Patient safety is at its best when clinicians openly exchange information about the patient’s status and treatment plan with other work teams and work shifts. Equally important is open communication within the clinical support and administrative ranks of hospitals.
It is impossible for any one manager to follow operational issues around the clock. Chances are high that without strong shift-to-shift communication, managers will deprioritize or overlook something. Furthermore, without actionable data, senior leaders are unable to hold employees accountable and to ensure they swiftly and permanently fix any problems.
A team of five off-shift administrators at the University of Texas MD Anderson Cancer Center implemented an innovative database solution that enhances institutionwide handoff communication and accountability in operations.
The OSA Team
For decades, the off-shift administrators have provided leaders and classified personnel with administrative oversight continuity for both the hospital and its 20-plus clinical care centers. The OSAs work with physicians, nurses, clinical support staff and administrative staff to maintain an environment that is responsive to patient needs, encourages customer service and promotes employee satisfaction. OSA coverage is broad: A typical day could involve simple authorization of an after-hours equipment repair or the more complex task of resolving a major operational mishap.
The OSA team discovered early on that handoff communication was essential to preserving safe and efficient patient care. Clinical operations daily activity reports became a mainstay, and executives requested that outstanding issues be addressed by midmorning the next business day. Until 2010, employees sent reports to leaders by writing them email messages. But with the rapid expansion of services and high demands on patient care support systems, the team realized that this system was not allowing them to quickly research reported cases, identify and track trends, or produce reliable data. Additionally, some issues re-emerged either in the same unit or in other areas at unanticipated moments. Thus, the team took steps to tackle this gap in information management.
After an extensive review of their options, the OSAs decided that installing a SharePoint database and companion InfoPath export system would be an efficient way not only to consolidate requests for assistance, but also generate reports that accurately quantify operational problems.
The chief goal during database development was to capture and organize the details of all received calls within one system as well as export reports to a carefully selected distribution list of executives, nurse leaders, administrative managers and other essential employees. The database would enable the OSA team to document and share key aspects of each case including the date, time, caller information, length of time to resolve the matter, a brief case summary and handoff specifics.
Given its broad scope of coverage (literally the front door to the back door of the facility), the OSA team used hospital blueprints to assist with the makeup of the database. They also developed a healthy keyword list that enables information to be queried easily by almost any call type. In addition, they incorporated user-friendly elements such as dropdown selections and checkboxes to make detailed data entry effortless. This report then is used as an awareness and daily institutional handoff communication tool.
Meaningful Data at Work
Many at the institution have applauded the move to this electronic system, and its strengths are many.
First, it enables the team to monitor and call attention to hazards. For example, multiple requests for repair of a bedside EKG monitor may result in equipment replacement. So, in a real sense, the enhanced automation can be lifesaving.
Other examples of recent changes resulting from OSA data sets include:
- improved management of patient business accounts;
- reduced wait time for after-hours case management support;
- policy change affecting campus response to missing persons reports;
- formation of multidisciplinary work groups to instigate policy and procedural changes.
Second, data are queried and reports are generated much more expeditiously than before. When data were manually tabulated, reports were labor-intensive and could sometimes take the team several days or longer to create. Today, reports can be produced and disseminated within minutes. The institution can use the database to shed light on many aspects of the patient care continuum.
Moreover, the unique data set arising from the OSA database has been a welcome information source for MD Anderson leaders, more of whom are asking to receive regular reports. For example, one vice president requests monthly reports for each department he oversees to ensure accountability and timely resolution of recurring problems. Another executive uses reports for a divisionwide customer service improvement campaign. The essentials of this database and reporting format have been replicated in smaller programs to improve communications.
On the Horizon
System improvements continue. Although the database already has proven to be a beneficial tool, the OSA team continues to work with application experts to build database and reporting sophistication. Another objective is to partner with other departments that can use data reports to improve hospital operations and patient satisfaction. As the old adage goes, "When you know better, you can do better."
Our administrative and clinical support-related problems are as important as those that surface in direct patient care, and timely handoff enables leaders to appropriately scale their response to them. Minimizing the communication failures that lead to poor service delivery and patient satisfaction ratings and enhancing accountability in health care organizations is assuredly the way to go. Our patients deserve it.
Angela Hayes-Rodgers, M.B.A./ H.C.M., is an associate director in clinical operations at the University of Texas MD Anderson Cancer Center in Houston. Altrivice Revis, M.B.A., is an off-shift administrator in clinical operations at the center.