decreasing noise to increase our hcahps€¦ · •6 months from kaizen to implementation –kaizen...
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Decreasing Noise to IncreaseOur HCAHPS
Joanne Muzzey, RN MSDirector of Patient Advocacy and Planetree
Karin Block, RNRelationship-Based Care Coordinator
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Agenda
• Introductions
• Awareness activity
• Elmhurst Memorial Healthcare overview
• Kaizen event
• Rest and relaxation hour
• Outcomes
• Lessons learned
• Next steps
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Elmhurst Memorial Hospital
• Suburban Community Based Hospital established in 1926
– 275 beds
• 66% private rooms
– Model of Care
• Relationship-Based Care
• Shared Governance
• Planetree Affiliation 2007
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Elmhurst Memorial Hospital Today
• Transitioned to a new replacementHospital on June 25, 2011
– 259 private rooms
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Awareness for Change - 2008
• HCAHPS first released for EMH
– Quiet at Night 47.2%
• 1% of HealthStream database
• One unit as low as 17.1%
• Planetree Progress Assessment Feedback
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Initial Interventions
• Work Life Council
– Silenced portable phones
• Planetree Steering Committee
– Healing Environment Team
• Organization awareness
• Unit Councils
– Unit specific noise
• Practice Council
– Sleep Standard
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• Minimal improvement in HCAHPS
• Feedback from our Patient Family Advisory Council
• Initial efforts were not coordinated and ineffective
• A culture change was needed
Reasons for Organization Wide Approach
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Assessment
• Kaizen event held on June 30, 2009
– Multi disciplinary focus included staff members from all areas, volunteers and members of Patient Family Advisory Council
– Organizational noise assessment
• Data collected
– Decibel readings
• Observation of workflow
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Assessment
• 46 tasks were identified and categorized
– Environment and equipment
– Processes
– People
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Accomplishments from Kaizen
• Quiet at Night Standard
• Elevator use Standard
• Standardized call light system and telephone ring tone volumes across all units
• Keypads silenced
• Tube stations padded
• Cushioned tops of laundry hampers
• IV pole inventory
• Rest & Relaxation Time
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Rest and Relaxation time objective
Create an environment conducive to healing by offering our patients one hour in the afternoon to rest without interruptions 80% of the time, through the coordination of patient care and support services.
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Rest and Relaxation Planning
• Multidisciplinary task force developed
– 31 areas/departments represented
– Senior leadership support
– Staff-level team leaders
• Members: clinical/nonclinical
– Emergency Department– Cardiovascular unit– Critical care unit– Progressive care unit– Oncology unit– Medical unit– Surgical unit– Food Service
–Family Birthing Center– Housekeeping –Respiratory care –Transitional care unit–Pediatrics– Ambulatory surgery unit– Central Admissions Area– Diagnostics
–Physical Therapy
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Planning: Initial meeting
• Senior leader message
• Awareness activity
• Overview of project
• Everyday Creativity
• Defined the scope
• Set timeline for implementation
• Initial discussion of unit hours
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Planning: Everyday Creativity
• Reframe the problem into an opportunity
• Change the group’s perspective
• Seek the next right answer
• Create passion
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Planning: LEAN process
• Defined scope
– In scope: inpatients
– Out of scope: new admissions, outpatients (ED, Ambulatory Surgery), Transitional Care Center, behavioral health unit, stat and emergency care
• Decision making activities
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Bedside handoff process
Verbal/written report tools
In-patient areas
Admitted patients(including OBSV and SPO’s)
Content of report
Outpatient to inpatient areas
Picture Frame Scope of Project
New
Admission Inpatient Nursing Units
Transitional Care Center
Outpatient
Areas:
ED &
Ambulatory
Surgery
Behavioral
Health Unit
Stat and
Emergency
Care
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Planning: Timeline
• 6 months from Kaizen to Implementation
– Kaizen June 30, 2009
– Initial task force meeting November 23, 2009
– Rest and relaxation hour February 1, 2010
phase one
• Hours by department/floor
• 1– 2p.m. Third floor: medical, oncology, Family Birthing
Center, Pediatrics
• 2 – 3 p.m. Second floor: cardiovascular, progressive
care, critical care
• 4 – 5 p.m. Fourth floor: surgical
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Implementation Phases
• Phase one
– Inform patient and family
– Rounding to prep patients
– Close patients’ doors as desired
– Dim hallway lighting
– Lower voices
• Phase two
– Decrease/eliminate environmental noise at the unit level
• Phase three
– Coordinate patient’s schedule to support rest time 80% of the time
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Outcomes
• Decibel reading
• Unit observation
– Hall lights dimmed
– Patient doors closed
– Staff activity
• Patient interviews
– Are you aware of rest and relaxation time?
– Was the environment suitable to allow you to rest?
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Decibel Readings
Unit Before After Change
3N 54.7 54.52%
reduction
CVC 54.5 51.232%
reduction
PCU 51.8 48.333%
reduction
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2008 2009 2010 2011 2012
Timeline
InitialHCAHPSReport
Steering Committee initiatives
Council projects
Kaizen
Rest and Relaxation
hour
New Campusopens
New Campus training
75.9%
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Quietness of area around room at night
• September 2008 47.2%
• September 2009 51.6%
• March 2010 55.9%
• September 2010 60.1%
• March 2011 60.6%
• September 2011 75.5%
• December 2012 75.9%
• March 2013 78.5%
• December 2013 73.9%
0%10%20%30%40%50%60%70%80%90%
New campus
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New Hospital
Quiet by Design
Decentralized work stations
Onstage / Off stagework and patient flow
Sound absorbing materials
Room darkening shades
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New Hospital
• Quiet by Culture
– Uncluttered
– Quiet equipment
– Staff awareness and ownership of the environment
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Implementing R&R in our new environment
• Individualized to patient preference
• Patient Centered Scheduling
• Multidisciplinary approach
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Lessons Learned
• Need a department champion
• Feedback is essential
– Share department best practices
• Keep the momentum
– Monthly check in meetings
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New Hospital Decibel Scores
Average Sound Levels (dB)
New Hospital October 2011
New Hospital September 2013
Unit Daytime Levels
(6:00 am – 10:00 pm)
Night-time Levels
(10:00 pm – 6:00 am)
2011 2013 2011 2013
Medical
5SW*
50.9 52.723% increase
48.1 48.21%
increase
Surgical
4W
54.5 57.338%
increase
47.9 55.0126%
increase
Oncology
4SE
54.5 56.627%
increase
48.9 52.249%
increase
Cardiovascular
3SW
53.5 56.134%
increase
49.9 52.840%
increase
Progressive Care
Unit
53.8 55.724%
increase
50.2 50.65%
increase
Family Birthing
Post Partum
NA 52.0 NA 46.4
Average 53.5 55.329.2%
increase
49.0 51.444.2%
increase
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Next Steps for EMH
• Awareness
• Patient Experience Team
• Relationship-Based Care Kaizen
– Always events expectations
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Questions?