Rounding at Robert Wood Johnson University Hospital

1. Improvement Collaborative
Patient Experience
2009 Field Brief
BENCHMARKING & IMPROVEMENT SERVICES
SUCCESSFUL STRATEGIES
Implementing Rounding
Enhancing the Role of Leadership
in Service Excellence
Building Staff Competencies
Creating a Service Excellence Program
THE POWER OF COLLABORATION

2. Patient Experience Improvement
Inside
Introduction to the Collaborative.........................3
Collaborative Participants About the Collaborative ...................................3
Successful Strategies............................................5
Clarian Health Partners: Methodist Hospital of Indiana Implementing Rounding ...................................5
Enhancing the Role of Leadership
Denver Health
in Service Excellence .........................................8
Harborview Medical Center Building Staff Competencies ...........................10
Creating a Service Excellence Program .............10
Hennepin County Medical Center Publication Summary ........................................14
Oregon Health & Science University
Robert Wood Johnson University Hospital
Stanford Hospital & Clinics
Stony Brook University Medical Center
Thomas Jefferson University Hospital
UC Davis Medical Center
UC Irvine Medical Center
University Health Systems of Eastern Carolina
(Pitt County Memorial Hospital)
University Hospital of the SUNY Upstate Medical University For links to UHC’s Patient Experience resources,
including the benchmarking project field book,
University Medical Center of Southern Nevada member presentations and Web conference
recordings, survey results, and innovative strate-
University of Michigan Hospitals & Health Centers gies, log in to the UHC Web site at www.uhc.edu
and go to the Benchmarking & Improvement
Services area under Improve Performance.
University of North Carolina Hospitals
University of Utah Hospitals and Clinics
University of Virginia Health System
(University of VA Medical Center)
University of Washington Medical Center For more information about UHC’s Patient
Experience initiatives or to be added to the Patient
Virginia Commonwealth University Health System Experience Improvement Collaborative listserver,
(MCV Hospital) contact the project manager, Deb McElroy, at
(630) 954-2782 or mcelroy@uhc.edu.
Yale-New Haven Hospital
University HealthSystem Consortium
2001 Spring Road, Suite 700
Oak Brook, IL 60523-1890
(630) 954-1700
Fax: (630) 954-4730
www.uhc.edu
2

3. Introduction to the Collaborative
Introduction to the
Collaborative
An excellent health care organization produces • Accountability and performance expectations
an excellent patient experience. For each • Communication of progress and success
patient, the quality of a health care experience
is based on the answers to these and other In several instances, the collaborative provided
similar questions: Was my pain level regularly an incentive to begin organizational improve-
assessed? Did the nurses ask if I had questions ment; in others, the collaborative acted as
about my care plan? Was the identity of the support for an ongoing organizational effort.
physician in charge of my care made clear The collaborative also helped participants
to me? Moreover, while many personnel overcome the barriers to success identified in
contribute to the patient experience, the the benchmarking project, such as competing
true excellence of a patient’s experience lies priorities, a lack of personal accountability,
in the perception of the patient and the a blame-oriented culture, and the challenges
patient’s family members—and no one else. inherent in sustaining efforts over time.
Rationale for the
The steering committee for the UHC Patient Several key benchmarking project findings1 Improvement
Experience 2008 Benchmarking Project felt it also guided collaborative participants’ efforts:
Collaborative
was important to define “excellent patient expe- • Patient experience programs with greater The challenge: Members
rience” as a point of reference for the collection longevity have better performance on patient asked for support after
of project data. The following definition was satisfaction measures, and that performance benchmarking projects
used for the project1: improves as the program becomes more because making significant
changes can be overwhelming.
An excellent patient experience, as comprehensive.
perceived by patients and their families, • Including patient satisfaction measures in The solution: UHC Bench-
evolves from care that is respectful of marking & Improvement
performance evaluation expectations results
Services offers improvement
and responsive to individual patient in an improved patient experience. collaboratives to help mem-
preferences, needs, and values, ensuring • There is a relationship between incentive bers implement change
that patients’ values and safe practices compensation and better performance, and through structured support,
inform all decisions affecting their care. the type of compensation may affect results. networking, and sharing of
best practices among mem-
The benchmarking project identified successful • Analysis of the project data demonstrated no bers with the same focus.
practices that sustain an improved patient expe- statistical variation related to case mix index,
rience and helped participants identify areas of gender, or Medicare or Medicaid status of the
strength and opportunities for improvement. patient population.
Twenty-one organizations enrolled in the
About the Collaborative improvement collaborative; participation in
Because making significant organizational the original benchmarking project was not
changes can be overwhelming, UHC offered a requirement for joining the collaborative.
the Patient Experience 2009 Improvement Participants first completed a gap analysis
Collaborative to help participants implement and worksheet to define their intended per-
the benchmarking project’s critical success formance improvement initiatives, goals, met-
factors1: rics, and team. (Examples of their initiatives are
in Figure 1.) Between December 2008 and
• Institutional commitment to service excellence May 2009, they participated in monthly collab-
• Organization-wide education and support orative conference calls to network, share advice
and tips, and report progress.
1
Patient Experience Benchmarking Project 2008 Field Book. Oak Brook, IL: University HealthSystem Consortium; 2009.
https://www.uhc.edu/docs/003731569_PtExp2008FieldBook.pdf. Accessed August 26, 2009.
UHC Patient Experience Improvement Collaborative 2009 Field Brief 3

4. Introduction to the Collaborative
Two work groups focused on initiatives related conference calls took place separately from
to education, organizational support, com- the collaborative calls and offered additional
munication, and accountability. Work group opportunities for discussion and networking.
Examples of Patient Experience Improvement Initiatives
Organization Initiativea
Oregon Health & • Improve nursing and physician communication
Science University • Reduce number of falls and pressure ulcers
Robert Wood Johnson • Hardwire and enhance “every 2 hours” rounding
University Hospital
Stanford Hospital & • Expand the service team to coach units/clinics on patient satisfaction scores
Clinics • Enhance hourly nurse rounding
• Develop support service report cards
University Medical • Implement a system that allows patient activation of the rapid response
Center of Southern action team
Nevada
University of Michigan • Implement a policy on calling patients 24 hours after discharge
Hospitals & Health • Improve awareness and visibility of patient- and family-centered care,
Centers including psychosocial and spiritual components
• Involve family members in root cause analyses of adverse events in the
pediatric intensive care unit
University of Utah • Create unit-based action plans to improve the patient experience
Hospitals and Clinics • Create patient experience incentives and evaluations for all leaders and faculty
University of Washington • Include patient satisfaction measures in performance evaluation expectations
Medical Center
Virginia Commonwealth • Organize nursing leaders of selected units to develop scripts for individual
University Health System roles in units
• Implement scripts with an “every 2 hours” rounding program
• Have nurse managers round on all new patients
Figure 1 – Source: UHC Patient Experience Improvement Collaborative participants
a
Not an inclusive list.
For More Information
To find these resources for the Patient Experience projects, log in to the UHC Web site at
www.uhc.edu and go to the Benchmarking & Improvement Services area under Improve
Performance. Resources available include:
• Benchmarking project field book
• Action plan
• Knowledge transfer meeting presentations and Web conference recordings
• Strategy map
• Survey results
• Innovative strategies
• Sample Performance Opportunity Scorecard
• Internal improvement project planning checklist
• UHC’s Patient Experience Improvement Collaborative listserver
4 UHC Benchmarking & Improvement Services

5. Successful Strategies
Successful Strategies
Implementing Rounding our union staff,” said Mansfield. Union staff
were concerned that if they signed the state-
Performing regular, thorough, and efficient ment, it could be used against them in a puni-
patient rounds was a successful initiative for tive manner. With the support of union leaders,
2 collaborative participants: Robert Wood the committee convinced
Johnson University Hospital (RWJ) and the concerned staff mem- All RWJ nurses now round every 2 hours from
Virginia Commonwealth University Health bers that the statement 10:00 AM to 6:00 PM, carrying a small refer-
System (VCU). Although the rounding of commitment was
program details varied, each organization ence card that summarizes rounding procedures.
intended as nothing more
discovered that rounding is a valuable tool than a behavioral expectation. In retrospect, the
for improving the patient experience. committeee members realized that they should
Robert Wood Johnson University Hospital. have involved union leaders from the start.
RWJ’s past efforts at rounding were less than Nevertheless, all staff members signed the
promising. In an attempt to improve patients’ statement without further pushback.
perception of staff responsiveness, better Two types of rounding were implemented:
manage patient pain, prevent falls, and en- nursing and leadership. All RWJ nurses now
hance nurses’ working plans, the organization round every 2 hours from 10:00 AM to
piloted rounding in 1 unit in September
6:00 PM, carrying a small reference card
2008 before implementing “every 2 hours”
that summarizes rounding procedures
rounding house-wide. Unfortunately, lack of
(see Figure 2 for rounding competencies):
accountability and staff buy-in prevented the
initiative from succeeding. “If rounding wasn’t • Introduce yourself
done, that just seemed to be okay,” said Laura • Use the whiteboard at the patient’s bedside
Mansfield, RNC, MSN, director, Patient to write down the care plan for the day
Satisfaction. Other barriers included unit-to- • Address the 4 P ’s: pain, position, potty,
unit variation in approaches to rounding as personal needs
well as resistance from unit leaders, nursing • Perform scheduled tasks RWJ formed a grassroots committee of
directors, and other staff. representatives from every nursing area to
• Communicate when you
Reflecting on that first attempt at rounding, will return examine the proposed rounding process and
Mansfield said, “We knew we needed a formal • Ask if you can do anything assist in its implementation.
process to be successful.” After joining the else for the patient
UHC collaborative, the organization re-
grouped by forming a grassroots committee • Document the round in the daily log
of high-performing nursing staff representa- In addition, a special rounding Post-it note is
tives from every nursing area to examine the available in all units for use when the patient is
proposed rounding process and assist in its sleeping. The note tells the patient the time the
implementation. rounding nurse stopped by and the time that
The committee developed a pamphlet with a the rounding nurse will return. Elderly patients
step-by-step explanation of RWJ’s rounding ini- in particular feel comforted to know that some-
tiative; the pamphlet included a statement of one is checking on them while they sleep,
commitment that staff were asked to sign. “We Mansfield noted.
initially had some tremendous pushback from
UHC Patient Experience Improvement Collaborative 2009 Field Brief 5

6. Successful Strategies
Rounding Competency Checklist at Robert Wood Johnson University Hospital
DATE
NAME
DEPARTMENT
EVALUATOR SELF ASSESS EVALUATOR COMMENTS
YES NO YES NO
INTRODUCTIONS
Knock on door prior to entering — ask
permission
Manage up your skill or that of your
co-worker
Use good eye contact
EXPLAIN HOURLY ROUNDING UPON ADMISSION
Explain the purpose of hourly rounding
(initial visit)
Use key words “very good” care
Describe rounding schedule
(6am-10pm q2hr)
UPDATE WHITE BOARDS
Place name on white board
Update nursing plan of care/goals
for patient
ADDRESS 4 P’S PAIN-POSITION-POTT Y-PERSONAL NEEDS
How is your pain?
Are you comfortable?
Do you need to go to the bathroom?
Personal needs
ASSESS ENVIRONMENT
Move items within reach (table, call bell,
phone, water)
PERFORM SCHEDULED TASKS
Complete MD-ordered treatments,
procedures
Complete nursing care as needed
Administer scheduled medications
CLOSING
We will round again in about 2 hours
Is there anything else that I can do for
you? I have the time
Document your round on rounding log
Figure 2 – Source: Mansfield LJ, Omabegho M. Rounding at Robert Wood Johnson University Hospital. Presented at: UHC
Patient Experience Improvement Collaborative Knowledge Transfer Web Conference; June 8, 2009.
6 UHC Benchmarking & Improvement Services

7. Successful Strategies
Leadership rounds follow a different proce- particularly by decreasing the number of
dure. Organizational leaders round twice a patient falls. Around-the-clock hourly rounds
day, 7 days a week. In the morning, the leader were rolled out in 2 acute care units (ortho-
checks the patient’s environment, introduces pedic surgery and surgery)
himself or herself, acknowledges any family in first quarter 2009. “The VCU implemented hourly rounding not only to
members who may be present, asks about the two units were similar in enhance the quality of the patient experience
quality of the nursing care the patient has what they wanted to do,
received, asks if a nurse has checked on the but they rolled it out but also to improve patient safety, particularly
patient every 2 hours, and asks if he or she can slightly differently, and by decreasing the number of patient falls.
do anything for the patient. Evening rounds, they were dealing with a
which are much briefer, consist of follow-up very different physical layout,” said Mary Kay
questions and information about the identity Beasley, clinical administrator. The orthopedic
of that evening’s charge nurse. Some leaders unit features a pod design with a mix of semi-
leave their business cards for patients as well. private and private rooms and a central nursing
station, while the surgery unit has all private
Since implementing a formal rounding rooms and a large, state-of-the-art decentralized
program, RWJ has seen improvement on nursing station design.
several measures. RWJ’s Hospital Consumer
Assessment of Healthcare Providers and In the orthopedic unit, rounding is alternately
Systems (HCAHPS) nursing score has performed by registered nurses and care part-
increased from 71% to 73%, and its respon- ners. Staff members who perform rounding
siveness score has increased from 56% to carry a cue card with reminders of rounding
58%. Several of RWJ’s Press Ganey scores procedures:
have also improved: “response to concerns • Assess pain level and offer pain medication
and complaints” increased from the 33rd
• Ask if the patient needs help going to the
to the 46th percentile, “staff work together”
bathroom
increased from the 44th to the 59th per-
centile, and “promptness to call bell” • Assess the patient’s comfort
increased from the 43rd to the 66th per- • Place the call bell, telephone, and TV
centile. The organization’s fall rate has seen remote within reach
improvement as well, decreasing from an • Make sure the bedside table, tissues, water,
average of 3.3 falls per month in fourth and trash can are next to the bed
quarter 2008 to an average of 3.06 per • Ask if the patient needs anything else
month in first quarter 2009.
• Tell the patient that staff will return in
According to Mansfield, organizations consid- an hour
ering their own rounding initiatives should
resist the urge to rush implementation, “A key question that seems to really elicit
focusing instead on helping staff understand replies from the patients is ‘Is there anything
and accept the process. else I can do for you before I leave the room?’”
said Beasley.
For more information about RWJ’s experience,
contact Laura Mansfield, director, Patient Surgery rounding at VCU differs slightly from
Satisfaction, at (732) 828-3000 or orthopedic rounding because it is performed
laura.mansfield@rwjuh.edu. only by licensed staff members. However, the
surgery unit uses a laminated cue card very
Virginia Commonwealth University Health similar to the one used in the orthopedic unit.
System. VCU implemented hourly rounding In addition, the surgery cue card features the
not only to improve the quality of the patient ACT (ask, check, and tidy up) rubric (Figure 3).
experience but also to increase patient safety,
UHC Patient Experience Improvement Collaborative 2009 Field Brief 7

8. Successful Strategies
Surgery Rounding Cue Card at Virginia Commonwealth University Health System
Front Back
SMILE Remember . . .
Tell the patient you are doing rounds
A: ASK Identify self
• Bathroom
• Change positions Make eye contact
• Pain
• Anything I can do Ask: “Is there anything else I can do for you before
C: CHECK I leave the room?”
• Call bell and phone
• Bed low, top rail up A good attitude is contagious!
• ID band on
• Trash can beside bed
• Water and cup within reach
T: TIDY UP
• Floor clear to bathroom
• Bedside table within reach
• Assist in setting up tray
• Keep room neat
Figure 3 – Source: Beasley MK. UHC Patient Experience Improvement Collaborative. Presented at: UHC Patient Experience
Improvement Collaborative Knowledge Transfer Web Conference; June 30, 2009.
VCU began to see success with its new A major success was the surgery unit’s signifi-
rounding protocols as early as the end of the cant decrease in the number of patient falls,
quarter in which they were implemented. In which dropped from an average of 7.38 per
a Professional Research Consultants (PRC) quarter in fourth quarter 2008 to 2.41 in first
loyalty study, the orthopedics unit saw a spike quarter 2009. “What this data does not pull
in “excellent” responses (from 56% to 62%) out is that surgery actually did not start the
to the question “How would you rate nurses’ hourly rounds until the end of February,”
caring for you or your said Beasley. “At the end of March, there were
family member when 0 falls. Once the project was fully rolled out,
“We don’t call this an initiative, because an it was actually almost a 6-week period without
needed?” The surgery
initiative sounds time-limited. This is a culture unit’s performance on falls. Our fall committee is going to be looking
change.” the same measure in particular at their way of doing rounds and
– Chrissy Daniels, director, Exceptional decreased slightly, from what it contributed to this.” Hourly rounding
Patient Experience, University of Utah 100% to 97.6%, pos- is now being rolled out in every unit at VCU.
Hospitals and Clinics sibly because it had just
For more information about VCU’s experience,
completed a geographic
contact Mary Kay Beasley, clinical administrator,
move within the hos-
at (804) 828-6392 or mbeasley2@mcvh-vcu.edu.
pital, according to Beasley. On the question
“What is the likelihood that you would recom-
mend VCUHS to friends and relatives?” the Enhancing the Role of Leadership
in Service Excellence
percentage of “excellent” responses jumped
from 50% to 73% for the surgery unit and University of Utah Hospitals and Clinics.
stayed at 60% for the orthopedic unit. Mean- In 2008, Utah held the Exceptional Patient
while, on the unit customer indicator PRC Experience Retreat to answer the question
satisfaction dashboard, the surgery unit’s per- “Why are we unable to consistently provide
formance increased from 60% to 65.8%, and an exceptional experience for each of our
the orthopedic unit’s performance increased patients?” It was the first time that the organi-
from 40% to 50%. zation had conducted a leadership develop-
ment program about the patient experience.
8 UHC Benchmarking & Improvement Services

9. Successful Strategies
“We were all out of our comfort zones, but videos of patients describing what made their
that’s sometimes a good place to be,” said experiences exceptional,” said Daniels. “Staff
Chrissy Daniels, director, Exceptional Patient being able to hear the senior vice president’s
Experience. A root cause analysis revealed personal message has been one of the most
a lack of an effective decision-making process, transforming things.”
a lack of accountability, care that was not
Local efforts were also launched. Physician
patient-focused, and a mission conflict: Was
initiatives included physician introduction
Utah’s purpose research or patient care?
cards, faculty behavioral standards, and bi-
Several action steps emerged from that retreat. annual individual physician reviews, while
Utah’s mission, vision, and values were vali- hospital initiatives included retreats, learning
dated, with an emphasis on having a single mis- sessions, and “we were here” housekeeping cards.
sion with multiple ways to achieve it: patient
The results of these culture-change efforts
care, education, and research. Principles for
have been gratifying. Press Ganey has recog-
decision making and patient-focused care were
nized Utah as a top decile improver, with a
also developed. Finally, the performance evalua-
1.6 mean improvement in the third quarter of
tion process was modified to include the patient
fiscal year 2009. In overall patient satisfaction,
experience. “We don’t call this an initiative,
inpatient psychiatry rose to the 90th per-
because an initiative sounds time-limited,”
centile, inpatient oncology to the 98th per-
said Daniels. “This is a culture change.”
centile, ophthalmology to the 70th percentile,
A follow-up retreat in February 2009 celebrated and the family medicine network to the 85th
successes and moved the culture-change process percentile. Slower but still improving is the
to the next level. Implementation plans were University of Utah Hospital, with a 1.2 mean
developed for value-based employment and improvement in the third quarter of fiscal
retention, reward and recognition, unit-based year 2009.
action plans, leadership roles and responsibili-
Utah’s chief recommendation to other organiza-
ties, and communication.
tions that are seeking to improve their patients’
As a result of these retreats, the Utah faculty experience is to create an
physician practice’s executive medical director environment that supports The Utah faculty physician practice’s executive
and the hospital’s chief executive officer aligned this goal. “[We want to] medical director and the hospital’s chief execu-
goals, measurement tools, and processes and listen to what our patients
say and hear what they tell
tive officer aligned goals, measurement tools,
attended leadership development opportunities
related to an exceptional patient experience. us,” said Daniels. “It’s not and processes and attended leadership devel-
Leaders also spent 2 to 6 hours shadowing knowing the answers; it’s opment opportunities related to an exceptional
someone in the part of the organization with asking the right questions. patient experience.
which they were least familiar. That experience It’s digging deep enough to
resulted in, among other changes, new remotes find root causes, not applying superficial fixes.”
for televisions in patient rooms. To that end, organizations should provide a safe
platform for open and frank discussion so that
To maintain the organizational focus on the problems can be identified, celebrate successes,
patient experience, Utah implemented weekly and make sure that staff members hold each
scorecards, monthly learning sessions, ways to other accountable.
reward and recognize individuals and teams
(such as a personal letter from the chief oper- For more information about Utah’s experience,
ating officer to any staff member named on a contact Chrissy Daniels, director, Exceptional
patient survey), and employee forums to review Patient Experience, at (801) 581-2423 or
progress and share experiences. “In addition, chrissy.daniels@hsc.utah.edu.
our senior vice president has made a series of
UHC Patient Experience Improvement Collaborative 2009 Field Brief 9

10. Successful Strategies
Building Staff Competencies work environment and include patients
and family members in actively seeking
University of Washington Medical Center. ways to eliminate the risk of patient injury
Before joining the UHC improvement collab- to maximize the delivery of quality care.
orative, University of Washington Medical This includes reviewing the pertinent poli-
Center (UWMC) created a Rehabilitation cies and procedures as well as understanding
Services Patient and Family Advisory Council all aspects of the work environment. All
(PFAC) that included 10 patient and family staff are required to indicate when there
advisers, a unit medical director, an occupa- is a patient safety concern and elevate issues
tional therapy manager, and 4 direct-care staff. to the appropriate leadership.
The council’s goal was to bring patient- and
family-centered care (PFCC) principles into During annual evaluations, feedback about the
direct patient care through the staff competen- new competencies was solicited. New compe-
cies used in annual performance evaluations. tencies were distributed to areas representing
various hospital services—inpatient, outpatient,
To accomplish that goal, the Rehabilitation and ancillary—and were given directly to staff
Services PFAC took several steps. The occupa- to solicit more feedback. Competencies were
tional therapy II position job description also reviewed by key organizational leaders
and summary were revised, and technical from compliance, quality improvement/patient
competencies were rewritten to include safety, and human resources areas. Currently,
PFCC language and principles. The Institute UWMC is using the hospital-wide feedback to
for Family-Centered Care’s “Templates— revise the competencies; the revised compen-
Philosophy of Care Statements, Definitions tencies and recommendations will then be pre-
of Quality, and Position Descriptions” was a sented to executive leaders.
valuable resource. The revised job descriptions
were reviewed with staff and council members, For more information about UWMC’s experience,
who drafted a final version that did not address contact Ann Buzaid, nurse manager, at
organization-wide behavioral competencies. (206) 598-3054 or abuzaid@u.washington.edu
or Jennifer Herrman, nurse manager, at
After joining the UHC collaboration, UWMC (206) 598-3004 or jherrman@u.washington.edu.
decided to expand the effort by revising the
organization-wide competencies. Standardized
Creating a Service Excellence Program
competencies were revised on every staff
member’s job description, using guidelines Stanford Hospital & Clinics. At Stanford, the
developed by the Rehabilitation Services PFAC. journey to improve the patient experience
Patient representatives were recruited from each began about 2 years ago when the organiza-
of 7 PFACs, and UWMC tion developed a service excellence workshop.
Competencies for UWMC staff were revised to staff representatives were It was felt that the organization already pos-
increase readability, infused with new language recruited from key areas sessed the key to a successful service excellence
that supports PFCC principles, and sorted to such as inpatient care program—an engaged and skilled manage-
reflect PFCC values. services, ambulatory care ment team. The workshop’s goal was to focus
services, organizational on service quality while addressing multiple
development and training, human resources, imperatives: Epic electronic medical records,
and patient relations. expense reduction, quality and patient safety,
and regulatory compliance.
Competencies for UWMC staff were revised
to increase readability, infused with new lan- At the workshop, “overall rating of care” was
guage that supports PFCC principles, and selected as the principal measurement of patient
sorted to reflect PFCC values. For example, satisfaction. Since that measure was so broad,
the competency previously titled “HIPAA workshop participants examined 2 years of his-
Compliance” was retitled “Patient Privacy.” torical data to see what was driving that overall
In addition, patient safety was included as rating in the inpatient areas, the emergency
a new competency: department, and the clinics.
Patient safety is a priority of everyone at Key inpatient drivers included whether patients
UWMC. Staff consistently review their had trust and confidence in the nurses and
10 UHC Benchmarking & Improvement Services

11. Successful Strategies
doctors treating them, felt that they were of feedback, support service report cards,
treated by the nurses with courtesy and respect, enables inpatient units and clinics to give con-
and felt that doctors listened carefully to them. tinuous feedback on their level of satisfaction
Stanford decided to aim for increasing inpatient with support services. The cards include basic
service excellence from the 75th to the 80th questions about the general services area, such
percentile in fiscal year 2009. Key drivers in the as how quickly transport
emegency department were whether patients staff arrived when called. A closed-loop same-day feedback program was
felt that they had to wait too long to see a
Stanford also implemented developed to give Stanford nursing and general
doctor and how highly they would rate the services teams access to real-time feedback
executive walk rounds, in
courtesy of emergency department staff. The
which executives ask spe- about concerns that can be resolved during a
goal in this area was to increase service excel-
cific questions of key patient’s hospital stay.
lence from the 28th to the 75th percentile in
stakeholders—leaders,
fiscal year 2009. Finally, key drivers in the
employees, physicians, and patients—to obtain
clinics were how well organized the office was
actionable service information. A closed-loop
perceived to be by patients, how they rated the
same-day feedback program was developed to
courtesy of the office staff and of their doctors,
give Stanford nursing and general services
and whether they felt that the main reason
teams access to real-time feedback about con-
for the visit was addressed to their satisfaction.
cerns that can be resolved during a patient’s
The goal was to increase the service excellence
hospital stay. The program’s goal is to improve
average score from 93.78% to 95% in fiscal
the patient experience by allowing for imme-
year 2009.
diate service recovery. An analyst goes to
Between January and June 2009, several new select units and passes out feedback cards with
best practices were introduced in the inpatient, 5 open-ended questions to patients and fami-
clinic, and support services settings. Among lies. The analyst then collects the cards, identi-
the first to be implemented was the AIDET fies any immediate issues, communicates the
(acknowledge, introduce, duration, explanation, issues to the appropriate nurse managers and
thank you) communication framework, which enters them into a database, and generates a
represents the 5 dimensions of patient-centered daily report that is e-mailed to nurse managers.
communication and which was held to be the
Several best practices were introduced in the
most effective practice for improving patient
emergency department in early 2009. A
satisfaction in the inpatient setting.
new holding room was designed to reduce
Implemented around the same time was the the number of hours that patients spend in
best practice of transferring trust, which entails hallway beds, increase the
using “the right words at the right time” to number of patient beds Support service report cards enable inpatient
transfer trust to the next health care provider. available, and improve units and clinics to give continuous feedback on
For example, when a physician is finished door-to-physician wait
examining a patient, he or she could say, “Just times. Stanford also imple- their level of satisfaction with support services.
proceed to check-out, and Sally, who is our mented a quick-triage
medical assistant, will make sure you get the model to improve door-to-triage end time and
referrals you need.” coached physicians and staff on service behav-
iors to improve patients’ perception of care
New recognition mechanisms include “WOW! provider courtesy.
cards,” a way to spontaneously recognize,
affirm, and show appreciation for employees In addition, Stanford has developed several
whose performance and actions model their physician-specific initiatives, such as integrating
personal commitment to excellent care and individual physician scores into quarterly
superior service. Anyone can fill out a card and quality scorecards, recognizing physicians with
submit it to the employee’s immediate manager, “WOW!” cards and monthly learning break-
who recognizes that employee with a certificate fasts with the chief executive officer and chief
and a small gift card for coffee. Another form
UHC Patient Experience Improvement Collaborative 2009 Field Brief 11

12. Successful Strategies
operating officer, launching the Service Alert The other pilot project is a physician-patient
e-newsletter, and designing a broader internal communication framework known as GIIFT
and external communications campaign. (greet patient and family, introduce yourself,
information sharing, feedback, transfer of care).
Two other physician initiatives are currently The pilot was launched in May 2009 for
being piloted: team cards and a communication medicine unit (cardiology) physicians, with the
framework. Team cards are business cards with goals of implementing a consistent physician-
photographs that are given to every patient. patient communication standard for all patients
The patient places the team cards into plastic in the unit and improving patients’ under-
sleeves distributed by unit/nursing staff. This standing of who their physicians are. The team
pilot began in March 2009 for more than in charge of the pilot developed this physician-
100 physicians and medical students on the specific script based on AIDET principles. See
internal medicine service, with the goal of Figure 4 for more details about the GIIFT
improving physician-patient interactions as framework.
well as patients’ understanding of who is on
their primary care team. Prior to this pilot For more information about Stanford’s experience,
program, for example, many patients did contact Asha Viswanathan, project manager,
not understand that residents and interns are Service Excellence, at (650) 721-6266 or
doctors, and these patients left the hospital aviswanathan@stanfordmed.org or Deepti
thinking that a physician had never seen them. Randhava, program manager, Process Excellence,
at (650) 736-4211 or drandhava@stanford.org.
GIIFT Communication Framework at Stanford Hospital & Clinics
G Greet patient and family
Knock on the door, make eye contact, and say hello.
I Introduce yourself
State your role and whether you are on the primary or consulting team taking care of the patient.
I Information sharing
Get information from the patient such as history, medications taken at home, and symptoms, and
give information such as tests ordered and when to expect results.
F Feedback
Ask the patient and family what questions or concerns they have.
T Transfer of care
“I will be your doctor until [state day and time], and Dr. Smith will take over from me at
[state day and time].”
Figure 4 – Source: Randhava D, Viswanathan A. Service excellence program: improving the patient centered care experience
at Stanford Hospital. Presented at: UHC Patient Experience Improvement Collaborative Knowledge Transfer Web Conference;
June 30, 2009.
12 UHC Benchmarking & Improvement Services

13. Successful Strategies
The Next Step Is Yours
Collaborative participants continue to move forward with their improvement
initiatives. Meanwhile, the information provided in this field brief can help
you develop strategies for designing and carrying out your own patient expe-
rience improvement projects. Ongoing networking is available through the
Patient Experience Improvement Collaborative listserver.
For links to UHC’s Patient Experience resources, including the benchmarking
project field book, member presentations and Web conference recordings,
survey results, and innovative strategies, log in to the UHC Web site at
www.uhc.edu and go to the Benchmarking & Improvement Services area
under Improve Performance.
For more information about UHC’s Patient Experience initiatives or to
be added to the listserver, contact the project manager, Deb McElroy, at
(630) 954-2782 or mcelroy@uhc.edu.
For More Information
To find these resources for the Patient Experience projects, log in to the UHC Web site at
www.uhc.edu and go to the Benchmarking & Improvement Services area under Improve
Performance. Resources available include:
• Benchmarking project field book
• Action plan
• Knowledge transfer meeting presentations and Web conference recordings
• Strategy map
• Survey results
• Innovative strategies
• Sample Performance Opportunity Scorecard
• Internal improvement project planning checklist
• UHC’s Patient Experience Improvement Collaborative listserver
UHC Patient Experience Improvement Collaborative 2009 Field Brief 13

14. Publication Summary
Publication Summary
To find these and other resources for the Patient Experience initiatives, log in to
the UHC Web site at www.uhc.edu and go to the Benchmarking & Improvement
Services area under Improve Performance.
Field Book—A comprehensive overview of the most significant findings and recommendations
of the benchmarking project. This project guide will help you make the best use of performance
assessments and other tools to improve the patient experience. It is available in both softcover
and electronic formats.
Action Plan—A detailed list of successful strategies and tactics in an action plan template to
guide your improvement initiatives.
Knowledge Transfer Meeting Presentation and Web Conference Recordings—Presentations
on the benchmarking project findings and how to use them, member presentations, and record-
ings of the projects’ Web conferences.
Strategy Map—An outline of the tactics that better-performing organizations have used to
improve the patient experience.
Survey Results—Comprehensive results of all data collected for the benchmarking project. The
data give a clear idea of how all participants compare across the full range of performance measures.
Innovative Strategies—Specific tactics that benchmarking project participants have used to
improve performance.
Sample Performance Opportunity Scorecard—A self-assessment tool that can be used to iden-
tify specific strategies to pursue.
Internal Improvement Project Planning Checklist—A checklist designed to stimulate discus-
sion and help you begin an improvement initiative.
Field Brief—A summary of the lessons learned from the improvement collaborative and the
improvement initiatives of the participants.
Project Manager
For more information about UHC’s Patient Experience initiatives or to be added to the
Patient Experience Improvement Collaborative listserver, contact the project manager, Deb
McElroy, at (630) 954-2782 or mcelroy@uhc.edu.
14 UHC Benchmarking & Improvement Services

15. University HealthSystem Consortium
2001 Spring Road, Suite 700
Oak Brook, IL 60523-1890
(630) 954-1700
Fax: (630) 954-4730
www.uhc.edu
© 2009 University HealthSystem Consortium. All rights reserved. The reproduction or use of this document
in any form or in any information storage and retrieval system is forbidden without the express, written
permission of UHC; however, participants in UHC’s Benchmarking & Improvement Services program may
copy portions of the document for internal use only at any time.
9/09 1000 OI0709