Using High Reliability and the Kano Model to Improve the Patient ExperienceJennifer Hooks, MBA Six Sigma Master Black BeltManager, Performance Improvement

Presenter

Presentation Notes

Partnership between SCHA and The Joint Commission Center for Transforming Healthcare First ever statewide effort to promote the adoption of high reliability practices in hospitals. Ultimate goal is significant improvement in patient safety and quality, resulting in a dramatic reduction in events causing preventable harm. To establish a culture of continuous improvement in the quality, efficacy and safety of patient care across all healthcare organizations and providers statewide.

MUSC High Reliability Journey

Presenter

Presentation Notes

Preoccupation with Failure : address any level of technical, human or process failure immediately Sensitivity to Operations: best picture of the current situation, especially an unexpected one, comes from the front line Reluctance to Simplify: HROs do not explain away problems, instead they conduct root cause analysis Commitment to Resilience: the ability to anticipate trouble spots and improvise when the unexpected occurs. The organization must be able to identify errors for correction while at the same time innovating solutions within a dynamic environment Deference to expertise: the acknowledgement that the person with the most expertise in a situation may not be the highest ranking or most educated person.

What is the Kano Model?

SATISFACTION

HOW WELL NEEDS ARE MET

Excitement needs(Delighters)

Basic needsMust Have

(Dissatisfiers)

Performance needs(Nice to Have)

DISSATISFACTION

Vacation

Towels

Towels

Towels

2 North: Institute of Psychiatry Baseline Survey Data

Month# Surveys Returned Mean Score

Jul 2014 7 77.89

Aug 2014 15 83.26

Sept 2014 9 70.13

Oct 2014 16 91.14

Nov 2014 10 84.7

Dec 2014 12 88.5Monthly

Goal 20 85

Survey Dimensions

My sleeping hours were disturbed only when necessary

The unit was clean and comfortable.

The Hospital was very clean, including entrances, hallways and elevators.

Environment

My meals were delivered at the right temperature.

My meals were served at the right time each day.

Food Service/Ancillary

Staff

Patient Feedback

How to create a Kano surveyTo create a Kano survey, the questions should be posed as a positive and a negative:

• How would you feel if the service/process had feature “X”?• How would you feel if the service/process did not have feature “X”?

Response choices for both questions are:• I like it.• I expect it.• I am neutral.• I can tolerate it.• I dislike it.

EXAMPLE

Positive question:

If your food is served on time, what do you think of it?

If your food is served hot, what do you think of it?

Negative question:

If your food is served late, what do you think of it?

If your food is served cold, what do you think of it?

I like it. I expect it. I am neutral. I can tolerate it. I dislike it.

I like it. I expect it. I am neutral. I can tolerate it. I dislike it.

I like it. I expect it. I am neutral. I can tolerate it. I dislike it.

I like it. I expect it. I am neutral. I can tolerate it. I dislike it.

2 North Kano Model

SATISFACTION

HOW WELL NEEDS ARE MET

Ability to open and close blinds myselfHot food on time everydayNice Air Fresheners

Good nights sleepWarm FoodArea doesn’t stink

Blinds that actually workMeals on time not to be reheatedArea that smells good but not like pine soil

DISSATISFACTION

Prioritize Patient Requirements Using a Kano Model

Must Have Nice to Have Delighters DissatisfiersGood nights sleep

Blinds that actually work

Ability to open and close blinds myself

Not seeingthe sunlight in the morning

Warm Food Meals on time not to be reheated

Hot food on time everyday

Cold food not knowing when meal time is

Area does not stink

Area thatsmells good but not like pine soil

Nice Air Fresheners

Stale smelling area and dirty smelly bathrooms

Avatar SurveyMy sleeping hours were disturbed only when necessary

My meals were delivered at the right temperature

The unit was clean and comfortable

Kano Model Delighters

Returned Surveys Root Causes/Solutions

Families not told to come early to

complete surveys before discharge

Created standard script for directing families to unit for

discharge, including more accurate time estimate for arrival.

Surveys given out too often at

beginning of the month

Space out how often surveys are given out throughout the month.

Surveys to be given out on days that historically have higher discharges

Older patients eligible to take the

surveys themselves are not

Greater number of older patients take surveys

themselves.

Physicians on unit evaluate older patients to

determine which ones can take satisfaction survey themselves.

MONTHJan 15Feb 15Mar 15Apr 15

May 15Jun 15Jul 15

Aug 15Sep 15Oct 15Nov 15Dec 15

# SURVEYS93329272119161410292624

MEAN SCORE84.7992.3493.8386.4389.4589.3896.2986.6980.7786.7783.685.6

Kano Project Data