project: patient satisfaction with pain … statement • what is the ... did you expect you would...

Project: Patient Satisfaction with Pain Management Name of Green Belt(s): Donna Grochow & Maurice Espinoza Name of Champion: Karen Grimley & Zeev Kain, MD Date: March 6, 2012

EP33g, Lean Six Sigma-Patient Satisfaction with Pain Management Presentation to Master Black Belt.pdf

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Problem Statement • What is the problem? Low patient satisfaction with pain management has

been identified as an organizational problem.

• How do we know it is a problem? The baseline patient satisfaction scores aggregated at the organizational level for satisfaction with pain management are at the 26th percentile when compared nationally.

• What data to we have on baseline performance? National comparative data from the HCAHPS Patient Satisfaction survey is available at the organizational and unit level. Additionally, nursing has been involved in a multi-center research problem sponsored by the National Database of Nursing Quality Indicators which has resulted in data regarding pain management.

• What “pain” does it cause? (impact to patient and/or bottom line): 74% of other benchmarked facilities receive better scores from the patient in regards to pain management, causing the patient to perceive less than optimal care was provided which can lead to poor satisfaction scores, poor publically reported data, decreased reimbursement, and a potential increase in length of stay.

DEFINE EP33g, Lean Six Sigma-Patient Satisfaction with Pain Management Presentation to Master Black Belt.pdf

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Presenter

Presentation Notes

This should come from your project charter and should include baseline data as a reference point if available.

Why is this important?

• Include Voice of the Customer (VOC): Patients are not satisfied with the pain management that is provided.

• Why this, why now? (“Burning Platform”): Scores have been low for a long time, Publically reported, Reimbursement issues, Quality of care issues, Affects Magnet Status

• What will happen if we don’t fix this? Potential loss of patients to other providers, Decrease revenue, Increase length of stay, loss of magnet designation, etc.


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Stakeholder Analysis-Template DEFINE

Insert your Stakeholder analysis here….

Stakeholder(s) Level of Influence Interest in project 2 Current Level of Support StrategyLikert 1 - 5

High = 3 Medium = 2 Low = 1 Gain = 3 Neutral = 2 Loss = 1

Very supportive = 5 Slightly Supportive =4 Neutral = 3 Slightly Resistant =2 Very Resistant = 1

Name and Title could they determine project success? do they perceive a gain or loss? how supportive are they currently? how can we engage their support?Dr. Kain 3 3 5Karen Grimley 3 3 5Nursing Staff 3 3 4MD Staff 3 2 3 Educate, Support from Peers

Stakeholder Analysis


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Project Charter Project Name: Patient Satisfaction with Pain Management

Champion: Karen Grimley & Zeev Kain, MD

Belt: Donna Grochow & Maurice Espinoza Master Black Belt: Laura Winner/Henry Alvarez Problem Statement: The current patient satisfaction scores aggregated at the organizational level for satisfaction with pain management are at the 26th percentile when compared nationally. Four units are <10th percentile.

Project Goal: To improve the perceptual experience of patients with pain management to the 50th percentile on selected units. To increase the mean of the 3 Path Y statements to the benchmark mean and/or 50th Percentile.

Project Y / Path-Y: Project Y: Patient satisfaction scores with pain management. Path-Y: Mean percent of patients with positive response to the statement “My Healthcare team involved me in the decisions about controlling my pain”. Path-Y: Mean percent of patients with positive response to the statement “My nurse suggested approaches to help manage my pain”. Path-Y: Mean percent of patients with positive response to the statement “My nurse believed my reports about my pain”.

Scope: Limited to these areas with current satisfaction scores <10th percentile: CCU, DH 32, Tower 4, & 5

Team Members: Nursing: Physician: Donna Grochow S. Liao, MD Maurice Espinoza I. De Alba MD Charlene Miranda-Wood Patient Relations: Khaled Al Eid Carla Camarillo Victoria Malonzo Haley McCraney Van Le Pharmacy Holly Wicklas Lan Zheng Dan Bernsein

Benefits: Improved patient pain satisfaction scores Decreased length of stay Improved physiological and psychological healing Decreased rate of readmission Decreased rate of outpatient visits

Timeline: Define/Measure July-September 2011 Analyze September-December 2011 Improve/Control January-March 2012


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SIPOC

DEFINE


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Early Waste Identification DOMOWIT • Defects:

– Lack of communication between MD & RN regarding pain plan of care

– Lack of communication between RN & aide regarding pain plan of care

– Lack of communication between RN & patient regarding pain plan of care

– Lack of communication between aide & patient regarding pain plan of care

– Lack of communication between MD & patient regarding pain plan of care

• Over-processing – RN often has to page and/or call MD multiple times for pain medication orders

– Patient often unaware of when pain medication is available and has to repeatedly ask nurse

• Motion – RN or aide has to answer patient’s call light to answer question about when next pain medication is due

• Over-production:

• Waiting – Adequate/correct pain medication not given timely, patient has to request pain medication

• Inventory

• Transportation


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Voice of Customer

Patients

Nursing

Physicians

Pharmacists


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Voice of Customer

• What We Currently Have Available: – Patient Satisfaction Data (HCAHPS)

– National Database of Nursing Quality Indicators (NDNQI): • Participated in research study to identify issues with pain management

• All eligible medical-surgical patients were surveyed on 1 day in April 2011.

• Baseline data available for review

• Repeat survey pending in November

• Next Steps: – Interview patients 1 day per week x 3 weeks using pre-designed

survey tool

– Focus groups with key stakeholders: MDs, nurses, pharmacist, etc.


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Voice of Customer (VOC): Patient

paste

DEFINE

Questions # of Yes Responses % 1. Did you expect you would have pain while in the hospital? 18 78% 2. When the staff came into your room, did they ask about your pain often enough? 20 87% 3. Do you understand the pain scale? 23 100% 4. Are you comfortable talking about our pain with the staff? 23 100% 5. Does the staff inform you of the plan to manage your pain so you understand? 18 78% 6. When you were in pain, did the staff act as fast as you expected? 19 83% 7. Do you believe the staff do everything they can to manage your pain? 18 78% 8. Do you notice any difference in your pain management day to day? 6 26%

→ 22% of the patients did not expect to have pain.

→ 22% of the patients were not informed about plan to manage pain

23 English speaking patients interviewed on DH32, 4T, 5T & MICU

The following lists the questions that the patients were asked to answer along with the responses.

→ 26% of the patients noticed differences in the management of pain from day to day


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Voice of Customer (VOC): Patient

paste

DEFINE

Questions UC Mean Benchmark 50th Percentile 1. My nurse believed my report of pain 5.61 5.68 2. I had pain medication available when I needed it. 5.41 5.56 3. My nurse suggested approaches to manage my pain. 3.73 3.67 4. My nurse discussed side effects of pain meds with me 3.54 3.63 5. The pain medications worked well to control my pain 4.89 5 6. My healthcare team involved me in decisions about pain control 4.8 4.94 7. Patients constantly experiencing pain in the past 2 hours 14.6 4.17 8. % of relief from pain treatments or medication provided 68.62 70

→ Our scores were < 50th percentile in almost all categories

23 speaking patients interviewed on DH32, 4T, 5T & MICU

The following lists the questions that the patients were asked to answer along with the responses.


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Voice of Customer (VOC): RN

paste

DEFINE

Themes 1. Communication 2. Knowledge/Education 3. Process 3. Patient Condition 4. Influence of Supervisors 5. Equipment 6. Complementary Therapy

Focus groups were held with staff from DH32, 4T, 5T & MICU. The focus group consisted of a written survey and verbal roundtable discussion

The following themes affecting pain management were identified from the focus groups:


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Voice of Customer (VOC): RN

paste

DEFINE

Focus groups were held with staff from DH32, 4T, 5T & MICU. The focus group consisted of a written survey and verbal roundtable discussion

The following themes affecting pain management were identified from the focus groups:

Compli

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Baseline Process Map MEASURE


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Presenter

Presentation Notes

Process Flow Charts and/or VSM.

Baseline Data for Y-Template

•Baseline data from HCAHPS Composite.

MEASURE

Describe how baseline data was obtained…

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Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11

Patient Satisfaction with Pain Managment

UC Irvine Percentile

HCAHPS 50th Percentile


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Presenter

Presentation Notes

Additional baseline data as necessary and Measurement System Analysis.

Interventions Implemented February 21,2012

Baseline Data for Path Y MEASURE


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Baseline Data for Y-Template

•Baseline data from HCAHPS Composite.

MEASURE

Describe how baseline data was obtained…


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Presenter

Presentation Notes

Additional baseline data as necessary and Measurement System Analysis.

Measure MEASURE

Results from Brainstorming on ALL potential X’s …


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Presenter

Presentation Notes

Generating X’s through tools such as: Fishbone, Pareto, Spaghetti.

Filter X’s FMEA Filtering of X’s to vital few…

MEASURE EP33g, Lean Six Sigma-Patient Satisfaction with Pain Management Presentation to Master Black Belt.pdf

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Presenter

Presentation Notes

Filter X’s through tools such as C&E Matrix, FMEA.

Filter X’s Filtering of X’s to vital few…


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Presenter

Presentation Notes


Filter X’s Filtering of X’s to vital few…


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Presentation Notes


Analyze

Which X’s are key?

5 Whys

Cause & Effect Analysis

ANALYZE EP33g, Lean Six Sigma-Patient Satisfaction with Pain Management Presentation to Master Black Belt.pdf

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Presenter

Presentation Notes

Known lean X’s (7 wastes) Statistical evidence from hypothesis testing

Cause & Effect Summary

• Multiple Inputs were originally identified in the SIPOC

• Common themes were identified via surveys and focus groups

• These were then rated within categories – Patient Satisfaction with Pain Management

– RN Role in Pain Management

– MD Role in Pain Management

• The C & E methodology identified the top Inputs/themes with scores as seen in the next slide

• The top ranked Inputs/themes guided the work for the Improve phase

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Cause & Effect

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Cause & Effect

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Analyze: 5 Whys of Pain ANALYZE


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Presenter

Presentation Notes


Analyze: 5 Whys ANALYZE


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Presenter

Presentation Notes


Analyze: 5 Whys ANALYZE


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Presenter

Presentation Notes


Analyze: VOC-Nursing

ANALYZE

C3 47 29 28 8 4 3 2Percent 38.8 24.0 23.1 6.6 3.3 2.5 1.7Cum % 38.8 62.8 86.0 92.6 95.9 98.3 100.0

C2

Compli

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Pareto Chart of C2


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Presenter

Presentation Notes


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Impa

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Ease of Implementation

Pain Scale Poster

Pain Goal & Medication Poster

Huddle Education

Quick Education Sheet Campaign

Pain Score Dashboards

Pain Score Reports to MD

MD Pain Management Education

Communication Reminders to MD

Require Pain Consult for Chronic Pain Patients

Pain Free Campaign-Lounges, Workroom & Intranet

Improve Pain Resource Website Visibility

IMPROVE

Ease v. Impact Based on key X’s identified, what improvements were identified?


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Presenter

Presentation Notes

Consider impact of improvement and ease of implementation analysis.

Interventions What X’s were selected for modification? Communication Education What are the Interventions and the key X’s they address? Improved Communication: Pain Scale Poster Pain Goal & Medication Poster Poster Campaign-Lounges & Workroom (Potentially) Improve Pain Resource Website Visibility (Potentially) Nursing Education Huddle Education Quick Education Sheet Developed Pain Score Dashboards MD Education Pain Score Reports to MD Communication Reminders to MD Pilot interventions and collect data…

IMPROVE EP33g, Lean Six Sigma-Patient Satisfaction with Pain Management Presentation to Master Black Belt.pdf

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Presenter

Presentation Notes

Detail which interventions/improvements were implemented.

Visual Pain Tools in Every Patient Room


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Presentation Notes


Ongoing Education-Example


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Presenter

Presentation Notes


Control Plan CONTROL

→ Control Plan to keep Improvements in place

→ Reaction plan/feedback mechanism


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Presenter

Presentation Notes

How will you maintain the gains/sustain results?

Control Plan CONTROL

→ Control Plan to keep Improvements in place

→ Reaction plan/feedback mechanism


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Presenter

Presentation Notes

How will you maintain the gains/sustain results?

Pain Management Scores-Prior to Improve Phase

DH 32

Interventions Implemented February 21,2012

CCU

4T 5T

CONTROL


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Pain Management Scores-Prior to Improve Phase Interventions Implemented February 21,2012

CONTROL


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CONTROL → Right after key interventions implemented, Audit Results

→ Visual Pain Tool is present in room

→ DC % steady with both improvement in median order time & discharge leadtime

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Yes No No Answer

Is the pain tool in the room?


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→ Visual Pain Tool is being used by 68% of RNs

→ Education regarding tool was provided

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Yes No No Answer

Is the staff RN utilizing the tool?


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→ Visual Pain Tool is visible to 96% of patients

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Can the patient see the tool?


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→ 82% of patients understand the tool


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Does the patient understand the tool?


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→ 78% of patients like the tool

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Yes No No Answer

Does the patient like the tool?


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→ 64% of patients think pain tool is helping team to effectively manage pain


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Yes No No Answer

Is the pain tool helping you and your nurse manage your pain effectively?


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Opportunity for Spread

• Could other areas of the organization benefit from a similar improvement effort?

Plan is to disseminate interventions to entire organization once pilot is completed and any needed changes are finalized.


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project: patient satisfaction with pain … statement • what is the ... did you expect you would...

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