The University of Chicago Medicine: Driving Engagement With Interactive Care 1
Training front-line clinical and administrative staff to encourage patients to use technology, but also reminding them of the importance of human-centered, face-to-face care. Implementing a mobile platform that allows caregivers to record health information and to connect with providers as needed to track treatment plan adherence, preventative care efforts, and disease management. The importance of validation of technology support and facilitated by leadership. Reminders, motivational messages, and education tips to patients through this platform. 2
The University of Chicago Medicine & Biological Sciences Embedded in the University of Chicago campus in Chicago s Hyde Park neighborhood More than a century of groundbreaking research and innovation University of Chicago Biological Sciences 800+ faculty; among top 5 U.S. medical schools for generating federal dollars per faculty Pritzker School of Medicine 3
University of Chicago Medicine Center for Care and Discovery, Bernard A. Mitchell Hospital, Comer Children s Hospital and Duchossois Center for Advanced Medicine 22K Admissions 385k diagnostic and outpatient treatment visits 75K ED visits 30K PED visits 9,500 employees 900+ Physicians 1,500+ Nurses 900 Residents/fellows 4
UCM Mission Our mission is to provide superior health care in a compassionate manner, ever mindful of each patient s dignity and individuality. PRIDE Values Participation Respect Integrity Diversity Excellence 5
Patient Experience and Engagement Program Nurse/ Physician Executive Leadership team Experience and Engagement strategic planning and implementation Analytics Patient Insights High touch services Technology Enablers 6
FY 2015 Goals Deliver a consistent patient experience across all four UCM platforms of care Create lasting market differentiation and loyalty through innovation and consistent performance Develop a continuous improvement model that infuses the voice of patients, families, employees, and physicians Unify quality, safety, efficiency, and experience strategies to improve satisfaction and outcomes Incite change by creating and celebrating memorable moments Quality Safety Experience 7
Set Experience Strategy Patient Experience Annual Operating Report Work streams Business Optimization Growth and New Payment Models Care Delivery Transformation Service Objectives Throughput and Asset Productivity Ambulatory Operations Improve Margin Position Clinical Service Line Business Planning Value Based Payment Population Health Management High Reliability Organization Care Model Redesign Clinician Accountability Patient-Centered Care PRIDE value focused Environment Patient Engagement and Empowerment Foundational Elements (Human Capital Plan, Master Space Plan, Lean Deployment Plan, IS Plan, EIA) 8
UCM Interactive Patient Care Vision We will provide an unparalleled, truly interactive patient care experience where the patient and family are active, engaged and empowered participants in the care process. 9
Technology Platform Assessment Interactive Patient Care (via GetWell Network) ED Videos PxP Discharge Recorded Messages Unit Patient Population Diabetes COPD Heart Failure MyChart 10
Interactive Patient Care (IPC) 11
Why Interactive Patient Care (IPC)? IPC provides a more personalized care environment for patients and their families IPC supports clinicians with a consistent approach for providing patient education that increases patient engagement Engaging patients to play a more active role in their healthcare Improves the patient experience (patient satisfaction) Enhances patient safety and improves quality Improves hospital performance 12
Fundamentals and Requirements Utilization is key to realizing the impact Requires strong nursing adoption and integration into the clinical practice Must be hardwired into care-giver role Important to design and configure the tools for seamless integration and flow into daily practice 13
Road Map To Success Engage Hospital Leadership: Manage change, motivate staff and generate results Care Process Integration: Implement best practice workflows for improved outcomes Empowers Clinicians and Staff: Train the staff support their pursuit of success Deliver World Class Service: Support every caregiver, every patient, every hour, every day Interactive patient care (IPC): A new and innovative care delivery model for today s interdisciplinary care team! 14
Clinical Practice Design Process PROCESS OBJECTIVES: Hardwire Interactive Patient Care (IPC) as a new care delivery model Create organizational context with a vision and impact expectations for IPC Use performance improvement targets to inform the patient care practice areas to focus on A multidisciplinary group to evaluate and redesign core nursing practices to realize IPC Vision and increase nursing adoption Apply the technology to help support that newly defined practice standard IPC Vision and Strategy Priority Focus Areas Current Practice Audit Clinical Workflow Design Configuration of Tools Change Management 15
Get Well Network 16
Education Videos There are 3 Patient Education Pathways Fall Prevention Pain Management Discharge Planning Video education is the main component for each pathway Clinician orders education via Epic Patient receives education via GetWellNetwork Additional patient interactions on GetWellNetwork Fall Prevention Alert (every 2 hrs for 15 secs) Call, Do Not Fall Only high risk patients receive this alert 17
Fall Prevention Pathway with Interface Education ordered HL7 HL7 Order Event Dat a Order Status to In Process HL7 HL7 Order Event Dat a HL7 Event Dat a HL7 Order Document to Result Review HL7 Result Fall Prevention Education Pathway Patient is prompted to complete education Education Complete?? 18
GetWellNetwork High Risk Falls Alert Senior User Experience Adult Experience 19
Day Prior to Discharge Prompt Nurse activated following multidisciplinary rounds 20
1 Discharge Management Countdown to Discharge Pathway Discharge Readiness Questions 3 2 1. Question 1: Do you have someone to help you at home? 2. Question 2: Do you have someone to give you a ride from the hospital to your home or care facility? 3. Question 3: Do you have any questions about medications? 4. Question 4: Do you have any other questions about your condition? 5. Question 5: Do you know when your follow up appointment is? 6. Question 6: Is there anything that would prevent you from going home on discharge date? 21
Pain Acknowledgement Pathway Goal: Continuity in patient family education regarding pain management Patient acknowledgement of their role in pain management process Expectation setting around pain management process 22
Patient Experience Perception (PxP) Patients receive survey questions on GetWell Network 1 survey (3 questions) at 1 PM CT (Monday-Friday) Every other day (starting day 2 after admission, ending on day 10) 1 survey question at 10 PM CT (Monday-Friday) Every day Provides the ability to monitor patient satisfaction in real time Address patient feedback and provide service recovery Identify trends and utilize patient feedback to improve the patient experience at University of Chicago Medicine 23
Questions asked of Patients via PxP Is the staff answering the call light? (Yes, I Don t Know, No) How is the hospital staff doing controlling your pain? (Great, Ok, Not Good) Is the noise outside your room keeping you awake at night? (Yes, I Don t Know, No) Have your nurses listened and explained things to you? (Yes, I Don t Know, No) ( PICU Only)Have your doctors listened and explained things to you? (Yes, I Don t Know, No) (NICU Only) Is the hospital staff teaching you about your medications and the side effects? (Yes, I Don t Know, No) 24
Staff Experience Notifications and Scorecard If the patient/ family selects the negative response (Not Good/ No) a notification is sent for follow up to: - The Nurse Manager and Charge Nurse - The Patient Relations team All patient responses are tracked and trended in the PxP scorecard on the Management Console for GetWell Network 25
Utilization for Key Focus Areas (CCD) Overall Utilization Service Utilization 100% 99% 100% 97% 100% 91% 95% 92% 80% 67% 80% Baseline Baseline 60% 60% All Units All Units 40% 40% 10 East 19% 10 East 20% 20% 10 West 10 West 0% 0% Overall Overall Health Utilization Safety Utilization 25% 25% 20% 20% Baseline 16% Baseline 15% 13% 15% 11% All Units 11% All Units 10% 6% 10 East 10% 6% 10 East 5% 1% 10 West 5% 1% 10 West 0% 0% Overall Overall 26
mygetwellnetwork Interactive Pathways Patient Pathways Daily touch-points with patient before and after hospital visit (proven to improve patient outcomes) Available from a variety of web-enabled devices. Reduce 30 day readmissions diagnoses (AMI, Heart Failure, Pneumonia) and chronic disease management (Asthma, Diabetes, COPD) 27
Daily engagement to keep on track Patient Pathways Pathway focuses on 30-days post discharge Day 30 Day 14 Day 1 28
Get Well. Anywhere. 29
Vocera Good to Go - Update 30
Vocera Good to Go - Update 9 west - Currently used for patients. ACTIONS - Continuing support to department to increase the number of patients whose discharge instructions are being recorded. - Provide monthly management information - Conduct staff walkthroughs Diabetes Nurse Educators - Highly motivated to use tool. - Department wishes to have an educational library installed in Vocera prior to start using tool. CONCERNS: the department would like to use videos that are currently being offered in Get Well Network. It s unclear if UCM is allowed to use these videos in Vocera, and /or if it s technically possible to use these videos. ACTIONS: - support department in building educational library. - exploring other sources of information than GWN to build library. - Exploring options to use tool prior to library being ready. - Working with GWN and Kari Petzold on finding solution for use of GWN videos. Identify other departments - Cardiology (5SW) - Interested in using tool. - Potential other departments: - COPD / Asthma - Transplants 31
MyChart 32
Patient Portal Enrollment Easily enroll patients in your portal while in hospital. Drives patient portal utilization. Fits easily into the discharge planning process. 1 2 3 33
Validation of Patient Center Technology Nurse Leader Rounding Discharge Care Center Calls Quarterly Outcome Patient Experience Results (Press Ganey) 34
Leader Rounding 35
Leader Rounding: Approach Challenges Lack of structured rounding Lack of clarity on standard practice Needed to streamline accountability Limited ability to capture patient complaints or compliments Unable to track or address trends Solutions Standardize rounding with ipad technology Create alert process for support departments Capture, act on complaints and compliments in real time Outline expectations and ensure accountability Report rounding trends Reward and recognize staff 36
Leader Rounding: Approach Identified 29 Units Conducted leader education on tactics and importance of rounding Engaged frontline staff and leaders to design proper rounding process Adult Inpatient Pediatric Inpatient Adult Emergency Department Pediatric Emergency Department NICU PICU Child Life Implemented Care Rounds technology to streamline, standardize, and track real-time rounding using an ipad Took action and rewarded leadership and staff immediately for wins 37
Leader Rounds: November 1, 2013 December 31, 2014 32 units practicing leader rounding Total Rounds: 40,945 Leader Rounds with Positive Rating: 25,479 (62%) Staff Recognitions: 9,324 Follow-up Requests: 1,203 38
Leader Rounding: Transparency and Accountability Collect - Analyze Share Learn - Act 39
Leader Rounding Engage and excite leadership by explaining potential for standardizing and tracking meaningful rounds Educate and involve frontline staff early in the training and development process Create a culture for cross-departmental coordination Reward and recognize employees throughout new process training Consistently track, report, act and improve Hardwire experience improvement strategies with technology 40
Mean Score Rounding Effectiveness: Nurse Manager Check Overall Rating of Care 96.0 94.0 92.0 90.0 88.0 86.0 84.0 82.0 80.0 78.0 76.0 74.0 12.4 Mean Score Point Difference n= 581 Nurse Manager Check on you Daily- No n= 1997 Nurse Manager Check on you Daily- Yes Mean Score- 81.0 Mean Score- 93.4 2015 Press Ganey Associates, Inc. 41
Discharge Care Call Center Goals: Elevate service to reduce readmission rates Extension of the service team and caring to home Coordinate feedback related to service experience Functions: Call DCAM and CCD ambulatory surgery patients post discharge to home Calls places within 3 to 5 business days post discharge, unless otherwise notified Forward compliments and complaints to management and Patient & Family Insights team Practice service recovery for patients and families Confirm post op and additional follow-up appointments Connect patients with specific clinical services for follow-up Coordinate with clinical services on follow-up calls and clinical issues Support a smooth transition for patients and families that extends to the home 42
Patient Feedback Discharge Calls Service Inpatient Inpatient Inpatient Comment People who served food as well as those who answered phones and took orders were extremely courteous. This was the best hospital experience of my life largely due to the work and attitude of my nurses. They were, without exception, wonderful. Nurse Cathy was wonderful - very caring and gave me all the information I needed to care for myself at home. Outpatient Oncology Outpatient Oncology Each & every time we needed to call WE WERE ABLE TO REACH them or they would call back in 10 min. One time, wonderful Dr. Hahn actually answered the call herself. If not, Tara would call back in 10 mins, Johanna too. They always let us know what's going on and how long to hook up. Very considerate. If my shoulder shows they close the drape. Outpatient Services Outpatient Services Inpatient Pediatric Inpatient Pediatric Emergency Department Emergency Department 2015 Press Ganey Associates, Inc. My medical practitioners, assistants & staff address not only immediate concerns, but exhibit extreme patience when I have questions in reference to complete care & options, by providing me with as much time needed. Their undivided attention is given to me prior to my discharge...to contribute to "calm departure". Over the phone communication was excellent (Chris was very informative, courteous, and professional, felt comfortable with his instructions. Informative. Nurse service was excellent start to end. Everyone from registration, to doctors and nurses were extremely informative & super friendly! Talked me through every step that was going on, the medicine that was administered and the way it will help. Reg[istration] staff was very courteous and professional. 43
Outcome Data/Press Ganey HCHAPS HCHAPS 44
Future Initiatives Kiosks Real Time Patient Feedback Ambulatory Care Pre-Post Visit Rounds Think Tank Group (IPC) 45
Lessons Learned Overall Review technology for your culture Leadership/Front line staff from beginning Build training into NEO for all resources Lots of data from all over manage data Consider starting on units where buy-in is present Share success stories the why behind 46
Debra Albert, RN MSN MBA NEA-BC Senior Vice President, Patient Care Services Sue Murphy, RN BSN MS Executive Director of Patient Engagement and Experience The University of Chicago Medicine 47