clinical communications at Advocate Health Care

DeYoung says, “We knew through our experience at Trinity that PerfectServe could make a real difference in nursing productivity while simultaneously improving physician experience with the hospital.” Implementation was phased. The approximately 400 residents and fellows at the medical center began using PerfectServe in May 2012; attending physicians accessed the system two months later.

The hospital implemented patient-centered routing for residents in pediatrics, family medicine and internal medicine to address the difficulty clinical staff experienced reaching the appropriate resident due to cross-covering and the rotating schedule of residents. Says DeYoung, “Resident utilization of PerfectServe is already exceeding expectations. We expect the same will be true for all attending physicians.”

Illinois Masonic Medical Center: Streamlining transmission of pathology reports

Located in the Lakeview neighborhood on the north side of Chicago, Illinois Masonic Medical Center includes a 408-bed teaching hospital with more than 1,000 affiliated physicians. The medical center has a strong commitment to medical education and is affiliated with the University of Illinois at Chicago, Midwestern University and Rosalind Franklin University of Medicine and Science. The hospital achieved ANCC Magnet designation in 2008.

Leaders at Illinois Masonic Medical Center were searching for a comprehensive communications system and were considering the implementation of a human-centric system for physician-to-physician consults. Instead, Rance Clouser, vice president of information systems support services and communications at Advocate, and site information systems director, Adem Arslani, suggested that the medical center select PerfectServe because it

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SUCCESS STORY

CONTINUED: Optimizing clinical communications at Advocate Health Care

is a single, comprehensive communications platform that supports direct contact between physicians, as well as between physicians and clinical staff members.

Leaders decided to begin with a pilot study to address a common complaint of physicians: lack of timely notification about pathology reports. Administration had received feedback from physicians about the difficulty of finding pathology results in the physician portal of the medical center website, and about not being alerted when reports, amendments or addendums were available.

To address this problem, the organization began a pilot project using PerfectServe to push pathology reports directly to physicians, according to their process rules. Physicians receive alerts and are able to access secure messages through the PerfectServe mobile app or a password-protected website. Physicians can choose the mode by which they receive notifications and can indicate whether they want to receive reports for patients for whom they ordered the test or biopsy, were the attending physician of record, or both.

Full implementation of the complete PerfectServe service across the medical center began November 2012.

Looking to the future

In addition to meeting the current needs of the Advocate hospitals, PerfectServe is helping with future needs, including those associated with becoming an accountable care organization. As McKenna from Lutheran General Hospital explains it, “If you are an ACO, you have to reliably get the information and data you need in order to deliver care, and you need to have very effective means of communication that are timely, accurate and effective. By allowing case managers to more easily access physicians, for example, PerfectServe can support accountable care.”

We want to show physicians that we are doing something different. We want them to know that when they come to work here, it is an easier place to get things done, the systems are more reliable, and we achieve greater safety and higher satisfaction.Michael McKenna, MDVice president of medical management Advocate Lutheran General Hospital

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SUCCESS STORIES

CONTINUED: Optimizing clinical communications at Advocate Health Care

PerfectServe is also working with Clouser to develop a system through which critical lab results can be delivered securely to physicians via mobile phone. Data from the clinical lab, pathology department and transcription services will be gathered in a central repository. A filter created by Advocate clinicians will dictate which lab results are marked critical. These results will then be routed to physicians via PerfectServe based on their process rules, call schedules and personal contact preferences.

Conclusion

Effective clinical communication is essential to performance improvement and clinical integration. For these four Advocate hospitals using PerfectServe to optimize clinical communications, PerfectServe effectively addresses the different priorities of each hospital, just as it addresses the different preferences of individual clinicians regarding how and when they are contacted. The ability of PerfectServe to meet the particular requirements of each hospital under the umbrella of a single, comprehensive communications platform highlights the versatility of the PerfectServe system.

SUCCESS STORY

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SUCCESS STORY

Care team collaboration praised at Advocate Medical Group with implementation of PerfectServe Synchrony™Careful planning and progressive rollout of PerfectServe Synchrony resulted in 96 percent adoption among Advocate Medical Group’s 500 physicians.

Advocate Medical Group, a Chicago-based medical group with over 1,500 physicians and specialists at more than 200 different practice sites, opened a centralized contact center in February 2014 to provide 24/7/365 coverage for 500 physicians across 40 of their sites. The center is also the main hub for patients to contact their doctors and other clinicians.

Expectations for the center were high. But the center’s technology wasn’t up to the task.

“Our technology didn’t allow messages to be transmitted in a meaningful or secure manner,” says Dr. Jennifer DeBruler, medical director of Advocate Medical Group. “We knew we were using an outdated technology, and we planned to implement something new.”

AMG resolved to find a secure communications technology that was fully automated — eliminating the need to update call schedules, and facilitating real-time calls with secure voice and text messages.

Balancing the need for rapid communication and response without unnecessarily interrupting physicians was another important priority for AMG. Because disruptive doctor-to-doctor communications had been a historic problem, the ideal solution required asynchronous communication so care providers could communicate with each other about a patient when it was most convenient. Says DeBruler, “When doctors are busy seeing patients, they don’t want to be interrupted for things that are not urgent, especially during the day.”

Advocate Medical Group is a physician-led medical group providing primary care, specialty services, medical imaging, outpatient services and community-based medical practices throughout Chicagoland and Bloomington/Normal. AMG is part of Advocate Health Care, the largest health system in Illinois and one of the largest healthcare providers in the Midwest.

Physician staff: 1,500

Locations: 220+

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SUCCESS STORY

CONTINUED: Care team collaboration praised at Advocate Medical Group with implementation of PerfectServe Synchrony™

Our outdated technology was a concern from the start. We needed something new.Dr. Jennifer DeBrulerMedical director of Advocate Medical Group

We needed better systems and standards for all clinical communications within the office.Dr. Jennifer DeBrulerMedical director of Advocate Medical Group

Ready. Set. Plan.

The search for a new technology started close to home. AMG knew that 4,000 physicians across 12 Advocate Health Care hospitals were using PerfectServe, which meant AMG physicians were already familiar with it.

PerfectServe Synchrony ensures secure communication of protected health information among providers and care team members, so AMG didn’t have to worry about HIPAA compliance. By automatically identifying care team members and routing information based on when and how they work, PerfectServe Synchrony met all their other needs as well.

“PerfectServe Synchrony was the answer,” says DeBruler.

AMG believed that successful workflow automation required a thorough understanding of the work in order to optimize its flow —starting with the needs and behaviors of the users.

Success also required understanding who needed to talk with whom and when, as well as mapping out the changes needed to enable a process that worked for everyone.

“We brought people together early in the process to discuss what we expected the technology to do and how we wanted to use it,” explains DeBruler.

Working closely with PerfectServe and the contact center, AMG offices carefully set up the rules required for the system. “We had to consistently bring the appropriate operations and physician leaders to the design sessions,” says DeBruler.

Physician engagement upfront and throughout the implementation was key. “We continued to listen to the physicians and make tweaks after going live with PerfectServe,” she says.

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SUCCESS STORY

CONTINUED: Care team collaboration praised at Advocate Medical Group with implementation of PerfectServe Synchrony™

Our systematic, gradual approach made for a very smooth transition.Dr. Jennifer DeBrulerMedical director of Advocate Medical Group

Gradual adoption proves successful

First impressions are important; a provider’s initial encounter with a new technology tends to leave a lasting impression. Rather than risk unnecessary confusion, frustration or backlash by implementing PerfectServe Synchrony everywhere at once, AMG set a timeline for gradual adoption. By bringing on doctors a few groups at a time, AMG was able to make frequent performance assessments, fine-tune the configuration for each hospital and ensure that doctors were successfully configuring PerfectServe Synchrony to their preferences.

Once the implementation of one group was deemed successful, AMG would start the next one. DeBruler reports that 500 providers were brought on board in 2015. “When we started in January, we were at 481 interactions; by December, we were up to 4,600 interactions.”

Feedback was continually sought during each group implementation. “We had huddles with the practices on a regular basis during the week,” says DeBruler. Physicians could call the medical directors at the contact center if they experienced any problems, and AMG quickly addressed any issues that emerged.

Two automated processes in particular were closely evaluated and tailored: the setup for managing outpatient phone calls, and the system rules and logic by which clinicians within a group could schedule on-call coverage for each other. Each process was first implemented from the contact center’s perspective, then deployed across each of the office sites.

AMG also created a committee to review questions about PerfectServe and respond to requests about who could use it and how it might solve additional problems. Through this methodology, the committee was also able to satisfy the need for home health nurses to manage their on-call coverage with PerfectServe Synchrony — just like the physicians.

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ARTICLE

When Communications Work, Patients WinIn every hospital, communication is at the heart of what care teams do. Physicians need to communicate with one another for consultations; nurses need to reach physicians to update physicians and receive orders. Case managers need to communicate with nurses and physicians to ensure on-time discharges and proper care transitions.

All of these communications are important — and they’re critical to deliver the best care possible to patients. Many hospitals, however, still treat their clinical communication processes as an afterthought, relying on antiquated, manual and inefficient communications tools and systems. It’s not abnormal for hospitals to require a nurse to juggle complicated information related to physician schedules, on-call hours and best method of contact — often stored on paper or in Rolodexes®.

These kinds of outdated communications processes are not just inefficient; they also have a negative impact on patient care. In fact, according to The Joint Commission, communication breakdowns are the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals. Poor communication can result in:

• Decreased productivity. According to a study publishedin The Permanente Journal, medical-surgical nurses spendnearly 21 percent of their time on communications related tocare coordination. Unfortunately, much of this time — up to40 percent — is wasted on failed contact attempts. This kindof waste is not only inefficient and frustrating, but also eatsaway at a hospital’s bottom line.

• Uncoordinated care. More than ever before, patient carerequires a high level of coordination among care teams. Butwithout the means to communicate effectively, it becomesdifficult for care teams to transition patients, discuss care

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plans or stay updated when a patient enters the emergency department. When clinicians can’t communicate with each other in a timely manner, it can cause delays in patient treatment — even errors. The greater the number of clinicians involved in a patient’s care, the greater the potential for delays and errors.

• Delayed care. Nurses need to frequently connect withphysicians so that they can discuss a care plan to intervenein a patient’s care. But when communication cycle times areunnecessarily long, nurses can’t act. This not only delays care,but also slows hospital throughput. When a nurse can’t get anapproval from a physician for a patient discharge, for example,such a delay often results in an increased length of stay. Forpatients entering the hospital (in the emergency department,in particular) this can result in longer wait times — and a majorhit to a hospital’s financial performance.

Lessons for hospitalsUnderstanding the need to foster a positive patient experience, St. Rita’s Medical Center, a 350-bed hospital in northwestern Ohio, launched an initiative to improve overall performance, quality and patient safety. Research has validated that a better patient experience is associated with improved health outcomes (and, unlike patient satisfaction, can be objectively measured). The leadership team at St. Rita’s realized that effective provider-to-provider communication is a very real part of the patient experience and impacts the swiftness of care delivery, coordination of care and nearly every other initiative the hospital was tackling.

As other hospital leaders take a closer look at their own system’s communication processes, there are four key activities St. Rita’s advises they undertake:

• Address communications holistically. Clinicians need multipleoptions for how they communicate, and these modes ofcommunication must be offered as part of a broader strategy.Giving providers the ability to easily structure how and whenthey should be contacted significantly increases the likelihood

CONTINUED: When Communications Work, Patients Win

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that nurses and other providers can reach the right person in the right role at every moment in time.

• Improve productivity. Hospitals need to decrease the “whitespace” in their clinical communication processes — the part thathas no value to the patient (i.e., missed calls, wrong numbers,pages or messages sent, and unnecessarily delayed responsetimes that slow care delivery). By reducing wasted time spentcontacting wrong physicians, nurses can have more time tospend on direct bedside care — which improves the patientexperience. When skilled nurses spend hours trying to trackdown the right provider, it’s a loss of valuable resources thatcould be better spent providing quality patient care.

• Look at metrics. When talking about clinical communicationprocesses, all hospitals will inevitably face disputes over whotried to contact whom, when and how many times — especially ifa communication failure led to a delay in patient treatment.Hospitals should look for systems and tools that provide accessto process metrics that will help them reconstruct anycommunications event after the fact, and enable them to moreeasily drive continuous communication process improvement.

• Aim toward fully coordinated care. As hospitals take stridestoward realigning care teams, it is becoming increasingly moreimportant for clinicians to communicate with one another easily.All physicians or nurses treating a patient should have access tothe same information and be notified of any changes or updates.While much of this information is in the EMR, much of it is notand clinicians still need to talk with one another. Better- coordinated care is higher-quality care. The capability to contactmultiple providers at once makes it easier to keep a team intactand everyone informed and committed to a patient’s care.

Hospitals and health systems have a lot of their plates right now, but by improving clinical communication processes, they can begin to make a meaningful impact on other initiatives — whether reducing readmissions, or improving care coordination or financial performance.

CONTINUED: When Communications Work, Patients Win

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INFOGRAPHIC

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VIDEO

Streamlining clinical communication | Advocate Health CareHear from clinicians at Advocate Health Care on how PerfectServe Synchrony™ has helped provide immediate access to the right care team member, enabling effective and efficient patient care.

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VIDEO

Reducing communication process waste among cliniciansThis video explains how Orange Coast Memorial Medical Center was able to reduce communication process waste among clinicians.

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