I think we have had a lot of success with revising the ambulatory EHR system, but working very much in concert with the disease site team. There is a framework that we are setting in place that everyone receives (functionality to see who has checked in, vs who still has things left to do), but their has been great customization in the structure of the notes, depending on the demands for each site. I think this process, while timely, has brought good will to the teams who otherwise might be disenfranchised.
This may sound very simple, but setting goals and trusting/empowering that staff to achieve those goals is likely the only way to reach the level of functioning that you wish for. And while not easy, support must be given so as to help the team know they have the confidence and support of their superiors.
Continuing to micromanage their affairs will only compound this problem, at least in my opinion. The real challenge is setting fair and reasonable goals to point them towards in the beginning of the process.
We too have great success with the HCAHPS survey, and part of that may be related to having oncology patients. The biggest success I think we had was simply educating the nurses. Every nurse had to review the survey to understand what they were being measured for, and improvement was undertaken based on their ideas. They were scripted in the way they undertook certain tasks with the patient. We had several HCAHPS measures as a part of our pay for performance metrics with our payors. We also conduct discharge phone calls within 24 hours to ensure the patient is comfortable transitioning to home.
In poring through the patient satisfaction at our center, it was very interesting to see what truly correlates with overall success on a survey. In fact, it seems in the health care world the biggest focus is on reducing wait times, increasing efficiency and giving the care you said you’d give in a timely manner. What’s fascinating is that at least for us, the “soft skills” really are what drive the survey. How much time did the MD spend with you, did all levels of staff communicate with you, professionalism/courtesy of the staff.
This sadly is a really difficult problem to solve. The challenge of meeting operational efficiency burdens our staff, and really the only way to ensure a great environment for our patients is having a workforce that is dedicated, and more importantly, has fun in their jobs. Success stories internally many times result for physician leads giving up some control, and sharing some of the best parts of the job with a nurse. The clinic that comes to mind has the nurse make the phone calls stating that a patient is in remission.
One of the biggest improvements we made in surgical care was after getting NSQIP. Understanding we have areas to improve led to introspection, and specifically the pre-operative risk calculator. We actually validated the calculator for our population (oncology) and saw benefit in using it in the pre-op clinic. As a result of this process, anyone in the surgical process can call a high risk meeting where the surgery plans are peer reviewed. This has led to either going ahead with the surgery, delaying the surgery with “prehab” or not doing the surgery and looking towards other options for the patient.