Transcript Clean Quiet - There`s no Place Like Hoag

Lesa Blake, Director of Support Services and Roxanna Bryant, Director, Corporate Facility and Services
Originally Presented at Performance Excellence Council, July 9th
Best of Clean Up and Quiet Down – Leadership Staff, Tuesday, July 17, 2012
1
HCAHPS (how often a service was provided)
Hospital Environment
8. During this hospital stay,
how often were your room
and bathroom kept clean?
Frequency Based Rating Scale
Never
Sometimes
Usually
Always
HCAHPS Performance Level Comparison
Source: Press Ganey
3
Cleanliness of Environment
‘How often were your room and bathroom kept clean?’
May, 2012
HCAHPS
“Always”
Rank
Data Base: 1735
Target
Jan
Feb
Mar
April
May
> Hoag
1555
1543
1396
1130
1162
< Hoag
172
230
394
608
572
>82%
63
64
66
70
70
>90
10
13
22
35
33
June
July
Aug
Sept
Oct
Nov
Dec
“How often was your room and bathroom kept clean?”
Daily “Service Level” Housekeeping:
• Empty trash
• Parameter Daily Cleaning of rooms
• Stock supplies
• Sanitize rest room
• Sanitize horizontal surfaces
• Mop floors
Other Patient Care Attendees
Assistance Needed for:
• Help organize the patient
belongings
• Unclutter bed tables
• Empty out the urinals/dump porta-potties ( EVS only sanitize when
empty)
• Remove Patient Trays when
Nutrition Assistants are not
available
• Pick up visible trash on floor.
• ‘Call or just do it’ when service is
needed, i.e., trash needs emptying,
bathroom is dirty
5
Housekeeping (EVS) Actions… Increase Touch Points
Now…
• Three Touch Points
- AM trash removal
- Daily Clean Room and Bathroom
- PM trash removal
• Increase patients awareness of cleaning - leave
EVS calling-cards on bed stands; confirms room
was cleaned and provides EVS contact number
• Develop Performance Metric Staff/Unit Matrix Grids
Assigned EVS
Staff Member
Metric
1.
2.
3.
4.
Correlate Performance Staff/Unit Matrix Grids
Identify and Align the Right Staff and Strongest Performers
Reward & Recognize Achievement, Coach/Train Underachievement
Report and communicate with Nurse Managers/Directors
Unit
HCAHPS (Unit)
Patient Satisfaction
(Unit)
Patient Satisfaction
(Unit)
-
• How often were
your room and
bathroom kept
clean?
• Room Cleanliness
• Courtesy of person
who cleaned your
room
Staff Member #1
6
Note: Housekeepers (EVS) interact with patients only 1/3 of the 24 hour Period
Performance Metric
REACH
Performance Metric
REACH
• Room Turnover
Time
• Glow Germ
Notes:
• # of years
experience
• Training
Completed
HCAHPS (how often a service was provided)
Hospital Environment
9. During this hospital stay, how
often was the areas around
your room quiet at night?
Frequency Based Rating Scale
Never
Sometimes
Usually
Always
HCAHPS Performance Level Comparison
Source: Press Ganey
8
Quietness of Environment
May, 2012
“How often was the area around your room quiet at night?
HCAHPS
“Always”
Rank
Data Base: 1735
Target
Jan
Feb
Mar
April
May
> Hoag
1434
1578
1468
1252
1058
< Hoag
293
195
322
486
676
>72%
48
45
47
51
54
>90
17
11
18
28
39
June
July
Aug
Sept
Oct
Nov
Dec
What could possibly be making that much noise?
General Activities & Processes
•
•
•
•
People coming & going
General traffic
Cleaning, trash removal
Maintenance activities
Communications
• Staff to staff (including volunteers,
physicians)
• Patients
• Visitors
• Overhead Paging
• Devices (Nextel, Cisco / Mobile
Phones, Pagers, Landlines.)
Equipment & Materials
Everything (non-clinical) that’s used on the Unit;
• Carts
• Bags
• WOWs, chairs
• Biomedical equipment general noise (non alarms)
• Building features: doors, latches, hinges, curtains,
lights, fans, vents, Gel dispensers,
• Deliveries
• TV
• Beds, gurneys, food service, etc.
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Source: Patient Interviews, HCAHPS Comments, and Secret Shopper Observations
Clinical & Emergency Alarming
•
•
•
•
Clinical Equipment and Machines
IV Pumps
Nuisance and False Fire Alarm Activations
Fire Alarm Testing
Actions in Progress, Development, and Concept…
• Continuous awareness and In-Service training for all employees about their influence on the healing
environment and the level of disturbing noise we generate. Increase E2E (Employee to Employee) and
physician expectations to coach fellow staff on working in the “quiet zone”, recognizing and promoting
quietness, and addressing noise “real-time”
• Support and Implement NO overhead paging of medical staff at HHNB. Has been in effect for 1.5 years
at HHI/HOI, no issues or complaints. This requires use of Perfectserv by physicians and the staff utilizing
instead of calling operator
• Support reduction of code announcements 3x3 to 2x2 and reduction of “all clears”. Support elimination*
of general staff/vendor overhead paging (only for medical emergencies)
• Support the silencing of audible fire alarms upon known or suspected false fire alarm activations
• Support the final phase of fire alarm system replacement and the zoning of fire alarm system at HHNB
• Inspect and repair equipment and mechanisms to reduce disturbing “sound”
• Delivery carts (materials, oxygen food)- done
• Cleaning & maintenance carts- done
• Isolation carts- in progress
• Sharps service carts- in progress
• Beds, Gurneys, Wheelchairs (will need to improve the inspection of gurneys and wheelchairs)
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Example - Fire Alarm System: HHI/HOI
In the past…when there was a “fire alarm” activation anywhere in any HHI or HOI building…
All alarms activated, All strobes flashed, All fire doors
closed, and All ventilation shut down
As of today, July 9th HHI/HOI’s One-Zone system will be divided into Seven-Zones; safely
isolating the precautions to appropriate “zones”
RN and PCA alternate rounding hours:




AM shift- PCAs round at even hours - 0800, 1000, 1200, 1400, 1600, and 1800
AM shift- RNs round at odd - 0900, 1100, 1300, 1500, 1700
PM shift- PCAs round at 2200 and 0400
PM shift- RNs round at 0000, 0200, 0600
*PCAs make rounds and answer patient call lights during Change of Shift RN Bedside Report.
Completed
OWN IT
Hourly Rounding – Actions
I own how I greet
and welcome you.



Knock on the door prior to entering, introduce yourself, use appropriate greeting.
Visibly demonstrate to the patient, the use of sanitation gel or hand washing as you enter the room.
Explain the purpose of your visit. Describe the hourly rounding schedule.
I own how I show
you respect.




Be present and mindful. Make eye contact with the patient as you actively listen.
Explain the use of the white board and update it with the plan of care/ goals, RN name, PCA name and appropriate contact numbers.
Demonstrate and explain the use of the call light and alternative methods to request assistance.
Give explanations in the way the patient understands.
I own how I engage
you and discover
your needs.







Complete scheduled tasks (medications, treatments, etc.).
Pain- Check the patient’s pain level. Offer alternative solutions for controlling pain.
Potty- Offer assistance to the restroom.
Position- Assist with repositioning. Check pressure points and skin integrity every shift.
Pumps- Check machines and alarms around the room to prevent them from alarming after you leave.
Scan the room for cleanliness and noise.
Check room temperature, cleanliness and quietness with patient.
I own how I assist
you and personalize
my actions for you.






Speak with your heart and your head.
Focus your attention on the present.
Acknowledge the patient’s feelings.
Speak loudly with your actions.
Clarify your positive intent.
Say something nice.
I own how I assist
you in transitioning
your continuum of
care.






Document at bedside.
Assure that the call light and personal items (telephone, table, water, etc.) are within reach.
Ask: “Is there anything else I can do for you?”
Inform the patient of what to expect next. “We will round again in about an hour…” or “Your next dose of medication is due…”
Visibly demonstrate to the patient, the use of the sanitation gel or hand washing as you exit the room.
Use appropriate departing remark.
This is a journey not a
destination
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