- Email: [email protected]
Patient Family–Centered Care in the Ambulatory Surgery Setting
AMBULATORY CARE
Patient Family–Centered Care in the Ambulatory Surgery Setting Susan M. Andrews, BAN, MA, RN, CAPA THE PATIENT FAMILY–Centered Care model in health care delivery encourages the active participation of patients and their families. This model has been shown to decrease medical errors and increase the patient’s and family’s level of satisfaction. We have always provided health care using this model in the ambulatory surgery setting, although we may not have called it by that name. We encourage the family to be active in care decisions and participate in the patient’s care during the preoperative experience, while the patient is in Phase I, and especially during Phase II recovery, so that they are comfortable caring for their loved one once the patient is discharged. So why then do we sometimes find our ourselves feeling intimated, threatened, or just plain frustrated when we hear the words Patient Family–Centered Care? It could be that in our hectic workday, we look at this as ‘‘just another thing that I have to do’’ or ‘‘something else that I’m going to be rated on,’’ instead of as something we do every day, with every patient and family, and as an area in which we have extensive experience and expertise. A colleague chuckles when she remembers a staff member stating ‘‘now you want me to smile?’’ What this nurse was really saying is ‘‘I’m stretched to the limit, I can’t do another thing.’’ Of course this nurse always smiles and warmly interacts with her patients, but rather than looking at Patient Family–Centered Care as a natural process in our care delivery, we sometimes look at it as a burden, something else to add to our already overloaded day. At MCGHealth, we consider Patient Family–Centered Care a journey that takes us to improved care and better outcomes for our patients and families. We use Press-Ganey as our score-keeper for patient satisfaction. We have Susan M. Andrews, BAN, MA, RN, CAPA, is the Perioperative Manager in the Deparment of Perioperative Services at MCGHealth, Augusta, GA. Address correspondence to Susan M. Andrews, Perioperative Services, MCG Health, 1120 15th St, Augusta, GA 30912; e-mail address: [email protected]. Ó 2009 by American Society of PeriAnesthesia Nurses 1089-9472/09/2404-0007$36.00/0 doi:10.1016/j.jopan.2009.05.100 244
had our ups and downs along this journey, have had many ‘‘lessons learned,’’ and know we have many more to experience. Our navigation through this journey has been both very rewarding and, at times, frustrating. The MCGHealth Children’s Medical Center Hospital (CMC) was designed and built based on the Patient Family-Centered Care model; children and their parents were part of the design teams and helped with everything from paint colors to patient flow plans. The CMC patients and families show their approval and endorsement of this integrated Patient Family–Centered Care model in their responses to the satisfaction survey, which consistently puts the pediatric medical center in the ‘‘Target’’ to ‘‘High Performance Range.’’ Until recently, the adult side of MCGHealth has struggled with fully embracing this model. Our adult day surgery unit patient satisfaction scores were lagging compared with our Press-Ganey national peers. We attempted to model and copy our children’s counterpart, but we were still behind where we wanted to be, and should have been. Our patient advisory committee had become inactive over the years and our initial spark had diminished. There are many reasons for this, but the main one was that we lost focus and got diverted from our journey along the Patient Family–Centered Care process. With the staff and our patients frustrated that we were not meeting our patients’ expectations, we regrouped and tackled the issues head on. We decided that we needed to get back on track. We understood that we needed to incorporate our patients and families in this journey. So we reactivated our patient advisory committee. When formulating this group, we realized that although the day surgery unit receives the Press-Ganey scores, the perioperative experience is more than just the day surgery component. In the original group that had disbanded only day surgery was represented. By overlooking the entire surgical arena, we had erred and missed valuable input and buy-in from the other members of the perioperative team. Therefore, when we created our new patient family advisory committee, we included all levels of nursing staff, managers, and educators from pre-op evaluation, day surgery, operating room (OR) holding,
Journal of PeriAnesthesia Nursing, Vol 24, No 4 (August), 2009: pp 244-246
PATIENT FAMILY
OR, and postanesthesia care unit (PACU), in addition to our patient-family advisors. Our monthly meeting consists of reviewing the patient satisfaction survey results from the prior month to examine what our customers are saying, what they like about us, and what improvement suggestions they have for us. With the question ‘‘Are we meeting our patients’ and families’ needs?’’ as our focal point, we recognized that the staff and advisors needed to be educated on what the survey responses were actually telling us. After a review of the survey and its meaning by the hospital’s planning staff, it was clear that we were not reading the responses correctly. A score of 89 could actually be in a higher satisfaction percentile than a score of 95. This realization helped relieve our disappointment that no matter how hard we worked to improve some areas, the results did not reflect our efforts. We now understood that some of the areas we were focusing on and trying to get the score into the 90s were actually areas that were already in the 95th or higher percentile, whereas other areas that had a score of 92 were actually only in the 60th percentile. Once we learned to evaluate the survey results correctly, we were able to focus our attention on the areas our patients wanted us to improve. Incorporating true Patient Family–Centered Care into our daily practice took team work as well as the education of all individuals involved, not just those on the advisory group. Having surgical patients on our patient and family advisory committee helped the staff to see concerns through the eyes of the patient. Our motto has become ‘‘All things are possible.’’ Our brainstorming sessions have resulted in simple changes such as hanging wall files for magazines in each patient room in day surgery and OR holding rooms, and more challenging issues such as working with administration to get funding for new waiting room furniture, window treatments, and making a patient education video. Some of the ideas for improvements come from staff and some from the advisors; we use our meetings to discuss the pro and cons of each suggestion. One of our most positive actions was a staff member’s suggestion to send thank-you cards to each patient. The advisory group suggested that the cards be placed in the patients’ charts in pre-op and follow them through day surgery in-processing, OR holding, OR, PACU to day surgery Phase II. All members of the team—nursing, anesthesia, surgeons— have the opportunity to sign the card and write a short personal message to the patient. These cards are mailed to the patient’s home the day after surgery. Our patient feedback has been very positive, and we have even received cards from patients thanking us for our thank-you card! To demonstrate to our patients and to each other our allegiance to Patient Family–Centered Care, we had a kick-off
245
celebration for the Perioperative Department’s staff. There was cake and punch, ‘‘We Strive for 5’’ buttons were given to each staff member and is now part of our daily uniform. A commitment to Patient Family-Centered Care was signed by all staff members and patient advisors. The pledges were framed and hung in the individual units as a daily reminder to staff and our patients of our engagement in and dedication to Patient Family–Centered Care. With Patient Family-Centered Care in the forefront, a ‘‘Spotlight on Service’’ is discussed in every staff meeting. This entails reviewing the satisfaction results from the prior month as well as talking about a specific customer service standard. In the Patient Family–Centered Care model of practice, the involvement of patient advisors is paramount to successful outcomes. Our patient advisors have been instrumental in developing and reviewing scripting. We discovered that expressing the same message using key phases is vital to the patients and families receiving a clear and consistent message. To enhance our patient and family’s knowledge of their surroundings, a ‘‘welcome’’ letter was developed for both pre-op evaluation and the day surgery unit. The letters give a brief description of the unit, where the vending machines and cafeteria are located, how to contact the charge nurse. Another staff member’s suggestion of creating ‘‘hotel-type guest books’’ for each patient room was reviewed by the advisory group. Suggestions on what information should be included were discussed, agreed upon, and the books created. Our advisory board recognized many things we do behind the scenes that patients and their families are often unaware of, such as providing for safety, extensive communications with the entire health care team, ensuring privacy both physically and in regard to personal information, among other actions. We believed that patients and families needed to be aware of this. Posters were created and hung in each area featuring pictures of the staff with bullet points outlining some of the steps we take to accomplish these extremely important aspects of care. Our most valuable accomplishment to date came from a suggestion by the Surgical Subspecialties Patient and Family Advisors. This group wanted patients to have access to an educational video on preparing for surgery in the surgical practice site’s examination rooms. Researching ready-made videos provided nothing that met all the needs identified by the patient and family advisors. One of the patient advisors had just been through an extensive surgery and suggested making our own video highlighting exactly what makes the experience at our hospital so special. The advisory group decided that the video should cover the entire surgical experience, not just the preparation for surgery. This required collaboration with multiple areas: the surgery outpatient practice site, pre-op evaluation, day surgery, OR holding, the OR suite, and the PACU.
246
The Coordinator for Surgical Subspecialties met with the Perioperative Services Manager to review the possibility of this coordinated effort. Both the Surgical Subspecialties and the Ambulatory Surgery Patient and Family Advisory Groups agreed that a video depicting a patient’s surgical experience was something that would greatly benefit our patients. The advisors wanted it to reflect an actual patient’s experience—in other words, to follow a patient each step of the way through the surgical process. A proposal was made for funding this major undertaking and, because of the institution’s commitment to Patient Family–Centered Care, this project was approved. Both advisory groups came up with key points they felt were important to communicate. The video company created a script and after several revisions by the advisors the script was finalized.
SUSAN M. ANDREWS
take home to review with their families. Since beginning the distribution of the videos, we have received multiple positive comments from patients and their families. They state that they feel more comfortable going into the surgical experience. They have shared with us that they recognized places and faces from the video and that they knew exactly what to expect, which made their whole experience less fearful. (To view the video, click on the Preoperative Patient video at http://www.mcghealth.org/ media-center/McgContentPage.aspx?nd5397).
The video required much coordination such as preparing and reserving sites, gathering props, choosing and organizing various outfits for the different shots, and giving instructions to staff starring in the video for the 2-day video shoot. It took about 3 weeks for the video company to get the 201 hours of filming down to a 7-minute video. Both advisory groups reviewed it and requested a few minor revisions, but for the most part, it was exactly what they had envisioned.
It is rewarding to see how Patient Family–Centered Care has come together for us and how the staff in so many different areas across the hospital and ambulatory care services came together to work as a team with our patient and family advisors to create something so important. This has been a valuable lesson in demonstrating how partnering with our patient and family advisors can teach us every day what Patient Family–Centered Care is truly about, which is understanding that the most important thing we can do in health care is to listen to our patients and act on what they tell us. After a year, we have a dynamic patient family advisory group that is both innovative and creative in their thinking. We have achieved an increase in our monthly scores to the upper 75th percentile (in the ‘‘Target’’ range). Our many successes are proof that Patient Family–Centered Care is a journey we want to take, and our patients recognize and appreciate the positive outcomes that come with this journey. We will stay on this journey, even after we reach the ‘‘High Performance’’ range, because having a collaborative partnership with our patient and family advisors is not only a patient satisfier, but also an important means to improve outcomes.
The video is linked to MCG Health’s home page, shown in the practice sites, and is available on DVD for patients to
For more information on Patient Family–Centered Care models, please visit http://www.familycenteredcare.org/.
Our goal was to make the video as realistic as possible, so we used nursing staff and physician volunteers as participants in the video. Two of the advisors believed that sharing their recent surgical experience would benefit others so they agreed to be the main characters.
Patient Family–Centered Care in the Ambulatory Surgery Setting Susan M. Andrews, BAN, MA, RN, CAPA THE PATIENT FAMILY–Centered Care model in health care delivery encourages the active participation of patients and their families. This model has been shown to decrease medical errors and increase the patient’s and family’s level of satisfaction. We have always provided health care using this model in the ambulatory surgery setting, although we may not have called it by that name. We encourage the family to be active in care decisions and participate in the patient’s care during the preoperative experience, while the patient is in Phase I, and especially during Phase II recovery, so that they are comfortable caring for their loved one once the patient is discharged. So why then do we sometimes find our ourselves feeling intimated, threatened, or just plain frustrated when we hear the words Patient Family–Centered Care? It could be that in our hectic workday, we look at this as ‘‘just another thing that I have to do’’ or ‘‘something else that I’m going to be rated on,’’ instead of as something we do every day, with every patient and family, and as an area in which we have extensive experience and expertise. A colleague chuckles when she remembers a staff member stating ‘‘now you want me to smile?’’ What this nurse was really saying is ‘‘I’m stretched to the limit, I can’t do another thing.’’ Of course this nurse always smiles and warmly interacts with her patients, but rather than looking at Patient Family–Centered Care as a natural process in our care delivery, we sometimes look at it as a burden, something else to add to our already overloaded day. At MCGHealth, we consider Patient Family–Centered Care a journey that takes us to improved care and better outcomes for our patients and families. We use Press-Ganey as our score-keeper for patient satisfaction. We have Susan M. Andrews, BAN, MA, RN, CAPA, is the Perioperative Manager in the Deparment of Perioperative Services at MCGHealth, Augusta, GA. Address correspondence to Susan M. Andrews, Perioperative Services, MCG Health, 1120 15th St, Augusta, GA 30912; e-mail address: [email protected]. Ó 2009 by American Society of PeriAnesthesia Nurses 1089-9472/09/2404-0007$36.00/0 doi:10.1016/j.jopan.2009.05.100 244
had our ups and downs along this journey, have had many ‘‘lessons learned,’’ and know we have many more to experience. Our navigation through this journey has been both very rewarding and, at times, frustrating. The MCGHealth Children’s Medical Center Hospital (CMC) was designed and built based on the Patient Family-Centered Care model; children and their parents were part of the design teams and helped with everything from paint colors to patient flow plans. The CMC patients and families show their approval and endorsement of this integrated Patient Family–Centered Care model in their responses to the satisfaction survey, which consistently puts the pediatric medical center in the ‘‘Target’’ to ‘‘High Performance Range.’’ Until recently, the adult side of MCGHealth has struggled with fully embracing this model. Our adult day surgery unit patient satisfaction scores were lagging compared with our Press-Ganey national peers. We attempted to model and copy our children’s counterpart, but we were still behind where we wanted to be, and should have been. Our patient advisory committee had become inactive over the years and our initial spark had diminished. There are many reasons for this, but the main one was that we lost focus and got diverted from our journey along the Patient Family–Centered Care process. With the staff and our patients frustrated that we were not meeting our patients’ expectations, we regrouped and tackled the issues head on. We decided that we needed to get back on track. We understood that we needed to incorporate our patients and families in this journey. So we reactivated our patient advisory committee. When formulating this group, we realized that although the day surgery unit receives the Press-Ganey scores, the perioperative experience is more than just the day surgery component. In the original group that had disbanded only day surgery was represented. By overlooking the entire surgical arena, we had erred and missed valuable input and buy-in from the other members of the perioperative team. Therefore, when we created our new patient family advisory committee, we included all levels of nursing staff, managers, and educators from pre-op evaluation, day surgery, operating room (OR) holding,
Journal of PeriAnesthesia Nursing, Vol 24, No 4 (August), 2009: pp 244-246
PATIENT FAMILY
OR, and postanesthesia care unit (PACU), in addition to our patient-family advisors. Our monthly meeting consists of reviewing the patient satisfaction survey results from the prior month to examine what our customers are saying, what they like about us, and what improvement suggestions they have for us. With the question ‘‘Are we meeting our patients’ and families’ needs?’’ as our focal point, we recognized that the staff and advisors needed to be educated on what the survey responses were actually telling us. After a review of the survey and its meaning by the hospital’s planning staff, it was clear that we were not reading the responses correctly. A score of 89 could actually be in a higher satisfaction percentile than a score of 95. This realization helped relieve our disappointment that no matter how hard we worked to improve some areas, the results did not reflect our efforts. We now understood that some of the areas we were focusing on and trying to get the score into the 90s were actually areas that were already in the 95th or higher percentile, whereas other areas that had a score of 92 were actually only in the 60th percentile. Once we learned to evaluate the survey results correctly, we were able to focus our attention on the areas our patients wanted us to improve. Incorporating true Patient Family–Centered Care into our daily practice took team work as well as the education of all individuals involved, not just those on the advisory group. Having surgical patients on our patient and family advisory committee helped the staff to see concerns through the eyes of the patient. Our motto has become ‘‘All things are possible.’’ Our brainstorming sessions have resulted in simple changes such as hanging wall files for magazines in each patient room in day surgery and OR holding rooms, and more challenging issues such as working with administration to get funding for new waiting room furniture, window treatments, and making a patient education video. Some of the ideas for improvements come from staff and some from the advisors; we use our meetings to discuss the pro and cons of each suggestion. One of our most positive actions was a staff member’s suggestion to send thank-you cards to each patient. The advisory group suggested that the cards be placed in the patients’ charts in pre-op and follow them through day surgery in-processing, OR holding, OR, PACU to day surgery Phase II. All members of the team—nursing, anesthesia, surgeons— have the opportunity to sign the card and write a short personal message to the patient. These cards are mailed to the patient’s home the day after surgery. Our patient feedback has been very positive, and we have even received cards from patients thanking us for our thank-you card! To demonstrate to our patients and to each other our allegiance to Patient Family–Centered Care, we had a kick-off
245
celebration for the Perioperative Department’s staff. There was cake and punch, ‘‘We Strive for 5’’ buttons were given to each staff member and is now part of our daily uniform. A commitment to Patient Family-Centered Care was signed by all staff members and patient advisors. The pledges were framed and hung in the individual units as a daily reminder to staff and our patients of our engagement in and dedication to Patient Family–Centered Care. With Patient Family-Centered Care in the forefront, a ‘‘Spotlight on Service’’ is discussed in every staff meeting. This entails reviewing the satisfaction results from the prior month as well as talking about a specific customer service standard. In the Patient Family–Centered Care model of practice, the involvement of patient advisors is paramount to successful outcomes. Our patient advisors have been instrumental in developing and reviewing scripting. We discovered that expressing the same message using key phases is vital to the patients and families receiving a clear and consistent message. To enhance our patient and family’s knowledge of their surroundings, a ‘‘welcome’’ letter was developed for both pre-op evaluation and the day surgery unit. The letters give a brief description of the unit, where the vending machines and cafeteria are located, how to contact the charge nurse. Another staff member’s suggestion of creating ‘‘hotel-type guest books’’ for each patient room was reviewed by the advisory group. Suggestions on what information should be included were discussed, agreed upon, and the books created. Our advisory board recognized many things we do behind the scenes that patients and their families are often unaware of, such as providing for safety, extensive communications with the entire health care team, ensuring privacy both physically and in regard to personal information, among other actions. We believed that patients and families needed to be aware of this. Posters were created and hung in each area featuring pictures of the staff with bullet points outlining some of the steps we take to accomplish these extremely important aspects of care. Our most valuable accomplishment to date came from a suggestion by the Surgical Subspecialties Patient and Family Advisors. This group wanted patients to have access to an educational video on preparing for surgery in the surgical practice site’s examination rooms. Researching ready-made videos provided nothing that met all the needs identified by the patient and family advisors. One of the patient advisors had just been through an extensive surgery and suggested making our own video highlighting exactly what makes the experience at our hospital so special. The advisory group decided that the video should cover the entire surgical experience, not just the preparation for surgery. This required collaboration with multiple areas: the surgery outpatient practice site, pre-op evaluation, day surgery, OR holding, the OR suite, and the PACU.
246
The Coordinator for Surgical Subspecialties met with the Perioperative Services Manager to review the possibility of this coordinated effort. Both the Surgical Subspecialties and the Ambulatory Surgery Patient and Family Advisory Groups agreed that a video depicting a patient’s surgical experience was something that would greatly benefit our patients. The advisors wanted it to reflect an actual patient’s experience—in other words, to follow a patient each step of the way through the surgical process. A proposal was made for funding this major undertaking and, because of the institution’s commitment to Patient Family–Centered Care, this project was approved. Both advisory groups came up with key points they felt were important to communicate. The video company created a script and after several revisions by the advisors the script was finalized.
SUSAN M. ANDREWS
take home to review with their families. Since beginning the distribution of the videos, we have received multiple positive comments from patients and their families. They state that they feel more comfortable going into the surgical experience. They have shared with us that they recognized places and faces from the video and that they knew exactly what to expect, which made their whole experience less fearful. (To view the video, click on the Preoperative Patient video at http://www.mcghealth.org/ media-center/McgContentPage.aspx?nd5397).
The video required much coordination such as preparing and reserving sites, gathering props, choosing and organizing various outfits for the different shots, and giving instructions to staff starring in the video for the 2-day video shoot. It took about 3 weeks for the video company to get the 201 hours of filming down to a 7-minute video. Both advisory groups reviewed it and requested a few minor revisions, but for the most part, it was exactly what they had envisioned.
It is rewarding to see how Patient Family–Centered Care has come together for us and how the staff in so many different areas across the hospital and ambulatory care services came together to work as a team with our patient and family advisors to create something so important. This has been a valuable lesson in demonstrating how partnering with our patient and family advisors can teach us every day what Patient Family–Centered Care is truly about, which is understanding that the most important thing we can do in health care is to listen to our patients and act on what they tell us. After a year, we have a dynamic patient family advisory group that is both innovative and creative in their thinking. We have achieved an increase in our monthly scores to the upper 75th percentile (in the ‘‘Target’’ range). Our many successes are proof that Patient Family–Centered Care is a journey we want to take, and our patients recognize and appreciate the positive outcomes that come with this journey. We will stay on this journey, even after we reach the ‘‘High Performance’’ range, because having a collaborative partnership with our patient and family advisors is not only a patient satisfier, but also an important means to improve outcomes.
The video is linked to MCG Health’s home page, shown in the practice sites, and is available on DVD for patients to
For more information on Patient Family–Centered Care models, please visit http://www.familycenteredcare.org/.
Our goal was to make the video as realistic as possible, so we used nursing staff and physician volunteers as participants in the video. Two of the advisors believed that sharing their recent surgical experience would benefit others so they agreed to be the main characters.