Last month more than 700 people gathered in Saskatoon to take part in Health Care Quality Summit 2012. One of the highlights for me was the panel discussion — “Engaging Patients in Quality Improvement: Best Practices for Best Results” – moderated by Liz Crocker, Vice Chair for the Institute for Patient- and Family-Centred Care. Patient advisors and health care leaders from here in Saskatchewan shared personal stories about the benefits of truly listening to and working with the patients we serve. After an excellent discussion, Liz invited the audience to talk about their experiences and observations.
Bonnie Brossart, CEO of Saskatchewan’s Health Quality Council stepped to the microphone and shared an incredibly personal story about one of her children. Matthew has Abdominal Migraine Syndrome and intermittently needs to get medical care in our local children’s emergency room. (Paul Levy, our closing keynote speaker captured Bonnie and Matthew’s story on his blog). The impact of Matthew’s story on the audience was palpable. Bonnie challenged us to rethink what exceptional care means to our patients, giving us a simple, practical, yet meaningful way to define and measure exceptional care: ask each and every patient you meet, “Is there anything else I can do for you today?”
I spent the week following the Quality Summit as the doctor in charge for the St Paul’s ICU. It is part of our culture and routine in our ICUs to invite the family to join the multidisciplinary team at the patient’s bedside as we gather to review the patient’s status and make the plan for the day. We’ve worked hard to make the ICU a place where families feel welcome and comfortable. But we haven’t yet really standardized our approach to having family member present on rounds, nor have we measured the impact of this change on our patients, families, and staff. I decided to complete my own PDSA of the simple change Bonnie challenged us all to make:
Plan: For one week, at the end of each bedside round, ask the patient and/or the family “Is there anything else I can do for you today?”
Do: Do and describe what happened. I chose the following measures: how much time asking and answering the question took, how many yes’s how many no’s and what additional questions and requests were asked.
Study: Analyze the results and determine what you learned
Act: Adapt, adopt, or abandon the change based on what you learned. Then complete the cycle testing out another small change.
I didn’t use any fancy data collection tools. Just a pen and a piece of paper that I carried in my back pocket, along with some additional attention paid to the clock on the wall. And I wrote down the answers to my question, which I asked 87 times over the course of one week.
What did I discover? Asking “Is there anything else I can do for you today?” added an average of 4.5 seconds to the length of the time I spent rounding with each patient. The patient and/or the family said “no thank you” 86 times. I only got one “yes.” This was a request that we figure out a way for our patient to watch that evening’s NHL playoff game. I also smiled a big smile when I overheard two of the four residents working with me that week asking the same question of nurses, patients, and families when they were working at the patient’s bedside.
Asking this important question did not slow me or my team down. I did not get asked any difficult or awkward questions. I felt like I made a stronger connection with the patients and families in the ICU. And I liked that this simple question provided a sense of closure to the round while signaling to the patient and family that we truly were interested in helping and supporting them. But those are just my feelings. What I should have done was ask a sample of patients and families what they thought of me asking them that question. Maybe that will be my next PDSA. Because now I’m committed to carry on asking every patient or family: “Is there is anything else I can do for you today?”
Did you come away from this year’s Quality Summit with any new ideas? What have you been testing since the conference?