Patient and Family Perspectives:
Engaging Your Customers In Quality
Improvement Initiatives
July 31, 2007
Vernon Henderson, BA, Patient & Family Care Volunteer
Leah Henderson, Patient & Family Care Volunteer
Peachy Hain, MSN, RN, Nurse Manager
Millicent De Jesus, MSN, RN, Clinical Nurse IV
One of the Nation’s Largest Medical Centers
Cedars-Sinai has evolved into
one of the most dynamic
and highly regarded
medical centers in the world.
We’re located at:
8700 Beverly Blvd.
Los Angeles, California
We have received Magnet
Excellence in Nursing
designation from the American
Nurses Credentialing Center
(ANCC).
Los Angeles Community Is Our Home
 Cedars-Sinai serves the
Los Angeles County market area –
with more than 9 million people. Our
primary service area, comprising
some
2.3 million people,
represents
approximately
75 percent of Cedars-Sinai’s
total inpatient discharges.
 Cedars-Sinai partners with
hundreds of community organizations
on programs to improve the health of
our community.
Service
 Entire continuum and spectrum of
services
— 952 Licensed Beds
 Intensive Care
 Acute Medical/Surgical Care
 Pediatrics
 Neonatology
 Psychiatry
 Perinatal
 Rehabilitation
 Comprehensive Treatment
Services
 Comprehensive Oncology
Services
 On average, every day we serve:
— 802 Inpatients
— 20 OB Deliveries
— 205 Emergency Room patients
— 70 Surgeries
— 4 Trauma patients
— 700 Outpatients - visits and
procedures
Most Preferred Overall Hospital
Awards & Recognitions
 Since 1990, Cedars-Sinai has been named consecutively in an
independent survey by the National Research Corporation
(NRC) as Southern California’s “gold” standard in healthcare.
 Los Angeles residents rated Cedars-Sinai “number 1” for:
— Best Overall Quality
— Most Preferred Hospital Overall
— Best Doctors
— Best Nurses
— Best Image and Reputation
— Most Personalized Care
Our Commitment to Quality Care
 California Award for Performance Excellence
 AARP Ranking
 Magnet Excellence in Nursing
 Most Wired Hospitals
Our Mission
 Cedars-Sinai has evolved to become the largest nonprofit, independent
healthcare organization in the western United States
 Cedars-Sinai is committed to:
— Leadership and excellence in delivering healthcare services
— Expanding the horizons of medical knowledge through biomedical
research
— Educating and training physicians and other healthcare professionals
— Striving to improve the health status of our community
 “Quality patient care is our priority. Providing excellent clinical and service
quality, offering compassionate care, and supporting research and medical
education are essential to our mission.”
Vision
Nursing is valued for its
contributions to patient and
health care in an
environment that promotes
career development,
interdisciplinary practice,
community service and
research.
Goals of Cedars-Sinai Nursing
 Provide care that is safe, patient centered, equitable, lean, reliable, based
on evidence
 Improve the health of the community through education referral and
expanding access to care
 Conduct research to improve nursing assessment, interventions that are
linked to positive patient care outcomes and community needs
 Create and sustain nursing as a Magnet service recognized by staff,
patients and the public for excellence
 Create new models of care for the profession to recruit, retain and develop a
qualified workforce to meet the demands for nursing care across settings
 Create delightful, efficient and effective work environments for patients,
families, nursing and interdisciplinary team members
Teamwork
Between Support
Departments
Charting by
exception
PATIENTS
MD-RN
Collaboration
Coordination of
Care
CSMC Quality Goals Aligned with IOM and TCAB Goals
CSMC
Quality Goals
SAVING
LIVES
SERVICE
ENHANCING
EXCELLENCE
VALUE
IOM Goals
Safe
Equitable
Effective
Efficient
Patient
Centered
Timely
TCAB
Design Targets
Safety &
Reliability
Patient
Centeredness
Vitality
Lean
Structure and Process to Achieve the Goals
 Structure: Unit Based
Shared Governance,
Interdisciplinary practice
committees- Patient Care
Council, PICs, MD-RN
Collaboration, Quality
Council
 Process Teams: TCAB 
design, implement and
evaluate tests of change
to achieve aims
What is TCAB?
 TCAB = Transforming Care At The Bedside
 National initiative sponsored by Institute for Health Care Improvement
and Robert Wood Johnson Foundation to find new ways to improve
patient care while improving work environment for healthcare workers
 Cedars-Sinai is one of the original 13 hospitals in the US invited to
participate in initial 2-year project.
 Now on Phase III of TCAB Project
— Cedars-Sinai is one of ten of the original 13 hospitals that continue
to participate
Overall Goals of TCAB
 To develop one or more models of care at the bedside on medical and
surgical units that will result in:
• Improved quality of patient care (Safety and Reliability)
• Improved quality of patient service (Patient Centeredness)
• More effective care teams (Vitality and Teamwork)
• Improved staff satisfaction and retention (Vitality)
• Greater efficiency (Lean)
Who We Are – Pilot Unit
 8 South is made up of two 24-bed
surgical units
— 8SE: Primarily admits post-surgical
GI cases, including various bowel
resections and lap gastric bypasses
— 8SW: Admits post-surgical
urological procedures such as
transurethral resections of the
prostate, radical retropubic
prostatectomies, transvaginal slings
— Both units admit other subspecialty
cases including those r/t trauma
 Involved in Quality Initiatives
— Magnet, IHI, Staffing Effectiveness,
CalNOC – Falls, Pressure Ulcers,
Restraints, Medication Errors
 Actively involved in various Performance
Improvement Projects as Pilot Units
— January 2002 to 2004 - Patient
Care Model Re-Design
— June 2004 to present –
Transforming Care At the Bedside
(TCAB)
 Strong Interdisciplinary Team
Involvement – Physicians, Nurses, Social
Worker, Case Manager, PT/OT, Dietician,
Home Health, Pharmacist, Respiratory
Therapist, Enterostomal Nurse, Patient
and Family Volunteer
The TCAB Core Team
 Interdisciplinary Team involved in the Pilot Units’ Performance
Improvement projects:
— Physician Champion
— Nursing Staff
— Social Worker
— Case Manager
— PT/OT
— Registered Dietitian
— Home Health
— Pharmacist
— Respiratory Therapist
— Enterostomal Nurses
— Patient & Family Care Volunteers (Patient Representatives)
Unit Posters to Encourage Patient/Family Involvement
First part of poster
describes TCAB, the
Model for
Improvement used,
and lists sample of
innovations already
underway.
Unit Posters to Encourage Patient/Family Involvement
Second part of poster
displays initial results
on improvement with
patient care.
It also displays
current tests of
change on the unit
and next unit TCAB
meeting, inviting not
only staff but also
patients, visitors, and
family members to
attend meeting and/or
give suggestions on
improvement.
The Model For Improvement
What are we trying to accomplish?
How will we know that change is an improvement?
What change can we make that will result in an
improvement?
Act
Plan
Study
Do
Volunteer Services – An Overview
 The Volunteer Program at CedarsSinai Medical Center began in
1976 with approximately 50
volunteers
 Currently, there are over 2,000
volunteers
— 1998 – Service Hours
contributed equaled 215,000
hours
 Services have expanded to > 400
different assignments throughout
CSMC
 Volunteering at CSMC reflects the
community it serves (i.e., diverse
volunteer population and ethnic
backgrounds)
 Average number of volunteer years
=4
 Volunteer Services include:
— Adult Volunteer Program
— Teen Program
— Independent Student Program
Patient and Family Care Volunteer
 Responsibilities
— Provide assistance to patients and families in negotiating the hospital
system
— Provide comfort and support to patients/families confronted with
surgical and medical procedures
— Make daily rounds on assigned nursing units/lobby areas
— Assist patients in preparing for discharge
— Assist health care team by providing patient support
— Listen and offer companionship to patients/families
Patient and Family Care Volunteer
 Responsibilities
— Communicate to health care team identified patient/family needs
— Assist patient/family with identifying resources within the medical center
and community
— Be sensitive to the needs of the patient/family
— Reading to patient
— Assisting patient with orientation to room upon admission
— Assisting patient with meal set-up/menu selection
Collaborative Effort
8 South Pilot Unit
+
Patient and Family Care Volunteer Services
+
Performance Improvement Projects
(i.e., Patient Care Model Re-Design,
TCAB)
=
Patient Involvement, Patient Safety, and
Patient Satisfaction
Benefits of Patient/Family Engagement in
Improvement Initiatives
 Review of Literature
— Patient Satisfaction Surveys: Patient input extremely valuable and instrumental
in developing surveys geared towards patient definitions of “good nursing care”
(Larrabee & Bolden, 2001)
— Enhancing patient participation in care and decision-making - a dynamic
process; central to nursing practice. There is potential for facilitation and
creation of opportunities for patient participation (Tutton, 2005)
— Patients prefer to participate in their care, while professionals, although
acknowledging the potential value of patient participation, prefer patients to be
passive recipients (Cahill, 1998)
Benefits of Patient & Family Engagement in
Improvement Initiatives
 Review of Literature
— A model of patient involvement, the Addenbrooke’s patient panel, in a large
teaching hospital resulted in positive successes in providing patient perspective
to improve service (Webb & Benstead, 2002)
 Successes of patient panel: promoted open debate between staff and
patients, created effective collaborative work, encouraged patient
feedback, improved access to hospital, assisted others to improve service
user involvement
— Active involvement of patient/family in the design and implementation of an
education poster to prevent falls in conjunction with ongoing patient/family
feedback to make poster more appealing and effective for patients – resulted in
marked decrease in falls on the unit over the pilot period (Jeske et al, 2006)
Story of
Vernon and Leah Henderson Cedars-Sinai’s 8 South Pilot Unit
Patient Representatives
Vernon & Leah’s Involvement in TCAB
 Personal experience as a patient / family member
— “Unbelievable medical care” received as a patient on a med/surg unit
— Care team went “above and beyond” to ensure comfort
— Surviving a life-threatening illness  life-changing experience 
vowed to volunteer when retired to “give back” to Cedars
 Roles and Responsibilities as Patient and Family Care Volunteer
— Typical day as volunteers on 8 South
— Strong relationship with staff and nurse manager
— Provide support to patients/families
 Patients often reluctant to share complaints or concerns with staff
out of fear of retaliation
 Patients sometimes more likely to discuss problems with a
volunteer
Vernon & Leah’s Involvement in TCAB
 How they became involved in TCAB
— Attendance at weekly unit and Steering Committee meetings
— Contributions to TCAB initiatives (unit-based & house-wide)
 Designing surveys
 Talking with patients
— Asking questions to identify problems and find immediate
solutions
 Unit staff depend on them for support of patients and unit as a
whole
— Participation at national conferences
— Public speaking opportunities to share personal experiences on TCAB
pilot unit
— Involvement in the national TCAB Advisory Committee
Vernon & Leah’s Involvement in TCAB
 Motivating factors
— They are part of a close knit “family” when they are on the unit
 Sense of belonging
 Part of a team
 Opinions and input valued
— Patients identify with them more, having been “on the same boat” as
them a few years back.
— Inspired by the positive changes seen in Cedars-Sinai as a result of
their innovations
“The TCAB team is committed to
accomplishing something. It’s a great
feeling to know that a hospital as good as
Cedars, one of the best in the country, and
the unit where we volunteer – the best unit
in the hospital – wants to make
improvements and we’re a part of it.”
- Vernon Henderson
“If I was able to walk out of a room and
know that I helped a patient, then I’ve
done my job. That’s a good day, bringing
a smile to the face of a patient because
I’ve resolved their issue.”
- Leah Henderson
Sample Contributions to TCAB Team
Test of Change:
Early Patient
Discharge Initiative
Patient Satisfaction Survey With Nursing Care - Sample
Date: _______________
Room Number: ___________
Dear Patient:
Please answer the following questions to the best of your ability. Any
comments, suggestions, and feedback from you will be greatly appreciated to enable
us to provide better care for our patients.
PATIENT
SATISFACTION
SURVEY WITH
NURSING
CARE
1. My nurse made me feel:
________________________________________________________________
2. I am glad my nurse:
________________________________________________________________
3. I wish my nurse would have:
________________________________________________________________
4. I feel my nurses are looking out for my safety. 1 2 3 4 5
1 = Strongly Disagree
2 = Disagree
3 = Neutral
4 = Agree
5 = Strongly Agree
5. Comments:
____________________________________________________________________
____________________________________________________________
THANK YOU!
Post-Discharge Survey - Sample
Post Discharge Test-of-Change
POSTDISCHARGE
TEST-OFCHANGE
Developed and
conducted survey
just prior to
patient discharge
Survey data compiled weekly by Vern,
findings presented monthly to the staff,
trends identified, and solutions to
improve care proposed.
1. Did you have confidence and trust in the
nurses treating you?
2. If you had any anxieties or fears about your
condition or treatment, did a nurse discuss
them with you?
3. Was it easy for you to find someone on the
hospital staff to talk to about your concerns?
4. Did someone tell you about medication side
effects to watch for when you went home?
5. Did they tell you what danger signals about
your illness or operation to watch for after
you went home?
6. Did they tell you when you could resume
your usual activities, such as when to go
back to work or drive a car?
Patient Room Reminder Poster – Early Discharge
PREPARING FOR YOUR DISCHARGE
Please be sure to have the following ready:
Before your Actual Discharge Date:
• KEYS to Your HOME
• CLOTHES to WEAR
• PRESCRIPTIONS from Your DOCTOR
On the Day of your Discharge,
• You will receive Discharge Instructions from
your Nurse & a copy will be provided to you.
• Have transportation available to pick you up
from the hospital by 10:00 AM.
REMINDER:
DISCHARGE TIME IS 10:00 AM.
If your ride home is not here by 10:00 AM,
please arrange to be picked up from the Discharge
Waiting Area on the Street Level-South Tower Lobby.
For any questions or concerns, please speak to the
Charge Nurse.
THANK YOU!
Contributed ideas
to content and
format of
flyer/poster
Letter to Patients – Early Discharge
Dear Patient:
Welcome to Cedars-Sinai Medical Center.
Although you are just being admitted, we would like to
provide you with some information that we hope will make
your stay with us a little easier and make your discharge
go more smoothly.
When you are discharged you will need both clothing to
wear and the keys to your house – if you don’t have them
with you, please arrange to have them brought in.
Discharge time is between 10:00 a.m. and 11:00 a.m. If a
family member or friend is not available to pick you up
when you are discharged, the Social Worker can assist
you in arranging alternative means of getting home (e.g.,
medical van, taxi). If you would rather wait for your
family member or friend to pick you up, please let them
know you will be waiting at the Street Level, South Tower
Waiting Area.
Thank you for choosing Cedars-Sinai Medical Center for
your health care needs.
Contributed ideas
to content of
letter to patients
Discharge Waiting Area – Patient Survey
Discharge Waiting Area
Post-Discharge Interview
Dear Patient:
In an attempt to improve the efficiency of our patient discharge process, we
have instituted a Discharge Waiting Area for our patients. This is to help insure
that once the discharge order has been given, we can make room available for
other patients who need to be transferred from the OR/ED. We want to see if it
is possible to do this without the inconvenience to our patients and to insure that
the discharge is as comfortable as possible
The following questions are to get your feedback about your recent experience
with our Discharge Waiting Area so we can learn and improve our discharge
process. Please answer each question using a 1-5 scale where:
1 = very dissatisfied/uncomfortable
2 = somewhat dissatisfied/uncomfortable
3 = neutral
4 = somewhat satisfied/comfortable
5 = very satisfied/very comfortable

How satisfied were you with the explanation that was given when you were
discharged from your room to the waiting area?

How comfortable were you while waiting in the Street South waiting area?

How satisfied were you with the assistance that was provided by the
volunteer during the time you had to wait in the Street South area?

Did you utilize the meal vouchers you were provided with? (YES or NO)

What (if anything) could we do to make your experience more comfortable
while waiting for your ride in the Street South Discharge Waiting Area? Please
comment on the following:
Waiting area:
Unit staff:
Volunteers at Street South:
Other:

Were you offered alternative transportation upon discharge? (YES or NO) If
so, did you or did you not choose to accept?
Thank you for your time and assistance.
Contributed ideas
to design and
content of patient
survey
Sample Contributions to TCAB Team
Test of Change:
Patient Room White
Board Redesign
Patient Room White Board Redesign Proposal
PATIENT NAME:_________________
ROOM: 8802
DATE:__________
PHONE #: (310) 423-8802
RN: ____________ CP: ___________
GOALS FOR TODAY:
-
OUR GOAL IS TO GET YOU READY
FOR DISCHARGE BY: ____________
TESTS/PROCEDURES:
-
__ KEYS
__ PRESCRIPTION
__ CLOTHES
__ TRANSPORTATION
__ PERSONAL ITEMS: GLASSES,
DENTURES, VALUABLES, ETC.
KEY ITEMS YOU WILL NEED UPON
DISCHARGE:
DISCHARGE TIME IS 10:00 AM.
DIET: __________________________
ACTIVITY: ______________________
TREATMENTS: __________________
OTHER:
IF YOUR RIDE IS NOT HERE WITHIN 2 HOURS
FROM THE TIME YOUR PHYSICIAN
DISCHARGES YOU, PLEASE ARRANGE TO BE
PICKED UP AT THE SOUTH TOWER, STREET
LEVEL DISCHARGE WAITING AREA.
Gathered ideas/feedback on content and format of
display board from multiple patients on the unit at time
of test of change; boards now in each patient room
Sample Contributions to TCAB Team
Test of Change:
Staff Patient
Assignment Board
Redesign
Staff Patient Assignment Board Redesign
Date: __________
NCT: _____________
Charge RN: _____________ Cell #: 3-8740
ROOM
MD
RN
CP
MANAGER: PEACHY B. HAIN
8 SOUTHEAST
ROOM
8801
8802
8803
8804
8805
8806
8807
8808
8809
8810
8811
8812
8813
8814
8815
8816
8817
8818
8819
8820
8821
8822
8823
8824
MD
RN
CP
X3-6747
DAYSHIFT
(Place staff photo magnets here)
PATIENT VOLUNTEER
NAME:
EVS
DISPATCH X3-2071
DAYS:
EVES:
NIGHTS:
NIGHTSHIFT
(Place staff photo magnets here)
INTERDISCIPLINARY TEAM
(Place staff photo magnets here)
CELL #: _________ RN _________ RN _________ RN ___________ RN __________ RN
X3-8711
X3-8718
X3-8719
X3-8721
X3-8722
Gathered ideas/feedback on content and format of
display board from multiple patients on the unit at
time of test of change
DISCHARGES
Sample Contributions to TCAB Team
Test of Change:
Unit Business Cards
for Patients/Families
Unit-Specific Business Cards for Patients/Families
8 South General Surgery
Room
________
Phone
(310) 423-________
Cedars-Sinai Medical Center
8700 Beverly Blvd., 8 Southeast
Los Angeles, CA 90048
Nursing Station Phone (310) 423-6883
www.cedars-sinai.edu
Contributed ideas/feedback on content and format of
unit business cards to be given to patient/family
upon admission to unit
Patient/Family Survey – Business Cards
“WELCOME” Business Cards
Patient/Family Survey
Post-Test of Change
Please rate your answers to the statements noted below based on the following
rating scale:
1 = Strongly Disagree
Designed patient/family
survey
2 = Disagree
3 = Neutral
4 = Agree
5 = Strongly Agree
The Nurse has given me a business card & I know how to reach the patient room
and/or nurses’ station easily for questions/concerns.
1
2
3
4
5
Receiving the business card has made communication easier for me.
1
2
3
4
5
Sample Contributions to TCAB Team
Test of Change:
Condition H Brochure
for Patients/Families
Condition H Brochure – Side 1
Welcome to Cedars-Sinai
Medical Center
The Staff at Cedars-Sinai Medical
Center are committed to providing
you with the best quality service by
ensuring that all of your needs are
met in a timely and professional
manner. This guide will assist you
in identifying the appropriate
resources to best meet your needs.
Feel free to call the services
provided.
Provided feedback on
design and content of
brochure
Resource
Guide
For Patients,
Our Credo
Families, and
We are committed to being one of
the nation’s premier health systems
and pledge to deliver the finest care
and services to our patients, their
families and our community.
We warmly welcome all who entrust
us with their care and promise to
treat them with compassion, dignity
and respect.
Visitors of Units
6SW, 6NE, 6NW,
8700 Beverly Blvd.
Los Angeles, CA 90048
6CVIC, 7SE, and
8SW
Condition H Brochure – Side 2
Patients, families and visitors
are encouraged to call
Condition H (Help) in the
following cases:
RESOURCES
We encourage you to speak to your
nurse, Charge Nurse, or Unit
Manager for any concerns or
questions you may have. Please do
not hesitate to also contact any of
our services below.
HOSPITALITY SERVICE
(310) 423-4444
CASE MANAGEMENT
(310) 423-4446
Open daily 8:00 AM – 5:00 PM
Case Managers are registered
nurses who provide assistance with
health insurance and financial
resources.
Open 24 hours a day
Contact Hospitality if you need
assistance with your room, food,
valuables, or parking.
PATIENT RELATIONS
(310) 423-3683
Open daily 8:30 AM – 5:00 PM
Patient Relations Representatives are
registered nurses who provide
assistance to patients and families to
ensure their stay is as comfortable
and pleasant as possible. They visit
patients, interpret Medical Center
Policy, and deal with any potential or
existing problems that may arise.
SOCIAL WORK SERVICES
(310) 423-6346
Open daily 8:00 AM – 5:00 PM
Social Workers are licensed
personnel who provide emotional
support and assistance with
discharge needs and smooth
transition to home.
CHAPLAINCY
(310) 423-5550
Open daily 9:00 AM – 5:00 PM
Jewish, Catholic, and Christian
Chaplains are available for the
spiritual needs of patients and family
members.
CONDITION H (NEW)
(310) 423-8288
1. If a noticeable medical change
in the patient occurs and the
health care team is not
responding.
2. If there is confusion regarding
the patient’s plan of care
despite communication
attempts made by the patient
or family member.
Access Condition H by calling 38288. The operator will ask for
your name, room number, patient
name, and patient or family
concern. The operator will
immediately activate a “Condition
H” where a Nursing Task Force
member will come to your room to
assess your situation. Additional
clinical support will be called in as
needed.
In offering our families the
Condition H option, we want you to
know that you are our partners in
care. We believe in teamwork and
ask that you be a part of our team
when visiting your loved ones. If
you have any questions, please do
not hesitate to discuss them with
your nurse or doctor.
Provided
feedback on
design and
content of
brochure
Condition H Brochure – Patient Survey
CONDITION H ORCHESTRATED TESTING
PATIENT Preliminary SURVEY
Date of Survey: __________________
Unit: _______________
Room #: ____________
1. The nursing staff reviewed and discussed the Resource Guide brochure with me
and/or my family.
YES / NO
2. The Resource Guide brochure provides me with the necessary resources I need to
access during my hospitalization.
YES / NO
3. The nursing staff educated me and my family on the Condition H line, its purpose
and criteria for initiating a call.
YES / NO
4. I/We believe that having direct access to the Condition H line is an excellent way for
patients and families to feel safer and more secure in the care received in the
hospital.
YES / NO
5. Given the current quality of care I am receiving, I do not feel the need to access the
Condition H.
YES / NO
Thank you.
Provided
feedback on
content of
patient survey
Sample Contributions to TCAB Team
Test of Change:
Pain Management
Pain Management Post-TOC Patient Survey
Pain Management Survey 8SE/W
Sept 17 - 24 2004
n=49
100%
90%
80%
88%
88%
92%
98%
70%
60%
50%
40%
30%
20%
10%
0%
Are you aw are of w hat
pain medication you are
receiving?
**Based on Picker Survey
Question
If so, has someone
Are you aw are of the
Do you feel that
review ed the medication
Frequency of your
everything is being done
w ith you?
medication and w hen your to control your pain?**
next dose is due?
Conducted
patient
survey and
created
graph as
analysis of
initial survey
results
Sample Contributions to TCAB Team
Test of Change:
Bedside Walking
Rounds
Bedside Walking Rounds – Poster
WALKING ROUNDS
PURPOSE
- Brief introductions of incoming RN/CP to patient
- Quick visual assessment of patient/environment

• Why?
• PATIENT SAFETY
> “Failure to rescue” during
change of shift
> Patient survey – NO
CARE/Service during change
of shift (feels neglected)
> Incoming RN may not see
patient until 1hr-2hrs after
start of shift
> Inability to ask outgoing
RN/CP for clarifications
> CUSTOMER SERVICE!!!
• BARRIERS

> Staff arriving late to
begin work at 0700/1900
> Late arrival leads to
OVERTIME!
> Overtime leads to staff
dissatisfaction
> Cycle: “Domino Effect”
Implementation:
Effective Monday, January 17th at
0700, the change of shift walking
rounds will be in FULL FORCE
throughout ALL OF 8 SOUTH!
Bedside Walking Rounds – Patient Survey
TCAB
Change of Shift Walking Rounds
1/7 - 1/13/2005
N = 13
92%
100%
85%
77%
80%
60%
40%
23%
15%
20%
8%
0%
0%
0%
0%
0%
0%
0%
0%
0%
1
2
3
4
5
N/A
1 DO YOU FEEL YOU HAVE/HAD SUFFICIENT OPPORTUNITY TO
BE INVOLVED WITH YOUR PLAN OF CARE?
1
2
3
4
5
N/A
2 DO YOU FEEL THE TRANSITION OF CARE FROM ONE NURSE TO
ANOTHER AT CHANGE OF SHIFT IS/WAS A SMOOTH PROCESS?
Conducted patient survey and
created graph as analysis of
initial survey results
YES
NO
3 DO YOU HAVE ANY
RECOMMENDATION/
SUGGESTIONS FOR IMPROVING
EITHER # 1 OR #2?
Sample Contributions to TCAB Team
Test of Change:
Interdisciplinary Team
Walking Rounds
Interdisciplinary Team Walking Rounds – Patient Survey
Interdisciplinary Team Walking Rounds
Patient Post-Survey Questions
Dear Patient:
Earlier today you participated in our unit’s very first Interdisciplinary Team Walking
Rounds. The purpose of the walking rounds is to allow you, the patient, to be more
involved in your care planning and discharge planning. We would like to ask you a few
questions related to your recent experience with the IDCP Walking Rounds.
1. Did you find it helpful / beneficial to you, as a patient, to have the
Interdisciplinary team talk about your care plan in the privacy of your own room?
YES / NO
Comments:
__________________________________________________________________
__________________________________________________________________
2. Did the IDCP walking rounds allow you to actively participate in your own care
planning? Were all your questions answered?
YES / NO
Comments:
__________________________________________________________________
__________________________________________________________________
3. What, if any, would you do differently to get you more involved in your plan of
care?
__________________________________________________________________
__________________________________________________________________
Conducted patient
survey
Interdisciplinary Team Walking Rounds – Post-TOC Survey Comments
aInterdisciplinary Discharge Planning Rounds – Patient Post Survey Comments.
May 2005
6 Patients interviewed, all felt that it was beneficial and felt that allowed them to
actively participate in their own care.
Comfort level that people are on your side, not just 1 person.
Makes me feel more comfortable
I like it!
Many questions at one time are able to be answered
Made me feel empowered
Better than having each person come in alone, all disciplines available so
questions can be answered.
Very helpful, great program!
Very cohesive, very together even though the first time doing it
Team is backing up Nurse/Charge Nurse
More explanation is needed as far as what the patient is supposed to do, wasn’t
sure how to respond. Need to know what the expectations of the patient are
Makes you feel that everyone is on board
This process can help the family members, especially if the family needs to learn
a specific skill or need to arrange3 the home in preparation for discharge
Information about Medicare coverage and Home Health Care and my walker took
a load off my mind.
Someone I can call and get information and get a straight answer.
Very nice, nice to be included.
Created
summary of
comments
from patient
survey
conducted by
volunteers
Tests-of-Change Involving Patients & Family
Patient-Centeredness
Patient Care Paths
Business Cards
Patient Assignment Boards
Bedside Walking Rounds
Patient Room Display Boards
Video Rounding System
Donor Nephrectomy Patients –
Deluxe Meal Tray Service
Patient Satisfaction Survey (Nursing Care)
Improving the Patient Experience (Current)
CSMC House-Wide Handbook (Current)
Tests-of-Change Involving Patients & Family
Vitality & Teamwork
Employee Recognition Program
MD-RN Collaboration
Monthly 8South “Success” Celebration
8 South Medication Room & Nursing Station Renovation Input
Staff Vitality Surveys
Tests-of-Change Involving Patients & Family
Safe & Reliable Care
Safety Star Program
Condition H Orchestrated TOC
Value-Added Care Processes
Early Discharges
Van Go Service
Post Discharge Survey (Readiness)
Patient Focus Groups
 Formed in Fall 2006 as a result of low scores on Patient Satisfaction
surveys conducted by Picker
 Goals:
— Identify and isolate the problem areas
— Come up with specific solutions to each problem
 Groups formed in the following categories:
— Pediatrics
— Women’s Health
— Adult Medical
— Labor & Delivery
— Adult Surgical
Planning for the Future
 Patients and family members to play increasingly important role
in organization’s improvement initiatives
— Continue to invite current and previous patients to attend
weekly TCAB meetings
— Patient representatives as members of hospital-wide
committees (Patient Satisfaction, TCAB, Improving the
Patient Experience)
Improving the Patient Experience: Categories of Need
Improving the Patient Experience: Categories of Need
1.
2.
3.
4.
DATA NEEDED TO DETERMINE
SUCCESSFUL ACQUISITION AND
DISTRIBUTION OF DATA
Responsible Committee
Members
1. Telephone etiquette for EVERYONE – Use consistent script
throughout all of CSMC
2. Communication skills
a. Verbal
b. Non Verbal – eye contact
c. Attentive listening
SUCCESSFUL TEST(S) OF CHANGE
Responsible Committee
Members
1.
2.
3.
4.
5.
Waits / Delays
Rights / Responsibilities
Service Recovery
Complaints
Information Provided
a. Verbal/Oral
b Written
c.White Board
SUCCESSFUL TEST(S) OF CHANGE
1. Holding Staff Accountable
2. Recognition
3. Inspiring Culture Change
SUCCESSFUL TEST(S) OF CHANGE
1. Scripts
a. Telephone
b. Meeting / Greeting people
c. Dealing with difficult people
d. What are basic comfort measures to offer visitors
e. Code of conduct-employees
f. Anger management
2. Classes
a. Respect for persons
b. Listening
c. Communication
d. Cultural competence
3. Resources for Support
a. Nursing Liaison
b. Work-n-Life Matters
c. Peer Support
SUCCESSFUL TEST(S) OF CHANGE
PRIORITIES
5.
6.
INTERPERSONAL COMMUNICATIONS
MANAGING PATIENTS’ EXPERIENCE
MOTIVATION & ACCOUNTABILITY
TOOLS & SUPPORT NEEDED FOR
STAFF
Comments from Picker Survey
Complaint Data
Feedback from Patient Relations
Feedback from focus groups (including videos of
January groups)
Feedback from employees & staff
“Secret Shopper (i.e. patient)”
WHICH WORK
Bernie Mendiondo
David Esquith
Allison Rotter
Barbara Leanse
WHICH WORK
Responsible Committee
Members
Eskedar Gobeze
Marlene Clark
WHICH WORK
Responsible Committee
Members
Flora Haus
David Esquith
Allison Rotter
WHICH WORK
Responsible Committee
Members
Bernie Mendiondo
Q&A
Session
Open
Discussion
References
Patient and Family Perspectives: Engaging Your Customers
In Quality Improvement Initiatives

Cahill, J. (1998). Patient participation – a review of the literature. Journal of Clinical
Nursing, 7(2), 119-128.

Jeske, L., Kolmer, V., Muth, M., Cerns, s., Moldenaur, S., & Hook. M. (2006).
Partnering with patients and families in designing visual cues to prevent falls in
hospitalized elders. Journal of Nursing Care Quality, 21(3), 236-241.

Larrabee, J.H., & Bolden, L.V. (2001). Defining patient-perceived quality of nursing
care. Journal of Nursing Care Quality, 16(1), 34-60.

Tutton, E. M. (2005). Patient participation on a ward for frail older people. Journal
for Advanced Nursing, 50(2), 143-152.

Webb, B., & Benstead, R. (2002). Patient panel: an ongoing learning process.
Nursing Standard, 16(20), 39-42.