Are you getting patients involved in their care?
Baylor addresses patient involvement
If a patient noticed a health care provider didn't wash his hands, or suspected she was being given an incorrect dosage of medication, would she hesitate to speak up about her concern?
"The majority of patients do not push back on caregivers, unless they have a medical background," says Terri Nuss, MS, director of patient centeredness at Baylor Health Care System in Dallas. "We need to open the patients' hearts and minds to be brave enough to stop us if they think we're doing something wrong."
The Joint Commission recognizes the importance of patient involvement with its National Patient Safety Goal requirement to "encourage patients' active involvement in their own care as a patient safety strategy."
At Baylor, this has been a major initiative with its Partners program, standing for participation, ask questions, request results, time you need with the health care provider, notes and questions, educate yourself, respect your dignity, and speak up.
Resistance from staff, at first, was "significant," says Nuss. "When you tell a staff member it's important to have a spouse in the room during a test, we have to first change our mentality within from not wanting 'outsiders' in the room," she says. "It is a long and arduous road, and you may find resistance in 100 different ways."
The solution is to "explain the 'why' of involving patients, and then show them a ton of data," says Nuss. "We use process measurements as well as outcomes measures."
Here are some of the things that were implemented at Baylor:
- Patients are given a pad and pen to write down any questions they have during their hospital stay.
In patient rooms, staff write their names on a white board and encourage patients and family members to put their questions on the board, so that staff can write down the answer if they are not in the room.
- Staff now explain the reason for practices such as checking the patient's ID band multiple times.
"Staff are taught to tell patients, 'I know we know each other, but I'm checking your ID band for safety before I give you this medication,'" says Nuss.
- The hospital's patient satisfaction survey includes the questions: How informed were you with your care? Did we include you with decisions about treatment and tests?
"We've got a solid year now of data on this, and we are nowhere near where we want to be, because this is a significant training issue," says Nuss. "Results are steadily climbing, but we are still not where we want to be. We want to do this well the first time, every time, with every patient."
- Data are collected on how often nurses are rounding, to see whether they are meeting the 90% threshold goal.
"Because this is a significant practice change for many clinicians, new habits must be formed that take time and diligent attention," says Nuss.
Rounding is tracked by "logs" that are posted in patient and exam rooms, which are collected and assessed by supervisors and managers. Nursing staff who are not participating are coached by their managers on the importance of rounding in caring for patients.
"Ultimately, the success of the team is measured in volumes of patient falls, patient satisfaction, and number of call light requests from patients," says Nuss.
- Point-of-service interviews are done.
Directors and managers routinely ask patients "What could we have done better?" In outpatient areas, patients are asked "What is the one thing we can do for you?" at the point of admission. For example, a patient going in for a computerized tomography scan who fasted all night for a contrast study might ask for food the minute the study is done, or a patient going in for a mammography might ask for her husband to be present the whole time.
- Data are collected on physicians, including physician-specific outcomes.
"This has been very humbling for physicians," says Nuss. "For example, in order for a patient to really understand the plan of care, it's helpful to spend enough time with the physician. The physicians thought they were doing that, but the data showed otherwise. Thankfully, once the data tell the story, it is easy to solicit the physician's help with changing the outcome."
As a result of the data's findings, physicians and staff are being offered training on "the basics," such as sitting down with the patient to give instructions and allow for questions, and how to elicit questions from the patient.
"Physicians are increasingly hungry for their own data," says Nuss. "When we put out data for the first time, we put it out blinded. But their immediate response was, 'It needs to be transparent — we need to see what's happening.' With attitudes like these, we'll be achieving all our targets very soon.'"
[For more information, contact:
Terri Nuss, MS, Director of Patient Centeredness, Baylor Health Care System, 8080 N. Central Expressway, Suite 500, Dallas, TX 75206. Phone: (214) 265-3612. E-mail: [email protected].]
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