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How to Improve Patient Experience in 60 daysPedal to the Metal Aamer Ahmed, MBA
Lisa Hare, MS
Where We Are5 hospitals and 45+ locations in:
• Milwaukee County
• Kenosha County
• Ozaukee County
• Washington County
• Waukesha County
Awards
Froedtert Hospital9200 W. Wisconsin AvenueMilwaukee, WI 53226
Community Memorial Hospital W180 N8085 Town Hall RoadMenomonee Falls, WI 53051
St. Joseph Hospital 3200 Pleasant Valley RoadWest Bend, WI 53095
Kenosha Medical Center6308 Eighth AvenueKenosha, WI 53143
St. Catherine’s Medical Center9555 76th StreetPleasant Prairie, WI 53158
Conveniently located health centers inMilwaukee, Kenosha Ozaukee,Washington and Waukesha countiesconnecting you to academic medicine atits best
Beds857 Physician Clinic Visits789,900Patient Admissions41,892 Intensive Care Units7
Patient Days of Care211,116 Staff and Physicians11,754Emergency Visits114,893 Total Physicians1,434
Average Daily Census578 Nurses3,334Outpatient Visits998,237 Volunteers784
Cardiology Procedures38,974 Live Births4,232
Froedtert Hospital
• Beds | 585• FY17 Admissions | 29,386• Emergency Visits | 71,989• Births | 2,701
The Medical College of Wisconsin
Patient Experience Landscape & Challenges
• Several clinics have not met goal• Staff and physician engagement• Competing priorities• Alignment to purpose
Our Journey
Provider Communication
Staff Communication Waiting Paperwork Prognosis Wayfinding Results
Our Lens
Patient Lens
Patient-Centered Alignment
Patient
Pt Experience Team
Performance Excellence
Team
Enterprise Registration
Org Development
Process Improvement
Teams
Plant Operations
Volunteer Services
Purpose
• To understand the entire patient journey from start to end from the viewpoint of the patient
• To improve teamwork and care coordination centered around the patient
• To reach top decile performance
60 Day Rapid Improvement Model
1. Concentrated Support Resources2. Measurable3. Specialty-Specific Analysis & Customer
Discovery4. Frontline Kaizen Workout5. Frontline-led workgroups
Four Phases1. Analyze: Data, comments, lit review [Week 1-2]2. Observe: PX Support team will shadow patients, faculty, APPs and
clinic staff [Week 2-4]3. Root-Cause: 2-4 hour workout session to review opportunities,
develop interventions [Week 5]4. Improve: Deploy and sustain action-plan [Week 5-8]
Analyze• Regression analysis by specialty• Pareto comment analysis• Literature review on interventions
0
2
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8
10
12
Wai
t tim
e
Expe
ctat
ions
Rece
ptio
nist
dem
eane
r
Prov
ider
Em
path
y
Seei
ng p
rovi
der o
f cho
ice
Inpa
tient
Phon
e ex
perie
nce/
Not
ans
wer
ed
Park
ing
& W
ayfin
ding
Appt
lag
Insu
ranc
e/ C
opay
s
Med
icat
ion
man
agem
ent
Test
res
ult f
/u
Chec
kout
dem
eane
r
Unc
lean
whi
teco
at
Surg
ery
sche
dulin
g
Pain
Man
agem
ent C
linic
My
char
t res
pons
iven
ess
BP ch
eck-
Priv
acy
ER S
taff
Felt
mis
unde
rsto
od
RN d
emea
ner
No
med
ical
reco
rds
Week 1-2
Observe• Patients are shadowed from arrival to departure• All providers and staff are shadowed and provided with real-time
feedback.• An email summary is sent to them.• Observation data is captured in Qualaris.
Week 2-4
Kaizen
5-Step Problem Solving Kaizen1. What is the current process?2. What is working?3. What needs to change?4. What can we trial?5. What is the impact?
Week 5
It’s Fun
Journey Mapping
5SW | Neurosurgery
Why
?Jo
urne
y M
ap (C
urre
nt S
tate
)W
hy?
Why
?In
terv
entio
nsW
hy?
Why
?
Need help with restroom
1st RN Rounds – Admission
overview
Physician/APP rounds
Call light pressed
HCAHPS
77.1%
Nurse explanation inadequate
I was asked about help needed at
home
I receive adequate discharge
instructions
Before receiving meds, I was told what they were
for
I was told in writing what symptoms to look
out forI understood the
purpose of my meds
Transferred to 5SE
HCAHPS
71.1%
Room/ bathrooms unclean
Test/ Procedure conducted
Ordered food DischargedSleep
ED
NICU
5NW
RN Rounds Medication changed
HCAHPS
51.4%
Explanation of new medication side
effects inadequate
HCAHPS
60.1%
Pressed call light and didn’t get help as soon as needed
HCAHPS
56.0%
Interruptions/ noise at night
RN station not always manned
HUC not at station 24/7
HUC covers other units
Lack of ownership/ 2 different services on
floor
Visible waste on toilet seats
5th floor has shared bathrooms
Bathrooms are cleaned once a day
No pass zone for RN staff
December 2016
Hospital is in red capacity
Call light to vocera
March 2016
Acknowledge/commit to clean at
admit
December 2016
Increase EVS frequency
Staff clean toilet seats
December 2016
More time spent needed than RN
resources available
Large amt of high acquity patients
Low morale among nursing staff
Challenging pt population/ some
long term
RN hourly rounding skills labs
January 2016
Monthly RN leader validation
February 2016
Docs change meds when not with
patient
For many meds, RNs don’t know side
effects
RNs must look in EMR. Often,
indicators are not on orders
Lack of communication
frequency between providers and nursing staff
Create common side effects handout
December 2016
Deploy MyStay brochure
Staff noise Ventilator alarm/ bed checks
Care team rounding every two hours at
night
Rounds are uncoordinated
between RNs, techs, providers, etc.
Offer ear plugs at admit
January
Develop process to cluster pm rounds
January
Hospital Medicine | Team Responsiveness
Why
?Jo
urne
y M
ap (C
urre
nt S
tate
)W
hy?
Why
?In
terv
entio
nsW
hy?
Why
?
Provider rounds on patient—Plan is
presented to patient
4NE
4SE
4NW
HCAHPS
<50thPressed call light
and didn’t get help as soon as
needed
No communication from consult team to attending/RN
Task overload
No clear communication when team is
rounding
Lack of whiteboard usage
Second call response ineffeciencies
Inconsistent use of call light log
Inconsistent messaging and
triage
Understaffed
High turnover
HUC receives call light from patient PCA paged via
voceraRN paged via
vocera
9NT
5SE
Charge Nurse point of contact for consulting
team
Standard pocket card
Monthly rounds w/HUC leader and unit
mgr
Rollout call light scripting from 7NT/
4NW pilot
Rollout PSA Reassignment group
act ion plan
No set time for rounds
All providers prioritize differently
Geo-localization has providers seeing
patients on 6-8 units
Not valuing it due to primary focus on pt
conversation
Requires extra step after explanation
given
Markers not easily accessible
Receiving multiple calls at once
Not clear to HUCs who is assigned to
patientLow CCR Attendance
Lack of uniform standard for
communication with unit
Lack of unit-based accountability
Med team changes/turnover every two
weeks
Biweekly Unit orientat ion at med
team rotation
Call log details not transparent on unit
Unit activity not driven by call light
trends
HUC activity not actively reported to
unit leadership
Standardize call log after NS log pilot
Copy unit manager on log to HUC leaders
No coverage at breaks
No standard expectations
Use of volunteer services for coverage
Provide HUCs with RN backup assignments
Standard Pre-hire screening for cultural
fit
Improve
• Multidisciplinary Workgroups led by frontline teams
• Facilitated by members of Patient Experience team
Week 5-8
Feedback
• Highly engaging• Frontline voices heard• Togetherness• Professional Development• Change that is visible
Results
Clinic Pre-Score
Post-Score
Change
Gastroenterology 85.4 89.0 3.6% #
Reproductive Med 78.2 81.6 3.4% #
Rehab Med 88.2 89.8 1.6% #
Pulmonary 87.4 93.1 5.7% #
Infections Disease 89.7 97.3 7.6% #
Neurology 86.4 88.3 1.9% #
Surgery 95.9 96.7 0.8% #
CGCAHPS Overall Provider Ranking
May
June
July
August
Septe
mber
October
Novem
ber
Decem
ber
January
Febru
ary
March April
May
Overall Ranking
90th %ile
ToolsSample
Qualaris
Trello
Sample Interventions
Team Slim Jims
Team Posters
Enhancing Communication
Visual Aids
Creating a Healing Environment
Creating a Healing EnvironmentPatients want to know• 59% of neurologists in the greater Milwaukee
area that are on the ‘best doctors in America 2017’ list are F&MCW neurologists
• 80% of neurosurgeons in the greater Milwaukee area that are on the ‘best doctors in America 2017’ list are F&MCW neuro-surgeons
• “I learned so much more about my chronic illness”
• “Dr. Remler spent extra time with me even after closing time. Very respectful and kind.”
• “Our experience with Froedtert, Dr. Mueller, and the entire staff, has been absolutely exemplary!”
• “Dr. Figueroa & his nurse Stacey treat me like a VIP. They are always so responsive & kind”
Creating a Healing Environment
Key Challenges and Learnings1. Time2. Staff and Physician Burnout3. Sustaining Change
Thank You
Aamer Ahmed, MBADirector of Patient Experience
Lisa Hare, MSManager of Performance [email protected]
