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Patient Experience in Cardiac Services
Georgia Tech Healthcare Management Practicum10 April 2019
Children’s Healthcare of Atlanta
Table of Contents
I. Team/Project Introduction
II. Journey Mapping
III. Observations
IV. Recommendations
2
Children’s Healthcare of Atlanta
Our 10-person student team brought a diverse range of perspectives to this project
3
Vikram VaradarajanMajor: BME
Minor: Pre-med
Taylor SpuhlerMajor: Business
Focus: Supply Chain
Shannon OwensMajor: BusinessFocus: Strategy
Bridget BallardMajor: Business
Focus: IT Management
Jenny ChoiMajor: Business
Focus: Strategy & Innovation
Rachel FrattMajor: Business
Focus: Marketing
Brady BoveMajor: BME
Minor: Leadership Studies
Maggie MartinMajor: Business Focus: Pre-Law
John WagnerMajor: BusinessFocus: Finance
Noah PerryMajor: BME
Focus: Research
Children’s Healthcare of Atlanta
Team Background
• All members spent the previous semester completing coursework in areas such as:– Public Health– Health Information Systems – Health Insurance and Finance– Patient Experience – Future Trends in Healthcare
• Course was focused around a speaker series and case study analysis
• Our team was chosen to participate in a practicum course in partnership with the Children’s Patient Experience team led by Sam Hosokawa
4
Children’s Healthcare of Atlanta
Our task: understand pain points for patients and families at Children’s through journey mapping
• Understand care experiences for patients and families in Cardiology
• Georgia Tech students must identify and prioritize gaps to inform future improvement initiatives for Children’s Healthcare of Atlanta
5
Children’s Healthcare of Atlanta
We conducted 15+ interviews with staff and families
• Interviewed the following staff to understand their pain points and goals
• Interviewed patients and families to assess their time spent at Children’s and any unaddressed needs
6
Children’s Healthcare of Atlanta
We broke down the patient journey into five steps
7
Intake & Referral
Pre-OpDay of
Surgery
Post-Op (ICU & Step
Down)Discharge
Observations
Children’s Healthcare of Atlanta 9
Intake & Referral: Rescheduling throws off parents’ planned hotels/flights
Family Experience
“We had to wait 9 hrs before going into a planned surgery only because there was an emergency that came up, but it was understandable.”Rescheduling
Issues
Children’s Healthcare of Atlanta
Intake Processing Time
10
Intake & Referral: Getting referred from their cardiologist can sometimes take a long time
Family Experience
“It took a couple weeks to get scheduled, then a couple longer before we were actually seen.”
“It took about a week to get an appointment mostly because they were waiting on UAB to send my records and referral over.”
Children’s Healthcare of Atlanta
Pre-Op: Long wait times tire out parents and kids
11
Long Wait Times
Family Experience
“I felt that there was too much idle time - it was a very long day during what is already an emotionally exhausting time for parents and patient.”
Children’s Healthcare of Atlanta
Pre-Op: Families have a difficult time with all the tasks that need to be done on Pre-Op day
12
UnclearExpectations
Family Experience
“It was a long day with a toddler who was cranky and hungry. I sometimes felt like we were being herded into places where they may or may not expect us to be there. It was not our smoothest experience with Children’s but it still wasn’t bad at all.”
Children’s Healthcare of Atlanta
Pre-Op: Parents fill out the same information in different places repeatedly
13
Family Experience
While filling out paperwork during Pre-Op“What is your child here for? Tetralogy of Fallot. What other conditions does he have? None. It’s not like we already filled this out three times today.”Repetitive
Paperwork
Children’s Healthcare of Atlanta
Day of Surgery: Families would like more updates during the surgery
14
Family Experiences
“Communication could have been more timely. If there is a delay we would like to know rather than sit and worry thinking procedures had already started.”
“Although apprehensive, receiving hourly phone calls was helpful for aiding parents in the process of their child’s surgery.”
Insufficient Updates
Children’s Healthcare of Atlanta
Day of Surgery: Staff sometimes are not well connected with parents during surgery
15
Family Experiences
“We mainly waited in the large surgical waiting area out of fear of missing an update. It was a little tough being in such a large area with people who were facing totally different types of surgeries. Meeting other families was nice, but more privacy (without leaving the hospital) would have been welcome also.”
Disconnect Between Staff and
Parents
Children’s Healthcare of Atlanta
Post-Op: Families value providers who know them well, but there is a lot of information to share
16
Staff Knowledge Transfer
Family Experiences
“Use repeat nurses when you can, especially on important days. Our son failed extubation 5 times. Having a new nurse on extubation day was stressful. We needed someone who knew him and us.”
“I think communication needs to get a little better even between the care team from day to day. The nurses do though make you feel very welcome to visit and really care.”
Children’s Healthcare of Atlanta
Post-Op: Staff doesn’t always know when or whether the family is at Children’s
17
Unknown Family Location
Family Experiences
“You can’t pour from an empty cup. After 30+ total days with her being admitted we have learned that sometimes it’s ok to step away from the ICU and get rest.”
Children’s Healthcare of Atlanta
Post-Op: It’s difficult to break down surveys by step of care, and providers can’t
18
Unclear Feedback Areas
Family Experience
“We loved Donna and Lidgy ... They were wonderful nurses in the cath lab. I think it was Tina who was also very good at working with out daughter through all the "ouchies" such as getting the IV out. Dr. Long and Dr. Kim along with the fellows were also very helpful!”
Children’s Healthcare of Atlanta
Discharge: Parents may be overwhelmed with the care they have to provide for their child
19
Family Experiences
“Be patient with parents. Be patient when they don’t understand what you just said or have to listen to them ask the same questions ... We are exhausted and emotional and fighting for our child the best way we know how.”
Complex Parent Education
Children’s Healthcare of Atlanta
Discharge: Families who do not speak English or Spanish might have difficulties
20
Language Barriers
Family Experiences
“I recall very little during that time. I was overwhelmed and anxious and relieved that the surgery went well.”
Children’s Healthcare of Atlanta
We identified 7 problems as high impact and low effort areas
21
Complex Parent Education
Staff Knowledge Transfer
Language Barriers Unclear Feedback Areas
Rescheduling Issues
Unclear Expectations
Unknown Parent Location
Our Recommendations
Children’s Healthcare of Atlanta
Utilize volunteers throughout the process to address needs for families, patients, and staff
23
PE
OP
LE
Rescheduling Issues Unclear Feedback Areas
Children’s Healthcare of Atlanta
Utilize volunteers throughout the process to address needs for families, patients, and staff
• Expand volunteer program into two
segments: business & pre-med
• Utilize volunteers for both booking &
rescheduling family travel accommodations
• Hospitality-focused volunteer
opportunities
24
PE
OP
LE
Children’s Healthcare of Atlanta
Utilize volunteers throughout the process to address needs for families, patients, and staff
25
PE
OP
LE
Rescheduling Issues Unclear Feedback Areas
Children’s Healthcare of Atlanta
Utilize volunteers throughout the process to address needs for families, patients, and staff
• Expand volunteer program into two
segments: business & pre-med•
• Specify training for pre-med students to be
more involved in detailed surgery updates
• Exposure for future employees/doctors
• Collect in-person surveying data from
patients and families--business or pre-med
26
PE
OP
LE
Children’s Healthcare of Atlanta
Employ detailed video training and indoor maps to set pre-op expectations and minimize complexities
27
Complex Parent Education
PR
OC
ES
S
Language Barriers
Unclear Expectations
Children’s Healthcare of Atlanta
Employ detailed video training and indoor maps to set pre-op expectations and minimize complexities
• Embed guideline prep videos within the Children’s app utilizing Seacrest Studios
• Add-on thorough step-by-step videos for parents unsure of pre-op, surgery, and post-op procedures
28
PR
OC
ES
S
Children’s Healthcare of Atlanta
Employ detailed video training and indoor maps to set pre-op expectations and minimize complexities
29
Complex Parent Education
PR
OC
ES
S
Language Barriers
Unclear Expectations
Children’s Healthcare of Atlanta
Employ detailed video training and indoor maps to set pre-op expectations and minimize complexities
• Customize indoor hospital maps for families based on their child’s course of care--ex: what to expect with a child who has tetralogy of fallot
• Set explicit journey expectations through personal accounts linked on the Children’s app (long-run)
30
PR
OC
ES
S
Children’s Healthcare of Atlanta
Map Recommendation Mock-Up
31
Children’s Healthcare of Atlanta
Map Recommendation Mock-Up
32
Heart Murmur
Tetralogy of Fallot
Congestive Heart Failure
Cardiomyopathy
Pulmonary Hypertension
Ventricular Septal Defect
Indoor Map
Staff expected to see
Parent Guidelines
Training Videos
External Resources
Common FAQs
Children’s Healthcare of Atlanta
Employ detailed video training and indoor maps to set pre-op expectations and minimize complexities
33
PR
OC
ES
S
Language Barriers
Unclear ExpectationsComplex Parent Education
Children’s Healthcare of Atlanta
Employ detailed video training and indoor maps to set pre-op expectations and minimize complexities
• Append other languages such as Chinese, Vietnamese, Korean, French, & Hindi to Children’s app indoor map & guideline
34
PR
OC
ES
S
Children’s Healthcare of Atlanta
Incorporate card access and team collaboration tools to increase communication between staff and families
35
TE
CH
NO
LO
GY
Staff Knowledge Transfer
Unknown Parent Location
Children’s Healthcare of Atlanta
Incorporate card access and team collaboration tools to increase communication between staff and families
• Know where parents/guardians are -
hospitality perspective
• Know where parents/guardians are -
data collection and outcome perspective
36
TE
CH
NO
LO
GY
Children’s Healthcare of Atlanta
Incorporate card access and team collaboration tools to increase communication between staff and families
37
TE
CH
NO
LO
GY
Staff Knowledge Transfer
Unknown Parent Location
Children’s Healthcare of Atlanta
Incorporate card access and team collaboration tools to increase communication between staff and families
38
TE
CH
NO
LO
GY
• Staff to staff communication for informal
updates and flow of work day via current or
new technology
• Real time updates
Children’s Healthcare of Atlanta
Incorporate card access and team collaboration tools to increase communication between staff and families
39
Channel Examples
Volunteer ExampleShift Change Example
Children’s Healthcare of Atlanta
Summary: Our Observations
• Rescheduling surgeries throws off family’s plans
• Clear family confusion during pre-op
• Difficult staff-staff communication
• Overwhelming discharge education
• Lack of translations for discharge instructions
40
Children’s Healthcare of Atlanta
Summary: Our Recommendations
• Utilize volunteers even more--both business & pre-med
• Enhance the Children’s app with personalized course of care approaches and translations
• Give families card access
• Increase staff collaboration
41
Children’s Healthcare of Atlanta 42
Thank you!
Supplemental Slides
Other recommendations for Children’s, and more information we gathered
Children’s Healthcare of Atlanta
Volunteer Positions: Potential Issues
• Infrastructure/Unreliability– If volunteers don’t show up for surgical shift, then the
existing call system can be the fallback • Patient Privacy
– Volunteers can be trained in HIPAA • Training
– Can shadow patient, attend a discharge class, and learn from nurses on how to give information
• Interest– There are a lot of motivated students
44
Children’s Healthcare of Atlanta
Our Survey: Questions we asked to the cardiac family advisory council (Part 1)
1. What condition brought your child to Children’s Healthcare of Atlanta?
2. Please enter the date of your child's surgery (month/year). We 3. We are focusing on surgeries within the past 2 years (March 2017 through March 2019), but feedback on surgeries prior to 2017 will be considered as well.
4. Describe your experience during the referral process. When were you referred to Children’s and by whom? What went well and what could be improved based on your experience?
5. Was there a delay in between the referral and contact from Children’s? If so, how long?
6. Describe your experience in pre-op. What went well and what could be improved based on your experience?
7. Describe your experience during the surgery. What went well and what could be improved based on your experience?
45
Children’s Healthcare of Atlanta
Our Survey: Questions we asked to the cardiac family advisory council (Part 2)
8. Describe your experience in post-op. What went well and what could be improved based on your experience?
9. What was the best piece of advice/knowledge given to you by your care team while at Children’s?
10. What were the updates like during surgery? Who gave them to you?
11. Describe the education you received during your child's hospital stay. What improvements could be made to the way your received this education?
12. If you had the opportunity to speak directly with the board of Children’s and you had the chance to provide input on how to make the experience better for another child, what would you recommend to them?
46
Children’s Healthcare of Atlanta
Impact of Issue vs. Effort to Improve Matrix
47
High Impact Low Impact
Low Effort
Rescheduling Issues
Unclear Expectations
Unknown Parent Location
Complex Training
Language Barriers
Unclear Feedback Areas
Staff Knowledge Transfer
Assistance with Lodging Information
High Effort
Repetitive Paperwork
Insufficient Updates
Intake Processing Time
Staff/Parent Disconnect
Children’s Healthcare of Atlanta
Pre-op Video Training: Potential Concerns
• Cost• Time• Inconsistencies
– There are a lot of conditions to care for and a lot of small variations that happen
– “The sutures used to close my son became infected. Dr. Shashidharan told us when we were readmitted for infection that she had just begun using that brand and had learned after his surgery that those stitches do not dissolve in very young babies.”
48
Children’s Healthcare of Atlanta
Team Collaboration: Potential Concerns
• Training • Usefulness (will people actually check?)• Incorporating more technology
49
Children’s Healthcare of Atlanta
Slack and Voalte are existing Team Collaboration tools which can be used in healthcare
Benefits
• The Enterprise version is HIPAA compliant
• Data encryption in transit and at rest
50
Benefits
• Used at hospitals currently like Texas Children’s
• Integration with nurse calls and vitals monitoring