Small Change Brings Huge Results

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Home Health Quality Reporting Drives Big ResultsThe Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home Health Care Survey raises the importance of quality reporting and patient satisfaction by linking reporting to payments.

Small changes can make large differences in both quality and patient satisfaction scores, as evidenced by the examples that follow from the hospital industry.

Starting things off on the right foot has taken on a whole new meaning at Twin Rivers Regional Medial Center in Memphis, Tenn. In 2011, only one-third of patients said they would definitely recommend Twin Rivers to a friend or loved one. Today, the number is around 70%, and the main difference is a small one that easily can be used by home health and hospice agencies.

The staff at Twin Rivers created a “sacred moment” checklist for patient arrival. The arrival of a patient to an inpatient room is a unique opportunity for clinicians to make a connection with the patient and family, ask key questions and convey safety information. For example, the primary nurse asks about patient pain, dietary needs, spiritual preferences and explains topics like medication protocols and how the call light works.

Dr. Steve Pu, Twin Rivers’ medical director, says the sacred moment not only has practical implications (e.g., discovering missed medication doses due to a long wait in the ED), but also cultural ones. “The patients look at the [clinicians] as humans who are actually caring for them again,” he said in the report.

The checklist is a great example of the power of combining patient satisfaction efforts with those aimed at preventing medical harm and achieving better clinical outcomes, according to a report in American Medical News.

Several other multi-function initiatives were noted in the report, including a document called Partnership for Patient Safety at Bassett Medical Center that outlines the patient’s role in preventing wrong procedures/tests, preventing medication errors and encouraging hand hygiene. The approach resulted in a 30% improvement in hand-hygiene compliance, a 50% reduction in Clostridium difficile rates and a 90% reduction in wrong-patient medication errors.

In 2006, the total-joint replacement practice area of the University of Pittsburgh Medical Center instituted a program of shadowing patients and families at every step in a care episode to look for ways to improve. They found that the more uninformed the person doing the shadowing, the better—they are more capable of seeing things through the patient’s eyes. An amazing 90% of total-joint patients are discharged directly home from the program (the national average is 25%), and the service ranks in the 99th percentile on patient satisfaction surveys.

What concrete steps are you taking in your agency to raise scores? Let us know in the comments section below.

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