1. Involving Patients in Performance Improvement March 26, 2014

2. Panelists Downey Medical Center NICU: Trav Ichinose, member of parent advisory council, Sarah Koshy, management co-lead and Marnie Morales, labor co- lead San Diego Medical Center Direct Observation Unit: Sheryl Almendrez, management co-lead Largo, Maryland, Urgent Care: Donna Fraser, labor co-lead

3. Special Guest Hannah King Director Unit-Based Teams Service Quality

4. A Few Logistics To minimize noise, attendees have been muted upon entry Please use the chat box at the lower left of your screen to type in questions and comments Link to slides and audio will be posted to the LMP website Link and resources will be emailed to today’s attendees later today

5. Environment is not familiar, can be disorienting Older people frequently use bathroom at night – its dark Why Are Patients Falling? What did not prevent falls Schmid score alone Bed placement Identifying patients as high risk for falls Fall protocols (bed alarms, identifiers) Toileting approaches Patient’s use of call light (lack of) Most falls (86%) were from patients mobilizing unassisted Pat helped us understand the underlying reasons “why” From independent to dependent Embarrassed to ask for help and wearing a gown

6. NICU UBT & Parent Advisory Council Downey Medical Center

7. UBT PARTNERING WITH NICU PARENT ADVISORY COUNCIL MISSION: Improve care design by partnering with all caregivers and giving a voice to the premature baby and family –Communicate patient needs and concerns –Help review and design policies and procedures –Encourage family involvement and information seeking –Strengthen communication

8. Advisory Council Identified These Issues: –process of shift change report varied greatly –Staff-centered versus patient-centered –Visiting hours excluded parents from shift change –Concerns about HIPAA TRADITIONAL NICU SHIFT CHANGE REPORT

9. Designed and Role Played Shift Change Reports –Staff role played with UBT and Advisory Council members and identified gaps Participated in Video Ethnography –Videos made discussing benefits of attending shift change, demonstrating what it would look like –Used as staff education tool NKE+ DESIGN AND IMPLEMENTATION

10. NKE+ COMPOSITE TOP SERVICE SCORE

11. Enhancing Patient and Family Focus Influencing Perception of Quality Care Customer Satisfaction Continued Improvement and Staff Empowerment Collaboration and Shared Commitment QUALITY THROUGH PARENT PARTNERSHIPS

12. Urgent Care Department Largo, Maryland (Mid-Atlantic States)

13. Largo and Camp Springs Urgent Care/Critical Decision Unit NameTitle/Classification/Union Donna FraserLabor Co-Lead, RN (lead) Felina CephasLPN Abraham AbbanRN, Clinical Operations Manager, Management Co-Lead Abagail NowlinLead Nurse, RN Maria ChiuLead Nurse, RN Paulette HardingUFCW Shop Steward/ RN Gary CampbellDirector, sponsor

14. Urgent Care projects needing member input Triage wait –Starts when member checks in –Finishes when the first vital sign is entered Provider wait –Starts when vital signs are entered –Finishes when provider opens the encounter From exam room to finish –Starts when provider opens the encounter –Finishes when AVS is printed –Varies greatly by whether patient requires lab or x-ray

15. A member as part of your UBT: What does it look like?

16. Together we can make things better!

17. Our Best Practices Team approach: one doctor, a nurse and an Urgent Care tech make up a team and work together to manage patients assigned to doctor Daily huddles: cycle time data was shared monthly with the entire UBT Cycle Time: keep below 100 minutes for Largo and Camp Springs Urgent Care centers

18. What are We Doing Now? Active Projects Focus on Member Service: “Treat Every Patient Like Family” Shift “champions” Proactive care: Mammos, Paps, blood sugar, LDL ordered or done in Urgent Care Patient safety: Name bands on every patient

19. Definitive Observation Unit San Diego Medical Center

20. Patient Involvement in Committees Patient/Family Care Council (PFCC) started in 2012. Service Excellence Team-Council members meet every 3 rd Tuesday for two hours Wanted to know inpatient patient perspective and ways to improve our patient care experience. –Improvements include discharge paperwork for patients and thank you cards Frank Hagg - Staff Nurse Council (PFCC representative) Susan Mahler, PhD - invited to Unit Based Teams (PFCC representative).

21. Patient Involvement in UBTs DOU UBT staff were very interested in inviting a committee member from PFCC to monthly meetings. UBT wanted to know how would staff would feel to hear the “Real Truth” (patient’s perspective of care experience) Everyone “thinks” they are doing okay. Patients have a different perspective. DOU UBT wanted to know ways to improve Patient Care Experience through the perception of the patient Question staff and UBT had for PFCC member: “What does Nurse Communication mean to you?” Answer: “Competency is expected. Quality Care is parallel to the courtesy and respect given to the patients during hospitalization.”

22. Current DOU UBT Projects Current Projects with Susan Mahler, PhD. Overall Score Staff to introduce themselves every time they enter the patient’s room. Nurse Communication MD/RN Collaboration Commonly used medications in the DOU/Possible Side Effects Staff Responsiveness Ask patients what “timely manner” means to them. Pain Control During rounding, talk about pain control and what the patient does at home for pain.

23. Discussion Why did you want to involve a patient in your performance improvement effort? What barriers did you face? How did other UBT members react? How did you overcome these barriers? What results did you achieve? How do you think having a patient voice in the project affected what you came up with? What is your advice to other UBTs that would like to try this?

24. Special Guest Hannah King Director Unit-Based Teams Service Quality