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03/12/2012 05:22 PM
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At our hospital we have begun an effort to improve upon this item. We are starting with a small slice of the entire issue, which is just the lab and how they explain "what would happen during tests and treatments" to inpatients. This is a patient satisfaction question. In particular, we've begun by just studying UAs and blood draws. We feel we need to narrow the scope with our initial effort, because this question applies across numerous functions: therapies, diagnostic imaging, etc. Unfortunately, regulations do not allow Press Ganey to break out the results of the question by function/department. And, by regulation, we are not allowed to ask any question remotely similar to the question as part of an independent survey. Therefore we seem to be limited to only looking at our Press-Ganey results for this broad question, with the results continuously confounded by the responses from patients who may have gotten tests or treatments from elsewhere from within our facility.
Any ideas on another way in which we could measure improvement with this project are appreciated.
Thanks.
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03/13/2012 10:34 AM
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Mark,
Low Press-Ganey scores are not a unique problem. Many hospitals have them. And the fact that the "score" does not tie back to a specific department of process is common issue with many types of assessments. But what you're left with is the equivalent of "something's wrong." Not a problem. You see with Lean, we assume that something is always wrong and everything can always be done better.
One thing you'll find pretty quickly in healthcare is that hospitals are systems made up of many, many inter-connected processes. It's rare that you can improve / fix just one and not affect many others. Some would say the big trick is finding where to start. Let me offer some advice based on personal experience.
First, don't go (fix) where you're not wanted. Even though the process that's causing the most pain (low Press-Ganey scores for instance) may be a tantalizing target, if the folks running that area aren't interested in changing their processes, you're wasting your time going there.
On the other hand, you may find an area that's not on top of the hit list that's very interested in improving their process. Go there, have some fun, dramatically improve their process, then advertise the results. Eventually the other areas will catch the fever.
Getting back to your original question though, Press-Ganey scores are lagging measures. Inside your hospital, you undoubtedly have leading or real time measures. You also probably have a pretty good idea which testing processes are causing your low scores based on these measures. There's your first area of opportunity.
Tom
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03/15/2012 12:28 PM
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Thanks for the ideas, Tom. Actually, it was our hospital's Service Excellence Committee that contacted me and asked me to help, so it's something they truly are interested in and I'm not going where I'm not wanted. And, I've been practicing lean for about 16 years; 6 of those in healthcare (just 4 months at my current hospital), so I'm pretty used to the environment and know what to expect. We've been getting excellent results with other projects - proven out with reliable metrics, such as medication errors on Med Surg reduced to about 1/6th of what they were, and registration errors reduced from 8% to 1.5% - so lean thinking is catching on and I have no shortage of leaders hitting me up for more projects. They are all initiated by our leadership.
I think the problem we have is that there is no actionable data directly related to this problem. Perhaps the best we can do is rely on the delayed results, although our data person can expedite them somewhat and they will be muddied with results from other areas. Once we develop a process we can audit against it, but that will only tell us whether or not we're following what we've developed - not whether or not it's making a difference.
Hmmmm..... This is a tough one...
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03/16/2012 12:59 PM
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Hi Mark,
As a former Service Excellence Manager and now Lean facilitator, I do understand the issue you are facing in regards to data delay. I think that what you need to do is to look for some actionable data within the current process. How is the explanation provided now for lab tests? Is there variation? Is it the same role providing the explanation, do other roles become involved? Right now the Press Ganey results can be used as the impetius to get started on the issue. Later they can be the indicator of how the changes have been percieved by the patient.
I hope this makes sense and helps the team.
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03/16/2012 12:59 PM
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Mark,
So you have plenty of experience with Lean in healthcare and you've already got traction where you're working. Cool!
Back to your original problem. We both agree that Press-Ganey scores are a lagging measure. We also agree that waiting that long to see if you've actually made improvements just isn't acceptable. So do you have any internal proxy measures that might help? (Low barometric pressure doesn't predict weather, but changes in barometric pressure do.) Hospitals are usually pretty good at gathering numbers on processes. The trick is turning that data into information. The first place I'd look is right under your nose. That's always been a pretty good place to hide stuff on me.
Hope that helps!
Tom
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03/19/2012 01:01 PM
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Thanks for the ideas Sherry & Tom. Good advice!
Mark
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03/20/2012 04:13 PM
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Mark
Believe Tom hit the nail on the head regards to data vrs information. The problem often is that data collected has no relevance to what you are trying to improve on...and often no real relevance to anything. But with the support of leadership and the folks working with you, metrics relevant to the workplace should be achievable.
As for working on areas that are a significant part of the process but unwilling to move ... I've used the work around them approach ... not a fan unless I really have no alternative. You know the rule: 1/3 will be for the change, 1/3 will be against, and the final 1/3 are waiting to see who wins. I find when leadership sees the value of making the change, those resisting eventually either leave or join.
Finally,
I could not help but take note of your comment regarding "no shortage of projects." Back in 2000, the Lovelace Clinic of Disease Management Fame noted the high cost of collecting metrics and the need to limit the number of Diseases one manages. With your experience, I'm certain you recognize the risk of spreading yourself out too thin. And the possible consequences to the same.
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03/23/2012 11:04 AM
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Mark-
Although we are a critical access hospital and not affected by the implications of Value Based Purchasing (yet) we are very focused at improving the perception of care that we provide to our patients. (Somewhat goes with the nature of the business!) In my role at our organization I am responsible for our Service Excellence program as well as Process Improvement. As you can see, the two really go hand-in-hand.
I know every place is a little different despite how close our two hospitals are, but I will share my initial thoughts with you from your post. Do you utilize Press Ganey for patient satisfaction in the OUTPATIENT setting? If you do, I would think that would be a place to look at data for how well lab is explaining tests and treatments. (Also, since the survey in your OUTPATIENT setting is not HCAHPS, you have some more freedom with what you do.) That may not directly impact your inpatient scores, but once the key words and processes get hardwired there, it would be fair to assume that they would carry over into your inpatient setting. Also, I would encourage observations by the department manager or a member of your Service Excellence team when a staff member goes in to explain the test/treatment. Truthfully, I feel that the outcome of this question is affected by far more people than the lab staff. Do they truly collect the UAs on inpatients? In my experience this task is completed by nursing staff. There are a lot of resources on the "Press Ganey Improvement Portal" that could possibly help you. My other bit of advice, when you are implementing improvements, look at your feedback by discharge date rather than received date in Press Ganey. Typically reports are pulled by received date and that can certainly muddy the waters.
Hopefully some of this helps or at least sparks some thoughts!
Thanks,
Julie
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