1. Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Nurse Communication January 16, 2013

2. Advancing Excellence in Health Care AHRQ/HRET Patient Safety Learning Network (PSLN) Project  This program is supported by the U.S. Agency for Healthcare Research and Quality (AHRQ) through a contract with the Health Research and Educational Trust (HRET).  HRET is a charitable and educational organization affiliated with the American Hospital Association, whose mission is to transform health care through research and education.  AHRQ is a federal agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. 2

3. Advancing Excellence in Health Care The Patient Experience of Care is Fundamental to Clinical Improvement  Understanding the patient experience of care is not an add-on activity: it should be used as a fundamental element in your other improvement efforts.  For those working on the HRET Partnership for Patients Hospital Engagement Network (HEN) or another HEN, your work will benefit directly from your efforts to improve the patient experience of care (e.g., readmissions, ADEs).  Lessons you learn in this HCAHPS Learning Network will help you succeed in the HEN project because— Patient-centered care is a driver of clinical outcomes Patient-centered care is a driver of clinical outcomes Employee and patient engagement are 2 sides of one coin Employee and patient engagement are 2 sides of one coin HCAHPS assesses key factors in ADEs and readmissions HCAHPS assesses key factors in ADEs and readmissions 3

4. Advancing Excellence in Health Care HCAHPS Curriculum 2012-13 All Web conferences are scheduled for 12-1pm Eastern  December 7, 2012: Fundamentals of HCAHPS  December 18/19, 2012: Using HCAHPS Data Effectively  January 16, 2013: Nurse Communication  February 13, 2013: Responsiveness  March 13, 2013: Medication Communication  April 24, 2013: Discharge Information  May 15, 2013: Physician Communication and Engagement  June 5, 2013: Pain Management  July 17, 2013: Clean  August 14, 2013: Quiet 4

5. Advancing Excellence in Health Care HCAHPS Technical Assistance Faculty  Carrie Brady, MA, JD  HRET’s primary HCAHPS faculty  Former senior Connecticut Hospital Association staffer  Previously a vice president at Planetree  Exemplary hospital peers  Memorial Hospital and Health Care Center, Jasper, IN  Denise Kaetzel, RN, MSN, Director Quality Services  Tonya Heim, MHA, MSN, RN Vice President Patient Services/Chief Nursing Officer  At the 95 th percentile nationally in nursing communication  Dramatic improvement in performance in past two years 5

6. Advancing Excellence in Health Care HCAHPS Nurse Communication Overview HCAHPS Nurse Communication Overview Case Study Case Study – Memorial Hospital and Health Care Center Improving Nurse Communication Improving Nurse Communication Questions and Discussion Questions and Discussion Today’s Web Conference 6

7. Advancing Excellence in Health Care During this hospital stay how often did nurses: treat you with courtesy and respect? treat you with courtesy and respect? listen carefully to you? listen carefully to you? explain things in a way you could understand? explain things in a way you could understand? At 78% “Always,” nurse communication is the third highest scoring HCAHPS domain nationally. Nurse Communication Domain HCAHPS Questions 7

8. Advancing Excellence in Health Care Correlations Table Source: CMS, www.hcahpsonline.org, posted 5-17-2012 8 Source: CMS, www.hcahpsonline.org, posted 5-17-2012www.hcahpsonline.org

9. Advancing Excellence in Health Care Case Study Exemplar: Memorial Hospital and Health Care Center

10. Advancing Excellence in Health Care On our Journey to Improved Nurse Communication  Background  Administrative Goals  Perceived barriers  Goals / Plans were diligently formulated

11. Advancing Excellence in Health Care On our Journey to Improved Nurse Communication  Discharge Education Process  Standardization of education materials  Folders in patient rooms  Focus to provide education throughout stay  Teach Back methodology

12. Advancing Excellence in Health Care On our Journey to Improved Nurse Communication  White Board installation  Communication between nursing, ancillary, patients and family  Standard content  Updated at shift change  Housekeepers also empowered to put name on board  Continuing audits to ensure updated information

13. Advancing Excellence in Health Care On our Journey to Improved Nurse Communication Hospital-wide initiative AIDET  Acknowledge – the patient by name  Introduce – yourself  Duration – tell them how long it will take to do what you are there to do  Explain – the procedure  Thank you – for being patient during the procedure

14. Advancing Excellence in Health Care  Shared Governance  Utilize our Unit Councils  Trial on a single unit  Share lessons learned to other units  Stage implementation hospital wide Our Journey to Improved Nurse Communication

15. Advancing Excellence in Health Care Our Journey to Improved Nurse Communication  Should be in place before other initiatives  Nursing Directors / Managers round on patients  Ask questions to ensure that initiatives are being carried out  Observe care being given

16. Advancing Excellence in Health Care Our Journey to Improved Nurse Communication  Unit councils developed the template  Process for doing call evolved from management to staff  Now staff love to do the calls because of all the good comments they hear

17. Advancing Excellence in Health Care Our Journey to Improved Nurse Communication Bedside Shift Report Bedside Shift Report  Culture change  Transformational

18. Advancing Excellence in Health Care Bedside Shift Report Before  Recorded report  Nurses did not always get all the info they needed  Patient was not a part of their plan of care After  Report at bedside  Introductions  Update whiteboard  Brief assessment  Patient and family participate  Most patients want to be awakened for night report

19. Advancing Excellence in Health Care  Bedside Shift Report  Collected data before, during & after go-live  Shared Governance – Unit Council  Whiteboard in conference room to document issues/solutions  Nurse Leader rounding  Ongoing audits for excellence Our Journey to Improved Nurse Communication 19

20. Advancing Excellence in Health Care  Physician ~ Nurse Rounding  Nurse receives text/call  Improved team communication  Decreased calls / interruptions for physician  Patients verbalize satisfaction with process Our Journey to Improved Nurse Communication 20

21. Advancing Excellence in Health Care  New Initiatives  Presence training  Huddles Our Journey to Improved Nurse Communication 21

22. Advancing Excellence in Health Care  Mission “Be For Others”  Radical Loving Care  Caring Circles  Spiritual Formation  Executive Director of Mission  On our Journey of Organizational Excellence which will take us to the next level Our Journey to Cultural Transformation 22

23. Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Thank you! Denise Kaetzel dkaetzel@mhhcc.org Tonya Heim theim@mhhcc.org Memorial Hospital and Health Care Center Jasper, IN

24. Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Improving Nurse Communication

25. Advancing Excellence in Health Care Communication is the Key to Quality and Safety “Inadequate communication between care providers or between care providers and patients/families is consistently the main root cause of sentinel events.” Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2007 In focus groups conducted during development of the HCAHPS survey, patients emphasized that communication was the most important characteristic of hospital quality 25

26. Advancing Excellence in Health Care What Hospital Patients Think Their Own Roles Are in Safety Patient Role% of Patients Identifying This Role Follow Instructions23% Expect Competent Care8% Listen7% Ask Questions7% Know About Self, Illness, Etc.4%... Encourage Staff to Practice Safety0.7% Source: Rathert C, Huddleston N, Pak Y “Acute Care Patients Discuss the Patient Role in Patient Safety” Health Care Manage Rev, 2011, 36(2), 134-144. 26

27. Advancing Excellence in Health Care Only 63% of hospital patients nationwide report that they always receive information about what new medicines are for and possible side effects. Source: “Summary of HCAHPS Survey Results.” April 2011 to March 2012 Discharges. CMS, Baltimore, MD. December 2012. Available at www.hcahpsonline.org. www.hcahpsonline.org. Patients Want to Follow Directions, But We Don’t Consistently Give Them 27

28. Advancing Excellence in Health Care A Fresh Look at Nursing Communication In your hospital, what do patients most frequently comment about (both positive and negative) related to nursing communication? In your hospital, what do patients most frequently comment about (both positive and negative) related to nursing communication? What can you learn from the nurses who communicate most effectively? What can you learn from the nurses who communicate most effectively?  Do you know what your nursing communication challenges are? Consider: WhoWhatWhereWhenWhyHow 28

29. Advancing Excellence in Health Care Who Who has the information? Who has the information? Where is the communication breaking down? Where is the communication breaking down? – Between providers E.g. huddles, interdisciplinary rounding E.g. huddles, interdisciplinary rounding – With the patient/family Who else should providers be communicating with? Who else should providers be communicating with? – E.g. family white board Who is responsible for communicating what with the patient/family? Who else can you engage in communication? Who is responsible for communicating what with the patient/family? Who else can you engage in communication? – Nursing staff – Other clinical staff E.g. pharmacy rounding E.g. pharmacy rounding – Other non-clinical staff E.g. patient ambassadors E.g. patient ambassadors 29

30. Advancing Excellence in Health Care Who: Start with the Care Team Nurture relationships Nurture relationships Review patient safety culture survey data Review patient safety culture survey data – Teamwork within units: 80% positive – Teamwork across units: 58% positive – Handoffs/transitions: 45% positive Source: Sorra J, Famolaro T, Dyer N, et al. Hospital Survey on Patient Safety Culture 2012 user comparative database report. Rockville, MD: Agency for Healthcare Research and Quality; February 2012 AHRQ TeamSTEPPS A comprehensive evidence-based system to enhance teamwork and communication among healthcare professionals A comprehensive evidence-based system to enhance teamwork and communication among healthcare professionals Free curriculum and tools available at http://teamstepps.ahrq.gov/index.htm Free curriculum and tools available at http://teamstepps.ahrq.gov/index.htm http://teamstepps.ahrq.gov/index.htm 30

31. Advancing Excellence in Health Care What information are you communicating? What information are you communicating? What tools and processes are in place to ensure that communication is complete? What tools and processes are in place to ensure that communication is complete? – e.g. discharge information (Project RED) What key information is not being consistently communicated? What key information is not being consistently communicated? – Post-discharge phone calls and complaints may provide valuable insight into omitted information What 31

32. Advancing Excellence in Health Care What: Remember You Are Always Communicating Are you delivering the message you intend to deliver? Are you delivering the message you intend to deliver? Are you sending a consistent message with: Are you sending a consistent message with: – Words – Attitude – Actions 32 Message AttitudeWordsActions

33. Advancing Excellence in Health Care Where does the transfer of important information occur? Are there ways to directly include patients in that information transfer? Where does the transfer of important information occur? Are there ways to directly include patients in that information transfer? – E.g. bedside shift reporting, huddles Where is information maintained? Can the patient create and access information? Where is information maintained? Can the patient create and access information? – E.g. white boards, patient folders, communication tools at the bedside Where 33

34. Advancing Excellence in Health Care When is the communication taking place? When is the communication taking place? – Pre-hospitalization, admission, in-hospital transitions, at the time of discharge, post- discharge E.g. orientation for scheduled procedures, written reference materials E.g. orientation for scheduled procedures, written reference materials – Proactive v. reactive communication Does the communication occur on a predictable schedule? Does the communication occur on a predictable schedule? – E.g. rounding When 34

35. Advancing Excellence in Health Care What is the goal? What is the goal? Is the communication designed to achieve the intended goal? Is the communication designed to achieve the intended goal? Have you asked patients/families? Have you asked patients/families? Why 35 *In a recent study, 53% of survey respondents agreed or strongly agreed that “most medical information is too hard for the average person to understand” Maurer M et al., Guide to Patient and Family Engagement: Environmental Scan Report, AHRQ Publication No. 12-0042-EF, May 2012) p.25

36. Advancing Excellence in Health Care Identify and address communication barriers Identify and address communication barriers – E.g. cultural, language, health literacy, patient priorities Teach staff communication skills Teach staff communication skills – E.g. words/phrases that do and don’t work – E.g. Using technology as an asset, not a barrier How Part 1: Technique 36

37. Advancing Excellence in Health Care Establish a relationship Establish a relationship Be fully present Be fully present – e.g. “reflect and connect” Encourage dialogue Encourage dialogue – e.g. teach-back How Part 2: Creating a Conversation 37

38. Advancing Excellence in Health Care Foundational Elements of Patient-Centered Care  Leadership  Patient/Family Partnership  Workforce Engagement  Data Use/Performance Improvement How Part 3: Reinforcing the Foundation 38

39. Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Questions and Discussion Ways to Get Involved in the Discussion 1. Follow operator’s instructions to ask a question 2. Type your question in chat 3. Use the HRET listserv or discussion board to ask questions or share your experiences

40. Advancing Excellence in Health Care Wanted: HCAHPS Success Stories If you have a success story to share in any HCAHPS domain, please email Ashka Dave at adave@aha.org 40

41. Advancing Excellence in Health Care HCAHPS Curriculum 2012-13 All Web conferences are scheduled for 12-1pm Eastern  December 7, 2012: Fundamentals of HCAHPS  December 18/19, 2012: Using HCAHPS Data Effectively  January 16, 2013: Nurse Communication  February 13, 2013: Responsiveness  March 13, 2013: Medication Communication  April 24, 2013: Discharge Information  May 15, 2013: Physician Communication and Engagement  June 5, 2013: Pain Management  July 17, 2013: Clean  August 14, 2013: Quiet 41