Clean and Quiet Environment f

Agency for Healthcare Research and QualityAdvancing Excellence in Health Care • www.ahrq.gov

Clean and Quiet Environmentf

August 14, 2013

Carrie Brady, JD, [email protected]

Ashka [email protected]

David [email protected]

Advancing Excellence in Health Care

AHRQ/HRET Patient Safety Learning Network (PSLN) Project

This program is supported by the U.S. Agency for Healthcare Research and Quality (AHRQ) through a contract with the Health Research and Educational Trust (HRET).

HRET is a charitable and educational organization affiliated with the American Hospital Association, whose mission is to transform health care through research and education.

AHRQ is a federal agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.

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The Patient Experience of Care is Fundamental to Clinical Improvement

Understanding the patient experience of care is not an add-on activity: it should be used as a fundamental element in your other improvement efforts.

For those working on the HRET Partnership for Patients Hospital Engagement Network (HEN) or another HEN, your work will benefit directly from your efforts to improve the patient experience of care (e.g., readmissions, ADEs).

Lessons you learn in this HCAHPS Learning Network will help you succeed in the HEN project because—

Patient-centered care is a driver of clinical outcomes

Employee and patient engagement are 2 sides of one coin

HCAHPS assesses key factors in ADEs and readmissions3


Guide to Patient and Family Engagement in Hospital Quality and Safety

Provides detailed implementation guides and tools for four strategies:– Working with Patient and Family Advisors– Communicating to Improve Quality– Nurse Bedside Shift Report– IDEAL Discharge Planning

http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/index.html

New AHRQ Resource

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Advancing Excellence in Health Care HCAHPS Technical Assistance Faculty

Carrie Brady, MA, JD HRET’s primary HCAHPS faculty Former senior Connecticut Hospital Association

staffer Previously a vice president at Planetree

Exemplary hospital peers

Community Hospital of Monterey Peninsula, CA

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HCAHPS Clean and Quiet

During this hospital stay: How often were your

room and bathroom kept clean?

How often was the area around your room quiet at night?

Source: CMS Summary of HCAHPS Survey Results and HCAHPS Percentiles July 2013 Public Report (October 2011 – September 2012 Discharges) www.hcahpsonline.org

Clean Natl Avg: 73% “Always” Best performing hospitals in

the country (95th percentile) get 86% or more “Always”

Quiet Natl Avg: 60% “Always” Best performing hospitals in

the country (95th percentile) get 78% or more “Always”

Lowest scoring topic

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HCAHPS questions ask about: Cleanliness “during this hospital stay” Quiet “at night”

Patient perceptions are influenced by: Cleanliness in outpatient areas Noise level at other times of day

Consider expanded improvement strategies Waiting area cleanliness rounding/concierge Daytime quiet hours

Incorporate clean/quiet in facility design

Think Broadly About Clean and Quiet

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Make the Connection Between Quiet and Healing

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Hospital Noises Likely to Awaken Patients

Noises Likely to Arouse Patients (from most likely to least likely)

Phone and alarms

Conversations and overhead paging

Snoring and electric towel dispenser

Squeaky door, flushing toilet, ice machine

Laundry cart, exterior noises (e.g. traffic)

Source: Solet J et al., Evidence-Based Design Meets Evidence-Based Medicine: The Sound Sleep Study, The Center for Health Design, 2010.

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Remember noise has physiological effects on patients and on staff


Ask patients what noises are keeping them up Offer to close the door if appropriate Ask about and preserve patient sleep rituals

e.g., a cup of tea, reading material, snack Pair patients by sleep habits in non-private rooms

Offer a sleep/relaxation kit e.g., sleep mask, aromatherapy, door hanger

Consider soothing sounds/white noise Provide TV headphones

Partner with Patients

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Partner with Staff

Engage staff to identify and eliminate “noise”: e.g. overhead paging, equipment “squeaks,” loud

maintenance, unnecessary alarms Use decibel meters creatively

e.g. put one in a bed and have staff members practice entering the patient’s room and performing tasks quietly

Raise awareness of “noise” Have a staff member sleep on a unit and record

what they hear11


Restore Quiet Time

Implement quiet hours Give patients respite from non-urgent

medical interventions or bundle interruptions Create quiet campaigns with tools to

support staff in reducing noise generated by guests

Provide cues to staff, patients, and families E.g. signs, brochures, dimmed lights,

announcement

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Environmental services staff are saving lives! Patient reports of cleanliness are associated

with lower rates of nosocomial infections– HCAHPS: Isaac T et al., The Relationship Between

Patients’ Perception of Care and Measures of Hospital Quality and Safety, Health Services Research 45:4 (August 2010)

– Patient reports (English National Health Service): Research Letter: Associations Between Web-Based Patient Ratings and Objective Measures of Hospital Quality, Arch Int Med 172:5, March 12, 2012.

Cleanliness and Patient Safety

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Routinely change your point of view to match the patient perspective– e.g. ride on gurney, in wheelchair, sit in bed

Sights– e.g. dirt, clutter, areas needing maintenance– observing things being cleaned

Smells, Sounds, Touch (e.g. hand sanitizer) A Reality Check: the toddler/cell phone test

Perceptions of Cleanliness

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Make Environmental Services Visible

Recognize EVS as key team members Encourage communication with patients

Consider assignment by unit Provide patients with ability to directly contact

environmental services team Let patients know service was provided, even if they

aren’t there e.g., white board note, washcloth animals on admission,

mints, newspaper, quote of the day, sanitized strips/stickers

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Engage Your Team

Revise job descriptions and related materials e.g., role is to prevent nosocomial infections

Provide business cards

Professionalize training

Emphasize that cleanliness is the responsibility of all staff e.g., overflowing trash cans, clutter

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Agency for Healthcare Research and QualityAdvancing Excellence in Health Care • www.ahrq.govTerril Lowe, RN,

Vice President, Nursing

Raul Lopez, Director, Environmental Services

Phillip Williams, RN, Director, Comprehensive Cancer Center


HCAHPS Run Chart Overall Rating for the Hospital

(Q1 2012 – q1 2013)


HCAHPS Run Chart Cleanliness of Hospital Environment

(Q1 2011 – q1 2013)


Our Strategy:– Reliable Means of Assessing Cleanliness– A Focus on Customer Service– A Process to Ensure Compliance & Accountability

Room kept clean during stay



A reliable means of assessing cleanliness.

Ensuring the patient experiences a clean environmentby:

Microbial contamination contains ATP (adenosine tri-phosphate), which should be significantly reduced after cleaning.

Handheld monitor measures ATP bioluminescence as an indicator of surface cleanliness.

We sample 4 rooms/week, 20 high-contact surfaces are sampled.


The use of scripting to facilitate use of desired patient-centered behaviors and eliminate variation.

EVS Customer Service Guidelines

1. When entering a patient room, remember to knock, greet the patient or family member and introduce yourself. “Hello, my name is _______ I’ll be your housekeeper and our goal is to insure your room is cleaned.

2. When you are about to exit the room, be sure to let the

patient or family member know, if they have any other cleaning requests, they can call extension 4928 to make contact. Then hand the patient or family member your business card. If the patient is not in the room, leave the card with your name on the bedside cabinet.

3. The management team and charge staff will conduct

patient interviews to collect feedback about the services they have received from EVS. We will advise the patient/family members they can reach us if they need anything.

Room kept clean during stayEnsuring the patient experiences a clean environment

by:


Compliance monitoring via director rounding with EVS staff & patients.

Instilling a sense of pride & accountability with the use of business cards.

Ensuring the desired behaviors are happening reliably by:



Daily: EVS Supervisor/Charge person observes sample of 4 Housekeepers interactions with patients.

Weekly: Management Team (Director, Supervisor) round on patients. Ask about interactions with Housekeepers, actual cleanliness of room, solicit comments/suggestions.

Monitoring Plan:


Factors that Contribute to Higher HCAHPS Scores

Hospital Environment• Cleanliness• Noise• Safe Environment• Food Quality• Equipment in working order• Comfort (furniture, temp.)

Overall Rating of Hospital

Patient Discharge

• Continuity• Transition

Physician Communication• Courtesy & Respect• Care Coordination• Listening• Explanations Understood• Availability• Trust • Safety

Nursing Communication• Courtesy & Respect• Listening• Explanations Understood• Response time• Pain Management• Medication Teaching • Trust• Safety• Care Coordination

Access to Care• Wait Times:

• ER, seen by MD• For Inpatient Bed

• Patient Registration Experience • Parking• Wayfinding• Communication of Services

• Outreach• Marketing• Public Education

• Cost of Care• Coverage• Pt. Billing Experience


Studer, NRC/Picker, Press Ganey & the IHI all agree with our observation that communication as a whole & NURSING COMMUNICATION specifically has the highest correlation with the patient’s overall rating of the hospital.


But as Studer research indicates, patients categorize caregivers as

either doctors or nurses so essentially all staff members affect the patient experience and ultimate

satisfaction.


A key factor in improving the patients’ care experience is CONSISTENCY in how we communicate with our patients & we have adopted Baptist Health’s Words-that-Work scripting.

Words that Work are patient-centered communication scripts that are aligned with specific HCAHPS indicators and allows staff to connect with patients on both an emotional and clinical level.

The scripting helps ensure patients receive a consistent message throughout the organization.

It allows us to “narrate our care” to reinforce to our patients that we are providing the care we set as an expectation.

EVS

Customer Service Guidelines

1. When entering a patient room, remember to knock, greet the patient or family member and introduce yourself. “Hello, my name is _______ I’ll be your housekeeper and our goal is to insure your room is cleaned.

2. When you are about to exit the room, be sure to let the

patient or family member know, if they have any other cleaning requests, they can call extension 4928 to make contact. Then hand the patient or family member your business card. If the patient is not in the room, leave the card with your name on the bedside cabinet.

3. The management team and charge staff will conduct

patient interviews to collect feedback about the services they have received from EVS. We will advise the patient/family members they can reach us if they need anything.

Words that Work


Mining the Data

When initiating your improvement strategy, it helps to illustrate your target audience (the Usually Respondents).

Typically, there aren’t enough of the Sometimes & Never Respondents to make the effort to improve their perception worthwhile.

Focus on the Usually Respondents is a far better use of time & resources.


Catalyst Background Data by Responses (Age Group)

Mining the Data


Mining the Data

Catalyst Background Data by Responses (Gender)


Don’t forget the ER!

Remember, HCAHPS are based on the patient’s entire hospital experience.

Agency for Healthcare Research and QualityAdvancing Excellence in Health Care • www.ahrq.gov

Questions and Discussion


HCAHPS Curriculum 2012-13All Web conferences are archived at:

http://www.psl-network.org/

December 7, 2012: Fundamentals of HCAHPS December 18/19, 2012: Using HCAHPS Data Effectively January 16, 2013: Nurse Communication February 13, 2013: Responsiveness March 13, 2013: Medication Communication April 24, 2013: Discharge Information June 5, 2013: Physician Communication and Engagement July 17, 2013: Pain Management August 14, 2013: Clean and Quiet

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Documents

Clean and Quiet Environment f