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Eileen Sporing | Kathy Jenkins |
Care of the future
As many of you know, every department in the hospital is looking at how it fits into the long-term planning effort, which looks 10 to 15 years ahead to project what Children's Hospital Boston can be like in the future.
We'd like to explain some of our ideas and how some projects we're working on will become a platform for achieving some of the Care goals:
• Become the industry leader in patient safety
• Achieve highest patient satisfaction
• Develop the best patient-centric care model
Patient safety
Many of our goals are related to the hospital's current strategic plan to enhance safety and quality. Like every department, we're establishing metrics that we'll use to benchmark ourselves against other leaders in the industry, and we're working to re-engineer internal processes to improve safety. We've hired a project director for systems operations to drive many of our institutional quality initiatives. One of them is called Discerning Children's, which employs cost-trend analysis to identify opportunities to improve quality and reduce costs; we're looking at OR efficiency, complex care, surgical and medical lengths of stay, the Emergency Department processes and developing guidelines to improve patient flow. Clinical leadership is fully participating—more than 70 clinicians attended sessions at Harvard Business School to understand how internal processes could be improved to benefit patient care.
Last year, we launched a safety initiative we're especially proud of. The plan, under the leadership of Monica Kleinman, MD, director of the ICU, and Herminia Shermont, RN, MS, CNA, director of Surgical Programs, in collaboration with other Children's hospitals around the country, was to reduce cardiac and respiratory arrests. Like most hospitals, Children's has a robust response system when a patient becomes critically ill while hospitalized. But we are taking it a step further by implementing a proactive system known as CHEWS (Children's Hospital Early Warning Signs) to identify the subtle signs that a patient may be deteriorating. During the pilot on four floors, nurses did extensive training in how to recognize these signs, how to communicate to physicians through a structured communication plan and how to get help well before the child is in arrest. The initiative has been spectacularly successful—there were some 200 days without an arrest—and our next step is to implement it throughout all the inpatient areas. As we go forward, we'll develop other initiatives that will help us become an industry leader in patient safety and quality.
Patient satisfaction
We co-chair a new committee that's devoted to improving the patient experience, a big part of which is measuring the satisfaction of patients and families. We'd been using the National Research Corporation (NRC) Picker survey tool, which was originally designed at our hospital and is now used at about a third of pediatric hospitals. But we weren't totally happy with it: It was long and complicated for families to fill out and we didn't see it capturing all the data we wanted. So our internal surveying experts are developing a new survey that we will pilot this fall with 300 families. We'll collect their responses and refine the measurement tool over the next year and a half.
After we gather information from these families, we'll expand to survey to subtypes of inpatients, outpatients and even assess physician satisfaction rates. Then we'll carefully evaluate how we are doing and what the real issues are that families care about and find ways to continually improve.
Patient-centric care
Over the next five years, we want to implement changes to current operations to meet the Program for Patient Safety and Quality's strategic goal of delivering care based primarily on the child's needs rather than existing departmental or hospital structures. This means taking a step back and reevaluating our care delivery process. To do this, we have organized everything a child comes in to Children's for (whether its a cold, immunization or something more serious) into a care model, such as "primary care," "longitudinal subspecialist care" and "diagnostic assessment," to name a few.
The care models are inspired by the newest concept in delivering health care: creating value from the perspective of the patient. Modern medicine is increasingly specialized, and patients don't always see the appropriate specialist right away. For example, if a child faints, does he go to Cardiology? Neurology? How are we routing the patient between all these specialties—and do they feel the process is working? It hasn't been part of our process to ever ask them. The hospital has never gone to families and asked, 'If you have a fever of unknown origin, how would you like that diagnostic process to work?' and tried to create that experience for them. We've been trying to fit them into the ways each of our departments are set up.
We want to produce excellent outcomes while considering all of the patient's needs, including quick access to tests and procedures, streamlined access to subspecialty programs, assigning one point person to a child's case to communicate the plan of care with him and his family and making follow-up appointments prior to discharge. We think we'll find that about half the time, the way we're structured is the closest we can get to what patients want. In those cases, the questions will become, How well do we execute the plan we currently have? And are we doing it right every time? But about half the time, we'll probably find that what patients want and what we offer don't match up, and that our expectations are different. It's a whole new way of looking and evaluating our care.
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