Rural hospital uses Lean Daily Improvement to increase patient feedback

Tuesday, March 12, 2019

Patient feedback is crucial to improving the healthcare experience, but that feedback can often be difficult to obtain. Typically, only a small percentage of patients who receive surveys will compete them, and, in busy practice or clinic settings, asking for and monitoring receipt of patient reviews are often viewed as low-priority tasks.

At Woodlawn Hospital in Rochester, Ind., Rehab Coordinator Dawn Gabrich was aware that rehab patients were completing surveys at very low rates, and she set out to change that trend by using Purdue Healthcare Advisors’ Lean Daily Improvement (LDI) methodology and tools. LDI establishes a team approach to address a specific challenge or problem through daily monitoring and interventions as well as corrective measures if interventions don’t result in improved metrics.

Gabrich noted, “We were only getting about 35 or fewer surveys per month, and that’s not a good sample size.” Woodlawn’s goals for the project were twofold: identify and overcome obstacles to asking for patient feedback and increase the number of surveys completed. By achieving these goals, the department would get a more realistic view of the patient experience in the rehab setting and could better determine what changes might improve patient care and customer service.

LDI Hones Processes and Drives Accountability

As a certified Lean Practitioner, Gabrich knew that LDI tools were perfect to help her team make small and sustainable changes, create a mindset of continuous quality improvement, and obtain a greater number of patient surveys. In the beginning, only about 35 patients per month completed surveys. After almost four months, the department made process improvements in asking for patient feedback upon intake and discharge and now receives completed surveys from approximately 97 patients each month.

Gabrich and her LDI team partnered with Purdue Healthcare Advisors (PHA) Managing Advisor Elaine McCracken on the project. The LDI team, a 13-member group comprised of both front office staff and therapists, used daily huddles; a visual management board, including items such as a run chart for easy representation of goals and status; and corrective activities to overcome identified obstacles to obtaining completed patient surveys.

Despite some initial staff resistance to daily meetings and increased monitoring of requests for patient feedback, the LDI team quickly adjusted course and had everyone on board. According to Gabrich, the graphic depiction of goals and progress on the LDI management board was instrumental in making the project successful because the therapy team is very visually-oriented. “Seeing the project results presented visually helped motivate the team,” Gabrich said.

Using the hospital’s internal messaging system and plenty of verbal encouragement also supported success. The team began the LDI project by meeting in person each day, but as the project got underway and the team began meeting goals, they utilized the messaging system for daily huddles and reverted to physical meetings only when daily goals weren’t met and corrective countermeasures were necessary.

Some barriers to survey completion were easily overcome. For instance, the team began numbering the surveys so they could readily compare the number of forms handed out against the number of patients evaluated or discharged during the day. The LDI process also uncovered issues in the timing of presenting surveys to patients. When patients required prior authorization before further treatment, for instance, that additional step often meant those patients were never asked to complete a survey. Once the team was aware of this gap, they resolved the issue by handing out surveys at a different phase during the intake process. Over time, the staff has gained confidence in asking for patient feedback, and requesting feedback has become a routine part of the intake and discharge processes.

We knew that getting more surveys could mean lower scores overall. But more accurate scores helped us focus on changing the customer experience for the better. When you’re handing every patient a survey, it makes you raise your game.

Impact of LDI and Increased Patient Feedback on the Rehab Department

Morale among Rehab Department staff was a concern during the LDI project because Gabrich knew that obtaining surveys from a broader pool of patients might result in lower satisfaction scores initially. She cautioned her team not to be discouraged by this preliminary dip. “We knew that getting more surveys could mean lower scores overall,” Gabrich commented. “But more accurate scores helped us focus on changing the customer experience for the better. When you’re handing every patient a survey, it makes you raise your game.”

Gabrich says keeping staff focused on the project as a means to improve the patient experience was important. She said of the LDI process, “It was never punitive. We celebrated the wins and made it quick and painless, keeping our focus on the patient.” As a result of increased patient feedback, the department has made several improvements, including addressing one of the biggest patient complaints: wait time.

Rehab Department staff also reaped the rewards of achieving success as a team. While the initial goal was to have at least 60% of patients evaluated complete the survey, the department far exceeded that goal: 125% of patients evaluated are now filling out patient satisfaction surveys (some patients complete the survey at both intake and discharge). Gabrich says the team was extremely excited about the results they achieved together, and team members have been energized by the opportunity to delve into satisfaction scores and comments that enable them to improve their interaction with patients.


Writer: Elaine McCracken, 219-796-4448, emccracken@purdue.edu

Tags: Process & Cost Improvement (Lean)

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