C2 Cunningham - Breakout session - MTPIN Health Summit/C2-Cunningham.pdf · Please do not quote or...

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COPYRIGHT © STUDER GROUPPlease do not quote or disseminate without Studer Group authorization

Slide 1

Accelerating Your ResultsMHA Summit

Lynne Cunningham, International Speaker and Coach


Slide 22

Why

What

HowDo we make a difference?

2


Slide 3

Let’s Look at Four Specific Tactics

1. Nurse Leader Rounding

2. Hourly Rounding®

3. AIDET®

4. Discharge Calls


Slide 4

1. Nurse Leader Rounding

The following depicts questions asked on a nurse leader round with an alert and oriented adult female with a tracheostomy

As she could not speak, she wrote her answers down. They are captured in this presentation in her own handwriting

On initial introduction this patient expressed she was very pleased with the care

Pay attention to her use of consistency words and ask yourself if this patient could give an “always” on HCHAPS composite

questions

3


Slide 5

Question: “Do the nurses always come to your room and introduce the oncoming nurse and involve you in a discussion about your care?”

• Nurse leader validating frequency of bed side report, patient centered care, and nurse communication


Slide 6

Question: “Do you have to use your call light often and if so what for?”

• Nurse leader validating hourly rounds

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Slide 7

Question: “Do we offer to bring your pain medications or do you have to ask for them?”

• Nurse leader validating hourly rounds and pain management


Slide 8

Question: “Do we check back with you to see if your pain medication was effective?”

• Nurse leader validating if reassessments are done after giving pain medications

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Slide 9

Question: “Do we always clean our hands when we enter your room?”

• Nurse leader validating consistency of hand cleaning by staff and physicians


Slide 10

Goals for Nurse Leader Rounding on Patients

• Set expectations for the patient

–What staff will do/what to expect from us

• Manage up/harvest recognition

–Reduce anxiety

• Service recovery

–Apologize, thank them for input, follow up

• Manage staff performance

–Most critical step – this is the outcome!

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Slide 11

Validating Staff Behaviors - #1

• Direct Observation–Competency Validation

• Rounding on Staff–Tell me how you are….

• introducing yourself?• indicating how long it will take?• explaining the procedure?

• Rounding on Patients and Families–Is my staff

• Introducing themselves• Explaining things in a way you can understand?


Slide 12

Validating Staff Behaviors - #2

• Patient Comments (This is a critical piece of Voice of the Customer)

–Review what patients are saying

–Does it validate use of AIDET?

• Patient Satisfaction Results

–Courtesy – Do results validate AIDET?

–Are results posted and reviewed with staff?

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Slide 13

Never Sometimes Usually Always

Always


Slide 14

Definition of insanity: doing the same thing over and

over and expecting different results.

Albert Einstein.

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Slide 15

2. A Little Validation – Hourly Rounding

• How many steps are in the inpatient Hourly Rounding bundle?

• How many steps are in the ED Hourly Rounding bundle?

• What question should you ask to validate Hourly Rounding?

• How can you reinforce Hourly Rounding at staff meetings?


Slide 16

Eight Behaviors for Hourly Rounds

Hourly Rounding Behavior Expected Results

Use Opening Key words Contributes to efficiency

Accomplish scheduled tasks Contributes to efficiency

Address 3 P’s (pain, potty, position) Quality indicators – falls, decubitis, pain management

Address additional comfort needs Improved patient satisfaction on pain, concern and caring

Conduct environmental assessment Contributes to efficiency, teamwork

Ask “Is there anything else I can do for you before I go, I have time?”

Contributes to efficiencyImproves patient satisfaction on teamwork and communication

Tell each patient when you will be back Contributes to efficiency

Document the round Quality and accountability

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Slide 17 COPYRIGHT © STUDER GROUPPlease do not quote or disseminate without Studer Group authorization

Slide 17

Study on Nurse Hourly Rounding®Agency for Healthcare Research and Quality (AHRQ)

3.7%

1.6%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

Month 1 Month 6

Per

cen

t o

f P

atie

nts

Time

Hourly Patient Rounds Reduced Pressure Ulcers by

50% in 6 Months

4.52

3.75

2.4

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Month 1 Month 12 Month 15F

alls

per

100

0 P

atie

nts

Time

Hourly Patient Rounds Reduced Falls by Over 50%

in One Year



Slide 18

Study on Nurse Hourly Rounding®Agency for Healthcare Research and Quality (AHRQ)

4,273

2,936

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Month 1 Month 5

Nu

mb

er o

f C

all

Lig

hts

Time

Hourly Patient Rounds Reduced Call Light Volume by Nearly

One-Third in 5 Months

23%

33%

67% 67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Patient Satisfactionwith Nursing

Patient Satisfactionwith Response

Time to Call Lights

Per

cen

tile

Ran

k

Hourly Patient Rounds Improved Patient Satisfaction

Month 1 Month 12

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Slide 19

ED Hourly Rounding

• Introduction

• Explain Hourly Rounding when rooming the patient

• Update white board

• Address PPD – pain, plan of care, duration

• Assess the environment

• Perform tasks

• Closing


Slide 20

Relationship Between Nurse Communication and Pain Management Results

20One way ANOVA indicates that difference in means for all slides are statistically significant p=.000

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Slide 21

Relationship Between Doctor Communication and Pain Management Results

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Slide 22

Relationship Between Responsiveness of Hospital Staff and Pain Management Results

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Slide 23

Unplanned Readmissions are Lower in Hospitals that Patients Rate Highly for Pain Management

23There is a statistically significant difference between hospital groups as determined by one-way ANOVA (F (3,3890) = 45.0, p = .000). A Tukey post-hoc test revealed that unplanned readmissions are statistically significantly related to HCAHPS pain management results (p=.000).


Slide 24

Medicare Spending Per Beneficiary after Discharge is Lower in Hospitals that Patients Rate Highly for Pain Management

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Slide 25

Relationship Between Patients’ Likelihood to Recommend and Pain Management Results

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Slide 26

Relationship Between Percent of Patients that Rate the Hospital a 9 or 10 and Pain Management Results

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Slide 27

Hardwiring “always” makes a big difference with M in the Box℠17% improvement vs. 2% for “usually!”

-3%

2%

17%

-5%

0%

5%

10%

15%

20%

2 - Sometimes 3 - Usually 4 - Always

Imp

rove

men

t in

Res

ult

s Y

TD

How Hardwired is the Tactic?

Percent Improvement in One Year in Top Box Results for "Communication about Medicines"

by How Hardwired the Use of Tactic


Slide 28

3. Why AIDET®?

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Slide 29

Studer Group Five FundamentalsAIDET®

A Acknowledge

I Introduce

D Duration

E Explanation

T Thank you


Slide 30

Advantages of AIDET®

=Decreased

AnxietyIncreased

Compliance+Improved clinical

outcomes and increased

perception of care.

Decrease anxiety with increased compliance

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Slide 31

Key Words at Key Times – AIDET® Outcome - Inpatient Results

Source: Lafayette General Medical Center, Lafayette, LA; Source: Press Ganey Inpatient Satisfaction Report –Large PG Database; 4Q2008

Tactic and Tool Implemented:AIDETSM


Slide 32

0102030405060708090

100

Likelihood to Recommend Room Cleanliness Overall Rating

Tactic: Introduction of AIDET® in EVS

Key Words at Key Times – AIDET®

Outcome - Environmental Services

Source: Upson Regional Medical Center 2006‐2011

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Slide 33

0 10 20 30 40 50 60 70 80 90 100

Overall Patient Satisfaction (53.0%)

Access to care (46.5%)

CP concern for prob/condition (84.2%)

CP efforts to include in decisions (73.3%)

CP information about medications (73.5%)

CP instructions for follow‐up care (80.0%)

Ease of obtaining test results (60.0%)

Change in Percentile Ranks

Post AIDET

Pre AIDET Percentile Rank

AIDET® – Impact on Safety and Quality

Source: Oklahoma University; OUP Hematology/Oncology Clinic & Infusion Center; 10 providers & 22 staff, take care of 15,000 clinic visits & 10,000 chemotherapy infusions per year


Slide 34

UMC Medical Practices Patient Satisfaction

Physician and staff AIDET training

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Slide 35

Source: Washington Hospital, Total beds = 360

Annualized Upfront Collections Increased: >$450,000

Up

-fro

nt

co-p

ay c

olle

ctio

ns

Return on Investment: Upfront Collections

Tactic and Tool Implemented:

AIDET


Slide 36

Key Words at Key Times – AIDET® Ambulatory Surgery Patient Satisfaction

56

87 89 79

50

55

60

65

70

FY06 FY07 FY08 FY09 YTD

Ambulatory Surgery Satisfaction

Tactic and Tool Implemented:

AIDETSM

Source: Miami Hospital, Total beds = 584, Employees > 1,500 employees, Admissions = 32,522

Pe

rce

nti

le

AIDETSM Training Implemented in FY07

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Slide 37

•So there’s nothing like a smile to create a good first impression.

•A warm and confident smile will put both you and the other person at ease.

•But don't go overboard with this - people who take this too far can seem “fake” or insincere.

A Winning Smile!


Slide 38

Make sure it’s real……………….

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Slide 39

TEN/FIVE RULE 10/5

• 10 feet-eye contact and a smile• 5 feet –speak/acknowledge, “Good Morning”


Slide 40

4. Discharge Phone Calls

• Demonstrate empathy

• Improve clinical outcomes

• Harvest reward and recognition of the staff

• Learn about the patient’s perception of service

• Gather process improvement suggestions

• Reduce readmissions

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Slide 41

And Still More Validation – Discharge Phone Calls

• What percentage of patients should we attempt to reach?

• What percentage of patients is ideal to actually reach?

• How can we increase the completion percentage?

• What feedback have you received from Discharge Calls?

• How can you reinforce Discharge Calls at staff meetings?


Slide 42

An Exercise . . .

What we permit…We promote

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Slide 43

5. BONUS - Reward What You Want Repeated and Manage Performance

Negative1 compliment1 criticism

1 to 1

Neutral2 compliments1 criticism

2 to 1

Positive!3 compliments1 criticism

3 to 1

Recognize and Reward SuccessSource: Tom Connellan, “Inside the Magic Kingdom”, pgs

91-95


Slide 44

Real Men & WomenWrite Thank You Notes?

Dear Goldie: Am I enchanted? You bet. Thanks for giving me such a relaxed good time at dinner. When I found out where I was sitting I was a little worried only because I’m not too hot of a dinner partner. You were a fantastic dinner partner. You made me feel welcome and totally at ease. I didn’t even have to unveil my 12-point plan for dealing with Gorbachev. Thanks for being so darn nice!!

Good Luck,

Source: The Art of Thank You, Crafting Notes of Gratitude by Connie Leas

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Slide 45

“It isn’t hard to be good from time to time, what’s tough is being good

every day.”

- Willie Mays

Hardwiring


Slide 46

Thank You

Lynne [email protected]

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