NACHRI 2008 Annual Meeting Session Presentation

Communication Strategies In Two Children’s Hospitals To Achieve Improvement Change

Ramesh Sachdeva, MD, PhD, DBA, JD, Vice President, Quality and Outcomes
Stephanie Lenzner, MSHA, MBA, Director, Clinical Data Management
Children’s Hospital of Wisconsin, Milwaukee, WI
Barbara Shultz, RN, BSN, Manager, Pediatric Emergency Department
Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN

Learning objectives:  Following this session attendees will be able to:

1. Understand the different approaches in communication science
2. Learn how qualitative communication can lead to improvement
3. Learn how quantitative data driven communication leads to change

Introduction/background:
Communication failures are a significant problem resulting in an adverse impact on quality and patient safety. There is a lack of communication within hospitals and also between hospital-based and primary care physicians (Kripalani, et al., JAMA, 2007). In order to develop effective solutions, it is important to understand the theoretical basis of communication science and the experience of implementation across hospitals. Communication to improve quality includes qualitative (verbal, non-verbal, culture) and quantitative (data) mechanisms of information transfer (Sachdeva, et al., JORS, 2007). This session shares the experience of communication to improve quality using these mechanisms in two independent children’s hospitals.

Initiative or project description:
This initiative aims at translating communication science theory using the experience of two large, independent, tertiary care children’s hospitals. The first hospital focused on its growing Pediatric Emergency Department (PED) to impact a climate of change. The Studer Group “Elevate” Principles were used to create that climate for change. The Studer Group provides evidenced-based tools to create and sustain outcomes in services and quality care for patients, families, and staff. The leadership team used “Elevate” principles to hardwire clinical excellence and quality improvement (QI) initiatives. Implementation of Crew Resource Management (CREW) training provided education on human factors to develop tools to standardize communication to prevent mishaps. The combination of initiatives, “Elevate” and “CREW” were used to make QI changes within the PED and other departments. A Kaizen website was created to give staff members a venue to make operational suggestions to enhance communication. The second hospital focused on data to enhance communication. By embracing principles of data quality, a culture of trust was established with physicians. A centralized data request process facilitated streamlining of data flow. Application of sophisticated statistical techniques presented in visual displays allowed implementation and tracking of QI over time.

Results/Outcomes:
Communication strategies to enhance QI resulted in several improvements in the PED. Examples include - ID band compliance and documentation of 98 percent, left without being seen rate less than 1 percent, decrease in overall length of stay, PRC National gold star award for “overall quality of care” three years consecutively, triage accuracy level – 93 percent, improved communication from PED to PCCU. Communication strategies in the second hospital resulted in – significant enhancement of trust in the data resulting in growth of centralized data requests from 638 in 2007 to more than double projected for 2008.

Future of initiative:
In the first hospital, the focus has evolved from generic to disease specific initiatives for febrile neonates, fever in hematology/oncology patients, and DKA. In the second hospital, data related enhancements have focused on improving reporting display methodology and collaborative efforts to provide alignment with the electronic health records for QI.

Lessons learned:

1. The experience from the first hospital shows that qualitative communication efforts using “Rounding” is very effective, thank you notes are greatly appreciated, multiple communication techniques are required to sustain results. However, data is essential to making improvement, and a team approach can make the impossible possible
2. The experience from the second hospital shows that emphasis on enhancing data quality builds trust with clinicians resulting in greater application for quantitative communication facilitating QI
3. The combination of quantitative and qualitative theories of communication provides a unique synergy to facilitate change and spread improvement in an organization