Monday, April 7, 2014

The A-B-ZZZZ's of Quiet at Night

Do you get enough sleep? If you do, chances are you haven’t been sleeping in a hospital bed.

Do you know what it’s like trying to sleep in a hospital? One group of curious hospital staff did; they recorded the sounds that a patient would hear in a typical MedSurg room between 9:00 p.m. and 6:00 a.m. The recording was put on a DVD, and each staff member took a copy home to play in their own bedrooms that night.

It was a disaster.

The staff were appalled and disappointed at the level of noise in their hospital—they wondered how their patients could possibly get any rest!

Quiet matters. Quiet is necessary for healing, essential for rest, and related to everything that hospitals represent.

Consider This:

Staff Noise

Surveys show that the highest decibel level in a hospital is recorded during shift change, so be aware of human noise at that time. Here are some suggestions for simple noise control.

Install a tasteful visual reminder, like the Yacker Tracker. The light shouldn’t be red when people are in bed!

Have a noise hotline that patients can call (instead of using the call buttons) when things get too rowdy.

Set alarms to ring at the nurse’s station instead of a patient’s room.

If you’re feeling ambitious, brainstorm ways to reduce food tray ‘rattle’ and similar noises.

If you designate “Rest” or “Evening Quiet” times (and you should), make sure to dim the lights on the floor so there’s no confusion for new arrivals. Posters (placed prominently during quiet hours) and public announcements made from overhead speakers will also help increase awareness.

Mechanical Noise

A certain level of mechanical noise in hospitals is unavoidable. All staff should be empowered to fix (if they can) or report to Maintenance (if they can’t) any noise interfering with patient comfort and tranquillity. Create a list of the major mechanical noise-offenders on your floor, and have them fixed one at a time. Better yet, create a never ending “Job Jar” by writing down all the things that need fixing and putting the pieces of paper in a big glass (or plastic) jar at the nurse’s station.

Some noise may not be easy to predict. For example: Check high traffic doors, and install bumpers if necessary.

One of the biggest noise offenders is trash compactors located near a patient’s room; it’s fairly easy to have them moved elsewhere.

The Mood

I’ve found that the traditional approach to improving “Quiet” scores is to stop needless mechanical noises, and start a “HUSH” (Help Us Support Healing) or “SHHH” (Silent Hospitals Help Healing) campaign. That’s a good start, but here’s the thing:

The only reference a patient has for ‘quiet at night’ is the solitude of their home.

Patients need to understand that a hospital bed is not like their bed at home, not even close. Staff should be managing patient expectations right from Admitting so that patients have a realistic idea of their nighttime experience. “Quiet” is different at hospitals; because treatment sometimes occurs at unusual hours, patients should be warned that they will hear sounds of care during the night.

Remember Domino’s Pizza? They had a guarantee: if it wasn’t delivered within thirty minutes, it was free. We had confidence in that promise, so it didn’t really matter if it was five or ten minutes late, because we could expect delivery in half an hour—or we could expect a free pizza. Domino’s managed our expectations by giving us a guideline, and that’s exactly what you need to do with your patients.

Try telling your patients:

“We are making every effort to perform those activities with the minimum amount of noise.”

“I know you are used to the quiet solitude of sleeping in your home – but the hospital is a little different.”

The Take-Away Stop complaints before they start by educating patients and creating reasonable expectations.

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Monday, March 31, 2014

The Tough Truth about HCAHPS and VBP

Let me begin this post with a tough question: in your area, are you the provider of choice… or the provider of convenience?

Do patients drive past other hospitals to get to yours? They should.

They could, if your hospital offered something unique from other hospitals.

They would, if your facility was dedicated to the patient experience.

Consider This

All other things being equal (like equipment, services, and location), it’s the intangibles that tip the scale. By “intangibles,” I mean all the things you do for patients that go above and beyond the call of duty, above and beyond your competition — the unwritten standard that you have for patient experience. If your hospital guaranteed a quiet night for each patient, would that give you a competitive edge? Absolutely. Even when you’re at home, feeling well, life is not very nice if you don’t get enough sleep. What I’m getting at is: the intangibles matter, now more than ever.

Your HCAHPS scores will be publicly reported, if they aren’t already.

Say a potential patient is comparing two hospitals. Hospital A is in the 75th percentile for Quiet at Night, Hospital B is in the 40th percentile. I would, without hesitation, choose Hospital A — and so will your potential patients.

Act as though the HCAHPS survey is mandatory, even if it isn’t. Converting from an in-house survey to the CMS standard is usually a rude awakening, so give yourself an advantage over your competition by embracing the new standard before it’s required.

Value-Based Purchasing is the new healthcare reality.

The Bad News: CMS has taken $850,000,000 dollars from hospitals by reducing Medicare-based DRG payments by 1%, and that’s just the start—that 1% is going to be 2% by fiscal year 2017.

The Good News: CMS put that money in a special account, and you can get some of it back by improving your HCAHPS scores.

I have three recommendations for overall HCAHPS improvement:

1. Engage everybody, right now. You don’t need 100% enthusiasm to get started, but it sure makes improvement easier if the staff aren’t working at cross-purposes. Imagine if you gave each staff member permission to improve the patient experience, to do whatever it took—how would the culture of the hospital change? How would patient satisfaction change? How would the employee experience change?

2. Strive to be well above the national average within a year. Figure out how other hospitals (other than your direct competition) are getting high scores in domains that you find challenging and offer to trade Best Practices in an area where you’re excelling and they’re struggling—that way, everybody wins.

3. Aim to be in the top quartile within three years. If you’re already there, fantastic! But can you do better? If you’re in the 75th percentile, aim for the 80th; if you’re in the 85th percentile, aim for the 90th! Always strive to improve your products and services.

Quiet at Night is an essential part of healing during a hospital stay, but who is really responsible for improving this domain? In every case, the buck starts and stops with the CEO. An important part of this is nursing, so the Chief Nursing Officer or Director of Nursing, Chief Engineer or maintenance manager, all nurse managers and supervising nurses. RNs and CNAs, Housekeepers and Dietary, everybody who passes by or enters a patient’s room is responsible for quiet at night.

Attempts to improve cannot be successful unless these individuals are engaged, and we’ll discuss methods of employee engagement in later posts.

I want to leave you with one final thought: I heard the story of a nurse at a rural hospital, who lived on a farm. Once, during a terrible snowstorm, she stayed overnight in the hospital. I remember hearing that the nurse was absolutely livid the next morning — because she could not get a good night’s sleep in the hospital room! The Take Away Quiet equals healing, and we’re in the healing profession. Make sure your HCAHPS scores reflect your priorities, and vice versa, so that you can capitalize on patient satisfaction and VBP.

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