Changing the Trajectory

Upon arriving in June 2020, the new Patient Experience (PX) Director identified an opportunity to improve performance in the Emergency Department. The Director collaborated with their Press Ganey Advisor to leverage their expertise and learn more about staff’s impact on patient experience. They discussed the value of establishing a foundational data strategy and developed a successful strategic improvement plan, which included:

• Developing an Emergency Department specific approach to data – leveraging top box scores, percentile rankings and patient comments to identify strengths and opportunities.
• Recommended Action: Data Transparency – Provide consistent flow of performance data to allow a better understanding of key measures.
• Developing a clear set of behavioral standards while ensuring consistent training, monitoring, and accountability.
• Recommended Action: Link expectations to purpose and empower staff to achieve desired outcomes. Align behaviors to measures on the survey and follow performance.
• Rewarding, recognizing and highlighting successes.
• Recommended Action: Develop a plan to provide recognition to those achieving positive results and spread best practices.

Armed with best practices and recommendations provided by their Press Ganey Advisor, the PX Director partnered with key leaders in the Emergency Department to discuss current performance, goals, and improvement tactics. Participants included the CEO, CNO, ED Medical Director, ED Nurse Manger and PX Director. These leaders were then able to motivate, engage and mobilize the entire department to change their footing and trajectory. They successfully:

• Personalized the data to highlight the individual impact each staff member can have on the patient experience every day – focusing specifically on their Overall Rating of Care (organizational goal measure) and performance in Nurses and Doctors sections.
• Established standard behavioral expectations and a foundational understanding of current performance (highlighting this is the patient perception of care) across entire department.
• Distributed weekly reports that included performance, comments, improvement initiatives and scorecards shared via email.
• Reviewed performance monthly at the Performance Review Committee (PRC) meeting including action planning.
• Monitored negative comments and followed-up with care providers (within 72 hours). Ensuring reflection and root cause analysis on opportunities for improvement and identifying common threads and barriers.
• This allowed them to ensure all voices were heard and shifted their culture to find value in patient feedback rather than minimizing it. Using it to better understand how they were being perceived by patients, which influenced the organizational reputation within the community.
• Created awareness and provided foundational education for all employees related to the patient experience of care survey administered by Press Ganey and established survey scripting for discharge instructions in both English and Spanish.
• Provided training for high value tactics for both new staff (incorporated in new employee orientation) and refresher for established team members.
• Increasing accountability for Nurse Leader Visit (NLV) and ED Team Member Visit.
• Ensured both practices are grounded in the communication model iCARE
• (Introduce, Connect, Anticipate, Reinforce, Extend).
• Validated and tracked NLV visits Monthly in excel workbook.
• Reviewed and reported NLV Compliance on Daily Safety Call.
• Provided AdventHealth ED program training for ED Team Member Visits.
• Monitoring “Frequent Team Visit” question from Press Ganey survey.
• Discussed at PRC for opportunities.
• Offering bedside handover, initial sit visit and frequent visit course available to RN’s and PCT’s
• Implementing “Commit to Sit” for both nurses and doctors to improve patients’ perceptions of their whole care team listening carefully and providing a consistent experience for patients.
• Implemented best practices by creating ED Journey Posters placed in rooms and common space areas in the ED to support patient’s understanding of the typical flow of care and what to expect.
• Developed a Physician Patient Call-Back Program to ensure patient transition is successful.
• Asked patient if they were feeling better, had issues getting follow up appointments or prescriptions, and gathered overall feedback.
• Learned from patient comments this tactic was implemented with the goal to improve patient sense of caring beyond the visit.
• Implemented an Employee Engagement and Recognition strategy with “brag boards, celebration wins, weekly leadership employee check-in’s (CNO and PX Director), and PX Title Belt. This has supported healthy competition between teams and maintained a continued focus on their goals.