1 Lesa Blake, Director of Support Services and Roxanna Bryant, Director, Corporate Facility and Services Originally Presented at Performance Excellence Council, July 9th Best of Clean Up and Quiet Down – Leadership Staff, Tuesday, July 17, 2012

Hospital Environment 8. During this hospital stay, how often were your room and bathroom kept clean? HCAHPS (how often a service was provided) Frequency Based Rating Scale  Never  Sometimes  Usually  Always

3 HCAHPS Performance Level Comparison Source: Press Ganey

Cleanliness of Environment ‘How often were your room and bathroom kept clean?’ May, 2012 Data Base: 1735 TargetJanFebMarAprilMayJuneJulyAugSeptOctNovDec > Hoag < Hoag “Always”>82% Rank> HCAHPS

5 Daily “Service Level” Housekeeping: Empty trash Parameter Daily Cleaning of rooms Stock supplies Sanitize rest room Sanitize horizontal surfaces Mop floors Other Patient Care Attendees Assistance Needed for: Help organize the patient belongings Unclutter bed tables Empty out the urinals/dump port- a-potties ( EVS only sanitize when empty) Remove Patient Trays when Nutrition Assistants are not available Pick up visible trash on floor. ‘Call or just do it’ when service is needed, i.e., trash needs emptying, bathroom is dirty “How often was your room and bathroom kept clean?”

6 Three Touch Points -AM trash removal -Daily Clean Room and Bathroom -PM trash removal Note: Housekeepers (EVS) interact with patients only 1/3 of the 24 hour Period Now… Housekeeping (EVS) Actions… Increase Touch Points Increase patients awareness of cleaning - leave EVS calling-cards on bed stands; confirms room was cleaned and provides EVS contact number 1.Correlate Performance Staff/Unit Matrix Grids 2.Identify and Align the Right Staff and Strongest Performers 3.Reward & Recognize Achievement, Coach/Train Underachievement 4.Report and communicate with Nurse Managers/Directors Assigned EVS Staff Member UnitHCAHPS (Unit)Patient Satisfaction (Unit) Performance Metric REACH Notes: Metric- How often were your room and bathroom kept clean? Room Cleanliness Courtesy of person who cleaned your room Room Turnover Time Glow Germ # of years experience Training Completed Staff Member #1 Develop Performance Metric Staff/Unit Matrix Grids

Hospital Environment HCAHPS (how often a service was provided) Frequency Based Rating Scale  Never  Sometimes  Usually  Always 9. During this hospital stay, how often was the areas around your room quiet at night?

8 HCAHPS Performance Level Comparison Source: Press Ganey

Quietness of Environment “How often was the area around your room quiet at night? Data Base: 1735 TargetJanFebMarAprilMayJuneJulyAugSeptOctNovDec > Hoag < Hoag “ Always ” >72% Rank> HCAHPS May, 2012

10 What could possibly be making that much noise? Source: Patient Interviews, HCAHPS Comments, and Secret Shopper Observations Communications Staff to staff (including volunteers, physicians) Patients Visitors Overhead Paging Devices (Nextel, Cisco / Mobile Phones, Pagers, Landlines.) Clinical & Emergency Alarming Clinical Equipment and Machines IV Pumps Nuisance and False Fire Alarm Activations Fire Alarm Testing Equipment & Materials Everything (non-clinical) that’s used on the Unit; Carts Bags WOWs, chairs Biomedical equipment general noise (non alarms) Building features: doors, latches, hinges, curtains, lights, fans, vents, Gel dispensers, Deliveries TV Beds, gurneys, food service, etc. General Activities & Processes People coming & going General traffic Cleaning, trash removal Maintenance activities

11 Actions in Progress, Development, and Concept… Continuous awareness and In-Service training for all employees about their influence on the healing environment and the level of disturbing noise we generate. Increase E2E (Employee to Employee) and physician expectations to coach fellow staff on working in the “quiet zone”, recognizing and promoting quietness, and addressing noise “real-time” Support and Implement NO overhead paging of medical staff at HHNB. Has been in effect for 1.5 years at HHI/HOI, no issues or complaints. This requires use of Perfectserv by physicians and the staff utilizing instead of calling operator Support reduction of code announcements 3x3 to 2x2 and reduction of “all clears”. Support elimination* of general staff/vendor overhead paging (only for medical emergencies) Support the silencing of audible fire alarms upon known or suspected false fire alarm activations Support the final phase of fire alarm system replacement and the zoning of fire alarm system at HHNB Inspect and repair equipment and mechanisms to reduce disturbing “sound” Delivery carts (materials, oxygen food)- done Cleaning & maintenance carts- done Isolation carts- in progress Sharps service carts- in progress Beds, Gurneys, Wheelchairs (will need to improve the inspection of gurneys and wheelchairs)

As of today, July 9 th HHI/HOI’s One-Zone system will be divided into Seven-Zones; safely isolating the precautions to appropriate “zones” Example - Fire Alarm System: HHI/HOI In the past…when there was a “fire alarm” activation anywhere in any HHI or HOI building… All alarms activated, All strobes flashed, All fire doors closed, and All ventilation shut down

 Document at bedside.  Assure that the call light and personal items (telephone, table, water, etc.) are within reach.  Ask: “Is there anything else I can do for you?”  Inform the patient of what to expect next. “We will round again in about an hour…” or “Your next dose of medication is due…”  Visibly demonstrate to the patient, the use of the sanitation gel or hand washing as you exit the room.  Use appropriate departing remark. I own how I assist you in transitioning your continuum of care.  Speak with your heart and your head.  Focus your attention on the present.  Acknowledge the patient’s feelings.  Speak loudly with your actions.  Clarify your positive intent.  Say something nice. I own how I assist you and personalize my actions for you.  Complete scheduled tasks (medications, treatments, etc.).  Pain- Check the patient’s pain level. Offer alternative solutions for controlling pain.  Potty- Offer assistance to the restroom.  Position- Assist with repositioning. Check pressure points and skin integrity every shift.  Pumps- Check machines and alarms around the room to prevent them from alarming after you leave.  Scan the room for cleanliness and noise.  Check room temperature, cleanliness and quietness with patient. I own how I engage you and discover your needs.  Be present and mindful. Make eye contact with the patient as you actively listen.  Explain the use of the white board and update it with the plan of care/ goals, RN name, PCA name and appropriate contact numbers.  Demonstrate and explain the use of the call light and alternative methods to request assistance.  Give explanations in the way the patient understands. I own how I show you respect.  Knock on the door prior to entering, introduce yourself, use appropriate greeting.  Visibly demonstrate to the patient, the use of sanitation gel or hand washing as you enter the room.  Explain the purpose of your visit. Describe the hourly rounding schedule. I own how I greet and welcome you. Hourly Rounding – ActionsOWN ITCompleted RN and PCA alternate rounding hours:  AM shift- PCAs round at even hours , 1000, 1200, 1400, 1600, and 1800  AM shift- RNs round at odd , 1100, 1300, 1500, 1700  PM shift- PCAs round at 2200 and 0400  PM shift- RNs round at 0000, 0200, 0600 *PCAs make rounds and answer patient call lights during Change of Shift RN Bedside Report.

14 This is a journey not a destination

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