Connecting Quality, Safety and Patient Experience

On the Road with Cook Children’s Medical Center – March 2015

by Michelle Garrison and Stacy Palmer

Our latest On the Road took us to Cook Children’s Medical Center, part of Cook Children’s Health Care System, a not-for-profit, integrated pediatric system based in Fort Worth, Texas. An institutional member of The Beryl Institute, Cook Children’s embraces an inspiring promise – to improve the health of every child in its region through the prevention and treatment of illness, disease and injury.

Our day began when we were met by Jan Althouse, patient experience coordinator, and our gracious host for the visit. As Jan proudly took us through the medical center, we were able to see firsthand what Cook Children’s has in place to create an environment where kids feel comfortable. They believe in providing kids with an environment that they can actively engage in to promote healing.

Elements of this are found throughout the medical center, from the Build-a-Bear Workshop near the lobby to the huge replica of the campus made of over 63,000 LEGO bricks. It is easy to imagine how a parent could use the lure of a trip to either as an incentive to encourage a child out of bed to walk around after surgery or a long day of treatments.

Jan also showed us a large indoor play area funded completely from staff donations. She recalled the pre-opening celebration where senior leaders were caught sliding down slides and manning the helm of the make-believe pirate ship. The play area is one of many examples of staff giving back that we heard about throughout the day. Others included volunteering to hold newborn babies, babysitting patients while parents enjoy a night of dinner and entertainment at Parent’s Night Out and wrapping presents at the Cook Children’s annual Santa’s Workshop.

A Place for Kids to be Kids

Our tour also took us to the Child Life Zone (CLZ), another fun place for patients to visit, be expressive and just take time to play, even if only for a little while. Here there are no needles or procedures, just the opportunity to enjoy fun activities such as playing pool or video games, reading a book in the library or hanging out in the teen room.

If patients can’t make it to the CLZ, they have the option to watch CLZ TV programming, the Cook Children’s channel available in all inpatient rooms. CLZ TV is recorded from the high tech broadcast studio, delivering game shows, quiz shows, creative arts and crafts, yoga and more right to the patients’ room. There are even interactive shows, like Tic-Tac-Toe, where kids can call in from their hospital room phone to participate. Patients may participate in videoing shows and games. The Child Life Zone also has a full recording studio and instruments (guitars, drums, tambourines, etc.) available for patients to play and record their music. The Child Life Zone is supported by Teammates for Kids, Garth Brooks and Troy Aikman’s Foundation.

The staff at Cook Children’s recognizes that sick kids still need the opportunity to just be kids, and the Child Life team works with both the medical and support staff to help create a child-friendly environment. They help patients and family members cope with their hospital experience by providing emotional and developmental support and even have Chanel and Ralph, a canine team who work full-time. Ralph is on call for inpatient visits and hangs out with the kids at the CLZ while Chanel works at the pain management clinic and makes rounds with her doctors to visit patients and assists in comforting patients during pain management procedures.

Parents and siblings are welcome in the CLZ and can take advantage of all of the activities. For parents, there is a family health library where they can, with the help of professional librarians, get the latest information on a variety of health topics. The library also provides a quiet place for parents to read and relax.

Family-Centered Care

While still young in their overall patient experience journey, Cook Children’s Medical Center has a well-established Family-Centered Care (FCC) focus that began more than eight years ago and has become an integral part of their organizational culture. We had the pleasure of spending time with Jill Koss, director of family support services, who oversees the child life team, family-centered Care and the volunteer program and Vicki Kelley, manager of family-centered programming.

They shared details about family involvement in the organization, from parent mentoring to active family and teen advisory councils and even parent participation on committees – including nine of the Center’s Hospital Acquired Condition (HAC) committees. Koss acknowledged initial apprehension from staff regarding parent involvement, particularly on the HAC committees where discussion can often touch on things gone wrong, but staff quickly came to appreciate the perspectives from family members and understand their personal passions to help make Cook Children’s Medical Center the best it can be.

“Staff did have to learn how to listen to parent feedback without becoming defensive or frustrated,” said Koss. “But they came to realize that these volunteers love our hospital and want to help us make it even better. They have ideas on what can make us 100% instead of 95%.”

It took time to achieve the level of family involvement that Cook Children’s enjoys today. Initial efforts included simple focus groups bringing in patients and families to speak candidly about their experiences. In addition to a plethora of less-formal parent advisor roles, the focus groups eventually evolved to formal family advisory councils with participants nominated by staff.

Those advisory councils have contributed to such things as improved wayfinding with new maps and signage, better handicapped/oversized vehicle parking options, drop-off areas and more personalization with whiteboards in all rooms. The councils were also instrumental in creating the PACT cards found in every patient room and even made recommendations for changes to staff badges (which now highlight first names in larger print and include easier to understand department and role information).

Even with Cook Children’s significant transition to Family-Centered Care over the past eight years, Koss and Kelley acknowledge that there is still work to be done. While staff have embraced the FCC culture, the question is do parents understand what it means? “We still have a lot of work ahead of us to bring parents into the culture change. We must continue to educate them on opportunities to get involved and contribute.”

Patients can get involved too. Cook Children’s is proud to have an active YAC/PAC (Youth Advisory Council/Patients Advocating for Change), a group of 12-18 year old patients who provide great insight on what it means to be in the unique position of being a teen in the hospital (not a child, but not yet a young adult). YAC/PAC members are currently working on a transition program to help pediatrics patients’ transition to adult care.

The total volunteer population at Cook Children’s Medical Center is more than 1,000 members strong, contributing over two million hours annually, from the groups mentioned above to volunteers who stitch blankets and pillows to provide patients extra comfort.

Connecting Quality, Safety and the Patient Experience

As Patient Experience Coordinator, Althouse reports to Rachel Wenthe, AVP quality improvement, who oversees quality, safety and patient experience. An active participant in Children’s Hospital Solutions for Patient Safety, a collaborative of 80+ children’s hospitals across the United States who share the vision that no child will ever experience serious harm while hospitals are trying to heal them, Wenthe understands the importance of engaging patients and families in developing a culture of safety. She quickly acknowledged the value of parents on all committees at Cook Children’s, “While staff members may fluctuate between their parent and staff member perspectives, the family members on these teams always wear their ‘parent hat’ and that brings an essential and invaluable perspective. And the more perspective we have, the better.”

Wenthe spoke about Cook Children’s ‘Journey Home’ program geared at helping patients and families prepare for their arrival home from the time they are admitted which includes a detailed journal outlining goals, diet and medication. She also emphasized the significance of health literacy in ensuring patients are informed during their stay and equipped for discharge as an overall contributor to quality, safety and patient experience.

Building a Patient Experience Learning Program

Recognizing the importance of employee engagement in patient experience efforts, Althouse developed an internal patient experience training program that most Cook Children’s staff go through in some capacity. The program touches on the definition of patient experience, makes the connection that all staff members impact patient experience and helps participants understand the importance of word choice and caring behaviors. Althouse personally delivers each patient experience training program weaving in multiple real-world stories she’s collected from a database of over 48,000 patient and family comments.

Engaging Staff through Patient Experience Champions

To conclude our day, we had the privilege of joining Cook Children’s Patient Experience Champions (PEC) for their monthly meeting. The PEC consists of approximately 30 staff nurses who come from all areas of the medical center, including outpatient surgery and specialty care. Having worked together for over two years, the objective of each meeting is to share patient experience education and best practices with one another. The meetings also provide them with an open forum to discuss both challenges and successes.

The goal of the program is for the PECs to take the information shared in the monthly meetings back to their individual units and share what they have learned, acting as a patient experience resource for their team. Because they are staff nurses, they have been given the opportunity to be directly involved in changes in their environment.

Julie Withaeger, director of magnet program, led a powerful presentation on the value of “Care-Full Explanations.” Through storytelling and modeling, she shared how the power of choosing the right words to convey empathy and caring can make the difference in patients’ and family members’ experiences. The group spent time working together and sharing situations on their own units and how these practices could be put in place to make a difference. Julie shared the thought that, “We will have better patient outcomes if we engage with our patients and family members, and we need to make sure that we are teaching this to our staff.” It is clear that education is only one of the purposes of these monthly meetings.

The time that the PECs spend with each other is also helping to re-energize them and remind them of their role as caregivers. By sharing best practices with one another, they are also able to get feedback from each other as well as spark some ideas that the other PECs might be able to take back and implement on their own units. Watching the PECs interact with one another, it is evident that this is a passionate and engaged group who are focused on what they can learn and take back to their fellow staff members to help improve the patient and family experience.

Some of the best practices shared in this meeting came from the NICU and the PICU units. The NICU shared what they are doing to address noise concerns. The NICU has the challenge of noise from crying babies, constant alarm monitors and not having a central nursing desk for nurses and staff to gather to talk with each other. To address the noise issues, they have implemented a defined lights out time, are monitoring and being aware of where conversations are taking place and even turning down the volume on alarm monitors at night. Recognizing that there are going to be some things that they cannot control, they are working to minimize the noise in the areas that they do have control over. They were excited to report that with these changes they are already seeing improvements in their patient satisfaction scores.

The PECs from the PICU then shared their 2015 patient experience goals which includes: updating whiteboards to make them more personal for family members, creating an hourly rounding script that will provide for more purposeful rounding, creating a monthly banner and email to educate staff, highlight important ideas and initiatives and redesigning their admission packets to be more comprehensive while providing useful information for patients and family members. They also shared examples of the banners that they are currently using to help educate staff. These banners share tips and suggestions on how to improve processes and then report their scores on that area. Looking at their goals, it is obvious that they not only want to educate and engage staff, but also want to make sure that the patients’ and family members’ experience is a positive one.

The PECs will however be the first to admit that there has been pushback and sometimes apathy from staff when they come back to them with new ideas because staff sometimes sees this as one more task for them to complete. They haven’t let this stop them. To address this and better engage with staff, some champions shared how they are working to do more one-on-one peer coaching and teaching. They are also reframing for the staff that they aren’t really adding additional tasks and instead they are giving them a better and more effective way of doing something that they are already doing. Their feedback on this approach is that it is more personal, more effective and better received by the staff than emails and written communication.

We were also excited to hear them brainstorm ideas for celebrating Patient Experience Week. Some ideas that they came up with included creating a “map to the patient” to help staff, especially nonclinical, understand their role and connection to the patient and patient experience. We loved this idea because it will help show staff that they truly are all a part of the patient experience.

A Never-Ending Journey

Our day ended by sitting with Althouse to discuss all we had seen throughout the day, from learning of the incredible involvement of family members to the volunteer program to witnessing firsthand the incredible engagement of the Patient Experience Champions.

While Cook Children’s is in early stages in their overall patient experience journey, we applaud the steps they’ve taken to taken to involve patients and families and their acknowledgement of the crucial relationship between quality, safety and patient experience.

We extend a special thank you to Jan Althouse for being our host for the day and to everyone we met for sharing the amazing work that is being done each day.