Just-in-time concept for patient satisfaction
Fixing complaints on the fly at the VA
When most people talk about asking patients about their care, they think of it in terms of a post-visit satisfaction survey. Not so for Bonnie Haupt, MSN, RN, CNL-BC, CHSE, an acute care clinical nurse leader and simulation specialist at the VA Connecticut healthcare system in West Haven. She's thinking about the one day a week when she spends a couple of hours asking a couple of patients pointed questions about how things are going right now, and then, whenever possible, fixing anything she can while that patient is still there to see it getting done.
This just-in-time thinking is usually reserved for retail stocking systems, certainly not for healthcare, and most certainly not for government healthcare, but at the VA hospital in West Haven, what Haupt and her team have implemented has caught the ear of so many other facilities that she spends time each week fielding calls from other VA facilities, as well as private hospitals affiliated with academic institutions, wondering how they can emulate what she does.
The hospital was having trouble getting timely reports from government Survey of Healthcare Experience of Patient (SHEP) surveys that enabled them to make a real impact on patients. So Haupt decided to start weekly veteran experience rounds, where existing patients are asked some questions and asked to share their experience with Haupt and other members of the VA staff. Haupt doesn't choose the patients; she only asks that patients be coherent and willing to talk. She actually prefers to avoid patients that the staff tell her are nice, funny, kind — she wants someone who she's sure will be real with her.
Each conversation is supposed to be about 20 minutes, but most of the time, once the patients start talking, the conversations tend to flow and they last about a half hour or 35 minutes. Haupt goes in with a rotating group of other staff — sometimes it's the director of nursing, sometimes a lead physician. It might be someone from environmental services one week and food and nutrition the next. Team members from every echelon and every department are included.
Questions include whether patients think they were treated with respect, whether the plan of care was clear or if some test or procedure was a surprise, whether their spiritual needs were being met, whether there are any environmental complaints, how the food is, whether they would recommend the facility to another veteran who might have the option of going to a private facility, whether they are adequately treated for pain, if their team communicates well with them and with each other, and what the VA team could do to make their stay better.
Initially, she says, other staff members were less than thrilled at being included in the project, but nearly a year later, she has to turn people away, limiting them to coming only when scheduled, and keeping the group going into the conversation at no more than five or six — as a teaching hospital, usually there are interns and residents present along with Haupt and that day's scheduled partner. "The patients here — they'd have a whole crowd in, no problem, but I don't want to overwhelm them," she says.
Any complaint that can be quickly resolved is handled as soon as possible, often while the round is taking place — for example, replacing light bulbs, getting a copy of that day's plan of care, or even a refill on a cup of coffee.
After each round, Haupt enters the data into a spreadsheet program for trend tracking, and a report that is shared with leadership and frontline staff, whether they were part of that week's round or not. Some of the problems can be dealt with quickly. For example, Haupt mentioned one soldier who complained that whenever a phlebotomist came in to collect blood from a patient in one of the other two beds in the room in the middle of the night, he turned on the lights over his bed, too, waking him from a sound sleep. "We thought it would be a staff education issue," she says. It turned out to be more of an old building issue: A quick investigation showed that there were two light switches, one of which covered two beds. It took a work order and a little time, but that problem was fixed.
Another old building problem that was turned up by talking to patients was that some rooms don't heat as well as others. So the hospital has instituted a night-time sleep menu. A student takes a cart around asking patients if they'd like a warmed blanket, a cup of tea, headphones for their TV, or a noise machine.
She has spotted trends quickly that would have taken months to discover due to the lag in SHEP reports. One of them included noises from unexpected sources. "We had a lot of people tell us about the noise of the janitorial equipment," Haupt says. "In the daytime, even when talking to the staff, when there was other ambient noise around, you could hear the wheels on the garbage cans going down the hall. Imagine what that would be like at night."
Haupt investigated and found out that the VA facility in Boston had purchased some quiet wheels. She spent a day following janitorial staff around there listening to see if they were quieter, put in a purchase order, and watched the complaints about janitorial noise drop.
Wayfinding for family members is another issue that came out of the patient conversations. New signage should be up shortly as a result of that, she says.
"With the director-level people seeing these complaints, right from patients in a real-time basis, I think it helps to get things fixed faster," she says. "It's right there, in their face, and it comes from people they saw today and will see tomorrow."
The total time investment is about 90 minutes a week, plus whatever follow up is needed to fix the problem. She thinks it's worth it. And the actual rounds? They're more like a chat than a job.
Other veterans who are in the hospital or who come in after a buddy has participated now want to be a volunteer for her rounds. So far, she has enough capacity to add the extras on to her two randomly selected patients. Her success hasn't gotten the better of her yet.
The VA, however, has got wind of it, and others are interested in replicating what she has done. She doesn't see why anyone can't. The numbers are small, but over time, even the information you get from two or three patients a week can add up to tremendous change. Already, the SHEP scores are up, and she's happy to think that the patient rounds and just-in-time fixes are part of it.
For more information on this topic, contact Bonnie Haupt MSN, RN, CNL-BC, CHSE, Acute Care Clinical Nurse Leader, Simulation Specialist, VA Connecticut Healthcare System, West Haven, CT. Telephone: (203) 932-5711 ext. 7323.
