- When Ashley Hodge, MBA, CCP, FPP, saw first-hand the distress many family members experience when their child undergoes surgery, she knew she had to make family communication a part of Nationwide Children’s Hospital’s patient satisfaction strategy.
Hodge, who is the associate chief of Perfusion Services and the Cardiothoracic (CT) Surgery Quality and Safety Officer at Nationwide, explained that the hospital has a long history of including family members as a part of pediatric patient care plans.
Between family caregiver councils and a framework for family involvement, Nationwide has put priority on parents who are experiencing care alongside their children.
But after Hodge, who usually spends most of her time inside the operating room and away from parents, saw one mother’s experience letting her toddler enter surgery, she knew the hospital needed to do more.
“When the mom handed the toddler her over to us, she collapsed on the ground and was sobbing and having a really emotional reaction to letting her child go into surgery,” Hodge told PatientEngagementHIT.com in a recent interview.
“There has to be a better way for us to let the family feel connected,” Hodge posited. “As a parent, sitting in a waiting room and feeling totally disconnected from your child is impactful. That's when I started thinking of some type of communication to improve the amount of times that we communicate with the family so they feel more connected.”
After nearly a year of trying to develop an in-house app with Nationwide’s technology team, Hodge found EASE, a tool that allows surgical team members to send text message updates to family members in the waiting room. The tool also allows team members to send photo or video updates and gives family members the option of reacting with a comment “like” or emoji message.
The tool has improved family satisfaction largely because it is higher touch, Hodge explained. Nationwide has always placed an advanced practice nurse (APN) in the waiting room to help answer any family member questions and to act as a liaison between the family and the rest of the surgical team.
Additionally, prior to implementing the app, surgical teams were required to communicate with family members throughout the surgery at least once every two hours. These conversations were to answer any family member questions, assuage fears, and provide updates.
However, the frequency with which surgical teams adhered to the two-hour guidelines was suboptimal, Hodge noted. Surgical teams adhered to the two-hour update rule only about 43 percent of the time.
Using the communication tool, surgical teams have been able to deliver on these promises because the technology makes communication more convenient.
“Technology helped us because it was the frequency of communication that we were able to augment,” Hodge stated. “But in that transition, we still wanted to make sure that they had that similar and familiar face of that CT surgery APN group to connect with.”
The hospital works to make the messages sent through the app detailed as to prevent confusion on family members’ ends. OR staff are instructed to use clear, scripted messages to ensure family members get the full story of patient progress.
And regardless of how long the surgery is, family members receive a message every 30 minutes. Surgical teams have delivered on this promise in 100 percent of cases since app implementation, Hodge reported.
Additionally, the care team educates family members during the pre-operative process to visit the receptionist who can call the OR for any potential needs.
Hodge and her team also wanted to maintain the human touch of family communication.
“While we're able to use technology to increase the amount of communication that we send, we also still have an APN that goes out that gives a face-to-face update and then allows family members to ask questions and interact with our team and help that personal connection with the families as well,” Hodge explained.
Anecdotally, Hodge has observed an improvement in family communication and with it, an improvement in family and patient satisfaction.
Those improvements are also clear in the numbers, she continued. Through point-of-care family satisfaction surveys, Hodge has seen satisfaction scores improve from about 80 percent to 99 percent after implementing the app. Hodge largely credits this trend to the increases in family communication.
Understanding these point-of-care satisfaction scores has been essential for Nationwide. When the surgical team can see how patients and family members experienced the surgical process specifically – as opposed to the entire hospital encounter – they are able to make more granular and meaningful changes.
“As an institution, when we try to focus on where the problems are and where the families would really like more or better or augmented communication, it's really hard when you're looking from an institution standpoint because it's really hard to drill down on where the issues are,” Hodge explained.
Point-of-care patient satisfaction surveys help to overcome that challenge by giving a step-by-step glimpse into the care experience. It also allows care team members to mitigate any satisfaction issues before the patient leaves the hospital.
This ultimately has its benefits for overall CAHPS scores, the patient satisfaction survey that informs some quality payments. Both point-of-care surveys and CAHPS serve an important purpose, and one can help work off of the other.
“I don't know that these surveys are exclusive,” Hodge pointed out. “As an institution we embrace them as one. If one phase of the hospital stay is an issue, we use that as a challenge and as an opportunity to improve our communication. We work on that specifically with hope that that's then going to further impact our larger scale surveys that we are being evaluated on.”
Ultimately, improving the family experience in any part of the hospital will require leadership to listen to patients and their family members, Hodge advised.
“The key is that you have to listen to the families,” she concluded. “You have to really value their feedback and allow it to be in a manner that they can be candid with how they feel. To really own that and essentially give the families what they're asking for is really important.”