At Texas Health Presbyterian Hospital Dallas (Texas Health Dallas), we pride ourselves on our environment, where nurses and other clinical staff work collaboratively to provide high-quality care to patients. In 2016, we were honored to join the elite ranks of hospitals nationwide that have achieved Magnet(R) recognition from the American Nurses Credentialing Center 3 times. Multiple Magnet designations mean that elements such as innovation and improvement, exemplary practice, transformational leadership, and shared governance are hardwired into our culture. We are not afraid to try new ideas when faced with a challenge.
This forward-thinking focus drove the formation of our Patient Advisory Council (PAC) as a key strategy to improve the patient experience. Composed of former patients; their family members; our patient advocate, chaplain, nurses, and myself, the PAC offers insight and recommendations for improving quality, safety, and service throughout the hospital.
Challenging Long-Held Beliefs
As veterans in healthcare, we thought we had a good understanding of what our patients wanted. But lagging patient satisfaction scores forced us to challenge many long-held beliefs. We realized that there is no substitute for hearing firsthand how patients and families feel. A better understanding of their desires and expectations helps us focus our improvement efforts where they are needed.
We were surprised to learn that a major patient dissatisfier occurred before anyone even entered the building. Patients were upset about having to track down discount vouchers for parking. We worked with our real estate team to implement improved access to vouchers and to standardize parking procedures.
When our council cochair pointed out that the large hospital handbook given to arriving patients was cumbersome and overwhelming, the PAC helped us revamp the materials to make them more user-friendly. Patients and families now receive a simple, 2-sided sheet that provides all the basics at a glance and fits easily on the patient's tray table, along with their phone, meal tray, and tissues.
A PAC member who serves as a volunteer in our Center for Women and Infants noted that often there was no wheelchair available for women arriving in labor. The hospital foundation provided funds to pay for a pink wheelchair dedicated solely to labor and delivery patients.
One of the PAC's biggest contributions centers on improvements to patient flow. Again, members gave us a very different perspective on this issue. They pointed out that patients admitted through the emergency department (ED) when a bed is not available, often feel they are in no-man's land. The perception is "nobody owns you." Now, the inpatient nurse manager visits these patients to welcome them and provide updates about their status.
These changes are making a positive difference in patients' perceptions of their care experience. Among patients recently interviewed about their ED stay, several report having an "exceptional experience." We attribute this partially to the PAC's feedback about admitted ED patients feeling overlooked while waiting for beds.
Advocates for Improvement
From the start, nurses were our biggest advocates and their contribution has been significant. As we planned our PAC, the very 1st group to give its blessing was our executive team, which includes our chief nursing officer (CNO) and assistant CNO. The chair of our nursing shared governance council, who also sits on our quality committee, was supportive. Our bedside nurses-steeped in a Magnet culture that highlights patient-provider partnerships-wanted the patient perspective and also enthusiastically championed the PAC's creation. They understand that strong, supportive relationships lead to improved healthcare decision making and outcomes.
Embracing the Next Frontier
Despite this support, some people in the organization were wary. A few members of our quality committee felt uncomfortable about including patients in candid conversations about quality and safety issues, such as surgical site infections or less-than-desired quality outcomes. However, as senior director of quality, I was determined: to be effective, we must give healthcare consumers a seat at the quality table. It is the next level in patient and family advisory councils and a necessary step forward to build transparency and move the quality needle.
Most hospitals have yet to effectively engage patients and families in strategic quality improvement and patient safety initiatives. But many of the most innovative organizations are enlisting community members to openly discuss adverse events and offer unique perspective on root causes. Who better to identify barriers and opportunities?
The Journey to High Reliability
Like many other hospitals today, Texas Health Dallas is on a journey to high reliability. High-reliability organizations prioritize safety above all else. Partnering with patients and families is a key strategy to build highly reliable systems. It provides information that can change the way you think about a host of operational issues. As we have learned, our patients and family members possess intricate knowledge and vastly different perspectives on care processes, communication, and coordination of systems, all of which are critical to improve care. By uncovering this knowledge, hospitals can design safer, more efficient, and more effective processes and achieve higher levels of quality patient care.
Texas Health Dallas remains committed to the strong partnership required for quality and safety. As we plan for 2017, one of our goals is to increase patient and family involvement in other hospital committees. For example, we are considering adding a patient to the fall-prevention team and the medication safety team. We believe that there is no better point of view to improve results for critical patient safety indicator than patients and families.