Kaiser Permanente, Northern California

Caritas in ActionHow Caring Science informs and inspires KP caregivers and affirms our commitment to provide our

patients and their families exceptional care

Caritas Consortium 2013Bring the Team to the Core: Establishing an Ethic to Incorporate

Caritas into our Patient Care Experience

Intent to Contribute Statement:Over the course of the last 2 years, 4 center has focused on creating a culture of patient centered care. We

developed a caritas plan that encouraged all members of our team to engage in the process of being authentically

present and using every part of who we are as caregivers to create a caring environment. We started paying

attention to the little things. Our unit leaders were focused on encouraging the frontline staff to take ownership of

the caritas plan. Our caritas champions set examples by celebrating the lives, interests and health of our patients.

The only problem = we weren’t getting consistent HCAHPS scores … We saw a large number of survey respondents

who rated our unit 8! We knew that people were satisfied with their care, but it wasn’t translating on our scorecard.

8 out of 10 should be flattering right? It was flattering to us! It’s was unflattering to our scores. The good news = we

realize that establishing a culture is a long process. 4 Center is not interested in rushing for results. If we rush and

introduce before assessing the potential outcomes, we may sacrifice the quality of our efforts. We are trying to

establish a lasting ethic that allows us incorporate our caritas principles into our patient care experience (HCAHPS).

We want to merry the two so that we can care for the patient as a whole and improve our scores without

neglecting one or the other. Our concept: Bring The Team To The Core

Bring the Team to the Core: Establishing an Ethic to Incorporate Caritas into our Patient Care Experience

1) Initiate a front line culture that enables our staff to care for patients using their whole and authentic selves. We

spent almost 2 years doing this and presented at the last consortium with this concept.

2) Develop a culture within our unit leadership team that exhibits the following principles:

a) Open mindedness - Without open minds, we may be inhibiting our staffs desire to act naturally or raise crucial

concerns.

b) Open Doors - Keeping the “doors open” is a metaphoric example of how leaders should be available to staff -

always! Nothing says “I care” more than absolute presence. The idea is that leadership visibility creates a more

cohesive team and a cohesive team is better equipped to care for patients!

3) Identify the areas of the patient care experience that can be married to some caritas principles. The hospital is a

busy place and it can become overwhelming when you consider the multitude of responsibilities we all have. We felt

like these 2 areas are equal parts of a coin: On one side are the tangible aspects of our care experience actions like

hourly rounding and sending thank you cards and the other side is depicted by the way in which we perform these

activities.

4) Maintain the things that are working and modify/change/erase the things that don’t. As a unit, we look at the

scores and celebrate our successes.

… Continued

Bring the Team to the Core: Establishing an Ethic to Incorporate Caritas into our Patient Care Experience

We want to know what our HCAHPS scores look like and we want to discuss our strengths and weaknesses in

relation to the score. Unit leaders are giving staff surveys and encouraging use of the anonymous suggestion box.

Unit leaders meet frequently to address each other’s concerns as well. There should be an ongoing dialog about the

things we do right and the things that need change. This is the dialog that writes the cultural rules of our unit. The

idea is to treat the concerns of everyone involved in patient care equally. How does the concept look?

1) We developed a culture that affirms patient centered in approximately 2 years

2) Unit leaders openly acknowledge faults and huddle with staff that there is no retaliation for expressing ideas for

change or to enhance unit leadership performance. This is ongoing . We want to use positive language and become

less punitive and more constructive

3) Align / combine the concepts of patient care experience and Caritas principles to improve HCAHPS. We are using

HCAHPS as a way to quantify the more expressive caritas concepts. Patient care and experience is enhanced through

consistent and diligent care details. These details start with the moment a patient arrives on the unit. Nursing staff

should be warm and welcoming. The care givers should be consistent because authenticity comes from building

relationships. We make consistent staff assignments. We assign our ANM’s to round on, send thank you cards, and

make phone calls to the same patients every day and every time. We are attentive to any special requests or needs

a patient or their family have.

… Continued

Bring the Team to the Core: Establishing an Ethic to Incorporate Caritas into our Patient Care Experience

We have formed two committees within our unit council that focus on the patient care experience. It is basic

because we have made it a priority to deliver consistently. 4 Center has been in the green (HCAHPS score above

target) for 5 months straight. We plan on developing a special requests team who will be responsible for obtaining

or creating unique moments for patients. This will be in addition to everything mentioned above. We want to be

creative and find interesting ways to show our patients that they are in our thoughts. As our HCAHPS scores have

shown it is not one big thing that makes a difference, it’s all the little things.

4) We are maintaining all of this through frequent huddle/feedback conversations, HCAHPS, and peoples pulse. As

mentioned above, this has to become an ethic in order to work.

5) We don’t rush things. We are striving for a quality of outcomes and are willing to sacrifice quick results for

sustainability.

Page 5

… Continued

Bring the Team to the Core: Establishing an Ethic to Incorporate Caritas into our Patient Care Experience

Inspired Contributor(s) 1 : Bryce Albright Michelle Gail Cusi Jed Rigor

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Service Area: San Francisco

Medical Center: SFO

Affiliation: PCS

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Year Shared: 2013

Venue: Caritas Consortium

Format: PowerPoint

ID #: n/a

1 Names as listed in Lotus Notes, otherwise personal e-mails indicated

Bring the Team to the Core: Establishing an Ethic to Incorporate Caritas into our Patient Care Experience

Keyword TAGs: Identifier

Consortium2013-July, San Francisco, Podium, Patient Care Services

Hospital Initiatives, Culture, Caritas Leadership, Team, Patients/Families

Descriptor Workflow, HCAHPS, Rounding

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Page 7

Ethic:RATIONAL, OPTIMAL AND APPROPRIATE DECISIONS MADE ON THE BASIS OF COMMON SENSE. THE BEST SOLUTION OF THE GIVEN OPTIONS…

CULTURE: The way we do things

HCAHPS (JAN. 2010 –JAN.

2012)

65%= OUR OVERALL RATING BEFORE LAUNCHING OUR INITIATIVES

We wanted to do better

2 years ago we came up

with a concept to

create a patient

centered culture.

The idea was to infuse teamwork into our culture, WHICH WOULD RESULT IN better PATIENT CARE.

WE DRAFTED 4 CENTER’S FIRST MISSION STATEMENT AND CREATED A SLOGAN THAT EXEMPLIFIES TEAM WORK…

We divided hourly rounding

We focused on call light responsiveness..

In July of 2012, we started thinking about ways to answer call lights more efficiently. We were able to get an average time of 9 seconds. The rule: Call lights are everyone's responsibility!

Staff responsiveness scores creeping up…

We kept consistent break relievers In order to provide the best care possible, we kept consistent break relievers . We wanted our break staff to be friendly, clinically strong, and competent in the role. We chose nurses who were excellent team players because we wanted to distribute the team energy across the widest field.

Consistency breeds mastery !

THE PATIENTS NOTICED! 2 of those break relief nurses won the daisy award in the same month!

HCAHPS (JAN. 2012 –

OCT. 2012)

72% = OUR OVERALL RATING AFTER INITIATING A TEAM FOCUSED CULTURE

18% OF OUR SCORES WERE 8’S

8 = 0WE WANT OUR PATIENTS TO LOVE THE CARE WE GIVE! 8 IS AN AWESOME SCORE AND WE ARE FLATTERED! WE WANTED TO DO BETTER…

72% = 9’s and 10’s

18%=8’s

10%=less than 8

OUR SCORES BROKE DOWN

LIKE THIS

72% = 9’s and 10’s

18%=8’s

10%=7or lessOUR

GOAL WAS TO

DO THIS

OPEN MINDS – OPEN DOORS

Visibility is a staple

Consistent Personalized Relationships

HCAHPS(OCT.2012– APRIL.

-2013)

82% = OUR OVERALL RATING SINCE INITIATING A TEAM FOCUSED CULTURE

HCAHPSFROM 65% TO

82%=

17% INCREASE OVER 2 YEARS

OUR CARING INITIATIVES HAVE BROUGHT ABOUT SOME MAINTAINABLE CHANGES.

The use of word cloud to understand the values of our patient population

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2

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Creating a unit vision

Kaiser’s Vision

4 Center’s Vision