The Value of Exceptional Patient Experience.

Patient experience metrics are increasingly the focus of value-based incentive programs by both the federal government and private payers. A clear financial imperative exists to improve experience; at the same time, it is becoming evident that engaging patients in their care also leads to better clinical outcomes.

The Transforming Power of Patient Advisors.

Vidant Health, a private, not-for-profit health system in Eastern North Carolina, began a system-wide quality transformation in 2006. A key strategy in the transformation was increasing the engagement of patients and families, including the establishment of Patient Family Advisory Councils. Meaningful partnerships with patients and families accelerated improvement efforts and sustained performance excellence over time.

The Vidant Health quality transformation.

BACKGROUND: Vidant Health (VH), a private, not-for-profit health system in eastern North Carolina, began a systemwide quality transformation in 2006 after a serious blood event resulted in a patient's death. METHODS: Systemwide patient safety training served as the foundation of the transformation. Strategic planning of the quality work outlined a series of approaches that included board literacy in quality, an aggressive transparency policy, patient-family partnerships, and leader and physician engagement. RESULTS: The transformation of the system has resulted in an 85% reduction in serious safety events, a 62% reduction in health care-associated infections, 98% optimal care in the Centers for Medicare & Medicaid Services (CMS)/Joint Commission core measures, Hospital Consumer Assessment of Healthcare Providers and Systems performance in the top 20%, and more than 150 patient advisors partnering with leaders, physicians, and frontline staff. From the bedside to the boardroom the improvement in quality is evident across VH's nine hospitals, 70 physician practices, ambulatory surgery, and home health, hospice, and wellness services. CONCLUSION: Strategic planning for quality set an ambitious agenda for VH's quality work and continues to drive action today. Engaging patients in quality work at all levels--as partners on performance improvement teams, in safety rounds, in quality improvement committee meetings, and in the boardroom--has been a deliberate strategy and a significant part of the quality transformation at VH. Additional requirements for public reporting, CMS's new payment reform, and the challenges inherent in the evolving health care industry at large make it imperative to maintain a focus on zero events of harm and exceptional patient experiences.

The front line of patient safety: staff nurses and rapid response team calls.

BACKGROUND: In response to growing concerns about patient safety, many hospitals are implementing rapid response teams (RRTs). Although the staff nurse plays a critical role in recognizing the need for the RRT and initiating the call, little is known about actions of staff nurses in relation to the RRT. OBJECTIVE: The purpose of this study was to examine relationships between nurse educational preparation, years of experience, degree of engagement, and the RRT call status (independent vs dependent). Nurse engagement was measured by the Manifestations of Early Recognition Scale. METHODS: A descriptive correlational design was used. The sample comprised 75 staff nurses at an academic medical center who cared for patients for whom the RRT was called. Educational level and nursing experience were independent predictors of call status, after controlling for effects of other independent variables. RESULTS: Independent callers were almost 5 times more likely to have a BSN degree, and almost 4 times more likely to have more than 3 years of experience, than did RNs who called because someone asked them to call. High levels of engagement were also significantly associated with call status, but after controlling for educational level and nursing experience, the relationship was not significant. CONCLUSIONS: This study has implications for clinicians and managers in health care facilities that rely on RRTs.

Confronting disparities in diabetes care: the clinical effectiveness of redesigning care management for minority patients in rural primary care practices.

CONTEXT: Diabetes mellitus and its complications disproportionately affect minority citizens in rural communities, many of whom have limited access to comprehensive diabetes management services. PURPOSE: To explore the efficacy of combining care management and interdisciplinary group visits for rural African American patients with diabetes mellitus. METHODS: In the intervention practice, an advanced practice nurse visited the practice weekly for 12 months and facilitated diabetes education, patient flow, and management. Patients participated in a 4-session group visit education/support program led by a nurse, a physician, a pharmacist, and a nutritionist. The control patients in a separate practice received usual care. FINDINGS: Median hemoglobin A1c (HbA1c) was not significantly different at baseline in the intervention and control groups but was significantly different at the end of the 12-month follow-up period (P < .05). In the intervention group, median HbA1c at baseline was 8.2 +/- 2.6%, and median HbA1c at an average follow-up of 11.3 months was 7.1 +/- 2.3%, (P < .0001). In the control group, median HbA1c increased from 8.3 +/- 2.0% to 8.6 +/- 2.4% (P < .05) over the same time period. In the intervention group, 61% of patients had a reduction in HbA1c, and the percentage of patients with a HbA1c of less than 7% improved from 32% to 45% (P < 05). CONCLUSIONS: These findings suggest that a redesigned care management model that combines nurse-led case management with structured group education visits can be successfully incorporated into rural primary care practices and can significantly improve glycemic control.