The Children’s Hospital of Philadelphia staff was frustrated with lagging survey data as the only source of information about how patients and families were experiencing the hospital. Nursing and clinical teams were concerned that they could not always rely on lagging survey data to gauge if improvement efforts were effective.Bedside nurses members stated they didn’t understand how they could, individually within their respective roles, could impact the overall patient & family experience scores.
The solution: Real-Time Patient & Family Check-Ins:
Partner nursing and family leaders to determine the best way to connect with families at the point of care to learn what is going well and not so well in order to:
o Check-in and “connect” with families every day…while they area here
o Identify best practices, service recovery opportunities
o Sustain, scale components of best experience with “real-time” metrics
PROBLEM IDENTIFICATION & SOLUTION
Family and Nursing Leaders at Children’s Hospital of Philadelphia partnered to successfully improve patient and family experience scores, which were trending at the 50th percentile ranking. The team created a process to obtain more immediate and actionable feedback from patients and families…and ended up changing their entire culture at the same time.
Using improvement methodology and relying heavily on the voices of patients and families, Nurse Managers, Patient/Family Experience Specialists, Family Consultants and members of the Family Advisory Council collaborated to pilot a standardized semi-structured conversation at the bedside on one unit. The goal was to “check-in” with patients and families in “real time” at the point of care to clearly and accurately understand how they are experiencing the hospital and then improve that experience wherever possible. I
n addition to real-time, actionable feedback from patients and families, nursing leaders reported that their teams experienced a culture shift toward proactively driving an ideal “total” patient experience at the bedside from admission to discharge and beyond which has begun to directionally impact the organizational metrics on patient experience.
The first test of change was to gather family feedback about their experiences at the point of care in a standardized approach: a semi-structured conversation modeled around themes found in HCAHPS surveys. The resulting feedback was shared transparently during daily multidisciplinary huddles, engaging frontline staff more proactively as key drivers of an ideal patient/family experience. The huddle quickly evolved as the vehicle for staff to proactively problem solve as a team and identify families who would benefit from a “check-in.” Small improvements have been seen in satisfaction scores related to communication. Secondarily, data yielded positive comments about staff providing opportunities for public recognition and increased staff satisfaction, anecdotaly and via survey results. Check-in tests have spread to 9 inpatient units, Perioperative Complex.
PATIENT & FAMILY INVOLVEMENT
Family consultants (parents of children who have or are currently receiving care from CHOP, paid staff positions) met with nursing staff and observed nursing rounds. Family consultants and nursing leaders also met with families at the bedside to gain input about family preferences regarding being asked for feedback in a way that feels like a safe, authentic invitation to partner and collaborate in the care of their child. Family consultants and nursing leaders crafted a semi-structured conversation with questions related to the care domains that are important to families: care coordination, access to care, pain management, communication, environment of care, etc. Staff gave feedback about wording and flow. Nursing and family leaders also took the project and proposed the “Real-Time Patient & Family Check In” conversation and process to CHOP’s Family Advisory Council and Family Partners (volunteers who engage and respond virtually to hospital initiatives).
- Daily Huddles (teams at the local unit level)
- Weekly Leadership meetings to share test learnings: leaders share learnings from small tests of change and progress points — what’s working, what’s not — to share and sustain.
- Operating Plan Steering Committee Updates: communicating to CHOP Leadership to secure support and scale best practices to additional units and points of care
INSPIRING STAFF TO FOCUS ON PATIENTS & FAMILIES
After 6 months of testing “Real-Time Patient & Family Check Ins,” 82.5% of nurses surveyed said they were comfortable with a nursing leader performing a “Real-Time Patient & Family Check In” with patients/families for whom they were caring.
95% of nurses surveyed said the Real-Time Check-In process helped them to better understand their individual role in supporting the best experience possible for patients and families on their unit.
Nursing leaders reported that bedside nursing adopted a more proactive approach to communicating with families, especially those with challenges. Nurses reported that instead of avoiding families where stress and concern might be evident, they embraced the ability to call on their teammates and leaders to proactively address, connect and troubleshoot problems and issues with families while they were still here with us to restore the connection/relationship.
TRANSFORMATION OF CARE DELIVERY
o Case 1:
A family on a unit experiencing high census reported that things were going well. During the “Real-Time Check-In” conversation, the father shared his son was autistic and music was important. Nursing leadership knowing to call Child-Life to the bedside transformed an otherwise good experience to great (according to the father.) The father reported that he would not have otherwise spoken up, but the process made him comfortable to share.
o Case 2:
A mother was tearful and frustrated as she neared discharge with her son after a 5-day stay for the first of several surgeries. A series of miscommunications resulted in the mother perceiving she was being treated disrespectfully due to her ethnicity. She threatened to go to social media and, most concerning to staff, stated she would take the baby elsewhere for the remaining surgeries. The “Real-Time” conversations gave staff and the mother the opportunity to review events, and for staff to explain the “why” of events, apologize and reestablish a strong connection.
Examples like these repeat every week. Staff reports a feeling of confidence and empowerment to drive great experiences through the “Real-Time Check-In” process.
IMPACT ON PATIENT EXPERIENCE & OUTCOMES
“I really felt invited onto the team”
“It seams like you REALLY want to know what I think and how it is going for us.”
Overall Unit Survey scores have improved FY 2014-2015 consistently increased from the 50th PR to 75th PR
Comfort with nursing leaders “Checking-in” on their patients. FY15 82.5%, FY16 90%
Helped feel comfortable raising a family concern with leadership. FY15 77.5%, FY16 80%
Process increases understanding of their role in creating a great experience. FY15 95% FY16 96.7%