and the implementation of a training program for staff. The process and progress to-date has been gratifying, and the commitment to ongoing

RD 5 Results of the Patient Satisfaction Survey over the last four years. Describe trends, interventions implemented and the impact on nursing practice. From 2001 through December 2006, Massachusetts General Hospital (MGH) contracted with Press Ganey, for patient satisfaction surveys. Press Ganey is a research-based, nationally recognized survey that uses scaled responses to a uniform series of questions. The tool, which has been demonstrated to be both valid and reliable, focuses on multiple aspects of the patient experience. The tool is available in both English and Spanish. On a monthly basis, about one-half of the patients discharged from MGH were randomly selected to receive the survey. On a quarterly basis, MGH-wide responses were analyzed and reported to leadership across the hospital. In addition, clinical and operational directors and teams received specialized analyses related to their specific areas. These results were used to identify opportunities for improvement and to address any problem areas. Attachment RD 5.a contains Press Ganey hospital-level quarterly reports for the final quarters of calendar years 2004, 2005 and 2006. Full reports for all quarters, including unit-level reports, will be made available on-site. Overall, the scores have remained relatively stable over this three-year period. MGH patients consistently expressed high loyalty to the hospital with the likelihood of patients recommending MGH being higher than for 98-99% of the 600 + bed hospitals in the Press Ganey database. Patients rated their doctors and nurses highly, with physicians skill and nurse s skill rating better than for 90% of the 600+ bed hospitals. Over the three-year period the surveys also indicated opportunities for improvement. Some specific areas in which patients were relatively less satisfied were: Meals Waiting times for tests and treatments Promptness of response to call Rooms Based on Press Ganey performance, MGH focused performance improvement efforts on patient meals. The departmental leadership for Nutrition and Food Services undertook a process of honest evaluation of its program and pursued feedback and collaboration from the Department of Nursing, the Nutrition and Food Service staff, hospital administration, and patients. The service improvement plan includes systematic feedback from nurses and patients, changes in the patient menus, the introduction of a dedicated customer service response phone extension called 4-FOOD, 1

and the implementation of a training program for staff. The process and progress to-date has been gratifying, and the commitment to ongoing evaluation is shared across disciplines involved. Patient ratings of meals improved steadily, reflecting the ongoing focus in this area. MGH Press Ganey scores rose for seven consecutive quarters, moving from the 18 th to the 50 th percentile for all 600+ bed hospitals. Promptness of response to call lights is also an area where patients reveal that they are less satisfied. On the 2004 report, the mean score for this indicator was 82.9, which placed MGH in the 56 th percentile when compared to hospitals with 600+ beds. Concern regarding this performance prompted the Department of Nursing to successfully pilot and then fully implement the use of cell phones for nurses. The cell phones were implemented over a three-year period from 2004 to 2007 and replaced overhead and intercom systems for on-unit communication. They allow immediate contact with the patient s Staff Nurse anywhere in the hospital, improving accessibility and facilitating timely communication. Phone messages from outside the hospital can also be forwarded directly to the Staff Nurse from the nurse s station, reducing time spent traveling to and from the central phones. MGH has also installed new nurse call systems on all inpatient units. This five-year project extended from 2002 through 2007. The cell phone and nurse call projects also had the added benefit of noise reduction at the patient bedside. The Press Ganey scores showed an improvement in patient response to the question about promptness of response. By late 2006 the mean score had increased to 85.0, which placed MGH in the 83 rd percentile (hospitals with 600+ beds). Two orthopaedic nursing units specifically identified this as an opportunity for improvement. The unit leadership and staff wanted to improve response time and identify/meet individualized patient needs. Performance improvement efforts identified some contributing factors, such as length of report and patient assignments. The units implemented a multi-pronged approach that included raising awareness about the issues and patient perspectives, providing education about strategies to enhance time management, an increased focus on assessment and communication skills, and patient visits by the Nursing Director to better communicate with patients and families about their experiences. The indicators related to rooms and accommodations (e.g. décor, cleanliness, noise) have frequently pointed to opportunities for improvement, with MGH performance at times below the 50 th percentile. MGH leadership appreciates the challenges around attempting to maintain a clean and pleasant environment when many patient care units are housed in aging buildings. Efforts are 2

on-going to identify appropriate clinical space and reconstruct new patient units to expand/improve space and better meet the needs of patients and families. For example, RD 13 describes the construction and relocation of the Pediatric Intensive Care Unit and the Neonatal Intensive Care Units to more attractive clinical space in 2005 and 2006. In addition to new unit construction, there is a focus on improvement of existing space through on-going renovation. Again, this is a constant challenge as the units/rooms that most require attention are often those with the highest patient occupancy. The commitment to this work involves creative strategies and collaboration with both clinical staff and the MGH Buildings and Grounds Department. In the past few years, the Patient Care Services Systems Improvement department has coordinated these efforts for all of the MGH inpatient rooms. When patient beds need to be closed for other reasons, repair, repainting and floor maintenance are accomplished at the same time. The recent installation of ceiling lifts offered this opportunity and 173 rooms were refurbished during the project on the same day that the lifts were installed. Likewise, seven units in 2006 and four units in 2007 had rooms closed for installation of new nurse call systems and these rooms were painted, repaired, and floors were stripped and polished at this time. Corridor walls were also repaired and painted recently which was coordinated with a program for installing improved signs in the corridors of inpatient units. Patient room furniture was updated for all inpatient rooms, Labor and Delivery, the Emergency Department and the Post Anesthesia Care Unit in 2006, in an effort to improve the bedside environment. Attachment RD 5.b includes the coordinated, six-month furniture delivery schedule for over 4,700 patient beds, overbed tables, bedside cabinets, patient and visitor chairs. Press Ganey scores improved slightly in 2006. For example, patient responses for room décor went from the 39 th to the 62 nd percentile and scores for cleanliness of rooms improved from the 44 th percentile in October-December 2005 to the 69 th percentile in October-December 2006. Patient Care Services (PCS) remains concerned about this performance area and will continue to target future performance improvement efforts in this area. At the September 2007 Patient Care Services Strategic Planning Retreat, the PCS leadership team conducted a series of activities to determine the Strategic Goals and Tactics for 2007-2008 (see Force 1.1 attachment 1.1.b.) The six dimensions of healthcare performance included in the Institute of Medicine s Quality Chasm Report (i.e. safety, effectiveness, patient centeredness, timeliness, efficiency, equity) were used to guide the selection of major areas of focus for the year. Strategic Goal #4 is to Provide a clean and clutter-free environment for our patients and staff. Tactics that were suggested to attain 3

this goal include establishing a Unit Service Associate Advisory Group and developing best practices and standards for clean and clutter free environments. In addition, Strategic Goal #2 is to Seek the patient s voice to improve the care experience which includes the plan to conduct an assessment of the care environment to identify sources of noise and create a plan to minimize/alleviate unnecessary noise. As described in RD 14, MGH discontinued use of Press Ganey at the end of 2006 and is now using the Consumer Assessment of Healthcare Providers and Systems (HCAHPS) tool, as required for acute care hospitals for 2008 by the Centers for Medicare and Medicaid (CMS). Attachment RD 5.c includes an internal hospital level report with three quarters of data for 2007. Although national benchmarks are not yet available, the report produced in September 2007 indicates that patients are not satisfied with the response to call lights. This will most likely be a focus for performance improvement in 2008 as PCS strives for safety, efficiency and patient centeredness. In an effort to provide front-line Nursing Directors with key and timely data pertaining to their units, members of the Patient Care Services Financial Management Systems team and 16 Nursing Director volunteers, built upon the information presented in the Nursing Director Leadership Development Program, Evaluating the Health of Your Unit. They developed a methodology to provide unit-based dashboards that are relevant, dynamic and tailored to unit needs. The group selected three Press Ganey indicators for the dashboard; overall satisfaction with nursing care, preparation for discharge and attention to personal needs. In 2007 the group came together again to update the dashboard and in the process identified five of the HCAHPS indicators that will replace the Press Ganey measures. Nursing Directors, along with their leadership and clinical staff, critically review this data and identify strategies to address identified issues. 4

Attachment RD 5.a 5

Attachment RD 5.a continued 6

Attachment RD 5 a continued 11

Attachment RD.5.b Patient Room Furniture Integrated Delivery Schedule Date Day of Wk Delivery Location Bedside Cabinet Marco Chair Olivia Glider Foot Stool Visitor Chair Beds Overbed tables Items to floor Items delivered 1/31/06 Tues Blake 14 13 12 13 2/16/06 Thurs 130 130 2/23/06 Thurs Ellison 12 36 36 0 22 43 137 White 12 24 24 0 14 29 91 228 2/28/06 Tues White 8 26 26 0 16 31 99 White 9 25 25 0 15 30 95 194 3/2/06 Thurs White 10 20 20 0 12 24 76 White 11 24 24 0 14 29 91 Bigelow 11 25 25 0 15 30 95 262 3/6/06 Mon White 6 30 30 0 18 36 114 Bigelow 14 27 27 0 16 32 102 Blake 14 12 0 0 0 14 26 242 3/7/06 Tues White 12 25 24 25 3/8/06 Wed Ellison 3 0 0 8 0 0 8 Ellison 4 0 0 0 0 24 24 Ellison 9 0 8 0 3 19 30 Ellison 10 36 36 0 22 43 137 199 3/9/06 Thurs Ellison 13 20 20 20 12 24 96 Blake 13 21 21 21 13 21 97 White 13 8 8 0 4 10 30 223 3/13/06 Mon Blake 7 0 9 0 3 22 34 Blake 8 0 0 0 0 22 22 Ellison 8 34 34 0 20 41 129 185 3/14/06 Tues 135 3/15/06 Wed Ellison 6 36 36 0 22 43 137 Bigelow 7 18 18 6 11 22 75 212 3/16/06 Thurs 130 3/20/06 Mon Blake 6 21 21 0 13 25 80 Bigelow 13 18 18 0 11 28 75 155 3/21/06 Tues Ellison 12 36 36 45 3/22/06 Wed Blake 11 24 24 0 0 29 77 Ellison 11 36 36 0 22 43 137 214 3/23/06 Thurs White 7 27 27 0 16 32 102 Ellison 7 36 36 0 22 43 137 239 14

Attachment RD.5.b continued Patient Room Furniture Integrated Delivery Schedule (continued) Date Day of Wk Delivery Location Bedside Cabinet Marco Chair Olivia Glider Foot Stool Visitor Chair Beds Overbed tables Items to floor Items delivered 3/29/06 Wed Ellison 16 36 36 0 22 43 137 Ellison 19 30 30 0 18 36 114 251 3/30/06 Thurs Ellison 17 20 10 10 3 24 67 Ellison 18 24 12 12 4 29 81 Ellison 23 5 11 9 4 49 78 226 4/4/06 Tues White 8 26 26 White 11 24 24 45 4/6/06 Thurs 191 4/11/06 Tues Bigelow 14 27 27 Bigelow 7 18 18 45 4/13/06 Thurs 200 4/18/06 Tues Ellison 10 36 36 45 4/20/06 Thurs 157 4/25/06 Tues Ellison 14 26 26 Bigelow 11 25 25 45 5/2/06 Tues Ellison 11 36 36 45 5/9/06 Tues Ellison 16 36 36 Ellison 13 20 20 45 5/16/06 Tues Ellison 21 20 20 Ellison 22 19 19 45 5/23/06 Tues Ellison 19 30 30 Ellison 20 20 20 45 5/30/06 Tues White 7 27 27 Bigelow 13 19 19 45 6/6/06 Tues Ellison 8 34 34 45 6/13/06 Tues Ellison 7 36 36 Blake 6 19 19 45 6/20/06 Tues Ellison 6 36 36 White 13 8 8 45 6/27/06 Tues White 6 30 30 Blake 13 21 21 45 7/5/06 Wed Ellison 17 12 12 Ellison 18 18 18 E23 ESD 14 14 45 7/11/06 Tues PACU 8 8 ED 16 16 Training 5 5 29 7/18/06 Wed Blake 11 25 24 25 Total Pieces 743 736 86 415 1045 810 943 4778 15

Attachment RD 5.c Please note: The scores on this dashboard have been rounded to the nearest whole number 1 Preliminary data from Quality Data Management (QDM); percent surveys completed; unshaded if less than 50% complete 2 Agency for Healthcare Research and Quality 16