Improving patient and family healthcare experiences through “shadowing,” taking a team-based approach to care and pairing transplant patients with a “guardian angel” are some of the practices that have been adopted and developed by healthcare facilities illustrated in a new book.
“Pursuing the Triple Aim” takes its title from ideals developed by the Institute for Healthcare Improvement to improve the patient experience, improve population health and reduce healthcare costs. It was presented at a recent seminar hosted by Kaiser Permanente at its Center for Total Health in Washington, DC.
Among the subjects of the book written by Charles Kenney and Maureen Bisognano, CEO of the Institutes for Healthcare Improvement is Dr. Anthony DiGioia III, an orthopedic surgeon and medical director of the bone and joint center at Magee-Womens Hospital of the University of Pittsburgh Medical Center. He gets a chapter in the book for his work in developing patient and family centered collaborative care. The approach has reduced hospital stays and infection rates, facilitated patients’ transition from the hospital to the home and produces greater patient satisfaction through several steps.
Shadowing patients and their families After getting patient permission, look at all the points from the patient’s arrival where they and their families make contact with hospital staff from the parking lot, the receptionist in the doctor’s office, interaction with staff before and after surgery, to discharge. This can involve someone taking notes or better yet, videotaping to ensure nothing is missed. It might seem curious to consider how parking attendants factor into care, but if you consider that most of DiGioia’s patients are coming to have knee and hip replacement surgery, walking will be an issue, and it’s important to reduce anxiety whenever possible. It could focus on aspect of care. For example, Magee-Womens Hospital’s Bone and Joint Center at UPMC shifted pre-surgical testing for joint replacement patients to a center where they could have all the required tests in one place rather than being sent to different departments around the hospital.
Evaluate contrasts Based on information gathered from shadowing, map out what the patients and families’ experience has been and contrast this with an ideal experience. One example highlighted in the book looked at the pre-operative experience, the proximity of the surgical center to the family lounge, and the discharge process.
Other components Ensure patients and families understand the procedure, what comes before and after surgery and map out a recovery plan. Use less invasive techniques when possible. Evaluate anesthesia and postoperative pain management options with patients. Map out a rapid rehabilitation and have a coach for the patient such as a family member or friend to help with the patient’s post-surgical recovery and who will be a point of contact for healthcare providers.
Guardian Angels transplant program One of the unintended results of the shadowing program was a UPMC initiative to pair nursing and social work students with transplant patients and their families. The program, in place for more than one year, involves nursing and social work students working on a part time, on-call basis. Their roles can include offering emotional support for patients and families, providing general details about the transplant process to directing families to nearby facilities like waiting areas and the nearest ATM. The program’s hours have been expanded to runs 24-hours, seven days a week. A spokeswoman said the program currently has 13 angels and continues to interview and hire. Since starting last spring, it has provided services to over 175 patients representing all transplant types at UPMC. Its goal is that every time a patient is called in for transplant, a guardian angel is available. We meet this goal sometimes, when we don’t it is because of staffing.
[Photo fromTed Eytan]