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2. 2 Metrics in a Small Hospital It is Possible

3. 3 Metrics in a Small Hospital

4. 4 Your Presenter Rev. Mr. T. Patrick Bradley, MA, BCC Director, Pastoral Care Cheyenne Regional Medical Center 214 E. 23 rd Street Cheyenne, Wyoming 307-633-7586 Pat.Bradley@crmcwy.org 4

5. 5 Objectives You will Understand the need for good metrics. Have ideas on how to develop metrics. Understand the need for good resources. Have ideas on who you should cultivate as resources.

6. 6 How Small is Cheyenne Regional? Licensed for 212 beds. Only Level II Trauma Center in Wyoming. Includes a hospice and a Skilled Nursing Facility (SNF). 6

7. 7 Why Metrics To overcome the perception that we just go in and pray with people. We are a county hospital. This sometimes creates the impression that spiritual care is not part of the mission. 7

8. 8 Let’s Get Going! 8

9. 9 What Metrics? Number of patients seen? How long you spend with patients? How many patients do you pray with? How many bibles did you distribute? NO! 9

10. 10 These Metrics Where are you most likely to be called? How much time do you spend on a typical call? What kind of situation are you called to assist with? What time are you most often called? How satisfied are nurses with your services 10

11. 11 Developing Good Data 6 years! Loose leaf notebook Basic computerized system –Only on certain computers –Needed a geek to get data Now on our intranet home page 11

12. 12 Computer Guru WITHOUT HELP YOU WILL GO UP IN FLAMES

13. 13 How Did We Do It?

14. 14 © 2010 Cheyenne Regional Medical Center From “Metrics in a Small Hospital: It is Possible Presented at the NACC National Conference March 21, 2009 Rev. Mr. T. Patrick Bradley, MA, BCC Director, Pastoral Care

15. 15 Service Entry Form Chaplain name is automatic. Patient name for follow up. Location, ER, ICU, Surgical, etc. –Drop Down Menu Code Blue, Patient Request, etc. –Drop Down Menu Date is automatic. 15

16. 16 Service Entry Form cont. Time In is time pager went off. Length of Visit from Time In. Helpful check boxes. Comments: A way for the on call chaplain to pass information to the day shift chaplains. 16

17. 17 What Data Does This Give Us? Statistics Charts Graphs Material For Presentations

18. 18 Sample Output to Excel Spreadsheet Date ChaplainLocationCodeTime-In Length of Visit OptionsHours 12/31/09David Heaney 82 - PalliativeRecent Change10:30:00 AM0.5 Business Hours 12/31/09Theresa Odhiambo 32 - SurgeryRecent Change9:30:00 AM0.5 Business Hours 12/31/09Theresa Odhiambo 51 - PediatricsRecent Change10:00:00 AM0.25 Business Hours 12/31/09David Heaney 82 - PalliativeStaff Request1:15:00 PM0.5 Business Hours 12/31/09Beth Wright 62 - TeleRecent Change1:50:00 PM0.25 Business Hours 12/31/09Mary Beth Melcher 10 - ERSTEMI Alert5:30:00 PM2On Call Hours 12/30/09Christian Robbins 42 - Ortho- NeuroFamily Request10:15:00 AM0.25 Follow Up Needed Business Hours 12/30/09Roserita DuFresne 41 - TCUOther2:15:00 PM0.75 Business Hours 12/30/09Beth Wright 82 - OncologyStaff Request2:15:00 PM0.5 Business Hours 12/30/09Beth Wright 82 - OncologyStaff Request1:00:00 PM0.25 Follow Up Needed Business Hours

19. 19 Find an Expert to help with this phase! OR

20. 20 Where Did Our Referrals Come From in 2009? As we expected

21. 21 Why Were We Called In 2009? SURPRISE! 21

22. 22 How Many Calls or Referrals

23. 23 Number of Calls: Business Hours What did we do different in December 09?

24. 24 Number of Calls: On Call Hours

25. 25 Average Time Spent: On Referrals

26. 26 Average Time: By Type of Referral How we gathered data evolved.

27. 27 Business hours calls are routine referrals. After hours calls are emergencies.

28. 28 What type of referrals do chaplains receive during business hours (7:00am - 4:00pm)?

29. 29 What type of referrals do chaplains receive during on call hours (4:00pm-7:00am)?

30. 30 What do these two charts tell us? ★ Most of our night calls are for emergencies ★ Most of our day calls are for referrals

31. 31 What type of Referrals Do Chaplains receive most?

32. 32 What Else Did We Do? A Staff Survey

33. 33 Survey Monkey Eight Questions All Staff Optional Anonymous 33

34. 34 Questions 1 - 4 1. What is your profession? 2. How would you rate the availability of chaplains in your setting? 3. How would you rate the cooperation and teamwork between chaplains and nurses in your setting? 4. How would you rate the communication between chaplains and nurses in your setting? 34

35. 35 Survey Questions 5-8 5. How often do you make a referral to a chaplain? 6. Do you read chaplain progress notes? 7. What Unit Do You Work On? 8. (Optional) Do you have any comments or suggestions for the chaplains? Is there anything that the chaplains could do to improve the service they provide? 35

36. 36 What Were the Results? We only had 139 people take the survey. Not a good sample. What did we learn? 36

37. 37 Some Results Who took the survey? – 84% were clinical Where did they work? –Dibs and Dabs from all over. The manager on Women & Children pushed the survey –21% were from Women & Children 37

38. 38 More Results 51% seldom or never make a referral to a chaplain. Only 35% ever read our progress notes. 38

39. 39 Their Suggestions A stronger presence on our ARU and TCU floors. –I–I assigned an intern to each of those units 4 hours twice a week. Nothing else but complements on what we do. 39

40. 40 How Did We Use This? We have made a concerted effort to be more visible on all floors. We are now attending staff meetings when possible to increase visibility. We check in with nurses to see who we might see before we round. 40

41. 41 What Did That Gain Us? Referrals are up. Patient Satisfaction with Spiritual and Emotional needs being met is up. How did we verify that? 41

42. 42 Team Seven: Sensitivity To My Needs © 2006 Chip Caldwell & Associates, LLC. All Rights Reserved. Increased referrals to Pastoral Care. Increased percentage of patients asked if they have emotional or spiritual needs. Increased rounding for emotional/spiritual needs: Improved format for documenting spiritual/emotional needs in Care Manager Overall Improvements 42

43. 43 © 2006 Chip Caldwell & Associates, LLC. All Rights Reserved. Team Seven: Sensitivity To My Needs 90-Day Check In Baseline Data (Tele & Oncology) numberNegativespositives 38317 Follow Up Data (Tele & Oncology) numberpositives 741955 60-Day Check In Baseline Data (Tele & Oncology) numberNegativespositives 38317 Follow Up Data (Oncology Only) numberpositives 24195 60-Day Check In 90-Day Check In 43

44. 44 Team Seven: Sensitivity To My Needs Percentage of Increase in Patients asked about their spiritual and emotional needs: Baseline data = 18% of patients surveyed were asked 60 Day Check In = 21% of patients surveyed were asked 90 Day Check In = 74% of patients surveyed were asked 44

45. 45 © 2006 Chip Caldwell & Associates, LLC. All Rights Reserved. Team Seven: Sensitivity To My Needs Pastoral Care Findings: Referrals Med/Surge Month Total Referrals Staff Referrals Patient/ Family Referrals Dec-091082 Nov-0915132 Oct-0915105 Sep-09862 Aug-09523 Jul-09532 Referrals Telemetry Month Total Referrals Staff Referrals Patient/ Family Referrals Dec-09331815 Nov-0920137 Oct-09413 Sep-09303 Aug-09633 Jul-09532 45

46. 46 Team Seven: Sensitivity To My Needs % of Increase Staff Referrals on Med/Surg Peaked at 300% in November* * December referrals down due to lower census % of Increase Staff Referrals on Telemetry September to Dec = 400% Percentage of Staff Referrals to Pastoral Care

47. 47 Team Seven: Sensitivity To My Needs Patient Satisfaction Trend Telemetry Response to the Press Ganey Inpatient Survey Question “Degree to which the hospital staff addressed your emotional needs” Month Received 2009 SeptOctNovDec Mean Score87.194.489.790.6 Percentile Ranking83999698

48. 48 Why Did We Do This? It gave us statistics in a format that MBAs, MHAs and CPAs understand. It focused us on what we really do. It gave us a healthy accountability. It shows how we contribute to patient satisfaction. 48

49. 49 Who Cares? We must be assertive Show the data to your: –Director –Vice President –CEO –CFO 49

50. 50 Brag! To the managers you help the most To the charge nurses To nursing managers To the Director of Nursing To the VP of Nursing To anyone you have lunch with 50

51. 51 Let’s Share What do you think would be good metrics? Cost of an average call to a Code One/Blue! Average time on a Code One/Blue by chaplain. Mean – Median – Mode statistics by type of referral. 51

52. 52 What Is Your Facility? Hospice Nursing Home Trauma Center Cancer Center Small Hospital Large Hospital 52

53. 53 Metrics in a Small Hospital: It is possible Your Presenter Rev. T. Patrick Bradley, MA, BCC Director, Pastoral Care Cheyenne Regional Medical Center 214 E. 23 rd Street Cheyenne, Wyoming 307-633-7586 Pat.Bradley@crmcwy.org 53