Patient-Centered Care Process
Staff Onboarding: Creating A Single Plan of Care
A National Planetree Best Practice Award Winner 2014
To learn about bringing our patient centered care model to your facility, contact Maria Hale, Vice President, Patient-Centered Support Services, 914.666.1951 or firstname.lastname@example.org
Northern Westchester Hospital (NWH) is committed to challenging the status quo in order to make its healthcare delivery system work best for patients, their loved ones and staff. NWH recognized that individual initiatives alone were not enough. It is how these initiatives are incorporated into the patient-centered care model and how that process is executed and sustained. Also, understanding that fragmentation between various disciplines can get in the way of that goal, the hospital set out to devise a viable Single Plan of Care, the cornerstone of the redesign effort, which would serve to get the interdisciplinary team all on the same page.
In the case of Northern Westchester Hospital’s Inpatient Process Redesign (IPR) initiative, achieving a single plan of care required strong commitment and cooperation from all key stakeholder groups – nurses, physicians, the interdisciplinary care team and patients and their family members.
Listening to Patients and Families:
Collaboration with the hospital’s patient and family advisory council was instrumental in ensuring that the implementation of evidence-based communication strategies, such as teach back, standardized handoffs, discharge checklists, etc., was done in a true patient-centered way.
Click image to view In-Room Communication Board
Handoffs: A new methodology for handoffs using the patient-centered care model was devised in which the primary goal became to identify, understand and address the patient’s and family’s biggest concern at that moment.
In-Room Communication Board: A re-designed in-room communication board was designed based on the information patients and family members prioritized as most important. It includes a section entitled All About Going Home to address the patient’s comments throughout their stay in preparation for discharge. There is space for listing any new medications and side effects in easy-to-understand language. The bulk of space is reserved for family to write notes and ask questions of the clinical team, as well as pen well-wishes to their loved one.
Patient-Centered Communication Strategies: Shifting to this bi-directional dialogue was a significant change for the clinical team. To develop staff members’ comfort and competency in patient-centered communication, the hospital used a curriculum specially-designed by a physician, called Ask-Tell-Ask and used patients in role plays and simulations with staff.
The goals of the Single Plan of Care are to improve patient safety and outcomes by:
- Providing patients and family members with clear and consistent information
- Encouraging patients and family members to be active participants in all aspects of their plan of care and to identify and address their concerns and needs
It is instrumental that a patient-centered single plan of care reflect what is most important to the patient themselves. In order to do this, the hospital identified numerous well-established, high impact patient-centered communication practices which encourage two-way communication between patients and their clinicians, among them:
- RN-MD huddles, bedside shift report, in-room communication board, the teach-back methodology and specialized staff and physician training in “Ask-Tell-Ask.”
- A patient-designed discharge checklist and a structured process for discharge phone calls and follow-up appointments. A “Patient Warm Line” where patients and families can call with questions and concerns regarding their discharge instructions, medications, sign and symptoms, etc.
- NWH’s commitment to patient engagement also included the implementation of patient’s having real-time bedside access to aspects of their medical record such as, who is their care team, medications lists, certain lab tests, imaging tests orders, diet, vital signs, allergies and applicable educational materials using a specially designed bedside tablet with patient centered software.
- Each patient leaves with a homemade banana bread, made by the Hospital’s Food Service Department as a fond farewell, equipped with recipe and thank you card signed by the Food Service Team.
Changing our communication behavior to focus more on listening than telling.
Methodology for Deploying Strategies:
A consistent methodology for deploying these various strategies in a cohesive and patient-centered manner (as defined by NWH’s patients) was developed and adopted. The result, communication between the interdisciplinary team and patients and their loved ones became less about imparting information and more about understanding the patient’s most pressing concerns at any one moment and ascertaining what barriers they may encounter in managing their health upon discharge.
Training, Coaching and Onboarding
- Staff participated in multi-modality educational sessions including lectures, patient vignettes and role-playing to equip them with the knowledge and skills to be successful and truly patient-centered.
- To further ensure culture change and sustainability of these new processes, staff coaches from each unit were trained and assigned to provide real-time, observation, support, mentoring and positive and constructive feedback as the processes described above were implemented.
- Daily debriefing sessions allowed for staff feedback and to identify what was working well and areas for improvement, during the initial phase of implementation.
- Managers complete over overnight stay per year to better understand the patient experience.
The impact of this carefully planned and executed patient-centered care model redesign has been dramatic improvements in all of the HCAHPS domains over the course of a one year period, including a:
- 5.9% increase in % answered always in nurse communication
- 2.3% increase in % answered always in physician communication
- 9.3% increase in responsiveness
- 5.8% increase in communication about medication, and a
- 3.6% increase in information about discharge scores.
Our specialized Replication Program includes:
- Staff and Leadership Rounds
- MD-RN Huddles
- Communication Strategies: Ask-Tell-Ask, Teach Back, I PASS the Baton
- Transition of Care Programs
- Patient Centered Training and Onboarding Curriculum
- Process Maps
“It is all about Teamwork and Communication. We have worked hard to design with our patients and families, a comprehensive, consistent and compassion communication model from the point of admission through transition to the next level of care. Its exciting to all be on the same page.” — Ann Winkler, MA, RN, CCRN, Process Owner, Daily Care Process
To learn more about our patient-centered care model, contact Maria Hale, Vice President, Patient-Centered Support Services, 914.666.1951 or email@example.com.