Our Stories: The importance of effective provider communication in patient care

Communication is at the center of what we do every day as humans. What I have learned is there are tools and behaviors that we can use to help us be better communicators. During the pandemic, I have learned that with improved communication comes empowerment through knowledge and sometimes, peace and comfort.

Effective communication allows us to develop common expectations, means we must not only speak clearly but also listen intently, and requires some mechanism to assure that there is a closed loop–what we think was said, is confirmed.

There is no more important communication than when we are taking care of our patients. We need to know about them and they need to understand what we are diagnosing and how we will evaluate and treat them. Unless we are on the same page, quality, safety, and the provider-patient relationship will suffer.

In this month’s blog, you will hear (and see) more about our Provider Communication Program. If you are a provider and have not attended this program, we—including your colleagues who have attended—recommend that you sign up.

Thanks for all you do!

Theresa Brennan, MD 

Communication between health care providers and patients is critical to our goal of delivering consistent, high-quality care to every individual

In our personal and professional lives, we have all experienced situations where communication might have been better. Sometimes this resulted in a simple misunderstanding, with no adverse impactOther times the result may have been a significant inconvenience, financial burden, or other unwelcome consequence.

Health care is unique, however, because poor communication can also result in poor-quality of care or poor health outcomes that could be avoided.

The good news is that everyone can improve their communication skills.

UI Hospital & Clinics’ Provider Communication Program is effective at improving provider confidence and skills as they relate to successful communication and building rapport with patients

Don’t just take my word for it though. Learn how one UI Hospital & Clinics’ provider, Kathy Lee-Son, MD, benefitted from the program.

The Provider Communication Program is free and available to all physicians and advanced practice providers (APPs) at UI Hospitals & Clinics. Successful completion of the program includes up to 4.5 AMA PRA Category 1 credits. 

To maximize the effectiveness of the program and ensure relevance of the content, each workshop is facilitated by practicing UI Health Care physicians and APPs. To help sustain, and reinforce, these critical skills, each attendee is paired with a professional coach rho will meet with them 30 and 60days postworkshop.

The Provider Communication Program workshop is also being offered 100% online through May 2021. After this date a determination to continue virtually or resume in-person sessions will be made (6 workshops are offered each month). Learn more and register for the Provider Communication Program.

Starting with this April Quest issue, the Office of the Patient Experience is excited to highlight a new Provider Communication “Booster Video” each month over the next 12 months, beginning with Skill Set #1: Beginning the Visit in the Adult Inpatient Setting.

If you have not already completed the Provider Communication Program, we sincerely hope you will join us for this rewarding and exciting experience.  

We hope to see you soon.

Alexander Nance, MHA
Director, Office of The Patient Experience

Our Stories: National Patient Safety Awareness Week

Ensuring patient safety is an essential part of providing high-quality health care and is a top priority for UI Health Care. Across the nation, health care systems will celebrate National Patient Safety Awareness Week, an annual health observance, from March 15 to March 19. National Patient Safety Awareness Week serves to increase awareness about patient safety and recognize the fantastic work by all of you and our great organization.

As we approach Patient Safety Awareness Week, please take the opportunity to reflect on the many ways in which we contribute to safe, high-quality patient care. The Quality Improvement Program has planned virtual events throughout the week to acknowledge and celebrate efforts to improve patient safety. I encourage all of you to participate.

I would also ask that you take some time to reflect on the unprecedented challenges that all health care systems have experienced this past year. Pausing to reflect will help you appreciate and be humbled by the power of team, by the power of the collective voice, and by the power of leadership that resides in each and every one of us to rise up and respond to such challenges.

It is by working together that we have and will continue to change health care. Please stay tuned to The Loop for details on UI Health Care National Patient Safety Awareness Week celebrations.

Thank you for all that you do each and every day!

– Theresa Brennan, MD

 

Our Stories: Staff Safety

Sometimes when we’re working, someone says something in a way that makes us uncomfortable. Often, we give people the benefit of the doubt, but if we feel threatened, we should not take chances when it comes to our safety. Everyone has the right to come to work and feel 100% safe.

It is our responsibility as leaders to provide you with a safe working environment and methods to address concerns when they arise. For the last 10 months, we have focused on how to stay safe from the virus that causes COVID -19. That is very important, and I hope you are following recommendations both inside and outside our UI Health Care facilities.

I want to highlight some of the available resources if you find yourself in a situation where you feel emotionally or physically threatened. Whether the situation involves a colleague, patient, or visitor, please know we have systems in place to address your concerns.

Following are four situations and instructions for dealing with each.

Unprofessional interaction with a coworker:

  • If you experience an unprofessional interaction with a coworker, please attempt to have a professional and productive conversation with that coworker. Wait until emotions are even and meet in a neutral and private location. Addressing conflict is a very productive way to build teams. If your conversation is not productive, if there is a power differential, or if there is a significant reason you two cannot meet, I encourage you to enter a report into the CORS (Co-worker Observation Reporting System). CORS uses a process aimed at delivering feedback in a non-judgmental way. This allows the identified staff member to reflect on their practice and associated interactions with co-workers, as well as the opportunity to self-regulate behaviors. I’ve learned we may not be aware of how we’re perceived or the impact of our words, their delivery, or our actions. Without feedback, none of us can learn. CORS provides a mirror into how we are perceived by others, insight on how that affects our team, and a gauge of the quality and safety of our care. After a CORS report is filed, trained peer messengers will share information with their colleagues to inform them about specific issues and provide the opportunity to improve their communication practices. This is an anonymous process, and information regarding who reported the incident is not shared with the peer messenger or colleague.

Threatening interaction:

  • If a workplace experience with an individual leaves you feeling threatened (i.e., he or she is exhibiting the potential for future violence or harm), but the individual is not presently violent, call Safety and Security at 319-356-2658. Safety and Security will work with the Threat Assessment Program to investigate the nature of the threat and respond accordingly. The Assessment and Care team provides an integrated and coordinated process for identifying and responding to students, faculty, staff, patients, and others affiliated with the University of Iowa who may be at risk of harming themselves or others.
  • If the person threatening you is a patient or visitor, it’s best to use language to diffuse the situation. We all have empathy and compassion for those who are sick and those who are worried about their loved ones. We may feel they are just “blowing off steam” and that we shouldn’t escalate the situation by taking their words seriously. For example, if a patient or visitor says something like “you’ll regret this,” “if he gets worse, I will be back and you won’t like it,” or “it won’t be good for you if she doesn’t get better,” their words may have been said in the heat of the moment; however, these declarations are actually signals that the person may not be thinking or acting in a logical way. These threats may also be warnings they may follow through with action and harm you or others. For example, I treated a sick patient in the ICU, and her husband was afraid he would lose her and threatened, “If she dies, I will be back with my gun.” We took that seriously and called for help. The Threat Assessment Program was great, both with our team and with the patient and her husband. He did own a weapon and may have never used it, but the Threat Assessment Program protected us. As in many of these situations, the husband regretted his words. By directly addressing this threatening interaction, we discussed boundaries and better methods for expressing his concerns in the future.

Violent interactions with a patient:

  • A Code Green violent patient management team is available to respond to potentially violent patient situations. Any staff member may declare a Code Green by dialing 192 if assaultive, combative, or uncontrolled patients pose a threat to themselves, staff members, patients, visitors, or hospital property. When calling the Code Green number, please:
    1. Identify that you need the Code Green team
    2. Identify yourself
    3. Identify the unit, building, and room number where help is needed.

Violent interactions with a visitor, family member, or staff member:

  • Contact Safety and Security by dialing 195 or 911 during situations when visitors, family, or staff are being disruptive, hostile, or threatening others. Safety and Security will work with hospital administration and local law enforcement agencies to control these situations.

As I mentioned above, we have resources available for all our staff members. If you’ve experienced a threat or violence, please seek emotional support after this event from any of the following sources:

  • The COPE team is comprised of volunteers including chaplains, physicians, social workers, psychiatrists, nurses, therapists, and others and strives to provide emotional support and healing to health care providers who have experienced difficult situations.
  • The Employee Assistance Program (EAP) provides integrated services to faculty, staff, and their family members to promote emotional well-being and to increase engagement and productivity among members of our UI community.
  • Office of the Ombudsperson is a resource for any member of the university community— including students, faculty, and staff—with a problem or concern. They provide informal conflict resolution, mediation services, and advocacy for fair treatment and fair process.
  • Diversity, Equity, and Inclusion @Iowa provides services related to human rights, anti-harassment, violence, anti-retaliation, and discrimination.
  • The Office of Diversity, Equity, and Inclusion provides cultural enrichment and acclimation programs for members of the Carver College of Medicine and UI Health Care community.
  • Office of the Sexual Misconduct Response Coordinator (OSMRC) coordinates the university’s response to reports of sexual harassment and sexual misconduct.
  • Ethics Point should be used to file an anonymous complaint related to a financial crime or misconduct.

Just as you hear at the Eastern Iowa airport: “If you see something, say something,” you should apply this idea at work as well. Know your resources and have a plan to utilize them if the need arises. Your safety matters, as does the safety of your team.

UI Health Care is on a constant quest for improvement, and as an institution we can’t address what we don’t know. We want to hear from you.

I wish you a happy and safe 2021. I am hoping for a year where we all have many opportunities to share our great stories. Thanks for your perseverance, your resiliency, and all you do each and every day.

– Theresa Brennan, MD

References:
UIHC Policies Manual 
Code Green Violent Patient Management Policy EOC-Safety-01.030 
Workplace Violence Policy, EOC-Security-02.007

Our Stories: Covid-19

Unfortunately, COVID-19 is now another one of “Our Stories.” It is in our community and I would venture that each of you has now have someone you know who has been infected. When this occurs, and when we see community transmission of infections locally, it becomes very personal. This leads each of us to begin to think about and worry about many things. For you, the issues are magnified as you are health care workers.

This blog has been devoted to “Our Stories” from the beginning and for most of them they are very positive. COVID-19 is not a positive story, but I think there are things we can do make it into one.

I would offer three things:

  1. First, all those working within UI Health Care are not new to facing great and complex challenges. It was recently said that we are made for this and I agree.  No matter what happens, we will FIGHT this and we will ultimately win the battle.  We can only do this, though, by standing together.
  2. Second, our community has been amazing in joining us in this battle. Be grateful for the entire UI Health Care team and our community. Show your gratitude with the WE STAND TOGETHER campaign.
  3. Finally, focus on what we can control, and focus on the positive. I am disappointed by all the negative that we see today. Be empowered, and focus on the positive.

Together, we’ll get through this.

Our Stories: Patient Safety is a Team Sport

March 8 to 14 has been designated as Patient Safety Awareness Week. The Institute of Medicine’s report, To Err is Human, has been transformational for patient safety. The report brought to light that many errors in health care result from a culture and system that is fragmented and that improving health care requires a team approach. Several major points in the report are that errors are common and costly, systems-related problems cause errors, errors can be prevented, and safety can be improved. Twenty years later, the Patient Safety movement has produced learnings that demonstrate significant improvement in the care patients receive, and conversely that many opportunities remain.

Health care organizations are in a constant state of stress due to high patient volumes, complex, sicker patients and staff shortages. UI Hospitals & Clinics is not protected from these challenges. Daily we prioritize and re-prioritize throughput issues, discuss barriers to discharge, navigate the impact of behavioral health on patient and staff safety, accommodate medication shortages, and at this point in time, strategically plan how we will respond to an impending pandemic related to coronavirus.

Who we are as an organization and how we responsibly engage in the work of patient safety could not be more important. In the past five years much work has been accomplished to implement and operationalize a quality and safety structure that has reduced fragmentation and emphasized alignment of quality and safety work across the organization. This alignment creates greater critical mass and collective voice around quality and safety priorities, and in turn establishes health care as team sport, allowing us to continue to improve the care we provide patients.

In addition, senior leadership continues to invest in tools and programs that will influence UI Hospitals & Clinics’ ability to achieve and sustain excellence in care delivery free of preventable harm. On March 9, we will launch a new incident reporting system, Riskonnect. The new system is intuitive with a user-friendly platform, provides improved detail in event reporting and analytics, and system availability of Root Cause Analysis (RCA), peer review, and claims modules providing one protected location for all event review information. This past week, training was provided on how to communicate and disclose information to patients and families that have experienced a harm event. In the near future, we will make a decision on a Just Culture consultant who will partner with us over the next couple of years to establish systems of strong accountability for safe practices in which healthcare is delivered.

As we approach Patient Safety Awareness Week, take the opportunity to reflect on the many ways in which we contribute to the provision of safe, high quality patient care. I invite you to participate in the activities that have been planned here at UI Hopsitals & Clinics. And last but not least, I encourage you to take the opportunity to thank the members of your team, those you work closely with each and every day, to ensure we make a difference in the lives of those we care for!

Beth A. Hanna, BSN, RN, MA
Director, Quality Improvement Program

Our Stories: Practicing gratitude

Our national history shows that in 1621, the Colonists and their Native American allies, the Wampanoag, shared a harvest feast.  This is thought to be one of the first thanksgiving celebrations in the United States.  This tradition continued, on and off, until 1863 when Abraham Lincoln proclaimed the fourth Thursday of November to be a national holiday—Thanksgiving.

These original “feasts” were really a celebration of life based on a successful harvest during times of significant hardship.  They celebrated their crops and they celebrated their families and friends.  This holiday is referred to by some as a day to celebrate with happy gratitude.  Many of us are blessed to be able to have this time of celebration with our family and friends.  Although we celebrate today, for many of us as a day of excess, the original Americans celebrated their ability to survive.

As your chief medical officer, a physician, and a patient, there is much for me to reflect on with happy gratitude.  We have a fantastic team who takes excellent care of our patients each and every day, and does it through unconditional support of each other.  Though there are times when we stumble, as the need arises the team with UI Health Care can always be counted on to rise to the occasion and bring forth our best.  I would be living in fantasyland if I did not also recognize the many hardships that we face each and every day.  Though our struggles are different than those first Americans, the effort required to overcome them are just as great.

I write to you today to express my sincerest gratitude for what you do each and every day for our patients, their families, and all who work at UI Health Care.  Although we all, I may be the worst, tend to look toward tomorrow and how we can be better, now is an excellent time for us to look back and celebrate.  I recently received an unsolicited note from a patient:

“… whomever is responsible for the amazing turnaround that appears to have occurred in patient services at UIHC should be commended and recognized. I have a considerable history at UIHC …. and have experienced the best care I could imagine. However, the services surrounding the direct care, as you know, have not always been great.

“Things have obviously changed for me and, I assume, others. For example, I walked into the digestive disorders clinic one afternoon bleeding from a polyp removal.  The staff said Dr, Gerke would be a minute. Dr. Gerke, completing a procedure  on another patient, met with me and indicated that though it didn’t appear to be an emergency he couldn’t be sure.  I could either go to the emergency room, stay the night and get prepped for a colonoscopy the next morning or, surprisingly, go back with his team and have the procedure, unsedated, NOW.   I chose the ‘NOW.’ I left an hour later, repaired, impressed, and laughing about the experience and pain.  There is no place in the world I could have gotten that kind of care.

“Though not as dramatic my recent experiences with your other clinics have also improved my perceptions of UHIC patient care and services. I hope your success continues. “

“Whomever is responsible”, is you!  And this is only the start.  Did you know that in fiscal year 19, we:

*The following numbers are rough estimates
  • Provided around 2,593,606 million meals
  • Volunteered over 110,000 hours
  • Cared for over 55,000 ETC patients (with over 740 being transported via AirCare)
  • Preformed over 34,000 surgical procedures
  • Provided over 315,000 radiographic exams and treatments
  • Filled over 2.2 million pharmacy orders
  • Provided around 5.5 million laboratory tests
  • Trained over 1800 students in Health Education
  • Provided over 220,000 social service consultations
  • Privileged 258 new providers, modified 120 current providers, and reaffirmed 762 providers
  • Submitted 15,811 PSNs
  • Submitted 218 NIH grants
  • Published 2,797 research pieces

And since January 1, 2019, we have:

  • Cared for over 27,755 inpatients
  • Delivered over 2,111 babies
  • Saw and cared for around 890,000 patients in clinics
  • Helped over 325 colleagues COPE with a challenging work-related experience

And we have successfully undergone 4 accreditation visits from the Joint Commission including our massive triennial survey.

All of this while improving our surgical site infection rates, our central line blood stream rates, our medication errors, our hospital acquired pressure ulcers, and our patient satisfaction metrics in nearly every category and achieving an all time high on our nurse and doctor communication HCAHPS.   And there is some much more to this amazing story….

This is Our Story and it makes me proud and filled with happy gratitude.   Take a moment to step back and be grateful to yourself and to quote one of our quality leaders, “Go (continue to) Be Great”!!

 

—Theresa Brennan, MD, Chief Medical Officer

Our Stories: Making Difference through Documentation

Accurate clinical documentation is essential to patient care. The medical record allows us to have asynchronous communication among the many team members and with our referring physicians. Telling the patient’s story, accurately, in the medical record allows for the highest quality and safest care for our patients. Documentation also lends to appropriate risk assessment of our patients. This is a critical way to assess our quality of care. Finally, clinical documentation leads to medical coding which results in overall payment for inpatient admissions. For all of these reasons, it is our duty as health care professionals to make sure that our documentation is accurate and complete. I have asked Deanna Brennan, director of Clinical Documentation Improvement to lead this month’s blog and discuss accurate and complete documentation. 

As we move into the month of May, I am excited to have the opportunity to share our program with you and answer your questions regarding how clinical documentation impacts our organization and why it’s such an important piece of your daily work. As the director of our Clinical Documentation Improvement department for the past three years, I have had the opportunity to hear the daily frustrations that many of you have regarding documentation requirements, queries, and coding nuances. One of the most common questions I hear from providers is, “What difference does it make?” To answer that question, your documentation has the potential to make a tremendous difference in accurately reporting the complexity and acuity of the patients you care for. In turn, this data is used to show the excellent care that we give, and that University of Iowa Hospitals & Clinics is a high-quality organization that cares for highly complex patients with excellent patient outcomes. 

Clinical Documentation Improvement programs are an integral part of health care facilities across the nation, facilitating high level accuracy of documentation and coding. These programs are made up of clinical documentation specialists that partner with providers and coding teams to impact documentation quality, patient outcomes, and accuracy of data analytics. UI Hospitals & Clinics implemented the Clinical Documentation program in 2004, with the assistance of eight “DRG nurses” who reviewed charts and assigned a documentation related grouper (DRG) that reflected the patients’ care needs, acuity of illness and expected length of stay.  As focus on documentation and coding increases, the UI Hospitals & Clinics program has evolved to take on new projects, challenges, and improved engagement strategies to help our organization achieve its mission. 

Through its daily efforts, the Clinical Documentation Improvement (CDI) team works with providers to ensure medical records contain a complete and accurate picture of the patient’s level of care, severity of illness, and risk of mortality, while also supporting necessary resource utilization. The CDI nurses help to ensure that the record supports accurate capture of documentation codes, statistical data, quality metrics, and reimbursement. This is accomplished through ongoing education and collaboration among the CDI nurses and various specialty teams.

The department works as a liaison service for multiple areas of the hospital, using data analytics to identify areas of opportunity for improved documentation. CDI uses a teamwork mentality to partner with services, provide education, and identify areas of focus to improve documentation accuracy. The department provides regular feedback to providers regarding individual patient records, takes part in chart review discussions, and provides resources for documentation improvement.

Our department is comprised of 16 clinical documentation specialty nurses and a quality oversight specialist. The team’s primary purpose is concurrent review of medical records to improve accuracy, clarity, and specificity of provider documentation. They bridge the gap between providers and hospital coders by clarifying at-risk documentation prior to claim submission. They collaborate extensively with physicians, coding staff, and other patient caregivers to improve accuracy and completeness of acute inpatient documentation. They must adhere to ethical and professional business practices as governed by the Association of Clinical Documentation Improvement Specialists (ACDIS) and the American Health Information Management Association (AHIMA).

Clinical Documentation Improvement is a specialized field that utilizes highly experienced nurses with a diverse clinical background, requiring them to acquire proficient coding skills and knowledge. CDI nurses must have the ability and willingness to seek out changes in healthcare reform and coding regulations, then incorporate those changes into their practice. These nurses must possess a high level of organization and computer skills, comprehensive medical knowledge, and utilize effective communication. These capabilities help them to identify gaps in the clinical documentation.

The CDI department at UI Hospitals & Clinics is an excellent resource for providers wishing to increase their knowledge of documentation requirements and improve accuracy and completeness of medical records. In the past year, CDI has partnered with a variety of specialty services, such as the Heart and Vascular Center and neurosurgery, to help identify opportunities for documentation improvement for accuracy and completeness. CDI continues to look for opportunities to educate, collaborate, and improve clinical documentation throughout our organization. If you or your team wish for increased engagement from the CDI program or if you wish to learn more about documentation improvement and engage in educational opportunities, please contact our program with information below.

Thank you for the excellent care you give to our patients and for your attention to the impact that your medical record documentation has on our organization.

Deanna Brennan, RN, BSN, CCDS
Clinical Documentation Improvement manager/director

Contact:
Clinical Documentation Improvement
Pager #5496 or
CDI-RN@uiowa.edu

Manager/director: Deanna Brennan, deanna-brennan@uiowa.edu
Quality oversight specialist: Jaime Sherman, Jaime-sherman@uiowa.edu

Our Stories: A Quality Improvement Journey at UI Hospitals & Clinics

I am pleased to have Beth Hanna, director of our Quality Improvement Program, as our guest author for the CMO blog this month. As we all are aware, quality revolves around our patients. High quality care with elimination of preventable harm is what we must strive for every day, and we do! Please take some time to read Beth’s very well done blog, and as usual, please contact us with comments.  

National Patient Safety Week was celebrated March 10–16, 2019. University of Iowa Health Care will celebrate Patient Safety Week April 29 to May 3 in partnership with the Quality Improvement Program, Department of Nursing, and the Office of the Patient Experience. Twenty years have passed since the Institute of Medicine, renamed the National Academy of Medicine in 2015, published To Err is Human: Building a Safer Health System. The report garnered the attention of many because it estimated that as many as 98,000 hospitalized patients in the United States die each year as a result of patient safety failures. Subsequent articles have suggested the number may be much higher. Regardless, this report heightened the nation’s awareness of the risk to those hospitalized and the urgency to further understand and mitigate risk moving forward.

Make no mistake, achieving patient safety is a journey—a journey constantly challenged by the complex, dynamic environment in which patient care is delivered. It’s a continuous search for ways to improve the quality and safety of care in a time of overcrowded emergency departments, hospital census at capacity, and ever-more complex and sicker patients. In an effort to leverage quality, safety, and performance improvement practices to mitigate risk in one area, risk may be created in another.

So how do hospitals persevere in such challenging times? As part of UI Health Care’s effort to eliminate harm to patients in every setting, the leadership of our organization has invested in and supported a number of strategic initiatives over the past few years to influence our ability to achieve safety for all. In 2016 a quality and safety structure was implemented consisting of five domains: Surgical Procedural, Adult Inpatient, Children and Women’s, Ambulatory, and Shared Services. Associate chief quality officers and nursing leaders are responsible for the organization of quality and safety committee structures within each domain. In March 2016, the Quality and Safety Oversight Subcommittee held its inaugural meeting. The subcommittee is comprised of 44 members who meet the first Monday of every month. At this same time, a new provider role, physician value officer, was incorporated into the hospital quality and safety structure.  And most recently, in January 2019, Clinical Quality, Safety, and Performance Improvement (CQSPI), Operations Excellence (OE), and Nursing Quality staff have formally integrated into one program, the Quality Improvement Program. Lastly, effective March 18, 2019, we re-launched the Quality Improvement Database, creating a central repository of institutional performance improvement initiatives.

As we establish and operationalize a more integrated and aligned quality and safety structure, we are positioned to more efficiently and effectively mobilize each and every one of us to address the risks that we face—to be the system that provides high quality, patient-centered care free of all preventable harm. Our greatest resource is all of you, who get up each and every day to provide the best possible care to patients who entrust their lives to us. The dedication, commitment, and work ethic of our staff, our team, is second to none.

As we approach the next fiscal year, the goals of the organization are being set. The goals are ambitious and necessary to continue advancing the cause of quality and safety. We look forward to partnering with all of you as we continue on our journey. As mentioned at the beginning of this blog, UI Health Care will celebrate Patient Safety Week April 29 to May 3. Take time to participate in the activities!

Thanks for making a difference!

Our Stories: Employee Suggestions

My sincere apologies for the gap between blogs. This winter has been very busy for our institution as well as our community. One project that has kept my team occupied was the development and implementation of Blind Spots. Through several meetings and discussions, I have noticed a theme from faculty and staff.

“We want to be heard.” And, “How do we go about getting (whatever the issue) solved?”

Historically, emails, phone calls, and even hallway conversations would be heard by senior leaders with concerns or issues. As a team, it was impossible to collate these and therefore no way to prioritize. Some issues have been addressed, and unfortunately many were not. We did not have an effective way of tracking these concerns or doing timely follow up. So we went to the drawing board. What if we had a “suggestion box” of some sort? A place where faculty and staff could share concerns or issues and someone from leadership would be assigned to review them. A “suggestion box” that could track themes and encourage faculty and staff to share their possible solutions.

The research I’ve read all said suggestion boxes are bad ideas. They can be ineffective and fail to produce engagement. Some of the reasons included: lack of follow up, only implementing a small number of ideas, no way to share improvements, hard for people to submit ideas, and no way to check out who is participating and who isn’t. Really, these were all the reasons why I wanted one in the first place. We took this idea to HCIS. From there, they created an electronic ticketing system. It is easy to use, and something we could pull data out of.

Next, we needed a name. A name that would explain what the system was designed for. My team, with great help from MarCom, did a thorough evaluation of a lot of ideas: rock-in-your-shoe, be the change, wouldn’t it be nice, good to great ideas, etc. Then, “Blind Spots,” an area where a person’s view is obstructed, was discussed and this is what we decided on. These would be things that may be out of view for leadership for one reason or another. In even the best managed organization, there will be blind spots. Perfect.

Anyone within UI Health Care can enter a Blind Spots report, and those reports get assigned to senior leaders. Those assigned then review the reports and decide the best way to address them. To simplify, we chose three main categories for closing a ticket:

  1. Closed: complete/getting taken care of.
  2. Closed: parking lot/great idea, but cannot be completed at this time due to some constraint.
  3. Closed: unable to achieve. These are the ones that are not possible (e.g., move the football stadium to get more parking!).

We went live in mid-December. The goal is to be able to assist when local efforts have failed. When marketing Blind Spots, we encouraged faculty and staff to use this reporting system as an additional resource if more help is needed, or if it is unclear who can help. We will direct the Blind Spot to the appropriate leader. Please remember to add your possible solution. We want to hear your thoughts!

So how are we doing? I am happy to share that as of 3/5/19 we have two open tickets and 47 closed.

  • 31/47 were completed/getting taken care of. Examples: adding better signage to ramps, changing the coffee line order, adding Visa/MasterCard accepted sign, fixing an error in provider enrollment, or fixing the heat in a particular area.
  • 8/47 were unable to achieve. Examples: one administrative structure for UI Health Care, University of Iowa, College of Nursing, and Athletics; or replacing Bread Garden with Java House.
  • 8/47 are in the parking lot. Examples: Ergonomics room for testing out equipment or fixing/cleaning up the skywalks.
  • All 49 tickets were addressed and assigned on average within 2 weeks.
  • The 47 closed tickets were closed within an average of 28 days.
  • 22 different leaders have been assigned tickets.

After reviewing the tickets, there have been no overwhelming themes for areas or departments with issues. However, there are lessons that can be learned from what has been gathered thus far. A large number of the tickets have to do with improper communication and education amongst teams. I challenge all of you to work on improving communication in your area. Share staffing changes, equipment purchases, and future upgrades. Educate co-workers on how to report EVS and maintenance issues, ethical concerns, or system problems. Ask questions! If you are wondering something, chances are there is someone else wondering the same thing. Lastly, do not just be a problem spotter, be a problem solver. We are counting on you!

I want to thank all that have entered or resolved a Blind Spot so far! With better communication and better teamwork, Blind Spots is just one more way we are striving for excellence at UI Hospitals & Clinics every day. To submit a report, click on the Incident Reporting link found on: The Point, under Top Links, or on The Loop, Employee Info page, under Tools.

 

—Theresa Brennan, MD, Chief Medical Officer

Our Stories: Improving Communication

‘The art of communication is the language of leadership’ -James Humes

Communication: a simple word that is anything but simple. It is the basis of everything we do. We communicate with our coworkers, team members, patients’ families, and patients continuously. In fact, most of us spend 70 to 80 percent of our waking hours in some form of communication. (Lee, Dick & Hatesohl, Delmar. 2018). Without effective communication, a message can turn into error, misunderstanding, frustration, or even disaster.  Excellent communication, on the other hand, is the foundation for great teams.

At UI Health Care, we have multiple ways to communicate: meetings, landlines, Voalte One (hospital hand-held devices), Voalte Me (app for your personal cell phone), email, pagers, Spok Mobile app, and Smart Web. Though having multiple ways to communicate can be convenient, it can present a unique set of challenges: incompatible platforms, dropped calls, undelivered messages, dead batteries, full inboxes, and frankly, just too many messages. This is why it is critical to ensure that your device(s) are on, batteries are charged, and when you are not available, designate another team member to return messages in a timely fashion.  Also, be sure to choose your preferred method of communication in your Smart Web profile          (Smart Web User Guide: Device Management, page 2).

‘The single biggest problem in communication is the illusion that it has taken place.’             – George Bernard Shaw

Excellent communication is vital to fostering a culture of safety.  The Patient Safety Net entries with an underlying issue of communication are entered daily, and the Clinical Quality, Safety and Performance Improvement Office evaluates each PSN report. Occasionally, a root cause analysis, or RCA, is necessary to determine how and why events occur. This process aids in the identification and implementation of systems-based improvements. Since July 2017, 85 percent of RCAs completed had communication issues as a contributing factor. Those errors may be as simple as a misunderstanding of what was said or not closing the communication loop fully. It is no wonder we ask our patients how well our providers explained things and listened, how nurses kept them informed and educated, and how well teams worked together. It is also why we ask you, our staff, how you feel team members do with communication. As a leader, it is part of my job to help teams communicate more effectively and understand where the gaps may lie.

There are several beneficial tools and strategies to help with team communication.  TeamSTEPPS has been rolled out in many areas throughout UIHC.  With this program and tools such as SBAR, (Situation, Background, Assessment, and Recommendation), we can more create consistencies of what each of us can expect when we communicate.  Read back and verify/Check-Back uses closed-loop communication, or repeating what was said, to ensure that the information conveyed by the sender is understood by the receiver. And I PASS THE BATON is just one example of a handoff tool designed to enhance information exchange during shift change or transitions of care.

(AHRQ Pub. No. 14-0001-2, Revised December 2013)

A more recent tool developed by a large workgroup at UI Hospitals and Clinics is clinical messaging templates built within Smart Web and Voalte. With these templates, the sender enters all required information into the message so the receiver can act on a request or simply be well informed of a patient’s status. Use of these templates should help decrease the number of pages to providers as well as improve the overall communication among clinical teams. By standardizing the messages, there are clear expectations of what must be included in each message sent and a timeframe expectancy on the action requested. STAT: Need at Bedside should be an immediate response.  Any Routine messages should be acted upon within 10 minutes.  And any Urgent messages should be addressed more quickly or within less than 10 minutes, but truly rare occurrences. If they do occur, the sender may page again sooner due to urgency, as actions requested may directly affect patient care. The sender should escalate to a senior resident or attending when there have been two messaging attempts with no response.

 ‘Communication and communication strategy is not just a part of the game- it is the game.’ – Oscar Munoz

Given the importance of communication in the development of our safety culture, I have decided to add a section highlighting communication and ways to enhance it in Quest, our monthly newsletter. This section will cover updates in communication platforms in addition to sharing stories about communication, both successes and areas that need improvement. I want to share best practices and any learning opportunities with you.

As always, I encourage you to share any story you may have with my office, and I challenge you to continue to improve communication in your area. Hopefully, you find some of the tools and strategies mentioned helpful.

If you would personally like to learn more about improving communication, I strongly encourage you to attend an Effective Communication course offered by the University of Iowa’s Learning and Development Office. Sign up through “My Training” in Employee Self Service.

‘Communication is a skill that you can learn. It’s like riding a bicycle or typing.  If you’re willing to work at it, you can rapidly improve the quality of every part of your life.’                  – Brian Tracy

In an effort to promote optimal communication I want to be sure that you know that I thank you for all your hard work and dedication to our patients and families, and to our team!

—Theresa Brennan, MD, Chief Medical Officer