Team tackles service shortfalls

Patient satisfaction scores skyrocket after doctors and staff from two units at the West LA Medical Center join forces

FRIDAY, MAY 1, 2009 :: By Kellie Applen

Edward G. Hersh, MD, and Tanisha Dickens, RN, with their patients Angela and Michelle Radzinsky.

Problem

The Labor & Delivery/Family Centered Care inpatient satisfaction scores at West Los Angeles Medical Center were dismal—and had been for years. In the first half of 2006, their 50% rating ranked in the bottom 10th percentile.

When Perinatal Services Department Administrator Tessie Desta was hired in 2002, she saw a department beset by operational problems and difficult work relationships. Among the most troubling, from the patient’s point of view, was a disconnect between the Labor and Delivery unit and Family Centered Care unit, leading to frequent complaints from new mothers who felt they weren’t receiving adequate attention after they’d given birth.

Solution

“I would get letters from dissatisfied patients almost every day,” Desta said. “I told the staff, you guys are going to fix this, not me—and everybody came up with some idea to improve care.”

Desta asked a team of physicians, ward clerks, scrub techs and nurses—a group that eventually evolved into a unit-based team—to come up with solutions. It was the first time in the department that doctors, nurses and other staff from Labor and Delivery and Family Centered Care units really worked together to improve patient care.

To ease patients’ transition between the two departments, the team created a script to help staff familiarize patients with their postpartum care and newborn care equipment and supplies.

We work in collaboration and that's why our care has improved. It makes us a better health care plan than the competition.

Edward Hersh, MD

In Family Centered Care unit, they adopted a team approach to rounding, so that all staff, including EVS workers, now respond to patient call lights. They also hang a paper clock on every patient’s door to make it clear the last time a nurse was in the room. If one hour goes by, any nurse from the team checks on that patient. 

Physician involvement in the department’s UBT has been crucial to their success, Desta said. Nurses work hard to schedule meetings around doctor’s schedules and doctors work hard to be there.

“We have to manage our time carefully but we’re talking one to 1-1/2 hours—it’s worth it,” said Edward Hersh, MD, chief of Department of Obstetrics and Gynecology. “In the old days, we were individualists. But now we know that the best care is given in the team environment. Because of this attitude, we work in collaboration and that’s why our care has improved. It makes us a better health care plan than the competition.”

Result

The department’s HCAHPS scores (Hospital Consumer Assessment of Healthcare Providers and Systems) have steadily improved since 2006, reaching 76.9—the 90th percentile—in 2008. As a result, their unit-based team was one of two teams honored in a new program in Kaiser Permanente’s Southern California region that recognizes inpatient UBTs for highest or most improved hospital rating scores.

The first two teams to win were honored for their high ratings by Benjamin Chu, MD, the president of Southern California region, and Jeffrey Weisz, MD, the medical director of the Southern California Permanente Medical Group. The other team, Woodland Hills Medical Center’s Telemetry/Observation unit, scored in the top 2 percent. Next quarter, “most improved” winners will be selected in addition to high performers.