Labor and Management Working Together to Improve Patient Satisfaction

By Preeti Jadhav, MD

As I approached the end of my first postgraduate year (PGY­1), one of the chief residents asked me to participate on the “LMP PCC project.” He explained that LMP PCC referred to a multidisciplinary labor-management, patient-centered care project where representatives from different disciplines would work together to enhance patient experience. At the beginning, I wasn’t sure what that actually meant, but I was excited for the opportunity to work on something that promised to make a difference, especially in my patients’ lives. As a PGY-1 resident, my days were usually occupied with floor work, didactic activities, and clinic schedules, so I looked forward to working on my first quality improvement project.

Bronx Lebanon Hospital (BLH) in Bronx, New York, is unique and treats some of the most underserved patients in the country. Like many other hospitals, BLH struggled with its HCAHPS scores, and leadership explored solutions that would actually be owned by the people providing care on the front line. The hospital worked with the Committee of Interns and Residents and 1199SEIU (the house staff and healthcare workers unions, respectively) to provide a train-the-trainer program where staff on our medical-surgical unit would learn the skills and tools needed to coach fellow staff members on a QI project to improve patient satisfaction. Two LMP trainers guided a team of union and management staff through the process of identifying problems, establishing project goals, and tracking outcomes. We decided to focus on reducing call bells by proactively addressing patients’ needs.

I was a bit taken aback at our first PCC meeting to discover that the project was sponsored by the hospital’s top administrative leaders. It was my first time interacting with them in any way. My wariness grew when we were asked to talk in front of the sponsors about the challenges we faced working on the 15th floor. Were we actually going to tell the truth?

To my surprise, we all just started speaking up. That day, I learned so much about the struggles of my coworkers. I heard about how difficult it was for a patient transporter to find the assigned nurse for his patient in order to get her off the floor at the right time; how tough it was for a nurse to find a patient care technician (PCT) to get a stat electrocardiogram while the other PCT was on break; and myriad other ways that lack of awareness about our interconnectedness resulted in roadblocks to good care. As the project progressed and the meetings grew in intensity, I learned things I wasn’t even aware I didn’t know. Originally, I had thought my team consisted of my co­residents and attendings. The multidisciplinary intervention made me realize the nurses, PCTs, social workers, unit associates, patient transporters, and housekeepers were equally important team members. The project was a forum where we got to know our fellow teammates better, and it reinforced our desire to make a better work environment for ourselves and a better healing environment for our patients.

Improving our performance on call bells was challenging, to say the least. We worked together to reenergize a “No Pass Zone” policy, which means if a call bell is ringing, anyone near the nurse’s station or patient’s room is responsible to assist. We also enhanced communication with patients through the “4 P’s” (pain/potty/position/possessions) and improved various work processes. One of the simplest and most effective tools was what we called the “Wilfredo Board,” named after a patient transporter who’d come up with the idea. The Wilfredo Board was a whiteboard outlining assignments at the nurses’ station, which served to eliminate a great deal of chaos from everyone’s routines.

We created and administered a monthly survey to assess our performance on hourly rounding with the 4 P’s, the No Pass Zone, staff roles and responsibilities, and mutual respect. The work was constantly reinforced in weekly educational huddles and one-to-ones. We also implemented monthly unit orientations for the new house staff, wherein everyone on the PCC team introduced themselves to the new residents and brought them up to speed on the project. These orientations reinforced project objectives for the team and gave house staff a warm welcome to the 15th floor. Both regularly infused the project with new energy.

The PCC project developed my ability to lead a large, diverse group of people to foster a sense of teamwork and mutual respect, making a better work environment and increasing patient satisfaction. Everyone had an equal voice in our meetings and was entitled to share their opinions. I developed an ability to manage these different perspectives and give them the space they were due through tasks such as creating agendas for meetings, making notes and highlights about action plans, keeping discussions focused, and managing time so team members could resume their duties around scheduled breaks for the project. The moments of emotional outbursts and laughter over the course of understanding patient-centered care, developing an assessment tool, collecting and analyzing data, and creating an educational video turned my coworkers into colleagues, and my colleagues into friends.

We were proud to report an 85% decrease in call bells,[1] which indicated that the improvements our unit implemented over the intervention period increased the likelihood that staff proactively addressed patients’ needs. Furthermore, improvements in the unit’s HCAHPS scores suggest that patient satisfaction increased because of the team’s efforts. Over the course of the project, we went from an all-time low of 8% for “Always got call button help as soon as I wanted it” to an all-time high of 95%. We also looked at results from a survey question regarding “mutual respect” among staff members. We went from an all-time low of 6% to an all-time high of 64%, illustrating how staff members’ treatment of one another improved during the project. In addition, our project was submitted and accepted for poster presentation at the IHI National Forum in Orlando, Florida, in 2014. One of our social workers, a patient transporter, and I went to explain the value of mutual respect to others, and we were thrilled to have the opportunity to do so.

It’s been almost a year since we started working on the PCC project. The experience has given everyone on the team a sense of the importance of our roles in patient care, and the confidence to express ourselves in front of leadership for the betterment of our patients without hesitation. It was especially motivating to see how working to improve our service to each other has improved our service to patients. We are so excited to bring the values of teamwork, understanding, and mutual respect wherever we go in the future.

Preeti Jadhav is a resident in internal medicine at Bronx Lebanon Hospital in Bronx, New York, and may be contacted at pjadhav@bronxleb.org.