Discover why health care organizations became Planetree affiliates. What motivated them? What were the specific challenges they faced and how did Planetree’s pathway to culture change lead them to achieve success?
Patient-Centered Lean® Leads Bethel Health Care to Greater Employee Satisfaction and Significant Cost Savings
Bethel Health Care (BHC) in Bethel, Connecticut has embarked on an enterprise wide value stream analysis utilizing the distinct Patient-Centered Lean℠ methodology to achieve greater efficiency and financial savings while enhancing the resident, family and caregiver experience. The first in a series of scheduled Patient-Centered Lean events at BHC focused on the area of greatest opportunity, the inventory and purchasing systems. Beginning in December, a team consisting of staff from purchasing, housekeeping, maintenance, nursing, and administration completely overhauled the inventory systems at BHC and The Cascades Assisted Living. Significant accomplishments included:
•Cleaning, organization, and consolidation of all storage rooms.
•Implementation of a new inventory tracking system.
•Providing greater access to supplies to clinical staff.
•Creation of a new file storage area with greater accessibility.
•Development of new standards for the ordering, delivery and distribution of supplies.
•Improved caregiver satisfaction
•$58,500 worth of square footage
Lean Approach to Nursing overtime
In June, a Planetree coach and BHC staff came back together with the aim of minimizing nursing overtime. The current state provided much opportunity for improvement.
Weekly OT in nursing = 504 hours ≈ $15,445
OT is built into the schedule process
All employees do not get OT. 0-199 hrs. = 80% of nursing staff, 200-400 hrs.= 15%, 400-500 hrs. = 5%
Human resource availability impacts staff vacancies.
••Move charting to nursing office
••Establish flexible schedules
••Develop a call list
••Ensure competencies through skill building
••Create rewards and incentives
•The Bottom Line Projected Savings: $12,381 weekly, $643,812 annualized
Additional LEAN Kaizen events are scheduled to focus on facility repairs, dining, marketing and staff education.
Patient satisfaction is a top priority at Danbury Hospital (DH). DH is a 371-bed teaching hospital in Connecticut and a level II trauma center with multiple Centers of Excellence in partnership with a number of office practices in the region. Recognizing that opportunities existed to improve communication around treatment plans and medication, two units were targeted for Patient-Centered Lean℠ Kaizen events.
The first unit, 8W, is a 25-bed cardiac telemetry unit. With the help of Planetree our staff set out to improve the communication of the plan of care amongst the team of providers and to our patients and their families. Our team included unit nurses, a physician’s assistant, a quality management staff member and champions from the medical staff, nursing and administration. Using the tools of Patient-Centered Lean℠ (value stream and process maps, cause and effect diagrams, PIC and SIPOC charts) we drilled deep into the problem and identified several opportunities for improvement. We “went to the Gemba” where we observed, first hand, how the Planetree components were demonstrated in the work that we do caring for our patients. Again, we discovered areas where we could do better.
Based on this analysis, we were able to put together a number of counter measures, some of which we started implementing right away; others are a work in progress. A multidisciplinary patient review team, including cardiologist, hospitalists, residents and nurses, meets daily to coordinate the plan of care. New phone technology enhances nurse to nurse reporting at change of shift. Expanded use of white boards in patient rooms includes displaying goals for the day, medication schedules and staff/provider names. With these improvements in place, we have already seen upward trends in patient satisfaction that consistency of practice brings.
Encouraged by our success, we moved on to 9W, a 26-bed medical unit, to focus on improving communications around new medications and their side effects. This time our team included nurses, physicians and pharmacists. We used the same set of tools, and more. A decision matrix was useful in helping us prioritize our improvements while emotional mapping served to identify the parts of the process where patients have the most anxiety. Nurses are now printing a brief drug summary at the bedside for all newly prescribed medications while physicians are focusing on discussing new medications and their side effects. House-wide, all employees were asked to complete an awareness-raising educational model regarding the importance of patient-centered communication. Again, results have been very positive. Interviews with patients, before and after the Kaizen event, show impressive gains in patients’ understanding of their medication regimen as observed through a series of qualitative bedside interviews. Patients felt as though both nursing and physician staff answered all related questions satisfactorily. Here is a snapshot of our results:
• Name of new medications – 64% to 92%
• Explanations of side effects – 18% to 58%
• Receipt of education materials – 9% to 50%
We now have a set of tools in our quality toolbox and experience using them in rapid cycle improvement. Reducing waste and streamlining our procedures gives us the opportunity to reinvest recovered resources directly back into the patient experience.
Hospital Israelita Albert Einstein: Humanizing Healthcare in Sao Paulo, Brazil
The first healthcare organization in Latin American to implement the Planetree model of patient-centered care, Hospital Israelita Albert Einstein (HIAE) is located in Sao Paulo, Brazil. A large hospital with more than five thousand employees, including 500 full-time physicians, HIAE also is the world’s first hospital to receive Joint Commission International accreditation.
HIAE provides an extensive range of services for patients from Brazil and from visiting patients from around the world, with numerous specialties including integrated cardiology, neurology, and oncology diagnosis and treatment, as well as organ transplantation, orthopedics, dermatology, gastroenterology, hematology, ophthalmology, plastic surgery, and urology. Einstein also has a Diagnostic and Preventive Medicine Center that offers numerous tests. HIAE is Latin America’s largest liver transplant center, performing some 200 transplants annually, and achieves a consistent liver transplant success rate of 90 percent, on par with the best US and European hospitals.
In 2009 HIAE joined Planetree to advance the humanized and personalized qualities of its services for all of its clients, including patients, family members, and employees. Since its first assessment by Planetree in Spring 2009, HIAE has achieved substantial advances in patient-centeredness.
Though Brazilian hospitals are not required to use patient experience measurement tools such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), HIAE has begun implementing HCAHPS both as a strategy for evaluating internal performance and identifying priority areas for improvement, but also for benchmarking with US hospitals. Since 2009, when the hospital starting working with Planetree, HIAE has achieved substantial improvements in patient experience scores across the hospital. For example, increasing percentages of patients report that they are satisfied or very satisfied with their experiences and that they would definitely or probably recommend the hospital to family and friends. HIAE also consistently collects feedback from patients through the widespread utilization of comment cards throughout the hospital. Utilizing this feedback HIAE has calculated an indicator of humanization [# of compliments - # of complaints / 100] with very impressive results.
Simultaneous with these advances in patients’ experiences, HIAE also has evolved its culture to be more humanized, with the high quality technical skills of well-trained healthcare professionals becoming balanced with “high touch” interpersonal skills of all HIAE employees. In focus groups conducted with patients, family members, and staff from across the hospital, the care provided at HIAE was characterized as humanized in alignment with the hospital’s Planetree efforts. “Remembering the human part” of HIAE’s patients was repeatedly emphasized as an important achievement, and Planetree, it was succinctly explained, “is a way of humanizing.”
The first Canadian institution to adopt the Planetree model, the Centre de réadaptation Estrie (CRE) is based in Sherbrooke, Quebec (Canada). CRE provides care for individuals with motor, hearing, visual, language or speech impairments in an outpatient setting with the exception of a 12-bed rehabilitation unit. A small organization, the CRE was challenged by a staffing shortage as well as waiting lists up to two years for services.
CRE joined Planetree in an effort to stand out from larger, more reputable healthcare organizations and improve staff engagement and retention. At the outset of CRE’s Planetree journey, they immediately identified a series of attitudes and behaviors to be promoted with a view to humanizing care. This, in turn, led to the development of quality improvement tools, notably satisfaction questionnaires for users and personnel, key competency profiles, as well as hiring and induction processes for new employees.
CRE’s management philosophy is to recognize each employee’s unique contribution, be open to differences, and see mistakes as a learning opportunity. Caregivers are not only encouraged to share their ideas and expertise but their artistic, musical and athletic talents to enhance physical and psychological health within the community.
In 2008, CRE was awarded first prize for the Quebec-based “Best Employer’s Challenge” in the 200-500 employees category. This achievement helps prove to healthcare professionals that it is still possible to feel empowered, fulfilled and happy when working within the healthcare network.
Planetree Quebec Network
Over the past years, a growing number of healthcare establishments have been observing the CRE journey with Planetree. Its many successes have led to the creation of a Quebec-based Planetree network, adapted to our specific context and cultural environment. It regroups organizations that are working together and supporting each other in developing a philosophy of person-centered healthcare, services and management. The mission of the new organization, created in the fall of 2008, is to become the standard bearer for the humanization of healthcare services and management throughout Quebec and French-speaking countries.
CMC-Mercy is a 180-bed, adult acute care facility in Charlotte, North Carolina, with 1,116 medical staff and 950 full time employees. The hospital is part of the Carolinas Healthcare System comprised of 33 affiliated hospitals in North and South Carolina. In 2007, CMC-Mercy experienced a leadership change and motivated by the opportunity to rebuild, CMC-Mercy partnered with Planetree to bring its vision of being a destination hospital to life. The team was committed to achieving Planetree Designation in three years.
In step with Planetree’s direction, a steering committee was developed in short order. Led by a Planetree coordinator as well as a physician, it included senior management and front line employees. A community advisory council with past patients was also established at this time. A selection process to identify high performers with desired characteristics was utilized for working group participation, retreat facilitators and “first attendees” at retreats. With a physician co-chairing the steering team in his newly identified role of “medical director of patient-centered care,” medical staff engagement received increased attention and a comprehensive approach including curricula for new physician orientation and Planetree updates at the Medical Executive Committee meetings were employed.
The committee focused on staff engagement and communication activities, and within the first two years more than 94 percent of staff attended phase one retreats, to be followed by phase two retreats in order to maintain momentum and enthusiasm. Planetree Department Certification was created requiring departmental projects to be submitted, along with an annual Patient-Centered Care Day celebration.
By engaging these high performing managers and caregivers, CMC-Mercy implemented numerous approaches to personalize care for patients and families. Care partner programs, bedside shift reporting and open medical records were introduced to improve communication and activation of patients in their care. A community advisory panel was launched to open lines of communication and identify needs of patients and families, and integrative therapies for patients as well as caregivers, such as aromatherapy, massage and tai-chi were introduced to promote additional paths to well-being.
Using the Mercy Experience Dashboard several outcomes are measured to gauge progress, which demonstrate that CMC-Mercy has significantly improved quality and safety measures along with patient satisfaction and employee engagement. The patient safety culture survey shows CMC-Mercy outperforming national averages in every domain, from hand offs and transitions, to staffing and overall perception of patient safety. Inpatient ‘excellent’ scores for nurse communication about treatment soared from 43.4 percent to 87.7 percent from 2007 to 2011 and during that same timeframe ‘likelihood to recommend’ increased from 61 percent to 80.8. By 2011, 90 percent of employees participated in the employee engagement survey, and the workforce commitment indicator score rose to the 89th percentile.
The team’s diligence and commitment led to the hospital achieving its goal in 2011 when it was named a Designated Planetree Patient-Centered Hospital.