Clinical Excellence
March 21, 2007
Service, Satisfaction and Silence
Emphasizing the little things helps Kaiser Permanente boost patient satisfaction
Oakland, Calif. — In the never-ending quest for better patient care, Kaiser Permanente employees are trying novel solutions to make hospital stays more pleasant and boost communication between clinicians, patients and families.
Last November, Walnut Creek Medical Center launched a program aimed at reducing noise on the inpatient floors after 10 p.m. Known as "The Quiet Campaign," the effort involves a number of behavioral changes for hospital staff and is being promoted across the facility through posters and banners.
"Our intent is to provide a relaxing, restful, healing experience," says Julie Fryckman, executive consultant for service in the Diablo Area of Kaiser Permanente's Northern California region.
To that end, staff conversations are being kept to a whisper, lights dimmed after 10 p.m., and cell phones turned to vibrate. Efforts also are being made to conduct shift reports and other lengthy conversations outside the earshot of patients. No detail is too small in the pursuit of a quieter environment, Fryckman says. Even squeaky wheels on carts have been replaced. And patients are offered earplugs at night.
"[The earplugs] might seem like a little thing, but giving patients the option to control their environment is a big deal,'' Fryckman says.
The medical center's campaign, which was developed by its service committee in response to patient surveys, is one of many grassroots efforts aimed at strengthening patient care now under way at KP facilities nationwide.
Another patient-satisfaction initiative that's been developed in KP's Northern California region is a checklist process known as the "Five Cs". This system was created for clinicians to follow during their interactions with patients. The Five Cs include:
- Caregiver: Introduce yourself, including your title, to everyone in a patient's room and explain your role so that patients are sure of who is taking care of them.
- Contact: Write caregivers' names and direct phone numbers on care boards in patients' rooms so patients are able to contact their caregivers when they need something.
- Communication: Regularly discuss plans for discharge or transfer with patients and their families so everyone understands what will happen next in the patient's care.
- Comfort: Before leaving patients' rooms, make sure they are as comfortable as possible, the rooms are clean, the patients are clean and their symptoms are well-controlled.
- Compassion: At least once per shift, sit at the patients' bedsides and ask if there is anything on their minds, or if there is anything more you can do for them.
Paul Feigenbaum, MD, Kaiser Permanente's regional director for hospital and continuing operations, helped identify the Five Cs. He says the technique is more than just a tool for improving patient care quality scores.
"This is what our patients want and it is what they deserve,'' he says.
Meanwhile, at Hayward Medical Center, nurse manager Estelita Santos, RN, has opted for a "back to basics" approach to providing better care.
Nurses on Santos' medical-surgical floor faced heavy patient loads, growing paperwork and the demands of learning new technologies. Patient complaints on the 63-bed unit were increasing.
As a result, Santos and her team began looking for ways to strengthen the connection between caregiver and patient. Instead of caregivers simply writing their names on patients' care boards, the nurses began attaching a magnetic button with their photograph and name to the board so patients and families could match a face with a name.
Nurses also started sharing interesting facts about patients on index cards to facilitate conversation, and they are now expected to visit patients at least once an hour. They offer backrubs and teddy bears to patients who seem to need a little extra care.
Santos and her team have dubbed their campaign "The Magical Moment."
"All you have to do is figure out one way to make that connection with the patient and the family,'' she says. "When you do, that's the magical moment."
