As you know, one of our strategic goals is to
actively engage patients and their families in their
care in a more meaningful way.
But despite all of our efforts, we're just not
quite where we want to be.
So, I want to introduce you to Theresa, one of our
former patients who has agreed to join our CUSP
team to help us think of better ways to engage
patients and their families.
Theresa, thank you so much for being here.
Thank you.
I'm excited to be here.
Would you be willing to share your story with the team
so they can have a better sense of your
interest and your perspective?
Sure.
I think I may have actually met some of you before.
Some of your faces seem familiar.
When I was younger, I was hospitalized several times
before my kidney transplant.
I had to have a lot of tests and procedures while
I was sick, and I also had to be on dialysis for a while.
But I'm thrilled to say I have not had to stay
overnight in the hospital for more than three years
since my transplant.
I had a lot of great doctors and nurses taking
care of me, and I have a lot of respect for what you all do.
But, to be honest, there were a few things that
could have been better during my hospital stays.
I think a lot of patients might have experiences like I did.
So, I'm ready to be a part of the CUSP team to make
care better for patients in this
hospital.
Well, we're all glad you're here, Theresa.
It sounds like we may be able learn from your
experiences to improve how we care for our patients.
Again, I have a lot of good things to say about my care.
The nurses were very kind, hard working and they really
took good care of me.
I was in the hospital once over my birthday and the
nurses got together and they brought me a little cake
and sang "Happy Birthday" to me at my bedside.
I know it might sound silly, but that kind of personal
touch was really important to me.
That is important.
I think it's important to understand that it's
humbling to be in the hospital, like when you're
walking down the hall wearing one of those silly
gowns that don't fit.
I really didn't want people to see me like that.
Well, other patients have told me the same thing.
And, Tanya, when I was really sick
I had to use a bed pan.
And you lose some dignity when you lose
control over your body.
It's the simple things that you do in your day-to-day life
that you don't have any control over when we're in the hospital.
Like, eating when you're hungry or being able to
get up and go to the bathroom.
I understand there's things we can't
control, like having to take certain medications
or undergoing treatments, but I think patients can
have some input and be involved in our own plan of care.
I've never really thought about it that way before.
I think there are a lot of little things that can
be done to make a hospital stay better for patients
and their families.
We've been working with the nurses to look at our
admissions process.
Maybe we can include developing a discharge
plan at the time of admission since this would
be the best time to start the conversation with
patients and their families.
I think that's a great idea.
As a matter of fact, I have a friend who is staying at
another hospital, and she told me how they developed
her daily plan of care right there at her bedside.
Yeah, we'd like to hear more about that.
Well, she asked her husband to visit during
the morning hours when the health care team was doing
rounds, so they could both be there and give input.
Then the whole team - the healthcare team, my friend
and her husband - wrote out the plan for the day.
It really brings back a sense of control when you
know what to expect for the day.
For instance, how many procedures you're
going to have during a given day or an update if
there's going to be a delay in a procedure.
Just little things like that help make you feel
more involved in your care.
Yeah.
That's really important and it's something we should
consider since we're trying to involve patients
and families more actively
in the daily plan of care and discharge.
It could go a long way toward helping families
feel more confident in contributing to their case
and continuing their care after the patient is discharged.
I agree.
Involving patients and their families can help
the patients meet their goals during their stay and help them
feel more comfortable when they are discharged.
It's a priority to get them out of bed early and
often during their stay with the goal of them
taking frequent daily walks.
We know this helps in recovery and can also
prevent serious complications.
Yes, you're right.
And I think we haven't been meeting our goals
because we haven't been working closely enough
with our patients and our families.
Well, I have some ideas about how to help with that.
You know those white boards in the patients'
rooms that have the names of the nurse and doctors?
Well, they also posters with the IDEAL
procedure spelled out: Include, Discuss, Educate,
Assess and Listen.
I also like that approach for getting patients
involved in discharge planning.
If we can educate patients and their families about the
importance of daily walking and how that can help
with their recovery process, then they'll be the ones to
push and help us meet our goals and timelines.
Alright. Ms. Adams, we've got you all set.
Your nurse will be in shortly.
You doing okay?
Yeah, honey, I'm alright, thank you.
Hi, Ms. Adams.
How are you feeling this morning?
I'm glad the surgery is over.
I'm pretty sore.
I know you are, Ms. Adams.
Can you rate your pain for me please?
You know that scale where one means it hurts just a
little bit and ten is the worst pain you've ever felt?
What's your pain right now?
Oh, I'd say it's at least a seven or an eight.
Well, the doctor has ordered some pain medicine
to help you.
We are going to give this to you now so that it's
working when we get you out of bed a little bit later.
It's really important to get you moving so that
you don't develop any blot clots or trouble
with your breathing.
I don't want that to happen.
I agree.
And while you're here with us for the next couple of
days, we want to make sure that you and your family
feel comfortable with our daily routine so that you can
continue to work on it on your own once you're discharged.
That's why we have the word IDEAL written out on
the board here.
It stands for: Include, Discuss, Educate, Assess and Listen.
It really helps us to work together to begin
preparing for your discharge.
Discharge?
Already?
I'm not ready to take her home.
She's in a lot of pain, and I'm not a nurse.
I understand, but talking about this now and
throughout your hospital stay will help to ensure
that when Ms. Adams is ready for discharge, you
both feel comfortable with what you need to do
to continue to help her heal and get better.
Okay, well, getting her stronger is my goal too.
So, we're a team?
Yep.
Let's begin working on this today.
Now, as you said, Mr. Adams, your wife is in a fair
amount of pain.
One of the things that we can do is to get her up
and walking after her pain medication has taken effect.
Wait, I don't know if I'm really ready to do that today.
I don't think you understand how sore I am.
Well, this pain medicine is pretty strong, and it
usually works really well for most patients.
We'll make sure your pain is under control before we
get you out of bed.
I would appreciate that.
And, you know, they've been giving me a lot of
fluids in this IV, so I go to the bathroom pretty often.
I want to make sure I can go to the bathroom before
we walk in the hallway.
Absolutely.
Can we actually plan when we'll do this?
I need to go into the office for an hour or two,
but I want to be here to help.
'Cause I think you're right.
That will make me feel much better at home when it's
just the two of us.
Sure.
Let's write out a timeline for today.
Honey, the kids are coming to visit around 2 o'clock
so you don't want to be walking then.
That's the kind of thing that you would need to know, right?
That's exactly what I mean.
You were due to be given some medications at 11 o'clock.
We can give you your pain medicine at noon,
right after lunch.
It should be helping by 1 o'clock, so you could
take your walk then.
How does that sound?
That works for me.
I can be back by 1 o'clock.
Great, that works out perfectly.
It does.
After I walk, I can rest and then watch my favorite
You got it.
You're doing great.
Keep going.
Good job.
Here, let me help you get your slippers off.
You did a great job on that walk.
You sure did, Ms. Adams.
How are you feeling?
Well, I'm kind of glad it's over.
It will get easier, won't it?
It will, hon.
It will.
That's what we're working towards.
So if you both look at the board here, it's spelled out.
Mr. Adams, I'm really glad that you're able to be
here when we're walking with your wife because I
think it's going to give you a better sense of what
to expect once you're home and how her recovery is
progressing.
It certainly will.
Now, we gave her the pain medication an hour before
she walked so that she would feel comfortable.
Then, as you saw, when we got her out of bed we had
her sit on the edge of the bed to make sure she wasn't
dizzy from the medications.
Then we had her to stand for a minute to make sure
she was okay before she started walking.
That's going to be important to continue once you're at home.
Uh-huh.
And we also talked about how it's important for
Ms. Adams to get all of her medications on time at home.
She's on a blood thinner to prevent blood clots, and walking
also keeps her blood circulating, and will
prevent clotting as well.
Yeah.
I really liked that little calendar you showed me
that has all the times charted out.
But, you know, I'm not sure either one of us is
clear on the dose of each medicine.
He's right about that.
I'm really glad you told me this, this is exactly the kind
of information I need to know.
I'll go over the doses now, and we'll review them
again when Ms. Adams is discharged.
Plus, I have some printed materials to give you when you
go home as well.
Thanks, that'll be really helpful.
Welcome, everyone!
We've got new data from our staff and patient
satisfaction surveys, and I'm excited to share the
results with you.
Overall, our satisfaction scores have increased over
the past quarter.
We've seen a slow but steady increase each month
and that's something worth celebrating.
That's excellent news, David.
I agree.
Let's celebrate, but I also want to take a look at
those areas where we still need some improvement.
It looks like we've increased satisfaction
with patients who are English speaking.
We have.
But our numbers haven't moved much for our
non-English speaking families.
I agree.
Did we get our interpreters involved
in the project to get patients out of bed and
walking early after surgery?
We didn't.
We do need to improve the process for our
non-English speaking patients.
We've had an interpreter working with us on this,
but they haven't been available 24 hours a day so
we're missing some patients.
Okay.
You're right, Dr. Milstead.
It looks like we even have room for improvement for
people who do speak English.
We use so many abbreviations, acronyms,
and medical terms and jargon that it may be
difficult for patients and their families to understand.
You're right; I find myself doing that and not
even realizing it.
I can remember my first couple of hospitalizations.
I felt like the doctors and nurses were speaking a
different language half the time!
But, you're right, though.
When doctors and nurses talk about medications,
explain test results, give information about a
patient's problem using plain language, without jargon,
that they can understand, it's just so helpful.
It really helps the patient start to take ownership
of their care.
I really want to compliment the team.
I like how you have included IDEAL posters in each
of the patient's rooms.
Now the patients and families not only know
who's on the team for that day, they know the plan.
It's really helpful to have a sense of what to
expect each day.
Thanks, Theresa.
I agree.
Patients have told me how much they really
appreciate having a plan they can count on.
Yeah, I was talking to Alicia after the last CUSP
meeting, and she was telling me how grateful a
patient's family was for being involved in the making of
the plan for the day, is that right Alicia?
Yes, that's true.
And we planned around the patient's family visits,
meal times and favorite TV programs.
[laughter]
You said the patient's family was thrilled, and
I'm sure the patient appreciated the effort to
lessen her pain as much as possible.
She knew that walking after surgery was
important, but she appreciated the effort of
the team to make it as comfortable for her as possible.
That's a good point.
We should be doing that regularly.
We should.
I remember the last time I was in the hospital
the physical therapist did a very nice job
working with the nurses to coordinate a schedule for
my exercise and walking.
And they included my preferences.
It was great.
But, at the same stay, a couple of doctors used jargon that
I just couldn't understand,
and I'm not stupid, but I'm not a doctor and I don't try to be.
Nothing personal, Dr. Milstead.
Oh no, of course not!
But I still think there's opportunity for more
doctors to use words that patients and their families can
easily understand.
You're right.
Theresa, would you consider coming to a
division meeting with me to talk with my surgical colleagues?
Sure.
Great.
Well, it's clear to me that involving patients
and families in the daily plan of care and discharge
planning is really important.
Focusing on the words and terms that we use when we
explain things to patients is also an important priority.
The surveys tell us they're much more
satisfied when we do these things.
Theresa, I really appreciate your
willingness to be on this CUSP team and to help us
to better understand how to get patients and
families more involved.
Thanks, Alan.
I'm grateful for the opportunity to share my
experiences and thoughts with you.
It's great to be a part of a team that's helping to
make a hospital stay more pleasant for the next patient.
I agree, and I believe we need this in all units
across our entire hospital.
I've been wondering if you'd be willing to help us
create a committee or a council of patients and
patient advocates so that we can also hear from them.
Sure.
I'd be open to that.
Good.
I know there are other hospitals that have created
patient advisory councils to help support
initiatives across the entire hospital to improve
patient and family engagement.
To do that right and to create the best council possible,
we could really use your help.
I'd love to participate.
I'm sure we can find some great people who'd be more than
willing to help other patients and families.