A Roadmap to Patient Experience Success: Lessons Learnt Form El Camino Hospital

What was the challenge, opportunity or issue faced?

El Camino Hospital in Mountain View, California wanted their patients’ experiences to be surrounded by a culture of service throughout the healing process. They believed this was best achieved by having a personalized approach — created from within their employees’ and patients’ hearts and minds. The goal of this work was to achieve top quartile patient experience performance through alignment of strategy, measurement, and infrastructure and by establishing consistency in techniques that solidify standards for service excellence within the organization.

What did they do to address it?

To help them get there, El Camino engaged DTA Associates, a consulting firm specializing in patient experience, to facilitate the development of a customized solution rather than something off-the-shelf. At El Camino, DTA started with a comprehensive organizational assessment, a customized roadmap with recommendations tailored to El Camino’s current status and future objectives. The outcome was an actionable plan with incremental steps to start implementing right away. 

In order to optimize their internal capacity and position the organization for success, El Camino leadership aligned their resources to support the improvements. This included creating a Director of Patient Experience role and bringing together some analytical and patient-facing resources. They optimized their existing survey to support measurement of key initiatives and realigned some of their improvement efforts and areas of focus. The creation of a robust Patient and Family Advisory Committee (PFAC), which consisted of previous patients and/or family members of patients, was essential to this success. 

MORE THAN JUST TRAINING

In order to create a Service Foundations session that reflected El Camino’s culture as well as the needs of their staff, service culture opportunities were identified through a Service-Driven Culture survey, employee engagement and physician satisfaction surveys, and employee and leadership focus groups. Then, behavior standards reflecting patients’ desires in employees’ words were developed and embedded into job descriptions and performance evaluations. Finally, a training plan was developed to determine the content for the various audiences, and tools and videos were created to support skills practice. 

Leaders were the first to attend the sessions so that they could support their staff that followed. After that, training cohorts were established to allow staff to progress through various educational experiences including projection of patient and employee voices, expert speakers, and skills practice opportunities. More than 1,400 employees progressed through this training over a 14-month period and the same principles were incorporated into Physician CMEs. To build internal capacity and help position the organization for longer-term consistency, effectiveness, and sustainability, a "train-the-trainer” model was employed. To date, the organization is on track to have all 2,400 employees attend this session by July, 2015. 

Additionally, supplemental toolkits for managers and supportive communications tactics were employed to help underscore the concepts shared in the training. The idea was to enable managers to own and translate the concepts into practice in conjunction with their staff on an ongoing basis. 

CARE TEAM COACHING

Care Team Coaching was offered to support physicians and staff as they sought to put the key practices into action with patients. DTA initially coached more than 30 leaders in their rounding with patients. From there the coaching opportunity was offered to the entire hospital and allowed interested participants to sign-up. A total of 142 physicians, nurses, nursing assistants, unit administrative support staff, pharmacists, and ancillary services staff were shadowed by a DTA coach between May 2014 and February of 2015. After each observation, the coach and staff debriefed on observed personal strengths and opportunities, and each participant was sent their own written report. This written report was kept confidential between the coach and the team member and served as a valuable summary take-away for the participant. 

Six unit councils desired to have aggregated feedback, so to accomplish this, cohorts of participants were established. Once a minimum of 15 participants from an area were coached, unit thematic data was compiled and shared. This enabled entire units to find areas of focus for improvement. As with the Service Foundations workshop, DTA provided a train-the-trainer so that several internal team members became care team coaches to keep this model alive within the organization. 

What were the outcomes?

El Camino has realized measureable outcomes in their HCAHPS scores: as much as 70 percentile improvements in areas such as Nurse Communication, Medication Communication, and Staff Responsiveness. Not only is this tough to do in a competitive era where the entire nation is focused on these areas but it is also difficult to achieve improvement in multiple composites at once. Client testimonials that speak to the success of developing a customized solution: 

"Our collective hope is that we are distinguished in our communities by having a patient-centered experience for patients and families. This requires that our culture honors individual preferences and values education, resulting in optimal clinical outcomes and allowing patients to restore their overall health and well-being.”
Tomi Ryba, President and CEO

"As we developed our plan to improve the patient experience at our health care organization, the voice of the patient was missing. While we knew this was such an important aspect of our journey to improvement, we were not sure where to start. With the help of DTA, we were able to create a very robust Patient and Family Advisory Committee (PFAC) consisting of previous patients and/or family members of patients.”
Cheryl Reinking, Chief Nursing Officer

"My job was empowered from the onset because of the good work with DTA that began before I arrived. I inherited a culture that was prepared to continue to make strides for the Patient Experience. DTA worked with me to integrate concepts into operations and performance improvement as well as identify champions on both campuses. I was also fortunate to have an unbiased sounding board as I oriented at El Camino.
RJ Salus, Director, Patient Experience

Their work has continued, and RJ Salus shared some of the steps that have taken along their patient experience roadmap:

• They continued the work from DTA.
• They Implemented new programs.
• They shined in HCAHPS during their 4th quarter (April – June).
• They are are about to stand up their next PFAC.
• Their Board Quality Committee has added two patients as members and picked Patient and Family Centered Care as its major strategic aim over the next three years.
• They collaborated with an array of existing vendors to enhance the patient voice.
• They switched survey vendors in July 2015.
• They are preparing for EPIC implementation and have put in place good integration to make sure their implementation is patient-centered.

About El Camino Hospital 

El Camino Hospital is a not-for-profit organization with hospital locations in Mountain View, California and Los Gatos, California. The organization continues to serve communities located in the South San Francisco Bay Area for over 50 years. El Camino Hospital Mountain View is a 395-bed hospital located in Silicon Valley. El Camino Hospital Los Gatos is a 143-bed hospital with an emergency department, medical-surgical and intensive care services. .

https://www.theberylinstitute.org/?page=CASE0915