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0 U N C H E A L T H C A R E S Y S T E M T RANSLATING C ARING T HEORY A CROSS T HE C ONTINUUM F ROM I NPATIENT TO A MBULATORY C ARE M eghan M cCann MSN,

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Presentation on theme: "0 U N C H E A L T H C A R E S Y S T E M T RANSLATING C ARING T HEORY A CROSS T HE C ONTINUUM F ROM I NPATIENT TO A MBULATORY C ARE M eghan M cCann MSN,"— Presentation transcript:

1 0 U N C H E A L T H C A R E S Y S T E M T RANSLATING C ARING T HEORY A CROSS T HE C ONTINUUM F ROM I NPATIENT TO A MBULATORY C ARE M eghan M cCann MSN, RN, NE-BC Director Oncology Services University of North Carolina Health Care

2 1 U N C H E A L T H C A R E S Y S T E M The Ambulatory Care Environment Translating Caring Theory to Ambulatory Care Translating Caring Theory to the Emergency Department Sustaining the Carolina Care Culture at UNC Health Care Across the Continuum to Ambulatory Care

3 2 U N C H E A L T H C A R E S Y S T E M Times with patients are shorter Repetitive over time Span the length of treatment May be interrupted by inpatient stays The Ambulatory Care Environment

4 3 U N C H E A L T H C A R E S Y S T E M Translating Caring Theory to Outpatient Oncology North Carolina Cancer Hospital Flagship site for UNC Cancer Care with 150,000 visits/year Clinical home of UNC Lineberger Comprehensive Cancer Center Multidisciplinary adult and pediatric space including 101 examination, treatment, consultation, and procedure rooms 72 infusion stations for adults (48), children (14), and clinical trials (10) 3 Linear Accelerators for Radiation Therapy 50 inpatient beds for medical oncology and bone marrow transplant

5 4 U N C H E A L T H C A R E S Y S T E M SCT and the Oncology Patient Maintaining Belief in patients ability to come through illness with meaningful life/dignified death Understanding what is most important to patients/families Supporting patients/families through difficulty Assisting patients who cannot do for themselves Enabling patients to progress to highest level during Treatment Survivorship End of life Tenets resonate for patients treated for a chronic illness over time

6 5 U N C H E A L T H C A R E S Y S T E M Dissemination in Outpatient Oncology Replication of Inpatient Success Effort led by Oncology Carolina Care Committee Multidisciplinary membership of staff and leaders Guidebook rewritten to accommodate ambulatory arena New behavior each month High patient volume with different providers across diagnoses and clinical environments

7 6 U N C H E A L T H C A R E S Y S T E M Few minutes of uninterrupted time to connect and convey concern during visit Recognize feeling of patient Establish connection Convey concern Goal – Each team member spend 3 uninterrupted minutes with at least one patient Registration Scheduling Waiting room Moment of Caring: Knowing and Being With Carolina Care and Outpatient Oncology Patients

8 7 U N C H E A L T H C A R E S Y S T E M Multi-level Rounding: Being With and Doing For Hourly Patient Rounding Schedulers and Registration Director Interdisciplinary Nurse Manager Carolina Care and Outpatient Oncology Patients

9 8 U N C H E A L T H C A R E S Y S T E M Hourly Patient Rounds : Being With and Doing For A R e you comfortable? O ther/the care providers accompanying patients to their visits are acknowledged U se the bathroom? Does patient need assistance/directions? N eed anything? D oor /curtain open or closed for privacy in clinic rooms? S afety assessment/call bell in reach? RR OO UU NN DD SS Carolina Care and Outpatient Oncology Patients

10 9 U N C H E A L T H C A R E S Y S T E M Allows Board members to connect with patient over shared experiences Offer insight and ease fears Patient/Family Advisory Board Rounding: Being With and Doing For Carolina Care and Outpatient Oncology Patients

11 10 U N C H E A L T H C A R E S Y S T E M Patients become active participants and decision makers in care Guide interactions to ensure caring and concern are consistently communicated Helps set and manage expectations Greet patients Correctly identify patients Perform hand hygiene Transition patient to next caregiver Words and Ways that Work: Being With and Enabling Carolina Care and Outpatient Oncology Patients

12 11 U N C H E A L T H C A R E S Y S T E M Entails careful listening to complaint, owning problem, and working quickly to resolve issue Listen with care Provide blameless apology Thank patient/family for sharing concern Fix the problem Consider provision of service recovery item Follow up with patient/family to let them know how problem has been addressed Carolina Care and Outpatient Oncology Patients

13 12 U N C H E A L T H C A R E S Y S T E M By actively listening, showing empathy, apologizing without blame, and fixing the problem, satisfaction can be increased Creates opportunity for follow-up to improve systems Carolina Care and Outpatient Oncology Patients

14 13 U N C H E A L T H C A R E S Y S T E M Team proactively discusses specific patient needs, is attentive to safety, and ensures needs are met during visit. Multidisciplinary daily team meeting in clinical area to encourage information sharing Promotes care team partnership Enhances patient care Creates forum to address safety concerns Fosters teamwork Clinic Huddle: Knowing Carolina Care and Outpatient Oncology Patients

15 14 U N C H E A L T H C A R E S Y S T E M During huddle Review of clinic schedule Discuss care needs that require focused attention/support Identify opportunities to improve clinic flow Kudos are shared Clinic Huddle: Knowing Carolina Care and Outpatient Oncology Patients

16 15 U N C H E A L T H C A R E S Y S T E M Evaluation and Sustainment in Outpatient Oncology Sustained scores highest in clinics across system 19 percentile increase for overall 4 percentile increase for nursing Consistent Top 5 Clinics of eligible clinic locations (Meg’s graph?) Review of PG data on monthly basis

17 16 U N C H E A L T H C A R E S Y S T E M Evaluation and Sustainment in Outpatient Oncology Coordination of improvement efforts with Oncology Operations Team Participation of Oncology leadership in organization wide CCIOC Repeat of roll out 2 years post initial implementation

18 17 U N C H E A L T H C A R E S Y S T E M Translating Caring Theory to the Emergency Department (ED) UNCH Emergency Department Annual visit volumes of approximately 72,000 adults and 10,000 pediatric patients One of the largest referral centers in North Carolina Admit rate near 30% Certified Level I Trauma Center for adult and pediatrics State Burn Center Joint Commission Stroke Center Chest Pain Center

19 18 U N C H E A L T H C A R E S Y S T E M Caring Theory and the ED Patient Tenets resonate for patients treated in an ED Stressors compounded High Acuity Mixed patient population High patient volumes Entry point for 50% of inpatient admissions

20 19 U N C H E A L T H C A R E S Y S T E M Dissemination in the ED Replication of Inpatient Success Effort led by CNO and ED Director Multidisciplinary membership of staff and leaders Multiple week roll out Each behavior introduced across shifts High patient volume with different providers across diagnoses and clinical environments

21 20 U N C H E A L T H C A R E S Y S T E M Convey presence and empathy despite pressures of busy/changing environment Pat on shoulder Kind words Talking with patient during assessment Sitting down to connect while starting an intravenous line Moment of Caring: Knowing and Being With Carolina Care and ED Patients

22 21 U N C H E A L T H C A R E S Y S T E M Multi-level Rounding: Being With and Doing For Hourly Patient Rounding Health Unit Coordinator (HUC) Director Interdisciplinary Nurse Manager Carolina Care and ED Patients

23 22 U N C H E A L T H C A R E S Y S T E M Hourly Comfort Rounds by Nurses and Nursing Assistants Focus on personal needs Offers of food and drink when permissible Pain management Helping patient and family understand wait time Communication of Plan of Care Hourly Patient Rounds : Being With and Doing For Carolina Care and ED Patients

24 23 U N C H E A L T H C A R E S Y S T E M Time compression makes 1st impression essential Wait times and the unexpected are key drivers of dissatisfaction AIDET organizes all major components into one tool A cknowledge I ntroduce D uration E xplanation T hank you Words and Ways that Work: Being With and Enabling Carolina Care and ED Patients

25 24 U N C H E A L T H C A R E S Y S T E M Other important Carolina Care behaviors and messages Closing curtains for privacy Washing hands for safety Stepping out to document care Posting important info on the white board in each room Words and Ways that Work: Being With and Enabling Carolina Care and ED Patients

26 25 U N C H E A L T H C A R E S Y S T E M Entails careful listening to complaint, owning the problem, and working quickly to resolve issue Listen with care Provide blameless apology Thank patient/family for sharing concern Fix the problem Consider provision of service recovery item Follow up with patient/family to let them know how problem has been addressed Blameless Apology: Being With and Enabling Carolina Care and ED Patients

27 26 U N C H E A L T H C A R E S Y S T E M Evaluation and Sustainment in the ED Increase from 15 th percentile and sustain at 65 th despite volume/capacity constraints Current focus Improving patient throughput Increasing survey returns through discharge calls Introduction of Bivaris Sends discharged patients text or with link to electronic survey Has increased response rate from 5% to 30% Patients respond within 24 hours versus 30 days Provides more detailed comments yielding more actionable format

28 27 U N C H E A L T H C A R E S Y S T E M Sustaining the Carolina Care Culture at UNC Health Care Accountability Sustaining Carolina Care in Changing Environment Carolina Care 2014 Evaluation and Sustainment of Carolina Care 2014 Sustaining Excellence – The New Frontier

29 28 U N C H E A L T H C A R E S Y S T E M Accountability Multidisciplinary Monday Morning Carolina Care Carolina Care Implementation Oversight Committee Big 5 Geriatrics Pulmonary/Infectious Disease Family Medicine/Nephrology General Medicine GI Surgery

30 29 U N C H E A L T H C A R E S Y S T E M Inclusion in Performance Evaluation Inclusion in Nursing Professional Expectations Weekly Updates and High 5 Accountability

31 30 U N C H E A L T H C A R E S Y S T E M UnitFY 15 Proposed Goal 3 AD87.5 CTSU AD WST85 6 BT86 8 BT84 6 WST85 4 AD-N89 5 BT EST91 5 WST91 7 NSH91 6 NSH EST WH WH WH89 7 CH91 6 CH87 5 CH89 4 ONC90 BMTU91 Annual goals: mean goals for each unit Accountability

32 31 U N C H E A L T H C A R E S Y S T E M Key Outcomes from Big 5 GI Prep with Gatorade Care of floors Temperature control Development of unit brochures HUC initiated rounding Warm afternoon washcloths EVS on Demand New food tray activators to keep food warm Nutrition Food Service leadership rounding Accountability

33 32 U N C H E A L T H C A R E S Y S T E M Sustaining Carolina Care in Changing Environment New challenges Organization adopted integrated Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey in July 2013 Implementation of new Electronic Medical Record Goal - Increase UNCH overall patient satisfaction scores during implementation of new electronic medical record and adjust focus to align with HCAHPS

34 33 U N C H E A L T H C A R E S Y S T E M Carolina Care 2014 Created Carolina Care 2014 Interprofessional Taskforce Nursing Pharmacy Pastoral Care Nutrition and Food Services Environmental Services Supply Chain Services Patient and Family Advisors

35 34 U N C H E A L T H C A R E S Y S T E M Carolina Care 2014 Taskforce divided into eight working groups, with each group assigned an area of focus Patient engaged report Nurse-physician rounding Communication through care boards Narrating care Active listening Positivity Communication in an electronic environment

36 35 U N C H E A L T H C A R E S Y S T E M Carolina Care 2014 Creating Carolina Care 2014 Taskforce met for an all-day off-site work session During session, team members Reviewed goals of the initiative Created educational materials for staff Devised a rollout plan to ensure implementation prior to the transition to the EMR

37 36 U N C H E A L T H C A R E S Y S T E M Implementing Carolina Care 2014 Carolina Care 2014 content was introduced in weekly segments Information was reviewed during weekly Carolina Care Huddles Managers utilized standardized template that included a weekly topic of focus with Set goals and tasks Tools to educate staff members and weekly metrics to determine success Electronic access Carolina Care tools on a shared network drive Carolina Care 2014

38 37 U N C H E A L T H C A R E S Y S T E M Carolina Care 2014 Implementation Tools Weekly Huddle Guides Words and Ways that Work Evidence-based literature to support interventions Pocket cards with key weekly topic information Managers also shared information and tools with staff members during monthly staff meetings and through weekly messages Carolina Care 2014

39 38 U N C H E A L T H C A R E S Y S T E M Evaluation and Sustainment of Carolina Care 2014 Following implementation, scores improved to 76 th percentile in March 2014 and reached high of 95th percentile week of March 16, 2014 Post-intervention metrics: outperformed FY14 organizational goal (75 th percentile) for patient satisfaction. These improvements were sustained in May 2014 (82 nd percentile) and June 2014 (83 rd percentile)

40 39 U N C H E A L T H C A R E S Y S T E M Sustaining Excellence – The New Frontier Ambulatory Improvements across Medical Center and Physician led clinics Physician Engagement Carolina Care across affiliate hospitals within UNC Health Care System Annual Competency for all Nursing staff

41 40 U N C H E A L T H C A R E S Y S T E M Tonges Translational Model for Theory-Driven Practice Tonges Translational Model for Theory-Driven Practice


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