Best performers strive to improve
June 1, 2000 3 minutes read
Best performers strive to improve
Even when you are a top performer in a benchmarking study, it isn’t time to simply pat yourself on the back and say "good job," says Kathy Donigan, RN, administrator of Fraser (MI) Eye Care Center.
Donigan and her staff found themselves ranked as the participant with the best average facility time for cataract extraction and lens insertion in a recent study conducted by the Accredita-tion Association for Ambulatory Health Care’s Institute for Quality Improvement in Wilmette, IL.
It takes work to retain quality standards
"We consider our practice a high-quality service, but maintaining high quality requires constant observation," says Donigan. "Our nurses are always involved in quality assessment, but benchmarking against other facilities is essential."
Although Fraser Eye Care Center did report the best average facility time for the procedure, Donigan was surprised to see that her center was not the top performer in the individual categories that contribute to overall facility time. "We saw an opportunity to improve pre-procedure time and discharge time by evaluating some of our processes," she says.
Although the report doesn’t identify individual participants, each presentation of statistical results includes a description of the category’s best performer’s typical practices that differentiate it from other participants. This information was helpful as Donigan and her staff reviewed their own practices and looked for ways to improve, she says.
Dressing adds time
"We noticed that many facilities did not undress the patient at all, while we have always had the patient remove their blouse or shirt to protect their clothing from accidental spills," says Donigan.
While undressing did not significantly add to pre-procedure time, it did add five to 10 minutes to discharge time, she explains. "Patients for this procedure are older and may even require assistance to dress after the procedure. We found out that our nurses were having to give discharge instructions at the same time the patient was dressing."
Now, Fraser Eye Care Center patients do not remove clothing. "We purchased extra-large gowns that easily cover the patient’s clothing, and our nurses sit with the patient while they have a snack after the procedure to give discharge instructions," says Donigan. Patients have responded favorably to the change and say they appreciate the more relaxed, increased face-to-face time with no other distractions, adds Donigan.
Looking at pre-op procedures
Pre-procedure ratings also gave Donigan’s staff an opportunity to improve their time even more. "Many facilities were doing preoperative assessments and history and physicals on a pre-op visit prior to the day of surgery," she says. "We were gathering some of the information ahead of time, but we did wait until the morning of surgery to gather many of the history and physical details," she explains.
The process has been changed to gather a more detailed history at the pre-op visit. "This means that we only review the history and make sure there have been no changes in health or medications since the pre-op visit," says Donigan.
Patients also now see a newly redesigned video at the pre-op visit that was produced by one of the center’s physicians. "The video discusses the procedure and presents informed consent information," says Donigan. Because patients now get this information at the pre-op visit, the informed consent form is signed before the morning of surgery.
The importance of benchmarking studies is that it helps you step outside your normal environment and see how you compare to others, says Donigan. You must be willing to look for and make changes in areas that can be improved even if you are a top performer in some areas, she says.
"My tennis coach always says that if you stop and pat yourself on the back after a good shot, you will miss the next shot," Donigan says.
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