Daniel Wallach

UC Davis Health SystemFalls Prevention Volunteer Program

Evaluation

Contents

Criteria............................................................................................................................................1

Introduction..................................................................................................................................1

Overview of Evaluation...............................................................................................................1

Purpose Statement........................................................................................................................1

Objectives....................................................................................................................................2

Timing for the Evaluation.........................................................................................................2

Area Evaluation............................................................................................................................2

Sample Population.....................................................................................................................3

Stakeholders................................................................................................................................3

Evaluators...................................................................................................................................3

Methods.........................................................................................................................................5

Method........................................................................................................................................5

Additional Methods.....................................................................................................................5

Sampling Technique...................................................................................................................5

Administration of Survey...........................................................................................................5

Survey.............................................................................................................................................7

Results............................................................................................................................................9

Conclusions and Recommendations...........................................................................................13

Conclusion.................................................................................................................................13

Recommendations....................................................................................................................15

References.....................................................................................................................................17

Appendix………………………………………………………………………………………...18

Criteria

Introduction

Name of the Organization: UC Davis Falls Prevention Volunteer Program

Type of Organization: Teaching Hospital

Type of Service: In Patient Care

Population Served: Greater Sacramento Area and northern California

Position with the Organization: Manager of the Falls Prevention Volunteer Program

Position’s Responsibilities: The manager of the Falls Prevention Volunteer

Program is responsible for coordinating, training, and recruiting the volunteers for

the program. The manager also tracks the effect the program may be having on

reducing falls in the hospital.

Overview of Evaluation

The Falls Prevention Volunteer Program (FPVP) is part of a comprehensive initiative at the UC Davis Health System to reduce falls of patients receiving treatment while in the hospital. Volunteers in the program assist hospital staff to educate the patients and their families about the risk of falls in the hospital and the overall risk of falls after the patient is discharged. This program is guided by the mission of the UC Davis Health System.

The mission of the UC Davis Health System is to improve lives by providing excellent patient care and transforming healthcare with bold innovation.

This evaluation will compare the volunteer experience in the FPVP with the stated goals of the mission to provide excellent patient care, transformation of healthcare and bold innovation.

Purpose Statement

The purpose of this evaluation is to determine the volunteer experience in the FPVP with the stated goals of the mission to provide “excellent patient care, transformation of healthcare and bold innovation.”

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Objectives

1. To identify if the UC Davis Health System Falls Prevention Volunteer Program

provides volunteers opportunities to provide excellent patient care.

2. To identify if the UC Davis Health System Falls Prevention Volunteer Program

provided patients services that is transforming healthcare.

3. To identify if the UC Davis Health System Falls Prevention Volunteer Program

provided patients bold innovation.

Timing for the Evaluation

This report will use a summative evaluation, as this will indicate if the FPVP is meeting the objectives stated. The goal of the FPVP is to reduce falls and educate the patients on general fall prevention and a summative evaluation will provide data that will indicate if that goal is being met. It is also important that the evaluator understand the link between the mission of UC Davis Health System (UCDHS) and the FPVP. The summative evaluation will indicate if that is the case also.

Area Evaluation

The evaluation will determine if the personnel in the FPVP are aligned with the mission of providing patient services that result in excellent patient care. Since the main personnel are volunteers, these individuals will be evaluated to determine if they are meeting the goals of the UCDHS. This will be done using interviews and surveys of the volunteers, as well as on site observations.

UCDHS is well known in the region as an innovator. The mission of transforming healthcare and bold innovation will also be evaluated in this document. The volunteers in the FPVP are a part of the mission of innovation and transformation of healthcare. The FPVP is a relatively new program, having begun operation in the fall of 2014 with a single volunteer and now has 15 volunteers rounding floors every day at the hospital. This makes an evaluation an important tool for managers and staff at UCDHS.

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Sample Population

The sample population will be the volunteers in the FPVP. They are assigned a few floors each shift to round. The normal course of a shift will begin with the volunteer going to each floor and getting an updated list of those on that floor at risk of falling, as determined by a “falls risk scale.” This list is generated by the floor clerk or the head nurse, whoever is available. Anyone on the list that day with a falls score of 60 or greater will have a visit from the FPVP volunteer. The volunteer will speak to each person on the list that day and any family members present about the importance of falls prevention.

Since volunteers are the front line in this program, they will be the ones evaluated. This will be done using direct observation of their interactions with patients and nurses during their shift. A comprehensive questionnaire and survey will also be used to gather data on how they feel the program is working and if any areas of need will be noted. UCDHS has a long history of using volunteers, having over 2500 persons actively volunteering at any one time. This evaluation will assist UCDHS in knowing how effectively volunteers in the FPVP are maintaining the mission and goals of UCDHS.

Stakeholders

The stakeholders include the UC State education system, since UC Davis Hospital is owned and operated by the University of California. Since it is a teaching hospital the students are also stakeholders in this evaluation. Other stakeholders would include the patients that come to the hospital for treatment. These individuals may come from any part of the state of California, and a few from outside the state. The majority of the patients come from the northern California region.

The volunteers also become stakeholders as they may have many reasons to volunteer at the hospital. Some may be looking for valuable experience. Others may be looking to network with similar interests in medicine. Some may have other motives that this evaluation will make clearer. Since the community supports UCDHS through tax dollars, they are also stakeholders that may be interested in the evaluation of the FPVP. By seeing how this program is a model of innovation it may give greater appreciation to the public as to what the hospital system is doing to have better outcomes for the community that come there for health services.

Evaluators

The evaluator will be on site to observe the volunteers as they go about their daily. Since the manager of the FPVP has the most knowledge of the program and the volunteers themselves, he will be doing the evaluation. The manager will do the observations of the volunteers and

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interview the nurses as to the way in which the volunteers interact with patients and nursing staff.

As for the surveys, the manager will appoint an individual outside the department to administer and collect the surveys from a sample population of the volunteers, so as not to have any influence on the answers the volunteers may give to the questions.

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Methods

Method

The evaluator will administer a survey to the program participants. This will be in the form of a drop off/pick up questionnaire. There is an advantage to using this technique in that the response rate is high and an explanation of the survey is possible at the time of giving it to the respondent. The disadvantages of this type of survey (cost of staff travel time and access to survey) will be mitigated since the program manager is on site and the volunteers for the FPVP also report to the manager on a regular basis. The survey will be worded in such a way as to get the overall feelings of the volunteer in regards to the program and how the program relates to the mission of UCDHS. It is expected that this census technique will have a very high response rate, thus using this method will lead to excellent qualitative and quantitave data.

Additional Methods

In addition to the survey, a secondary method will be used. This method involves observation of the volunteers as they carry out their duties in the FPVP. The manager will observe various volunteers in the program over the course of the evaluation period. This data will be used in addition to the questionnaire. It will give a more objective view of how the volunteers are interacting with nursing staff and the patients that they speak to. To assist the manager in observation a standard checklist of duties normally performed by the volunteer will be used to judge compliance with the program and adherence to the mission of UCDHS.

Sampling Technique

The sampling technique used will be the entire population of volunteers. Since there are only 15 volunteers in the VPVP, this will be most accurate and allow for greater validity. The observation period will be of sufficient time to allow for direct observation of at least 50% of the total amount of volunteers. Although observation of every volunteer is possible, it is not practical or cost effective to do so. The high compliance of the survey will offset some of weakness in the observation sampling percentage.

Administration of Survey

The manager will give each volunteer a survey packet to take home and fill out. The volunteer will return the filled packet to the manager on his/her next shift. The drop off/pick up survey method has a high response rate and allows for questions by the respondents to be

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answered before the survey is completed. Reminders via email will be sent to each volunteer to return the survey as soon as possible. The return rate is expected to be 100%, however if a volunteer is unable to participate in the survey the manager will know right away. The normal disadvantages of the drop off/pick up method such as costs of travel and site access will not be a factor.

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#

Survey

Thank you for volunteering in the Falls Prevention Volunteer Program (FPVP) at UC Davis Health System. Your involvement makes this program possible. Our goal is to provide excellent patient care. In order to reach this goal we need your input on the FPVP. We know your time is valuable; therefore, the survey will only take about 15 minutes. This survey is confidential and will be used by FPVP staff to improve your volunteer experience. No personal information will be needed except some specific demographic questions at the end of the survey.

Thank you for your support and time.

1. Was this your first time volunteering for UC Davis Health Systems?

Yes No

2. UC Davis Health System is committed to providing excellent patient care. In thinking about your volunteer experience in the FPVP, please rate your level of agreement to the following statements as they pertain to your volunteer experience in the FPVP (1 = Strongly Agree to 5 = Strongly Disagree):

StronglyAgree

Agree Neutral DisagreeStronglyDisagree

I have extended conversations with the patients. 1 2 3 4 5Sometimes I move items within reach of the patient. 1 2 3 4 5

The patients confide in me about the care they are receiving.

1 2 3 4 5

I have found that speaking kindly to the patient’s family is comforting to them. 1 2 3 4 5

The nurses are supportive of my rounds on their floor.

1 2 3 4 5

I try to strike up conversations with my patients. 1 2 3 4 5

I feel that reminding patients about falls risk is helping them. 1 2 3 4 5

The patients respond favorably to my visits. 1 2 3 4 5

3. Please explain in one sentence, what you enjoy most about volunteering for the FPVP.

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4. While volunteering for the FPVP you are also helping to transform healthcare at UC Davis Health Systems. With the statement below, please put an “X” next to all of the choices that reflect transformation of healthcare in reference to the FPVP.

“While volunteering in the FPVP I have found that: ”

Patient’s knowledge of falls risk has increased. The nurses are more likely to put a falls band on patient after my visit. I feel my volunteering has helped some patients be more careful. Patients have told me that they are going to make their home more “fall proof”. Patients look forward to seeing me. I have been able to respond to patient’s needs when I visit them. I try to discern if the patient needs something on my visits.

5. UC Davis Health System has a reputation of bold innovation. Since the FPVP is a new program we would like to know which aspects of the program you feel contribute most to the spirit of innovation. Based on your experiences, please rank the choices that you feel contribute to innovation, from 1 = the most helpful to 6 = the least helpful.

Law compliance Safety equipment Daily rounds Kind interaction with patient Compassionate staff Uncluttered room

6. Have you found volunteering in the FPVP helpful to you personally? Yes No

Please Explain:

7. Please tell us about yourself:

Age: 18-20 21-23 24-26 27-30 31-40 41-50 51-80

Sex: Male Female

Ethnicity: Caucasian African American Hispanic

Native American Asian/Pacific Islander Other:

College Student: Yes_____ No____ If yes which college? _______________

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Results

A total of 50 volunteers participated in this survey, out of the 50 volunteers, 30 were male and 20 were female. Hispanic and Caucasian volunteers made up the majority of the group (30% each), followed by African American (16%) and Asian (16%), Other (6%), and Native American (2%) (Ethnicity, Figure 1). The majority of the volunteers were students (62%) with the remaining volunteers (38%) coming from the community at large. The age of the volunteers was from 18 to 50 years old. The majority (52%) were from 18-20 years old, followed by the 21-23 year old group (32%) and equal amounts of 27-30 and 31-34 year old (8% each).

Caucaisan

African American

Hispanic

Native American

Asian

Other

0 2 4 6 8 10 12 14 16

15

8

15

1

8

3

Figure 1: Ethnicity

When volunteers were asked if it was their first time volunteering for the UCDHS, 28 (56%) responded that was not their first time volunteering, while 22 (44%) responded that is was their first time volunteering (First Time Volunteering, Figure 2).

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44%

56%

First Time Volunteering

Yes No18

Figure 2: First Time Volunteering

The volunteers in the survey were asked to rate their experience as a FPVP volunteer in providing excellent patient care on a basis of 1 to 5. One represents strong agreement with the statement and five represents strong disagreement with the statement as it pertains to patient care. In this table the lower the average score, the stronger the agreement with the statement. In this table the question relating to moving items within reach of the patient had the highest level of agreement while having extended conversations with the patient had the lowest level of agreement (Average Agreement, Table 1).

Table 1: Average Agreement

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Statement Average

I have extended conversations with the patients. 3.40

Sometimes I move items within reach of the patient. 2.68

The patients confide in me about the care they are receiving. 2.80

I have found that speaking kindly to the patient’s family is comfortingto them.

318

The nurses are supportive of my rounds on their floor. 3.12

I try to strike up conversations with my patients. 3.16

I feel that reminding patients about falls risk is helping them. 2.86

The patients respond favorably to my visits. 2.80

Volunteers were asked to mark with an “X” all of the choices that they felt contributed to the UCDHS mission of transforming healthcare. Thirty of the respondents (60%) felt that the patients communicated to them that they would go home and make their home safer. Twenty-eight of the respondents (56%) felt that the patients enjoyed their visits. Only 22 (44%) marked that they thought they were able to discern the patient’s needs (Transformation of Healthcare, Figure 3).

Patient's Knowl-edge

Nurses Put

Bands On

More Careful

Home Fall Proof

Patients Enjoy Visit

Patient's Needs Met

Discern Needs

0

5

10

15

20

25

30

35

2327 27

3028

23 22

Transformation of Healthcare

Figure 3: Transformation of Healthcare

The volunteers were asked to rank six choices that they felt helped to contribute to the spirit of innovation at UCDHS. The most helpful was rated 1 and the least helpful aspect was rated with a 6. The volunteers ranked Kind Interactions (3.00) and Compassionate Staff (3.22) as the highest innovative statements, while marking Law Compliance (3.94) and Daily Rounds (3.68) as the least helpful contributors to innovation (Contribution to Spirit of Innovation, Figure 4).

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Uncluttered Room

Kind Interactions

Law Compliance

Propper Equipment

Compassionate Staff

Daily Rounds

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5

3.54

3

3.94

3.62

3.22

3.68

Contribution to Spirit of Innovation

Figure 4: Contribution to Spirit of Innovation

When volunteers were asked if they found volunteering helpful to themselves personally 30 respondents (60%) agreed that they were personally helped by volunteering in the FPVP while 20 respondents (40%) did not feel that volunteering helped them personally (Volunteering Helpful Personally, Figure 5).

Yes No0

5

10

15

20

25

30

35

Volunteering Helpful Personally

Figure 5: Volunteering Helpful Personally

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Conclusions and Recommendations

Conclusion

The purpose of this evaluation was to determine if the volunteer experience in the FPVP is congruent with the stated goals of the mission to provide “excellent patient care; transformation of healthcare; and bold innovation.” In order to determine if that purpose was being met specific objectives were evaluated.

One objective was to determine if the UCDHS Volunteer Falls Prevention Program provides volunteers opportunities to provide “excellent patient care”. Several aspects of patient care were used in the survey to determine at what level the volunteers thought they were delivering care to the patients. The highest rated aspect of delivering care was in regards to moving objects closer to the patient. This is an important aspect because if the patient has to reach for an object, such as a phone or water glass they are more inclined to fall out of bed. Since most volunteers made this a priority on each visit the patients would likely have felt that the care received was specific to them and helpful.

One area of patient care that likely needs improvement is in the ability of volunteers to have extended conversations with patients. Many patients in the hospital are there alone. Some do not have any family or friends visiting them during their stay. By spending time with the patients in extended conversations the volunteers can find out valuable information concerning their care, and it is feasible that they will reveal aspects of home life relating to falls prevention. This may give the volunteer a unique opportunity to interject some information on how to make the home safer for the patient after they are discharged from the hospital.

A second objective that was evaluated was identifying if the FPVP provided patient services that transformed healthcare. Most of the respondents felt that the strongest indicator of transformation of healthcare was in the fact that patients told them that they would try to make their home safer. Since the volunteers make it a point to give each patient a pamphlet on preventing falls at home, it is likely that the patients are reading that information. This has the potential of long lasting impact because most falls occur at home (Northridge, et al, 1995). Even a small reduction in falls in the elderly at home could be considered as transformative.

The third area evaluated considered whether or not the FPVP provided patients bold innovation. The respondents indicated that innovation was accomplished by kind interactions and

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compassionate staff. In our culture many people are isolated and missing positive interactions in their life. In the sterile and busy environment of a hospital it can be very easy to overlook the

importance of kindness and compassionate care. Volunteers in the UCDHS have an excellent opportunity to provide this kind of innovative care to the patient population. They are not subject to the pressures of productivity that paid staff experience. They also have the advantage of a more open schedule, allowing more time with patients that may want or need to talk to a kind and listening ear. This psychological and social benefit to patients can speed healing (Business Wire, 2014). UCDHS has over 2000 volunteers active during a given month, so this cumulative effect can be significant.

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Recommendations

This evaluation has shown that the FPVP is in alignment with the mission of UCDHS in regards to providing excellent patient care; transforming healthcare; and bold innovation. It is recommended that this program continue to operate as it has over the past 12 months. That does not mean however that there is no room for improvement. The survey responses show clearly that there are opportunities to improve on the FPVP that will result in more volunteers involved in the program and improving the outreach to patients that are in the hospital. This may result in lower rates of falls in the hospital and after discharge when the patient goes home.

The first recommendation would be for more direct training of volunteers in the FPVP. Currently the volunteers in the FPVP are given a PowerPoint presentation to take home and view. That is the extent of the training for making the rounds in the hospital. It is possible that with more targeted training of the volunteers that they may be more prepared to converse longer with patients. The survey revealed that the weakest aspect of agreement in the volunteers was that they had “extended conversations” with the patients. The inherent value of deeper level conversations involving patients is that it can potentially lead to details important to changing falls outcomes. Even changing a few minds per month concerning the importance of falls prevention is important, since one fall can lead to a life-changing catastrophic event.

One possible solution to the training of new volunteers could be to use the experienced volunteers in the training process. The nurses and administrators of the hospital are very busy and find it very difficult to train volunteers for involved tasks. Current, experienced volunteers can be a viable solution. It is likely that a qualified and prepared volunteer that has at least 6 months experience in the FPVP could spend take a new volunteer on his rounds the first time. That experienced volunteer could model how to interact and report compliance on each floor. This could add continuity and consistency to the FPVP. It also has the potential of showing more timid volunteers exactly how to get into extended conversations with patients.

A second recommendation that deserves attention is in the area of discerning patient’s needs. This also was a weak area in the survey. When respondents were asked what contributed to transforming healthcare at UCDHC, the lowest category was in the area of discerning patient’s needs. It is possible that this is related to the age of the volunteers. Fifty-two percent of the volunteers surveyed were in the 18-20 year old age group. Since discernment is associated with age and experience (Hazel, et al, 2010), it is not a big leap to conclude that 18-20 year olds may lack in being able to discern from verbal and non-verbal cues what a patient may need. This is another example where training or mentoring new volunteers may help. Since about 8% of the respondents were in the 31-34 age group, this is the more likely group to mentor new volunteers. They are

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significantly older and more likely to have developed discernment. By taking an active role in assisting the younger volunteers, the program is in the position to benefit from such passing on of information.

Overall the FPVP is doing well in its stated goals and shows great potential in effecting positive outcomes for the volunteers and the patients it serves.

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References

Hazel C.V. Traüffer, Corné Bekker, Mihai Bocârnea, & Bruce E. Winston. (2010). A

three-factor measure of discernment. Leadership & Organization Development

Journal, 31(3), 263-284.

Northridge, M. E., Nevitt, M. C., Kelsey, J. L., & Link, B. (1995). Home Hazards and

Falls in the Elderly: The Role of Health and Functional Status. American Journal

Of Public Health, 85(4), 509-515.

Scientific literature review shows health care delivered with kindness and compassion

leads to faster healing, reduced pain. (2014, Nov 12). Business Wire Retrieved from

http://search.proquest.com/docview/1622662458?accountid=10358

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