Better Care

Something exciting is happening at GBMC.

Our vision is to become the healthcare system where everyone, every time, is treated the way we would want our own loved ones treated. We say that this includes: the best health outcomes (better health), with the best satisfaction with the way the care is delivered (better care), with the least waste (lower cost), and the most joy for those providing the care.

So what is the exciting thing that is happening? The November monthly patient satisfaction survey shows an overall 87.6 inpatient satisfaction score, the highest score ever for our hospital!

More than 40 percent of U.S. hospitals utilize the company Press Ganey to measure patient satisfaction. Each month, a random sampling of inpatients from units across the hospital are surveyed by Press Ganey and asked to score their patient experience in a variety of areas, on a scale from 1, equaling “very poor” (score of “0”), to 5, equaling “very good” (score of “100”). Press Ganey than converts respondents' ratings to a mean score for hospitals in various areas such as nursing care or meals.

Since about the beginning of 2011, GBMC’s overall monthly inpatient satisfaction scores have been improving; marking real change as opposed to random peaks and valleys. If you look at the scores of most other hospitals or health systems you are not going to see this. (You actually can compare hospitals by going to www.hospitalcompare.gov and compare HCAHPS scores but the data are only published yearly and what you find today is from December of 2010.)

This most recent survey score of 87.6, places us in the 82^nd percentile for hospitals with 300 beds, which is our peer group in the Press Ganey database.  The percentile ranking means we scored higher than 82 percent of comparably-sized hospitals. We’ve certainly made significant improvement, considering that in 2007 we were at the 35^th percentile for hospitals in our peer group.  We were at a plateau from about early calendar year 2010 until essentially this year and have started moving our scores higher and higher.  We are making true measurable progress.

I have been in healthcare a long time and I have seen many organizations measure patient satisfaction. Every month the score would come out and people would try to explain the result. Rather than get in action on implementing change, we were wishing that the score would improve.

Today, at GBMC we are now using continual improvement as our way to manage our organization. In more and more areas of our system, leaders are asking the question: “How can we do it better?” and then getting their team in action on change!

So what changes have brought our score up? There are too many changes to talk about them all but let me give you a few.

In February and April of this year, we had fallen to a score just under 77 in patient satisfaction for meals, which ranked GBMC at the 10^th or 15^th national percentile, which is well below average. We are not a well below average system….but that’s where we were scoring.

Nurses were telling us that a mistake was made when the structure of meal delivery was changed and we needed to return to the system where foodservice workers were assigned to a specific unit.  So we made that change, and have seen a statistically significant improvement in our meals score since doing so. The arrow shows when we implemented this change. There is still room for improvement in our overall meals score, but patients are voting that we have improved.


Meals Section Score

We have also improved our score in room cleanliness. We know that people don’t like a dirty hospital, insensitive staff, cold meals, or waiting. And we are working on initiatives around these issues. Press Ganey scores show that the hospital is getting cleaner through the eyes of the patient, which is who matters the most. You can see from the scores that we are still working to standardize our new processes and make them happen reliably and everywhere.


Room Cleanliness Score

Our nurses are working hard to improve communication with patients. They have begun to standardize when and how they communicate to reduce the chance that the patient feels left out. One of the tools that nurses are using is called AIDET. The AIDET model is a helpful framework comprised of:

§  Acknowledge - Greet people with a smile and use their names if you know them.

§  Introduce — Introduce yourself to others politely. Tell them who you are and how you are going to help them. Escort people where they need to go rather than pointing or giving directions.

§  Duration — Keep in touch to ease waiting times. Let others know if there is a delay and how long it will be. Make it better and apply service recovery methods when necessary.

§  Explanation — Advise others what you are doing, how procedures work and whom to contact if they need assistance.

§  Thank You — Thank somebody. Foster an attitude of gratitude. Thank people for their patronage, help or assistance. Use reward and recognition tools.

Another area of standardized work that nurses are testing is called hourly rounding. This technique schedules a member of the nursing team to do a formalized check-in with each patient once per hour during the day (and less frequently during the night when patients are sleeping.) Below you can see the effect of nursing standardization of these tools on the patient’s response to the question of whether or not nurses kept them informed.


Nurses Kept You Informed

Standardizing the work gives us a better shot of getting to the desired outcome than if we are just relying on the hard work and good intentions of our staff alone.

We’ve made a lot of real changes and I am very grateful to all of our hard-working staff who have made them.  We must stay in action by reviewing what our patients are saying, asking ourselves what changes we can try, and then testing those changes. Once we find a change that works, we need to implement it throughout our system. This is how we will get to Better Health, Better Care, Lower Cost, and More Joy.

We are using Continuous Improvement as our business model.  One of the tenets is design, and right behind that is measurement.  The examples above show that we are redesigning systems, and we are measuring the performance of these redesigned systems, and I’m very proud of all of our people for doing this.

So, right now we stand at a patient satisfaction score of 87.1, with room to improve.  What idea do you think your team could test in your area to get better and to foster continual improvement?  Please share your thoughts below.