Uncover and rectify patient peeves
One home infusion agency’s award-winning effort
Would you like to make your processes more streamlined but don’t know where to begin? Are you concerned with the quality of care you’re providing?
If you answered yes to either question, a patient satisfaction survey may be your answer. This month, Home Infusion Therapy Management looks at how Home Health Corporation of America in King of Prussia, PA, improved its order fulfillment process after noticing a troubling trend in the results of its patient satisfaction survey. Its quality improvement efforts landed Home Health Corp. on the winner’s list of the Client Success Story Contest, held by Press Ganey Associates, a health care satisfaction measurement firm based in South Bend, IN.
Home Health used Press Ganey client satisfaction surveys as a starting point in uncovering problems in its order fulfillment processes and redesigned the entire process. Here’s a step-by-step look at how Home Health did it:
• Uncover the problems.
Home Health Corp. initially mailed Press Ganey patient satisfaction surveys to each patient. The responses were returned to Press Ganey, which tallied the results and compared the data to its national database of provider results. By benchmarking the results of Home Health Corp. patient surveys with the national standards, Becky Sullivan, the director of quality improvement for Home Health Corp. and her colleagues were able to see where Home Health Corp. trailed the industry.
Two specific areas showed the need for improvement, according to patients accuracy of supplies being delivered and the timeliness of those deliveries.
"We may have sent an order out that was missing an item, or we may have sent an order out with too much of something," notes Sullivan. "We weren’t getting it right the first time out the door."
• Create a team to address the problems.
Once the areas of patient concern were uncovered, Home Health Corp. put together a task force of those directly involved in the problem areas. The task force consisted of: Sullivan; Linda Burns, BSN, director of infusion; Anne Daley, PharmD, pharmacist; Ron Brunner, who oversees the warehouse and delivery staff; and a pharmacy technician no longer with the company.
The task force then outlined the process in detail. This allowed the team to analyze the process and find any potential problems.
"We identified all the weak areas in the process that could possibly lead to an error or a duplication, then we redesigned the processes to take care of each issue," says Sullivan. "Once we flowcharted it out and saw where the weak areas were, it probably only took about six weeks to get the process redefined."
The flowcharts and analysis found that the problems came from a new computer system and newly hired pharmacy staff, says Burns.
• Change the problematic areas.
Once the task force saw the potential causes, it went about revising the processes. Here are the changes the task force made:
Training on the new computer.
All staff were trained on the new computer system, learning to input the proper codes when putting together a supply.
Implementing a system to double-check orders.
The first change made was a method of double-checking every order. In the past, just the pharmacist checked orders. Now, after an order is pulled and the delivery ticket is printed, the order is placed in a clear plastic bag.
"The orders easily can be double-checked," Sullivan says. "It gave us better visualization and allowed the pharmacist to check the supplies going out the door to make sure everything is exactly as it should be."
Now, a nursing representative does a second check on each order.
• Develop standardized lists.
The task force developed standardized supply lists for popular infusions to further reduce the chance of missing an item or adding an unnecessary supply.
"We developed standardized supply lists so a certain therapy would receive the same equipment," notes Sullivan. "For example, the infusion of antibiotics would receive this list of supplies, a TPN would receive this list of supplies. From those standardized supply lists we added individual patient items, so our delivery ticket then became more stable." (See sample standard supply lists, pp. 63 and 64.)
Burns adds that some therapies are given two or more times a day. Rather than making staff compute the amount of supplies for a twice-a-day (or more) infusion patient, the computer now totals the quantity of each item needed and prints a matching supply list that includes the items and quantities needed.
• Develop a patient follow-up program.
The most efficient way to tell if the changes were working was to check with the patients themselves. That led to the implementation of a "patient call-back program."
"Until we were satisfied we had improved our results, we called patients to find out from their perspective if they were satisfied with the delivery," says Sullivan. Patients were asked questions such as "Did the delivery arrive on time?" and "Were there any problems with any supplies or the items?" Patients also were asked for their overall satisfaction with Health Care Corp. Calls revealed that orders were going out on time and, just as importantly, were correct the first time.
Initially, a call was made following every order. Now that the processes have been refined, calls are made on a spot-check basis. The agency also monitors its patient complaint log.
"If there is a complaint, I check that the process was followed or, if through employee turnover or whatever, it had not been adhered to completely," says Sullivan.
Phone follow-up was critical in getting immediate feedback, says Burns. She notes that mailed surveys don’t get a 100% response, and there is always a delay waiting for surveys to be returned. Sullivan says the patient call-back program and validating and monitoring the compliance of the new policies and procedures took about three months.
• Validate the improvements.
Sullivan says improved patient satisfaction wasn’t the only benefit from the process overhaul. The agency has saved time and money in several areas.
First, by getting the order right the first time, the agency saves money by reducing unnecessary employee work.
"Because orders are right the first time, our cost in terms of fewer extra deliveries being made went down," says Sullivan.
The cost of supplies also decreased.
"If we sent a wrong supply to a patient, from an infection-control standpoint, we could not put that back in stock again," adds Sullivan.
The standardized supply lists also helped the agency better forecast its needs. If a busy time period is on the horizon, the agency can assemble extra kits ahead of time, thus becoming more efficient.
"I can’t put a dollar figure on it," says Burns, "but I know when I sent out extra deliveries or had to call staff back into the pharmacy, we were paying a price for that."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content