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Metrics in a Small
Hospital
It is Possible
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Metrics in a Small Hospital
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Metrics in a Small
Hospital
Your Presenter
Rev. Mr. T. Patrick Bradley, MA, BCC
Director, Pastoral Care
Cheyenne Regional Medical Center
214 E. 23rd Street
Cheyenne, Wyoming
307-633-7586
Pat.Bradley@crmcwy.org
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Objectives
You will
• Understand the need for good metrics.
• Have ideas on how to develop metrics.
• Understand the need for good
resources.
• Have ideas on who you should cultivate
as resources.
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How Small is Cheyenne
Regional?
• Licensed for 212 beds.
• Only Level II Trauma Center in
Wyoming.
• Includes a hospice and a Skilled
Nursing Facility (SNF).
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Why Metrics
• To overcome the perception that we
just go in and pray with people.
• We are a county hospital. This
sometimes creates the impression
that spiritual care is not part of the
mission.
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Let’s Get Going!
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What Metrics?
• Number of patients seen?
• How long you spend with patients?
• How many patients do you pray
with?
• How many bibles did you distribute?
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These Metrics
• Where are you most likely to be called?
• How much time do you spend on a
typical call?
• What kind of situation are you called to
assist with?
• What time are you most often called?
• How satisfied are nurses with your
services
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Developing Good Data
• 6 years!
• Loose leaf notebook
• Basic computerized system
– Only on certain computers
– Needed a geek to get data
• Now on our intranet home page
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Computer Guru
WITHOUT HELP YOU WILL GO UP
IN FLAMES
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How Did We Do It?
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From “Metrics in a Small Hospital: It is Possible
Presented at the NACC National Conference
March 21, 2009
Rev. Mr. T. Patrick Bradley, MA, BCC
Director, Pastoral Care
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© 2010 Cheyenne Regional Medical Center
Service Entry Form
• Chaplain name is automatic.
• Patient name for follow up.
• Location, ER, ICU, Surgical, etc.
– Drop Down Menu
• Code Blue, Patient Request, etc.
– Drop Down Menu
• Date is automatic.
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Service Entry Form cont.
•
•
•
•
Time In is time pager went off.
Length of Visit from Time In.
Helpful check boxes.
Comments: A way for the on call
chaplain to pass information to the day
shift chaplains.
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What Data Does This
Give Us?
Statistics
Charts
Graphs
Material For Presentations
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Sample Output to Excel Spreadsheet
Date
Chaplain
Location
Code
Time-In
Length of
Visit
12/31/09
David Heaney
82 - Palliative Recent Change 10:30:00 AM
0.5
12/31/09
Theresa Odhiambo
0.5
12/31/09
Theresa Odhiambo
32 - Surgery Recent Change 9:30:00 AM
51 Pediatrics
Recent Change 10:00:00 AM
0.25
12/31/09
David Heaney
82 - Palliative Staff Request
1:15:00 PM
0.5
12/31/09
Beth Wright
62 - Tele
Recent Change 1:50:00 PM
0.25
12/31/09
Mary Beth Melcher
STEMI Alert
12/30/09
Christian Robbins
10 - ER
42 - OrthoNeuro
Family Request 10:15:00 AM
0.25
12/30/09
Roserita DuFresne
41 - TCU
Other
2:15:00 PM
0.75
12/30/09
Beth Wright
82 - OncologyStaff Request
2:15:00 PM
0.5
12/30/09
Beth Wright
82 - OncologyStaff Request
1:00:00 PM
0.25
5:30:00 PM
Options
Hours
Business
Hours
Business
Hours
Business
Hours
Business
Hours
Business
Hours
2
Follow Up
Needed
Follow Up
Needed
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On Call Hours
Business
Hours
Business
Hours
Business
Hours
Business
Hours
Find an Expert to help
with this phase!
OR
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Where Did Our Referrals
Come From in 2009?
As we expected
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Why Were We Called In
2009?
SURPRISE!
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How Many Calls or Referrals
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Number of Calls: Business Hours
What did we do different in December 09?
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Number of Calls: On Call Hours
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Average Time Spent: On Referrals
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Average Time: By Type of Referral
How we gathered data evolved.
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Business hours calls are routine referrals.
After hours calls are emergencies.
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What type of referrals do chaplains receive
during business hours (7:00am - 4:00pm)?
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What type of referrals do chaplains receive
during on call hours (4:00pm-7:00am)?
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What do these two charts tell us?
★Most of our night calls are for emergencies
★Most of our day calls are for referrals
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What type of Referrals Do
Chaplains receive most?
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What Else Did We Do?
A Staff Survey
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Survey Monkey
• Eight Questions
• All Staff
• Optional
• Anonymous
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Questions 1 - 4
1. What is your profession?
2. How would you rate the availability of chaplains
in your setting?
3. How would you rate the cooperation and
teamwork between chaplains and nurses in your
setting?
4. How would you rate the communication between
chaplains and nurses in your setting?
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Survey Questions 5-8
5. How often do you make a referral to a
chaplain?
6. Do you read chaplain progress notes?
7. What Unit Do You Work On?
8. (Optional) Do you have any comments or
suggestions for the chaplains? Is there
anything that the chaplains could do to
improve the service they provide?
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What Were the Results?
• We only had 139 people take the
survey.
• Not a good sample.
• What did we learn?
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Some Results
• Who took the survey?
– 84% were clinical
• Where did they work?
– Dibs and Dabs from all over.
• The manager on Women & Children
pushed the survey
– 21% were from Women & Children
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More Results
• 51% seldom or never make a
referral to a chaplain.
• Only 35% ever read our progress
notes.
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Their Suggestions
• A stronger presence on our ARU and
TCU floors.
– I assigned an intern to each of those
units 4 hours twice a week.
• Nothing else but complements on
what we do.
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How Did We Use This?
• We have made a concerted effort to
be more visible on all floors.
• We are now attending staff meetings
when possible to increase visibility.
• We check in with nurses to see who
we might see before we round.
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What Did That Gain Us?
• Referrals are up.
• Patient Satisfaction with Spiritual
and Emotional needs being met is
up.
• How did we verify that?
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Team Seven: Sensitivity To My Needs
Overall Improvements
Increased referrals to Pastoral Care.
Increased percentage of patients asked if they have
emotional or spiritual needs.
Increased rounding for emotional/spiritual needs:
Improved format for documenting spiritual/emotional needs
in Care Manager
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© 2006 Chip Caldwell & Associates, LLC. All Rights Reserved.
Team Seven: Sensitivity To My Needs
60-Day Check In
60-Day Check In
Baseline Data (Tele & Oncology)
number
Negatives
positives
38
31
7
Follow Up Data (Oncology Only)
number
24
positives
19
5
90-Day Check In
90-Day Check In
Baseline Data (Tele & Oncology)
number
Negatives
positives
38
31
7
Follow Up Data (Tele & Oncology)
number
74
positives
19
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© 2006 Chip Caldwell & Associates, LLC. All Rights Reserved.
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Team Seven: Sensitivity To My Needs
Percentage of Increase in Patients asked
about their spiritual and emotional needs:
Baseline data = 18% of patients surveyed
were asked
60 Day Check In = 21% of patients surveyed
were asked
90 Day Check In = 74% of patients surveyed
were asked
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Team Seven: Sensitivity To My Needs
Pastoral Care Findings:
Referrals Med/Surge
Month
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Total
Referrals
Patient/
Family
Referrals
Staff
Referrals
10
15
15
8
5
5
8
13
10
6
2
3
2
2
5
2
3
2
Referrals Telemetry
Month
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Total
Referrals
Patient/
Family
Referrals
Staff
Referrals
33
20
4
3
6
5
18
13
1
0
3
3
15
7
3
3
3
2
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© 2006 Chip Caldwell & Associates, LLC. All Rights Reserved.
Team Seven: Sensitivity To My Needs
Percentage of Staff Referrals to Pastoral Care
% of Increase Staff
Referrals on Med/Surg
% of Increase Staff
Referrals on Telemetry
Peaked at 300% in
November*
September to Dec =
400%
* December referrals down due to
lower census
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Team Seven: Sensitivity To My Needs
Patient Satisfaction Trend Telemetry
Month Received 2009
Month Received 2009
Mean Score
Percentile Ranking
Sept
87.1
83
Oct
94.4
99
Nov
89.7
96
Dec
90.6
98
Response to the Press Ganey Inpatient Survey Question
“Degree to which the hospital staff addressed your emotional needs”
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Why Did We Do This?
• It gave us statistics in a format that
MBAs, MHAs and CPAs understand.
• It focused us on what we really do.
• It gave us a healthy accountability.
• It shows how we contribute to
patient satisfaction.
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Who Cares?
• We must be assertive
• Show the data to your:
– Director
– Vice President
– CEO
– CFO
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Brag!
• To
• To
• To
• To
• To
• To
the managers you help the most
the charge nurses
nursing managers
the Director of Nursing
the VP of Nursing
anyone you have lunch with
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Let’s Share
What do you think would be good
metrics?
• Cost of an average call to a Code
One/Blue!
• Average time on a Code One/Blue by
chaplain.
• Mean – Median – Mode statistics by
type of referral.
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What Is Your Facility?
• Hospice
• Nursing Home
• Trauma Center
• Cancer Center
• Small Hospital
• Large Hospital
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Metrics in a Small Hospital:
It is possible
Your Presenter
Rev. T. Patrick Bradley, MA, BCC
Director, Pastoral Care
Cheyenne Regional Medical Center
214 E. 23rd Street
Cheyenne, Wyoming
307-633-7586
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Pat.Bradley@crmcwy.org