Improved communication boosts experience
When 8-year-old Sutherland Smith was diagnosed with Kawasaki disease in April, his doctors spoke to him directly about his diagnosis and made sure he was part of the treatment plan.
His mom, Betsy, was impressed.
“The doctors made a point to include Sutherland in the dialogue and always took the time to ask him, specifically, if he had any questions,” said Betsy. “Our family had what felt like a million questions, and the team made sure we understood everything regarding Sutherland’s treatment. We are beyond grateful for our excellent experience.”
The Smiths’ experience wasn’t always the norm for families at Le Bonheur. The hospital assembled a multidisciplinary taskforce of hospital executives, physicians, nurses, family members and other care providers to address recurring concerns about overall patient experience and a lack of coordination of care.
“We knew we wanted patients to have a safe experience here, to receive excellent medical care and to have good outcomes,” said Chief Medical Officer Bill May, MD. “In partnership with several Le Bonheur families, we determined that patient experience hinges on three things: how we connect with patients, how we listen to their needs and expectations and how well we honor our commitments.”
May and his team knew the hospital needed to create better ways for families and caregivers to share information. The plan paid off.
Since the taskforce’s formation, Le Bonheur has seen a significant increase in its inpatient experience scores, landing in the 90th percentile among children’s hospitals. This score is measured by National Resource Corporation (NRC) in response to the question, “Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your child’s stay?”
Physician communication is key
Hospital administrators attribute the spike in patient satisfaction to initiatives focused on three of Le Bonheur’s key drivers for measuring patient experience:
- communication with physicians
- communication with nurses
- pain management
Survey results shows that communication with physicians is currently Le Bonheur’s most influential driver. NRC measures physician communication as showing courtesy and respect to families and the child; listening carefully to the parent; and explaining things in a way that’s easy for everyone – including the child – to understand.
Hospitalist Cynthia Cross, MD, says she believes that, as team leaders, physicians set the tone.
“Many problems boil down to a simple rift in communication,” said Cross. “If we establish that communication is a priority for us – that we want our families to know what’s going on, to receive consistent messages and to hear information that they can understand and apply – then I believe everyone else will follow, and satisfaction will improve.”
To improve two-way communication among team members, staff remodeled white boards in patient rooms and changed the resident physician rounding process. The new boards, developed from family input, are designed to encourage two-way communication between the family and all members of the care team. Space is available to list the child’s care team, family names and phone numbers, the day’s plan of care, the child’s pain level and questions from the family. When family members or nurses aren’t present during physician rounds, the boards are used to help facilitate communication.
The new resident rounding process gives families a more consistent care team. Residents are divided into teams and assigned to specific inpatient units each month. Residents – led by an attending – participate in a formal hand-off and teaching rounds every morning between 7 and 8 a.m. with the patient’s family and other care team members.
The new model helps ensure everyone is on the same page and actively discussing the plan of care with families and with one another.
“Residents and nurses have a chance to build relationships with one another, and nurses are encouraged to participate in rounds, to share information and to offer suggestions for the plan of care,” said Infant/Toddler Unit Clinical Director Jessica Fleener, MSN, RN-BC, CNML. “Resident rounding also helps bridge the gap between all consulted subspecialties and the pediatric team leading the plan of care, which has made a huge difference.”
Prioritizing pain management
In another effort to improve patient experience, Le Bonheur leaders and families looked at ways to reduce the pain and anxiety associated with needle sticks. In two years, Le Bonheur’s pain management scores rose from the 21st to the 87th percentile among children’s hospitals, according to the National Research Corporation.
“Parents don’t want their children to be afraid, and they don’t want them to suffer pain,” said May. “Every time we stick a child – whether conducting a spinal tap or a routine blood draw – we want to minimize or eliminate that child’s pain.”
Le Bonheur implemented a program to educate clinicians, patients and families about ways to decrease pain and distract children during procedures. Techniques include topical anesthetic products and vapocoolant sprays, as well as non-pharmacologic interventions like oral sucrose, shot blockers, comfort kits, distraction therapy techniques and Buzzy® – a toy bee that uses both vibration and cold to help minimize pain.
Le Bonheur also implemented use of a “poke plan” – a written tool to help understand each child’s needs when faced with pain – with inpatients and patients in the hospital’s outpatient clinics.
“We ask family members if the child has a fear of needles; if a parent would like to be present for all needle sticks and blood draws; if the child has favorite coping mechanisms and other questions to help us tailor a specific pain management plan. We then use the poke plan as a roadmap moving forward for all potentially painful encounters,” said Neuroscience Clinical Director Ann Reed, MSN, RN, CNML.
The program has been so successful that Le Bonheur nurses are now partnering with community pediatricians to make interventions more widely available.
With pay-for-performance on the rise and family-centered care at the forefront of the hospital’s goals, the taskforce will continue to explore ways to improve overall experience.
“Measuring patient experience matters because it gives us an idea of how well we’re taking care of our patients,” said Donna Vickery, administrative director of Quality Improvement. “If they don’t tell us that something is broken, we won’t know what we need to fix. These questions tell us how well we’re communicating with families and if we’re giving them what they need to help us care for their children.”