Quality Improvement and Evidence Based Practice - Making the Connection: Reducing Suffering with Compassionate Connected Care Christina Dempsey, MSN, MBA, CNOR, CENP Chief Nursing Officer Press Ganey 2014 Press Ganey Associates, Inc.
Objectives Define and articulate the concept of suffering Describe quality improvement strategies that have been associated with enhancement of patient centered care outcomes as perceived by the patient. Explain the relevance of the National Database of Nursing Quality Indicators ( NDNQI) in today s healthcare environment. Discuss how the Compassionate Connected Care framework addresses both patient suffering and caregiver engagement. 2013 Press Ganey Associates, Inc. 2
Deconstructing Suffering Avoidable Suffering Arising from Defects in Care and Service Suffering Associated with Treatment OUR GOAL: Prevent this suffering for patients. Provide evidence-based care. Prevent complications and errors. Ensure coordinated communication, demonstrate cooperation among staff. Reduce wait, show respect and value for the individual. Suffering Associated with Diagnosis OUR GOAL: Mitigate this suffering by responding to Inherent Patient Needs. Address symptoms, improve functioning, seek to cure, reduce pain and discomfort. Reduce anxiety and fear, educate and inform. Minimize the extent to which medical care disrupts normal life to the greatest extent possible. Provide distractions from the medical setting that provide respite to the anxious patient. 2014 Institute for Innovation 3
Refining the Concepts Suffering Reflecting Inherent Patient Needs Variability comes from individual differences in patient needs. Arises from within the individual in response to his/her illness and in reaction to an optimally functioning care delivery system. Unavoidable does not mean un-addressable, though we may not be able to completely eradicate this suffering. Avoidable Suffering Variability comes from differences in how organizations provide care. Arises from the dysfunction present in the care delivery system. Avoidable implies that in an ideal state we would not create this suffering, therefore our goal should be to reduce these defects to zero. 2014 Institute for Innovation 4
Alleviating Suffering Respond to Inherent Patient Needs Promote Confidence in Skill Manage Pain Ensure Safety Inform/Prepare Personalize Care Reduce Fear/Anxiety Protect Privacy Include in Decisions/Choice Demonstrate Empathy Prevent Avoidable Suffering Improve Teamwork Deliver Care with Courtesy Be helpful Avoid Unnecessary Wait Make Processes efficient/easy Clean/Quiet Environment Adequate Amenities Appropriate Service Recovery 2014 Institute for Innovation 5
Suffering in Patients Words Categories derived from existing Hot Comments Physical Clinical Emotional Social Environment General Abuse Accident Afraid Apology Cold Awful Agony Adverse Anxious Argument Dirty Broken Bruise Bleed/Blood Cruel Blame Filth Fail Danger Complication Difficult Criticize Hot Horrible Die/Died Emergency Dignity Fault Loud Inadequate Harm Error Horrified Forgot Lack Hurt Fall/Fell Nightmare Ignore Law/Liable Injure Incident Problem Insult Sue Pain Incompetent Regret Mean Suffer Incorrect Upset Nasty Terrible Infect Trouble Risk 2014 Institute for Innovation 6
Looking at the Data Differently How do we segment data? By person/team providing care By patient demographic By care process By patient condition Why? To understand individual/team performance for accountability To understand who we are caring for To understand what impacts patients To understand what patient needs really are! What happens? Assume the person/team caused the scoresask them to do better We describe the different expectations of the young, or the educated or the minority and feel we can t change their expectations We see how evaluations vary by process and try to make changes but could be overwhelmed by things are beyond our span of control. We view the scores as a reflection of what this group of patients need and whether we are meeting those needs. We improve on what matters to those patients. 7
Patient Perceptions Differ 2014 Press Ganey Associates, Inc. 8
Pinpoint Where to Address Inherent, Avoidable Suffering CARING BEHAVIORS CLINICAL EXCELLENCE CULTURE OPERATIONAL EFFICIENCY Inherent Suffering Inform Personalize Care Show Empathy Demonstrate Clinical Skill Manage Pain Show Teamwork Protect Privacy Prepare for Discharge Offer Choice Avoidable Suffering Show Courtesy Use Service Recovery Minimize Wait Provide Comfortable / Clean Environment Offer Adequate Amenities 9
Example: Measuring Need for Information Physician kept you informed INFORM Nurses kept you informed Doctors explained things in a way you could understand Nurses explained things in a way you could understand Explanations regarding tests or treatments Staff described new medication side effects Staff told you what new medication was for Integrates patient data from Press Ganey and CAHPS items into one methodology Weights relative importance within overarching patient need 10
Measure Unmet Patient Needs Standard measure scale with weighted algorithm Reflects which patient needs impact suffering the most TOTAL C3 SCORE 11
-.10 -.05 0.05.10 PAIN CLINICAL EXCELLENCE Disch info symp DISCHARGE PREP CHF vs. Medical COURTESY CHF Patients Have INFORM Different Needs CARING BEHAVIORS PERSONALIZE EMPATHY WAIT ENVIRONMENT OPERATIONAL EFFICIENCY 2014 Press Ganey Associates, Inc. 12 GLOBAL
-.10 -.05 0.05.10 PAIN CLINICAL EXCELLENCE Disch info symp DISCHARGE PREP CABG vs. Surgical COURTESY CABG Patients Have INFORM Different Needs CARING BEHAVIORS PERSONALIZE EMPATHY WAIT ENVIRONMENT OPERATIONAL EFFICIENCY 2014 Press Ganey Associates, Inc. 13 GLOBAL
Why Segment by Condition? Segmenting by condition helps us use the data to understand what matters to different kinds of patients. If it matters to the patient, it matters to everyone else. When you focus on a type of patient, you encourage staff to build a persona for this patient group that helps create understanding for why they have particular needs. 2014 Press Ganey Associates, Inc. 14
What It All Means to the Patient The care of the nurses depends on which nurse. Some were wonderful and some could have stayed home. We never knew day to day & night to night what kind of care would get. Some info would get passed on and some would not. One nurse yelled at him over and over & we kept telling her the patient was passed out and needed help. My surgery was delayed for over 4 hours. The nurses could have kept us better informed about that. My nurse was over worked. She had 6 total pt. to her self. I was the only one could walk, the other 5 were total care. That's why she could not help me as much. 2013 Press Ganey Associates, Inc. 15 The room was dirty, especially the bathroom needed cleaning, I had to ask for the room to be clean. Some food tasted bad, some hot food was served cold, always late, sometimes food for someone else was brought in room. D/C order written that morning and I was not D/C'd until 10 p.m. that night. Day shift nurse was not very attentive to my needs nor did she inquire about my prolonged D/C until after I inquired.
What it Means to the Caregiver Balancing cost and quality Reimbursement Productivity Clinical perfection Regulatory and accreditation demands Changes in caregiver education/preparation Generational diversity Physician issues Staffing issues Leadership issues And every day it s One more thing. 2013 Press Ganey Associates, Inc. 16
Engagement on the Job F(1, 7) = 160.21, p =.000 2014 Press Ganey Associates, Inc. 17
Engagement at The Bedside t(37,205) = -9.38, p =.000 DIRECT NO DIRECT n = 35,692 n = 1,515 2014 Press Ganey Associates, Inc. 18
Priorities 2013 Press Ganey Associates, Inc. 19
Patient Loyalty 19% of patients All Patients 15.7% Recommendation Failure Rate 81% of patients Low: Confidence in Provider 74.6% Fail to Recommend High: Confidence in Provider 1.9% Fail to Recommend 14% of patients 5% of patients 8% of patients 72% of patients Low: Worked Together 90% Fail to Recommend High: Worked Together 28% Fail to Recommend Low: Worked Together 11% Fail to Recommend High: Worked Together 1% Fail to Recommend 11.4% of patients 2.5% of patients 0.8% of patients 3.4% of patients 2.4% of patients 5.9% of patients 3% of patients 68.4% of patients Low: Courtesy 92.8% Fail High: Courtesy 78.2% Fail Low: Listens Carefully 45.7% Fail High: Listens Carefully 24.7% Fail Low: Concern for Worries 22.3% Fail High: Concern for Worries 6.3% Fail Low: Concern for Worries 5.6% Fail High: Concern for Worries 0.6% Fail High Risk Low Risk 2014 Press Ganey Associates, Inc. 20
Variability and Likelihood to Recommend 2013 Press Ganey Associates, Inc. 21
Transparency: Using the Data Differently 2014 Press Ganey Associates, Inc. 22
Exceptional Patient Experience 50% 40% 1 out of 2 of our physicians are in the top 10% nationally 46% % of total providers 30% 20% 10% 4% 9% 22% 27% 0% 2009 2010 2011 2012 2013 #GIA14 Medical Practice Survey providers must have n=30 returned in calendar year National Rank compared against the Press Ganey National Database: 128,705 physicians
Exceptional Patient Experience 30% 25% 1 out of 4 of our physicians are in the top 1% nationally 25% % of total providers 20% 15% 10% 13% 17% 5% 0% 1% 3% 2009 2010 2011 2012 2013 #GIA14 Medical Practice Survey providers must have n=30 returned in calendar year National Rank compared against the Press Ganey National Database: 128,705 physicians
Common Myths Only disgruntled people answer surveys The patients always say things are fine when we round but our scores are terrible! We can t provide exceptional clinical service and exceptional patient satisfaction something has to give! The scores are all over the place and we haven t changed the way we take care of patients We can t focus on patient satisfaction when we are short staffed all the time. The survey questions don t make sense how do they really measure patient satisfaction? 2013 Press Ganey Associates, Inc. 25
Respect Courtesy/Respect of the nurses This item measures how nurses approach meeting patients' needs. Scoring highly in this area does not require that nurses perform any additional tasks or duties but simply conduct their existing activities in ways that build relationships with the patient and family. No other staff group in the hospital will communicate with your patients and families as regularly or frequently as nurses. This measure assesses the sum of these interactions. 2013 Press Ganey Associates, Inc. 26
Responsiveness Promptness in responding to the call button (Call Button help as soon as you wanted it) This question addresses the patient's perception of staff responsiveness. The question primarily assesses how quickly staff get to the patient's room after the call but also can access how long it takes staff to fulfill the patient's request. Patients' expectations are tempered by an acute awareness that nurses are busy The most common reasons patients call is because they are in pain or their equipment is making noise or malfunctioning Expectations for the time it takes to fulfill each request will also be adjusted based upon the relative severity or importance of the request. 2013 Press Ganey Associates, Inc. 27
Attention Amount of attention paid to your special or personal needs (Communication and Responsiveness) This question assesses the effort patients believe that hospital staff made to understand and meet their minimum requirements for care. These needs may be unique and highly variable necessitating an assessment, documentation and integration into the care plan. The capacity to adapt and personalize health services is becoming a core competence that will determine the success of health care organizations in the future. Meeting personal requirements is an almost universal definition of customer service and satisfaction. 2013 Press Ganey Associates, Inc. 28
Information How well the nurses kept you informed (Nurse Communication) This question measures the patients' evaluation of the adequacy of nurses' provision of information throughout the hospitalization. The patient expects to understand what will happen, when it will happen, why it will happen, who will make it happen, where it will happen, how it will happen and what the end result will be. Numerous studies have shown that the simple act of providing information is strongly, positively associated with patient satisfaction. 2013 Press Ganey Associates, Inc. 29
Skill Skill of the nurses (Nurse Communication) This item measures patients' perceptions of how effective nurses are in executing their duties and responsibilities. Patients do not judge clinical competence relative to professional standards; rather, various cues influence a patient's perceptions of a nurse's expertise: Professional appearance (e.g., attire, grooming, cleanliness, free of perfume or smoke odors, etc.) Adherence to safety guidelines (e.g., wearing gloves when touching patients' surgical sites or wounds) Adherence to physicians' orders (e.g., following the medication schedule) Nurses' communication skills and understandability of his/her speech The effectiveness of collaboration, communication and coordination acrossdisciplines and throughout the care continuum. Number of attempts to successfully accomplish a procedure (e.g., How many tries were necessary to set up the patient's catheter? How many attempts were made inserting the IV?). Maintenance of patients' privacy and confidentiality. How nurses, physicians and other hospital staff treat each other. Responsiveness to patients' needs. 2013 Press Ganey Associates, Inc. 30
Family Accommodations and comfort for visitors This question measures the patient's perception of how well the hospital made it easy and comfortable for people to visit. During difficult times, families and loved ones draw strength from each others' presence. Patients not only appreciate their presence, but can be quite concerned for the comfort and well-being of their visitors--as if they were in the patient's home. The scope of this question ranges from the responsiveness of staff to meeting to the amenities offered in the patient's room and hospital at large. 2013 Press Ganey Associates, Inc. 31
Discharge Speed of discharge process after you were told you could go home (Nurse Communication and Discharge Readiness) This question measures the patient's perceptions of how long it took to get out of the hospital after the physician told the patient that they were going home. Once the physician makes the announcement, a clock starts in the patient's mind. The efficiency of the process will be reflected in the patient's perceptions. 2013 Press Ganey Associates, Inc. 32
Consistency is Key 90% 90% 90% 73% % of Individuals X X = % of Behaviors % of The Time % of Expectation Delivered 2013 Press Ganey Associates, Inc. 33
2014Press Ganey Associates, Inc. NDNQI
Relationship between Nurse Staffing and Patient Experience (PG) PG Patient Experience Domain Total Nursing Hours Per Patient Day Total RN Hours Per Patient Day ADMISSION 0.309 0.376 ROOM 0.256 0.312 MEALS 0.236 0.308 NURSES 0.331 0.405 TESTS 0.326 0.398 VISITORS 0.271 0.330 PHYSICIAN 0.280 0.356 DISCHARGE 0.270 0.329 ISSUES 0.335 0.416 ASSESS 0.345 0.434 OVERALL 0.346 0.416 Nursing hours per patient day significantly correlated with all PG domain scores (rising tide) 35
Relationship between Nurse Staffing and Patient Experience (HCHAPS) CMS Domain / Staffing Measure Total Nursing Hours Per Patient Day Total RN Hours Per Patient Day Communication with Nurses 0.270 0.313 Communication with Doctors 0.242 0.249 Responsiveness of hospital staff 0.286 0.319 Cleanliness and quietness of hospital 0.234 0.241 Pain management 0.190 0.234 Discharge information 0.347 0.409 Communication about medicine 0.313 0.354 Overall Rating 0.295 0.376 Likelihood to Recommend 0.273 0.362 2014 Press Ganey Associates, Inc. 36
Relationship between certain HACs and Patient Experience Domain / Outcome Measure Unassisted Patient Falls Per 1,000 Patient Days CLABSI per 1000 Central Line Days CAUIT per 1000 Catheter Days Percent of Surveyed Patients with Hospital Acquired PUs Percent of Surveyed Patients with Hospital Acquired PUs Stage II+ ADMISSION -0.137-0.161-0.052-0.162-0.237 ROOM -0.136-0.235-0.179-0.179-0.275 MEALS -0.137-0.206-0.211-0.194-0.272 NURSES -0.215-0.214-0.151-0.207-0.281 TESTS -0.175-0.251-0.198-0.219-0.302 VISITORS -0.150-0.242-0.187-0.179-0.257 PHYSICIAN -0.180-0.161-0.076-0.154-0.212 DISCHARGE -0.183-0.242-0.179-0.248-0.333 ISSUES -0.229-0.203-0.163-0.195-0.267 ASSESS -0.276-0.148-0.072-0.186-0.235 OVERALL -0.211-0.231-0.170-0.216-0.295 Pressure Ulcers, Falls, and CLABSI have the highest correlations with Press Ganey patient satisfaction scores 2014 Press Ganey Associates, Inc. 37
You probably can t quite read this Rank / PG Q Friendliness and courtesy of the nurses Promptness in responding to the call button Nurses attitude toward your requests Body Perceived Subhead Enough RNs to 1 2 in General Would Recommend this Hospital for Employment 3 Job Enjoyment 4 5 6 7 8 9 10 Enough RNs to provide quality patient care Enough staff to get the work done Perceived on Last Shift Worked Overall Had a Good Shift Adequate support services allow me to spend time with Patient Assignment Was Appropriate High standards of nursing care are expected by the provide quality patient care Enough staff to get the work done Perceived in General Perceived on Last Shift Worked Adequate support services allow me to spend time with Job Enjoyment Would Recommend this Hospital for Employment Overall Had a Good Shift Enough time and opportunity to discuss patient care Patient Assignment Was Appropriate Would Recommend this Hospital for Employment Perceived in General Enough RNs to provide quality patient care Job Enjoyment Enough staff to get the work done Perceived on Last Shift Worked Patient Assignment Was Appropriate Overall Had a Good Shift Adequate support services allow me to Amount of attention paid to your special or personal needs Enough RNs to provide quality patient care Enough staff to get the work done Perceived in General Would Recommend this Hospital for Employment Job Enjoyment Perceived on Last Shift Worked Overall Had a Good Shift How well nurses Staff concern for kept you informed Skill of the nurses your privacy Enough staff to get the work done Enough RNs to provide quality patient care Perceived in General Would Recommend this Hospital for Employment Job Enjoyment Perceived on Last Shift Worked Adequate support services allow me to spend time with Patient Patient Assignment Was Assignment Was Appropriate Appropriate Adequate support services allow me to spend time with spend time with Nurse staffing Nurse staffing levels are levels are adjusted from adjusted from shift to shift shift to shift A clear philosophy of nursing that pervades the High standards of nursing care are expected by the Would Recommend this Hospital for Employment Perceived in General Would Recommend this Hospital for Employment Perceived in General Degree to which hospital staff addressed your emotional needs Perceived in General Would Recommend this Hospital for Employment Response to concerns or complaints made during your stay Perceived in General Would Recommend this Hospital for Employment Job enjoyment among top-5 most correlated 38 across all questions Staff effort to include you in decisions about your treatment Would Recommend this Hospital for Employment Perceived in General How well staff worked together to care for you Perceived in General Would Recommend this Hospital for Employment Job Enjoyment Job Enjoyment Job Enjoyment Job Enjoyment Job Enjoyment Job Enjoyment Enough RNs to provide quality patient care Perceived on Last Shift Worked Enough staff to get the work done Patient Assignment Was Appropriate Overall Had a Good Shift Adequate support services allow me to spend time with High standards of nursing care are expected by the Patient Assignment Was Appropriate Overall Had a Good Shift Perceived on Last Shift Worked Enough RNs to provide quality patient care Enough staff to get the work done Nurse staffing levels are adjusted from shift to shift Had enough help to lift/move Enough staff to get the work done Perceived on Last Shift Worked Enough RNs to provide quality patient care Adequate support services allow me to spend time with High standards of nursing care are expected by the Patient Assignment Was Appropriate A clear philosophy of nursing that pervades the Enough RNs to provide quality patient care Perceived on Last Shift Worked Enough staff to get the work done Patient Assignment Was Appropriate Overall Had a Good Shift Adequate support services allow me to spend time with A clear philosophy of nursing that pervades the Enough RNs to provide quality patient care Enough staff to get the work done Perceived on Last Shift Worked Patient Assignment Was Appropriate Had enough help to lift/move Adequate support services allow me to spend time with Overall Had a Good Shift Enough RNs to provide quality patient care Enough staff to get the work done Perceived on Last Shift Worked Adequate support services allow me to spend time with Patient Assignment Was Appropriate Overall Had a Good Shift A clear philosophy of nursing that pervades the 70+ items (scales), 9 of them consistently in top-10 Nurse perception of org quality among top-3 most correlated across all questions Nurse LTR among top-4 most correlated across all questions (except 1) Likelihood of recommending this hospital to others Would Recommend this Hospital for Employment Job Enjoyment Perceived in General Enough RNs to provide quality patient care Enough staff to get the work done Patient Assignment Was Appropriate Adequate support services allow me to spend time with Unit Inservices Was Adequate Perceived on Last Shift Worked A preceptor program for newly hired RNs Overall rating of care given at the hospital Would Recommend this Hospital for Employment Job Enjoyment Perceived in General Enough staff to get the work done Patient Assignment Was Appropriate Enough RNs to provide quality patient care Adequate support services allow me to spend time with Perceived on Last Shift Worked Overall Had a Good Shift A clear philosophy of nursing that pervades the
Themes in Top-10 Body Subhead Overall items most strongly correlated Resourcerelated items 2014 Press Ganey Associates, Inc. 39
2013 Press Ganey Associates, Inc. Compassionate Connected Care
Compassionate Connected Care Clinical Excellence: Connecting clinical excellence with outcomes Operational Excellence: Connecting efficiency with quality. Compassionate Connected Care Caring Behaviors: Connecting engagement with action. Culture: Connecting mission, vision, & value with engagement. 2014 Institute for Innovation 41
Compassionate Connected Care Themes Acknowledge Suffering We should acknowledge that our patients are suffering, and show them that we understand. Body Language Matters Non-verbal communication skills are as important as the words we use. Anxiety is Suffering Anxiety and uncertainty are negative outcomes that must be addressed. Coordinate Care We should show patients that their care is coordinated and continuous, and that we are always there for them. Caring Transcends Diagnosis Real caring goes beyond delivery of medical interventions to the patient Autonomy Reduces Suffering Autonomy helps preserve dignity for patients 2014 Press Ganey Associates, Inc. 42
Acknowledge Suffering We should acknowledge that our patients are suffering, and show them that we understand. 1. Bearing witness to their suffering shows patients that we care. 2. Asking the patient what they are worried about allows them to be a person rather than a disease 3. Anticipating and mitigating the patient s discomfort shows concern for their suffering A physician said, I m sorry to a patient who said she didn t sleep well the night before. A doctor who has just told a daughter that her mother is terminally ill sits with her to console her. When care does not go as planned, staff apologize, acknowledge the impact on the patient, and engage the patient in exploring options. The clinician asked what concerns they may address The clinician asks the patient what they are most concerned about. While caring for a patient, the clinician discovers something personal about the patient that establishes a connection to make a positive memorable moment for future interactions with the care team. The clinician asks how the patient would prefer to be addressed. The clinician notes patient s greatest concern on communication board so all caregivers are aware. The nurse applied EMLA cream to the patient s hand before starting the IV. Staff update the patient and family of delays at least every 30 minutes Staff inform the patient and family of what to expect prior to beginning any procedure or test. 2010 Press Ganey Associates, Inc. 43
Body Language Matters Non-verbal communication skills are as important as the words we use. 1. Eye contact matters The clinician sits at eye level and looks me in the eye during the conversation The front desk caregiver looks up from the computer to establish eye contact As the patient begins to say what is really on his mind, the caregiver pushes his/her laptop aside, leans forward, and listens attentively. Caregiver explains to patient that he/she is listening and is fully engaged with the patient while documenting in computer 2. Physically touching the patient closes distance The nurse gently held the patient s shoulder while obtaining the blood pressure The physician sat down and held the patient s hand while explaining tests and treatments. The clinician takes a seat and holds the patient s hand when the patient starts to cry. The physician makes a point of shaking hands with the patient and the visitors when introducing him/herself 3. Body position matters The physician sits face-to-face with the patient while talking with him/her The caregiver sits down at eye level with the patient. The caregiver does not turn their back to the patient until the interaction is over and the caregiver leaves the room. 2010 Press Ganey Associates, Inc. 44
Anxiety is Suffering Anxiety and uncertainty are negative outcomes that must be addressed. 1. Reducing uncertainty and anxiety for patients and families acknowledges that they are in stressful situation. Caregivers round on patients frequently in a way that is purposeful and meaningful to the patient inquiring about pain, positioning, toileting, and at least one non-disease/treatment oriented discussion topic. The employee noticed a lost guest and personally escorted the person to their destination. Staff members describe what will happen next when the patient arrives to the exam room. Clinicians tell patients when they will be in to see them again. Provide reassuring phrases, eg. Mrs. Smith, I am going to be with you every step of the way; Mrs. Smith, we are going to take very good care of you; Mrs. Smith, we are going to do this together. Caregivers greet patients with, We ve been expecting you, (Mr/Mrs/Ms. Volunteers escort patients and families to surgery area, and other tests and treatment areas 2. Reducing waits shows we understand their suffering and respect their time There is no lag time in response when patient presses the call light. Staff members provide an estimate of wait times Staff members do not pass call lights without inquiring if they can help Staff members work together to reduce waiting time for bed placement, transfers, and testing. 2010 Press Ganey Associates, Inc. 45
Coordinate Care We should show patients that their care is coordinated and continuous, and that we are always there for them. Showing patients that the relationship doesn t end when they are not directly in contact deepens the relationship The clinician calls the patient for follow-up within 48 hours. Clinicians follow up appropriately when information is received on the discharge phone call. Clinicians show that they are concerned about what will happen when the patient goes home and provide instructions to make them successful in their recovery. Caregivers manage up each other, complimenting the caregivers on the care team. The nurse explains who will be taking care of the patient after shift change. The clinician uses good hand off techniques and is accountable for communicating patient condition and needs. Caregivers use the teach back method to assure patients understand discharge instructions. Patients are provided with written instructions for home care prior to the day of discharge with an opportunity to read and ask questions. Clinicians use data to improve patient care processes 2010 Press Ganey Associates, Inc. 46
Caring Transcends Diagnosis Real caring goes beyond delivery of medical interventions to the patient 1. Personal touches outside medical care strengthen relationships The nursing assistant brings a patient his/her favorite dish from the cafeteria as he/she awakens from surgery The director of service excellence walks a patient s service dog outside the hospital to give a stressed family member time to grab lunch The nurse talks with patient about his/her children. The nurse is simply silent while touching the patient or family during a difficult time. 2. Caring for the patient means caring for the family The nurse gave a warm blanket to a family member who was cold On a nightly basis, the nurse held the phone to the ear of a terminally ill patient, so his daughter could say goodnight. Caregivers provide instructions to the family prior to discharge to assure they are comfortable with caring for the patient at home. 2010 Press Ganey Associates, Inc. 47
Autonomy Reduces Suffering Autonomy helps preserve dignity for patients The patient is full participant in guiding his/her care. The clinician asks patients and family members about their preferences in care issues lying ahead. The clinician asks the patient for his/her preferences on even minor issues, such as which hand would you prefer your IV to be in? The clinician provides a full range of care options when discussing diagnosis and treatment plans. Caregivers involve the patient in bedside shift report 2010 Press Ganey Associates, Inc. 48
Best Practices Interdisciplinary rounds/collaboration Involve the patient in their care Managing up Whiteboard maintenance A different version of the Ps: Proximity, Proactivity, Positioning, Pace Proximity sit down next to the patient Proactivity proactively supply information Positioning make eye contact, assure that the patient can see Pace go at the patient s pace, not your own; repeat, write it down, teach back 2014 Press Ganey Associates, Inc. 49
Remember the Patient Remember: your patient is scared Remember: your patient has lost almost all control Remember: they hurt and they are the ONLY judge that matters Remember: YOU are likely their only means of information Remember: they need compassion 2014 Press Ganey Associates, Inc. 50
Questions/Discussion Christy Dempsey, MSN MBA CNOR CENP 855-816-5111 cdempsey@pressganey.com 2012 Press Ganey Associates, Inc.