always quiet8aa2679ff4850707cd54-48875710e37d07ec90d263509dd76d77.r83.cf1... · always quiet...

Nashville, TN May 14 - 15, 2013

ALWAYS Quiet Quietness of the Hospital Environment

Vikki Choate, MSN, RN, CCM, RN-BC, CPHQ

Studer Group Coach

Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.

Learning Objectives

At the end of this session, participants will be

able to:

Define the physiological and psychological

effects of hospital noise on patients

Recall three best practices to decrease hospital

noise

Describe how Daily Huddles, Hourly

Rounding®, Bedside Shift Report, and Nurse

Leader Rounding may be leveraged to improve

HCAHPS ‘quiet at night’ results


Is It a Hospital or a Highway?

Heavy truck traffic

decibel level = 80

Alarms on monitors

decibel level = 79


A Patient Perspective – Straub Foundation

“If you have had the pleasure of a stay in the hospital, you know exactly what I mean. Patients rarely get any sleep. Every hour or so the overhead fluorescents flash on as a nurse makes his or her rounds. Pagers sound, machines beep, alarms blare, and cart wheels squeak. Room doors are open and the sound of staff chatter filters in. One eventually leaves the hospital exhausted.”


Hospital Noise

Unnecessary noise is “the most cruel

absence of care which can be

inflected either on sick or well.”

Florence Nightingale, 1859, Notes on Nursing


Purpose,

worthwhile work

and making

a difference

®

Healthcare Flywheel®

Bottom Line

Results

Improved

HCAHPS

results on

‘Quiet at Night’

question

Self-

Motivation

Prescriptive

To Do’s

Hourly

Rounding℠

Bedside

Shift Report

Leader

Rounding on

Patients

Daily Huddles


Execution Framework Evidence-Based LeadershipSM

Standardization Accelerators Must

Haves®

Performance

Gap

Objective

Evaluation

System

Leader

Development

Foundation

STUDER GROUP®:

Agreed upon tactics and behaviors to achieve goals

Re-recruit high and middle/solid performers

Move low performers up or out

Processes that are consistent and standardized

Process Improvement

PDCA Lean Six Sigma Baldrige Framework

Software

Aligned Goals Aligned Behavior Aligned Process

Create process to assist leaders in developing skills

Implement an organization-wide staff/leadership evaluation system to hardwire objective accountability (Must Haves®)

Rev 4.8.11


Organizations Coached by Studer Group Outperform the Nation across HCAHPS Composites

5

10

17

5.5

17

20

16

12

19

0 5 10 15 20 25

Doctor Communication

Responsiveness of Staff

Discharge Instructions

Clean and Quiet

Communication of Medications

Nursing Communication

Pain Management

Willingness to Recommend

Overall Rating

Studer Group Difference over Non-Partnersin National Percentile Ranking

Studer Group Difference over Non-Partners in National Percentile Ranking

percentile points higher

Source: The graph above shows a comparison of the average percentile rank for Studer Group Partners that have received EBL coaching since Oct 2008 and non-partners for each composite; updated 5.2.13 using 3Q11-2Q12 CMS data.

New Update!

3Q11-2Q12


Never Sometimes Usually Always

HCAHPS – The ‘Quiet’ Question

During this hospital stay, how often was the area

around your room quiet at night?

Do we really care only about night time noise?


Did You Know?

World Health Organization recommends that

hospital noise levels should not to exceed 30 db

Studies show noise levels in hospitals may

range from 53 to 117 db

Peak noise levels of a busy surgical floor can

exceed 95 db

ICUs usually have the highest sustained levels

of noise with an approximate average mean

equivalent sound level of 56 db

Source: Ann R Coll Surg Engl. Noise pollution on an acute surgical ward. 2008 Mar;90(2):136-9.


Why ‘Quiet’ is Important

Did you Know that noise?

Increases stress and anxiety levels, escalates fear

Elevates cortisol production which increases blood sugar levels and decreases immune responsiveness

Causes sleep deprivation which can lead to mood swings, confusion, or delirium

Increases heart rate and blood pressure

Increases gastric acid levels which give rise to nausea, ulcers, and GERD

Increases susceptibility to infections

…..and this goes for health care workers as well!

Source: Nurs Adm Q. The effects of hospital noise. 2010 Oct-Dec; 34(4): 327-33.


Noise Impacts Critical Communication

Noise jeopardizes important communication

between patients, families, and healthcare

workers

Miscommunication may leads to mishaps

Mishaps may lead to errors

Errors may have profoundly

negative effects on our

patients and their families


What We Say Matters

Use key words on admission to manage

patient’s expectations around noise and rest

Develop key words to use proactively during

times of construction or renovation

Set expectations for key words to be used by

staff

Adapt key rounding questions for leaders to

validate effectiveness of ‘quiet’ tactics


Driving Improved ‘Quiet at Night’ Results

Not new…..better!

Daily Huddles

Hourly Rounding®

Bedside Shift Report

Nurse Leader Rounding on Patients


Daily Huddles

Develop ‘quiet at night’ goal

Engage staff to identify strategies to reduce

noise

Incorporate goal and tactics as standing

huddle agenda

Reward & recognize or coach to gaps in

performance

Update staff with results regularly


Bedside Shift Report

Develop daily rest plan with patients

Note plan on patient communication board

Review effectiveness of plan at

each report, adjust as indicated

Use key words ‘quiet’, ‘rest’,

and ‘healing environment’


Hourly Rounding®

Offer ‘quiet kits’

Add ‘Pumps’ to the 3 Ps and

anticipate alarms

Close patient doors after rounds when safe

Follow rest plan developed with patient

Bundle care to avoid interruptions and noise

Explain rounding at night is a standard of safe,

quality care

Use key words ‘quiet’ and ‘rest’


Nurse Leader Rounding on Patients

Obtain specific feedback from patients

Act on opportunities to improve

Validate individualized rest plan and ‘quiet kit’

Use key words ‘quiet’, ‘rest’, and ‘healing environment

Reward & recognize or coach to gaps in performance

Share findings and trends during Daily Huddles


A Case Study in Noise Reduction

Mary Greeley Medical Center:

• 220 bed regional referral center in Ames, IA

• Quiet at Night HCAHPS outcome lagged

significantly behind comparative data

• Many physical/mechanical noise issues

addressed, however no movement in results

• Needed new strategy to address the people

aspect of noise



Developed HCAHPS Domain Teams

Formed ‘Blitz Team’

Established sustainability:

• Leader Rounding on Patients for quiet

• House Manager noise audits

• Celebration & lessons learned



Implemented a ‘Quiet Committee’

Invested in signage,

communication boards,

and elevator door skins



Installed noise monitoring devices

Visiting hour overhead message – “thank you for

helping us maintain a quiet, healing environment for

our patients

Established standards for phone and TV volume,

implemented Vocera etiquette

Dimmed lights

Closed patient doors

Obtained pillow speakers for TVs

Leaders modeled quiet behaviors


Confirm Learning

As a result of this presentation, are we able to?

Define the physiological and psychological

effects of hospital noise on patients

Recall three best practices to decrease hospital

noise

Describe how Daily Huddles, Hourly

Rounding®, Bedside Shift Report, and Nurse

Leader Rounding may be leveraged to improve

HCAHPS ‘quiet at night’ results


Thank You!

Vikki Choate, MSN, RN, CCM, RN-BC, CPHQ

Studer Group Coach

207.607.2218

[email protected]

mailto:[email protected]

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