Calling itself the hospital of Silicon Valley, El Camino Hospital is an acute care organization with campuses in Mountain View and Los Gatos, California. The 443-bed nonprofit shares with its pioneering neighbors a deep belief that continuous innovation in technology can drive improvement in patient care.
Yet technical innovation alone doesn’t guarantee a quality patient experience; disciplined measurement and timely analysis are needed. With the advent of public Hospital Assessment of Consumer Healthcare Providers and Systems survey reporting and reimbursements linked to patient satisfaction, hospitals cannot wait for the quarterly Centers for Medicare & Medicaid Services rankings to see what their patients think.
Historically, two departments at El Camino Hospital – Performance Improvement and Patient Experience – have shared responsibility for care quality. Their methods draw heavily on lean principles and rely on patient and staff rounding conducted by hospital and nurse leaders to ensure the best possible patient experience. But by late 2013, key measurements of these purposeful conversations between managers and staff and patients were trending negatively. Many patients did not receive a leader rounding visit to assess care quality. Some care issues were discovered after the fact. A previously established staff rounding process by executive managers did not meet objectives and was very difficult to sustain. Each development was contributing to declining patient satisfaction and lower HCAHPS scores.
Injecting Lean Discipline into Patient Rounding
Convinced that a new dose of lean discipline was overdue, quality managers undertook a complete process redesign. Every aspect of the rounding practice was re-evaluated, including how to measure the dimensions of care quality, what meaningful questions to ask patients, how to prioritize service gaps and initiate recovery, whose participation was essential, and how to track requests and responses.
The hospital also launched an open search for a technology solution to support the new rounding process. “I’d seen the inefficiencies of doing this manually, with paper,” says Chris Pratt, senior director of performance improvement. “It’s really hard to track utilization and maintain accountability, and it’s too easy for service referrals to fall through the cracks.”
After reviewing all its options, El Camino Hospital selected Vocera® Care Rounds, a configurable, secure software-as-a-service solution that facilitates patient rounding based on industry best practices. The choice was partly based on previous experience with the Vocera Communications System, a wireless communication solution successfully deployed by the hospital.
“Our CIO told us that Vocera would be really flexible in tailoring the product to our needs,” Pratt explains. “He said we were going to need that flexibility, and he was right.” Also appealing was the availability of a staff rounding module for Vocera Care Rounds.
Improving the Patient Experience
Implementation began with a new patient rounding process executed by multiple disciplines. While the hospital prioritizes nurse leadership rounds, other clinical and administrative personnel also participate, including nurse managers and directors, housekeeping supervisors, volunteers, and department managers from respiratory, laboratory and radiology services. In all, to maximize the number of patients reached, more than 30 individuals now use Vocera Care Rounds daily in 20 inpatient units across two El Camino Hospital facilities.
Most participants carry an Apple iPad tablet to access Vocera Care Rounds during patient visits. The application is prepopulated with patient information acquired from the hospital census and prompts the user with questions to initiate patient conversations. The hospital developed a core question set to address three aspects of patient experience that feature prominently in HCAHPS surveys: nurse communication, medication communication and staff responsiveness. Staff can supplement these basic topics as necessary to address other areas of interest.
El Camino Hospital has built service recovery workflows into Vocera Care Rounds to expedite responses to care and comfort issues. Buttons on the application trigger email alerts to the appropriate departments. Housekeeping alerts take advantage of the direct integration between Vocera Care Rounds and the hospital’s Vocera Communication System. A text message keyed into the Vocera Care Rounds interface is sent directly to a housekeeping supervisor’s wireless Vocera Communications Badge, ensuring immediate action. Other patient services can be proactively initiated through Vocera Care Rounds, including spiritual care and various healing services (art, music and massage therapies). All service alerts receive a confirmation email when the request is fulfilled.
“Vocera Care Rounds is a great tool,” says RJ Salus, director of patient experience at El Camino Hospital. “It’s very powerful and lets you hold people accountable to your process.”
Ensuring Compassionate, Safe Care
El Camino Hospital has also implemented Vocera Staff Rounds to support a variety of management rounds focused on internal personnel and processes:
• Executive management rounds to meet hospital staff in their workplaces and discuss work processes, communication and safety issues.
• Whiteboard utilization rounds to monitor staff use of whiteboards in patient rooms and nursing stations and to facilitate unit-based problem-solving efforts.
• Housekeeping staff rounds to standardize work processes and monitor performance.
• Daily staff huddles in each nursing unit, conducted by nurse leaders and executives.
Gaining Greater Accountability and Continuous Improvement
A year after launching its new rounding processes with Vocera Care Rounds, El Camino Hospital has experienced quantifiable improvements in every dimension of patient experience. The percentage of patients receiving at least one rounding visit during their stay has risen from 15 percent to more than 50 percent. Duplicate visits, a potential nuisance to patients, have been reduced. Rounding participation is now tracked and reported to the hospital’s chief nursing officer on a weekly basis.
Service recovery interventions are consistently more prompt, and patient complaints were down 50 percent between February and June 2015. “I was with a patient just a few days ago who had concerns about room cleanliness,” Salus recalls. “I hit the housekeeping referral button and went on to see another patient. As I was leaving the unit, maybe 10 minutes later, the housekeeping supervisor was already walking in.”