Menu

Blog Posts

Studer Group

Studer Spotlight: Improving Patient Experience for Emergent Admissions

Posted on Wed, Aug 31, 2016
Studer Spotlight: Improving Patient Experience for Emergent Admissions

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Stephanie Baker, RN, MBA, CEN

With as high as three quarters of all unscheduled hospital admissions coming through the emergency department (ED), the overall patient experience hinges on how patients perceive the care they receive in the ED. 1

For those with hospital admissions greater than 90 percent from the ED, the patient satisfaction stakes are even higher. Recently a hospital senior leader asked our team what more they could be doing for patient experience given their high percentage of emergent admissions and correspondingly low percentage of elective admissions which tend to report an overall better patient experience.

Below are three strategies we recommend for driving a positive patient experience:
 

  1. Fast track all direct admission patients or elective patients to protect their arrival experience. The goal is for patients to be admitted and in their bed within 60 minutes of arrival. It is imperative that patients receive effective communication using AIDET® so they understand the plan for their care and feel comfortable. Nurse leaders should round on all new admissions within the first 12-24 hours to welcome them to the unit, provide relevant information, and let patients know that they will round on them daily during their stay. Although this may only apply to a small percentage of your admitted patients, it helps streamline and hardwire an effective admission process and creates a positive first impression. Be sure to validate patient turnaround times daily to see how close you are to the 60-minute arrival-to-bed goal. This lets you know if the process is working and holds admitting and patient placement staff members accountable for results.

  2. Expedite ED admissions based on acuity and length of stay. This is an inherent goal of every ED, but when a large percentage of all hospital admissions come through the ED, the approach must be relentless. Here are a few best practices that can help get the job done:

    • Patient placement coordinators or related roles should round together with the ED manager and charge nurse every four hours to talk to patients to keep them informed and ensure the patient’s clinical status is appropriate for the unit selected for admission. This keeps everyone updated on the status of patients and informs decisions about prioritizing admissions.

    • Inpatient nurse managers should round on ED holding patients at least once a shift to introduce themselves to patients, assess clinical status, ensure admission orders are in progress, and show care and compassion to the patient. This is a big win for both ED holding patients and ED staff as it demonstrates partnership and ownership. The CNO plays a big role in the quality of the experience for ED patients.

    • The CNO should round with the ED Manager on all patients with hold times greater than four to six hours and then round again with those same patients within 24 hours of arrival on the inpatient unit. This sends a strong message to staff and patients that expediting care and admissions from the ED is a priority and helps the CNO assess how well the admission process is working and what specifically needs improvement. To drive accountability and transparency, the CNO will want to review admission process metrics daily at patient flow meetings. Lastly, the CNO provides coaching for leaders who are underperforming and leads sub-groups for areas that need process improvement.

  3. Focus on your care transitions. Effective and safe handovers from the ED to inpatient units are critical to patient safety and clinical outcomes. Of all the patient experience measures included on the HCAHPS survey, care transitions has the highest correlation to overall patient satisfaction. Yet based on national averages, most organizations are not getting it right. There are some best practices for ED to inpatient care transitions you can implement and you should also consider the impact of handovers happening across the continuum of care.

1 American College of Emergency Physicians. http://newsroom.acep.org/2015-05-04-ER-Visits-Continue-to-Rise-Since-Implementation-of-Affordable-Care-Act. (May 2015)

Stephanie Baker

Stephanie Baker has over 25 years of clinical nursing and administrative experience in the areas of Emergency, Trauma, Flight and Critical Care medicine and proven results with her partners around the country. She is a graduate of San Diego State University, has a Bachelor of Science in Nursing and a dual Masters degree in Business Administration and Health Care Management, and is a Certified Emergency Nurse. She is a past recipient of the prestigious “Tribute to Women in Industry” (TWIN) award, a nine-time Studer Group Pillar award winner, and the recipient of the prestigious Studer Group “Flame” award.

Baker is the Emergency Services Division Leader for Studer Group and is an international speaker, coach, and account leader. In addition, she has published multiple articles in peer-reviewed nursing journals, author of the book Excellence in the Emergency Department: How to Get Results and co-author of the book Advance Your Emergency Department: Leading in a New Era.

 

Share    

Studer Spotlight: Rethinking Emergency Department Results: Are You Treating Before Diagnosing?

Posted on Wed, Jul 20, 2016
Studer Spotlight: Rethinking Emergency Department Results: Are You Treating Before Diagnosing?

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Karen Smith, MSN, RN, CEN, NE-BC

Would you ever start an antibiotic without having a diagnosed infection? How about having a cast applied before the X-ray is taken? We expect to be examined and a diagnosis made BEFORE starting any prescribed treatment. The same approach should be taken when identifying ways to improve Emergency Department (ED) results.

Have you ever wondered why your ED does not seem to have efficient processes? Do your goals for the department seem elusive and unattainable? Are you concerned that the engagement of your staff is not where you want it to be? The problem may be that you aren’t addressing the right problems, or you are trying to treat a problem before properly diagnosing.

With many ED volumes rising1, EDs and healthcare organizations must develop and implement the right tools and skills to drive results.

Our Studer Group Emergency Department experts use a diagnostic approach to determining the individual needs of an ED. This precedes the formulation of the treatment plan and consists of four key steps:
 

  1. Assess: The first step is to conduct a comprehensive assessment of the operational flow of the ED. This includes direct observation of patient movement, review of key operational metrics, staffing patterns to match patient volumes, overall productivity, and patient survey responses.
  2. Align goals: The next step is to determine goals for the ED and how those goals will be measured. The leaders must be in agreement of the vision for the department and setting goals that align with that vision. These are the building blocks for an objective evaluation system, such as Leader Evaluation Manager® that holds leaders accountable for achieving and exceeding their goals.
  3. Align behaviors: There are certain behaviors and tactics that drive results in the correct direction. Expecting ED staff to change patterns or habits can be hard. Careful sequencing of change implementation must be accompanied by a large dose of the ‘why’ or the evidence-based reason to change. Teams will not see the full results of these changes without ensuring each are hardwired (have become habits).
  4. Align processes: Using the observed patterns and existing ED flow metrics vs. known best practices will help teams to determine which flow models need to be implemented. Splitting the flow of patients and processing them based on their assessed acuity level will ensure that every patient receives excellent care in as timely a manner as possible.

Let’s look at an example: If an ED wants to assess and treat a higher-than-average rate of patients leaving without being seen, the four steps might look like this:
 
  1. Assess: Examine the reasons why the rate is elevated based on triage process flow from arrival to being seen by a provider. Key metrics may indicate prolonged door-to-provider intervals or longer-than-average lengths of stay. Analysis of staffing to match arrival patterns must be considered as well as the efficiency of key interdependent departments.
  2. Align goals: Setting goals for improvement might include reducing the overall percentage of patients leaving without being seen and also the return-on-investment resulting from captured revenue. Leaders can then formulate specific action plans to focus their attention on the goals.
  3. Align behaviors: Our approach and communication to patients as they wait to be evaluated by a provider will directly and positively affect their willingness to wait and their overall satisfaction.
  4. Aligned processes: Implementing best practices for expedited triage and direct bedding can reduce the time interval of arrival to being seen by a provider. Other process tactics to implement could include placing a provider in triage or use of a results pending model.

Remember to connect back to the ‘why’? Reducing left-without-being-seen (LWOBS) will improve patient safety and satisfaction, increase revenue, and reduce risk when patients leave without evaluation. Plus, it will save ED staff members’ valuable time.

The results of this approach are staggering. For example, in one organization coached by Studer Group, a decreased overall LWOBS resulted in an annual savings of $289,000. In another Studer Group partner organization with an ED volume of 120,000 patients, LWOBS rates decreased by more than 50 percent resulting in an ROI of $6.4M in increased annual revenue.

High-performing EDs have mastered efficient patient flow using foundational behavioral goals and behaviors. As EDs are the front door to most hospitals, our patients deserve an evidence-based approach to their clinical care that is based on a diagnostic workup. Additionally, patient flow through the ED is also positively influenced by evidence-based processes that are part of a comprehensive treatment plan based on diagnosis.

ED providers and staff make a difference every day in the lives of patients and families. By putting these steps into place, the life you save may someday be your own!

1 ER Visits Continue to Rise Since Implementation of Affordable Care Act. American College of Emergency Physicians, May 4, 2015. http://newsroom.acep.org/2015-05-04-ER-Visits-Continue-to-Rise-Since-Implementation-of-Affordable-Care-Act

Studer Group Karen Smith

Karen has over 35 years of clinical and administrative experience, primarily in emergency departments. As a Certified Emergency Nurse and a Nurse Executive – Board Certified, she maintains an expertise in emergency care and nursing administration recognized by professional organizations.

Prior to joining Studer Group, Karen served in clinical staff roles for many years in both a Level-1 trauma center and community hospital settings. Her 10 years of direct leadership experience were at a Magnet hospital within a major hospital system in Rhode Island. During these leadership years, Karen coached staff to improve the patient experience, achieving patient satisfaction scores for nurse measures consistently in the 90th percentile or better. As an emergency department consultant, she held numerous emergency department leadership positions where she implemented measures to improve the patient experience, reduce numbers of patients leaving without being seen, and reduce door-to-provider intervals among other throughput measures.

 

Share    

Studer Spotlight: Patient Communication that Builds Trust in Advance Practice Providers

Posted on Wed, Apr 13, 2016
Studer Spotlight: Patient Communication that Builds Trust in Advance Practice Providers

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Josh Kosowsky, M.D., FACEP

Over the past two decades, advance practice providers (APPs) have been growing both in sheer number of jobs and in their importance to the delivery of healthcare. U.S. labor statistics estimate that more than 90,000 physician assistants and 122,000 nurse practitioners are practicing today with growth rate estimates ranging from 33 percent to more than 50 percent over the next decade.i

Healthcare reform continues to drive demand for APPs, not just in primary care, but across all inpatient and outpatient specialties as organizations respond to the convergence of physician shortages, cost reductions and increased demand for services.

While healthcare organizations are expanding the roles of APPs, patients' understandings of these roles has not evolved as quickly. As leaders, we can't afford to wait for public perception to catch up. It's up to us to manage patient expectations, and in turn the patient experience, by leveraging proven communication techniques.

Nowhere is this more true than for APPs practicing in the emergency department (ED) setting. While the scope of practice for a nurse practitioner or physician assistant will vary depending on the ED, APPs play an increasingly significant role in emergency departments big and small, rural and urban, academic and community-based. Whether performing advanced triage, providing fast-track coverage, overseeing an observation/clinical-decision unit, or seeing patients alongside physicians in the main treatment area, APPs have become ubiquitous to the point where at some EDs the average patient is more likely to have contact with an APP than with a physician.

Because they often tend to see lower acuity patients, APPs have an outsized impact on the perceptions of patients who end up being discharged from the ED. And it is those discharged patients who will receive the Emergency Department Patient Experiences of Care (EDPEC) survey. Because survey questions place an emphasis on the quality of communication with providers, we need be sure that our APPs are well versed in tools and techniques such as AIDET® (Acknowledge, Introduce, Duration, Explanation, Thank You).

How can APPs make patients feel confident they are in good hands?

For a lot of patients, there is confusion and apprehension around the role of APPs within the ED care team. The AIDET® framework is proven to reduce patient anxiety and build trust with patients. In particular, AIDET® is important for APPs when it comes to "I" - Introduction.
 

A     Acknowledge      Provider smiles and greets the patient and family members/friends in the room.

"Good evening, Ms. Jones. Who is here with you today?"
I Introduce

"My name is John Smith. I've been a physician assistant - or PA -in this Emergency Department since 2012. I'll be the provider taking care of you today."

If working alongside a medical doctor, either directly or indirectly, the PA would continue: "I'm working with a fabulous team, including Dr. Meltzer, the attending physician on duty today."

D Duration "Dr. Meltzer will be in to see you after we have your x-ray results. Typically, that takes about 45 minutes."
E Explanation "I want to be sure we're not missing anything, so I'm going to review your case with Dr. Meltzer and ask him to come take a look at that rash".
T Thank You "Thank you for trusting us to care for you."

In a less careful introduction, a patient might hear "nurse practitioner" and think "nurse," or, in the case of a physician assistant, they might hear "physician". In either instance, this confusion can impact the patient's perception of care of their entire visit. For example, it is not unusual to read survey comments from EDs that utilize APPs, where patients complain "I was never seen by a doctor" or "there were different doctors coming in and out of the room, but I couldn't tell who was in charge." These anxieties can influence a patient's overall perception of care even when their experience has been excellent in every other area.

With the increasing prevalence and expanding roles of APPs in ED settings, their impact on patients' perceptions of care will continue to grow. Focusing on key words for APPs, particularly around how they are introduced, is something you can start doing today to make a difference for your ED and for your patients.

Josh Kowosky

Dr. Josh Kosowsky is coach on Studer Group's Emergency Department Services team. He is Vice Chair and Clinical Director of Emergency Medicine at Brigham & Women's Hospital in Boston and holds an appointment as Assistant Professor of Emergency Medicine at Harvard Medical School.


iBureau of Labor Statistics http://www.bls.gov/oes/current/oes291071.htm and http://www.bls.gov/oes/current/oes291171.htm
 

Share    

Studer Spotlight: Developing and Empowering Front Line Leaders

Posted on Tue, Nov 24, 2015
Studer Spotlight: Developing and Empowering Front Line Leaders

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Regina Shupe, DNP, RN, CEN

Solid leadership creates results that last. However, many healthcare professionals are moved into leadership roles without the skills needed to succeed. Studer Group has long coached organizations to develop and train leaders through regularly scheduled, two‐day leadership training sessions, known as Leadership Development Institutes (LDIs). The purpose of these training events is to develop new, current and future leaders in the organization. The curriculum aligns to the goals of the organization and focuses on the skills and knowledge leaders need to be successful in meeting such goals.

What we typically find, however, is that front line leaders, those who may not hold traditional leadership titles (such as manager or director), are often not included in these trainings. Charge nurses or department supervisors are prime examples. Do your front line leaders have basic knowledge regarding the external environment? What about strategies and techniques to effectively communicate with peers, staff and providers? To address this gap, Front Line Leadership Educational Boot Camps (FLLEBC) were created specifically to enhance the leadership skills of those leading closest to the staff and patients.

The Front Line Leadership Educational Boot Camps were designed to provide front line leaders training in four key areas: understanding the external environment, foundational leadership skills, how to coach performance, and how to conduct difficult conversations. Let’s look at each of these a little closer.
 

  • Understanding the external environment. The healthcare environment is constantly changing, which requires leaders to stay up-to-date on the latest developments. Understanding the impact of items such as Value-Based Purchasing, HCAHPS, reimbursement and so on, is crucial to the role of front line leaders.
  • Foundational leadership skills. Many front line leaders are promoted into leadership positions because they are excellent clinicians. This doesn’t always mean they know how to develop and motivate staff, or connect the dots on why certain organizational goals are important.
  • How to coach on performance. Moving from “buddy” to “boss” can be a difficult transition for new supervisors or charge nurses. For many front line leaders, it may be uncomfortable to mentor or coach staff on their performance, especially when opportunities for improvement are present.
  • Conducting difficult conversations. Building this skill is necessary to ensure front line leaders are equipped to have confident and professional conversations with staff. Whether disciplinary or praise conversations, both are essential to this role.

Shining a light on this skills gap is only the first step. Executing the proper training, whether through Front Line Leadership Educational Boot Camps or other training events, is crucial to ensuring front line leaders are set up for success in their role. As a result, leaders will feel more confident in their abilities to lead staff and develop the next phase of leaders. When all leaders and staff are providing consistent, effective and informed patient care, it creates an excellent environment for patients to receive care, employees to work and physicians to practice medicine.

Regina has greater than 25 years in administrative and clinical nursing experience that includes Emergency, Trauma, and Critical Care. Shupe holds a Doctor of Nursing Practice degree from Indiana Wesleyan University. She is a member of Sigma Theta Tau International, Greater Cincinnati Nurse Executives and the Emergency Nurses Association. She holds a certification in emergency nursing (CEN) as well as certification in LEAN for Healthcare.

Regina is a national speaker and author for Studer Group. She is co-author of Nurse Leader Handbook and Advance Your Emergency Department: Leading in a New Era. Regina has been twice awarded the Studer Group Pillar award for achieving excellent results in operations, service and quality.

Share    

Studer Spotlight: The Fundamentals of Emergency Department Physician Leadership

Posted on Thu, Sep 24, 2015
Studer Spotlight: The Fundamentals of Emergency Department Physician Leadership

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Josh Kosowsky, M.D., FACEP

We know solid physician leadership creates results that last. However, many emerging leaders start their career in healthcare or transition into a new leadership role without the skills needed to succeed. The good news is that these skills can be acquired.

Emergency Department Physician leaders require skills such as how to interpret and impact patient experience data, integrate with hospital operations and build accountability within their team. Through our work with emergency departments and thousands of leaders, Studer Group has identified the skills that separate the best physician leaders in healthcare from the rest.
 

  1. Explain the why. The healthcare industry is in a constant state of change. As a physician leader, it’s your job to help other providers become more comfortable with and adapt to change quickly. That’s why we coach leaders to always start with “the why”. By explaining why we’re rolling out a new initiative or implementing a new procedure, staff gain the reason behind the change first. Then you can share what the process looks like and how it will make an impact. Be sure to share what’s in it for the patient but also, what’s in it for the provider.

  2. Role model the change. We find that physicians and staff are more likely to change when the physician leaders they trust demonstrate the behavior. For example, if tactics such as AIDET® and Rounding for Outcomes have been rolled out, physician leaders should also use the tactics to support a culture of service. One tip is to huddle with your team at the start of each day to convey expectations, drive a collaborative relationship and create a shared effort.

  3. Round on physicians. When physician leaders round on other providers it establishes sincere communication and partnership between both leader and physician. We recommend scheduling a time at the provider’s convenience when a one-on-one meeting can be held, and physician leaders should have set questions to structure the meeting. One of the most impactful questions we suggest leaders ask providers is “What can I do for you?” This further demonstrates the physician leader’s level of caring and respect.

  4. Measure performance and share data. We often find that physicians are “knowledge rich but data poor”. In this age of transparency with data being publically reported on the Hospital Compare and Physician Compare websites, we have access to valuable information readily available. During one-on-one meetings, physician leaders should review the individual data but also comparative data as well. A dashboard is a great way to track and trend results, as well as identify the biggest opportunities for improvement. Then, identify one or two objectives to focus on moving forward.

  5. Reward and recognize behavior. As a physician leader, you may at times feel like you spend more time putting out “fires” and fixing problems than anything else. It’s important, however, to focus on what’s working well and reinforce good behavior when you see it happen. This is especially important when we’re asking individuals to change a behavior or rolling out that new procedure. Taking time to say “thank you”, both verbally and in hand-written thank you notes, sharing positive patient comments, providing an annual award or even incentive compensation are great ways to show appreciation.

These fundamentals are designed to save physician leader’s time, impact patient experiences and improve outcomes. In the process, better relationships are formed, the resistance to change is minimized and both physician leaders and providers feel a strong connection to the same goals and outcomes.



Josh Kosowsky, M.D., FACEP,  is a nationally recognized expert clinician and lecturer who serves as Vice Chair and Clinical Director of Emergency Medicine at Brigham & Women’s Hospital in Boston. A former Fulbright Scholar and a graduate of Harvard College and Harvard Medical School, he is currently holds an appointment as Assistant Professor of Emergency Medicine at Harvard Medical School.

Share