Fostering Culture to Improve Patient Experiencein the Emergency Department and Beyond

Troy Gideon, RN, MBA, Executive Director, Emergency Services and Programmatic IntegrationMary Ann Perez, Manager, Cultural Transformation and Patient Experience

Objectives

• Explore an organizational approach to fostering culture• Identify key elements to engaging staff, physicians and

patients/families• Implement a comprehensive, multidisciplinary and

multimodal approach to performance improvement• Utilizing data to inform action and tell a story

Our Cultural Transformation Journey

• Magnet Journey Redefined• Patient and Family Advisory Council

• Leadership Commitment• Infection Prevention Structure• Employee Committees• Culture of Recognition

• CULTUREPALOOZA• Daily Huddle Launch• New Employee Orientation

• Leadership Action Planning

Our Cultural Compass was written to enliven our mission and vision, and bring our values into our daily routine in a more meaningful way.

• Our Motto• Our Commitment• Own It• I Pledge Statements• St. Jude Promise to our Caregivers

Tools to Connect our Culture

Engagement of Caregivers

Outcomes in Patient Experience

and Clinical Excellence

Connection through

Philanthropy and Community

Outreach

Our Family Caring for Your FamilyAn intentional focus on our culture

What’s the Impact?

Quality Outcomes

Patient Experience

Caregiver Engagement

10

88 3 10 14*

22 I believe strongly in the goals and objectives of this organization. 93 -3 10* 12*

23 I am willing to put in a great deal of effort beyond what is normally expected to help my organization succeed. 93 -3 5 11*

30 I am proud to tell others I work for my organization. 97 6 14* 15*

35 I am able to sustain the level of energy I need throughout the work day. 85 9 11* 15*

37 My job provides me with a sense of personal accomplishment. 94 7 10* 19*

39 My department is able to meet our work challenges effectively. 84 -1 11* 11*

50 There are no substantial obstacles at work to doing my job well. 76 7 11* 15*

53 I have access to the equipment and supplies I need to do my work. 82 0 4 11*

Caregiver Engagement Results

Patient Experience Results

Quality Outcomes

Our Emergency Department• 36 beds• 71,000 visits in 2017

– 5911 visits/month– Average Daily Census 200/day

• Stroke and STEMI Receiving Center• Paramedic Base Hospital• Straddle Los Angeles and Orange County

Focusing on the Discharge Experience

Readmissions

Safety

Quality

Patient/Family Confidence

DISCHARGE COMMITTEE

CARE DELIVERY COUNCIL

(CDC)

STAFF MEETINGS &

DAILY HUDDLE

MEDICAL STAFF

COMMITTEE

Committee IntegrationBegins here

Feedback gathered

Socialized here

More PhysicianFeedback

Voice of our patients/families

Patient/ Family Advisory Council

Discharge phone calls

Social Media

Voices/Comments

Patient Letters

Discharge phone calls

Social Media: Real-time response

Voices/Comments: More than data

Letters from Patients: How we share

Patient and Family Advisory Council: Partnering to make improvements

CULTURE

Voice of our team

Daily Huddle

Physician Engagement

Committee & Staff Meetings

Celebrations &

Recognition

Building Community

Daily Huddle: Common purpose and department focus

Physician Engagement: Champions

Committee and Staff Meetings: Important way to gather and share

Celebrations & Recognition: Milestones

Building Community: Staying connected

CULTURE

Care Delivery Council (CDC)• Led by a front-line RN• Staff from Day, Mid- and Night Shift,

Paramedic Services• Medical Director, Physician Champion and

Physician Assistant• ED Leadership• Invited contributors/partners

• Information Systems/Meditech Team• Education• Patient Experience• Construction

Staff Researching

Best Practices

Reaching Out to Other

Hospitals

Feedback through

Communication Channels

The Development of Improvement Tactics

Multimodal Approachto the Discharge Experience

• Discharge Lounge– Research based– Private, calm environment– Access to resources

• Discharge Checklist– Multidisciplinary ownership

• Post-discharge Phone Calls• Simulation Lab• Standard Work Review with all Staff• Poster Presentation to Current Staff• Preceptor Checklist for New Staff

Daily Emails with Score and Voices Report

Daily Huddle

Physician-Specific Data

• Discharge Committee received Daily

• Voices: Chart Review, Discuss in Meetings

• Targeting Physician Communication

• Physician Shadowing

• Sharing data and learnings

Deploying Data to Meet Stakeholder Needs

Results

23

Sustainable EngagementTroy Gideon Organization

Total Favorable

Troy Gideon Organzation

2016PSJH Overall

2017

US Healthcare

Norm

Sustainable Engagement 88 3 10 14*

22 I believe strongly in the goals and objectives of this organization. 93 -3 10* 12*

23 I am willing to put in a great deal of effort beyond what is normally expected to help my organization succeed. 93 -3 5 11*

30 I am proud to tell others I work for my organization. 97 6 14* 15*

35 I am able to sustain the level of energy I need throughout the work day. 85 9 11* 15*

37 My job provides me with a sense of personal accomplishment. 94 7 10* 19*

39 My department is able to meet our work challenges effectively. 84 -1 11* 11*

50 There are no substantial obstacles at work to doing my job well. 76 7 11* 15*

53 I have access to the equipment and supplies I need to do my work. 82 0 4 11*

Emergency Department

48.7

30.1

17.9

62.8

42.8

22.3

75.5

63.769.1

OVERALL QUALITY OF CARE TEAMWORK AMONG PHYSICIANS AND STAFF

QUALITY OF DISCHARGE INSTRUCTIONS

Emergency Department Patient Experience Results

2015 2016 2017PRC: Percentile Rankings based on % Excellent responses

Questions?