littlehank

The Pediatric Neurosurgery team in Oakland couldn’t figure out why their staff courtesy scores were low.

They had a new office building and felt providing exceptional care was part of the routine.

Then union co-lead Tanya Johnson noticed there was very little for the department’s young patients and their families to do in the waiting room.

“Kids would be running up and down the hallway,” says Johnson, who is a medical assistant and SEIU UHW member. “Parents would be chasing after them and not being able to focus. It was crazy.”

The department of Pediatric Neurosurgery cares for children with a full spectrum of disorders, including tumors of the brain, spinal cord and peripheral nervous system.

“These kids are the sickest of the sick,” says service manager Jim Mitchell, RN PNP. “They have serious, serious conditions. Anything we can do to make their visit a little brighter, we do.”

So the team decided to create a child-friendly environment, and went to senior leadership for funding.

The improvements included a large, colorful playhouse, a treasure chest, books and toys in each of the patient rooms—as well as a custom-built train set.

“Everyone on the team had input as to how the clinic would be set up and where the items would be placed,” union co-lead and receptionist Leap Bun says of the improvements that cost about $18,000.

To ensure infection control, the toys are wiped down on a regular basis by Environmental Services employees.

And the atmosphere does a lot to ease tension for their medically fragile patients and their families. 

“The children are less threatened and want to come here to play,” Mitchell says. “It seems like every day we have parents on a regular basis having to coax their children to leave the clinic.”

In three quarters, department scores for staff courtesy increased from 69.6 percent to 90.3 percent.

“In addition to our MPS scores we can measure the change in the faces of the children we interact with,” Mitchell says.

For other teams interested in this type of project, they suggest field trip to other facilities doing the same work. The Oakland team visited Sacramento and Roseville to refine their workflow processes.

And the team also found that families with children choose to wait in the clinic, even if their appointment is elsewhere or they’re picking up a prescription from the nearby pharmacy.

"They tell us it’s a nice place to relax and to calm their kids down while waiting,” Bun says.

Colorado’s asthma care coordinators discovered that children were refilling their medications at the lowest rate in the region. The group works alongside physicians and staff to provide education and outreach to Kaiser Permanente members with asthma or chronic obstructive pulmonary disease.

Inhaled corticosteroids help control asthma by reducing inflammation and mucus production. Asthmatics who use the meds daily experience fewer attacks, use their emergency medicine less and make fewer visits to the emergency room.

There are some common threads among patients, who don’t refill their prescriptions. These include the costliness of inhalers, the fact some patients are reluctant to take a steroid, and often patients stop medication when they start to feel better.

“It took us a while to identify the most important thing our UBT could do,” said Cindy Lamb, RN, an asthma care coordinator and member of UFCW Local 7. “It was definitely a learning process.”

So, the asthma coordinators decided to improve the refill rate through an outreach program and targeted members ages 5-17. They made phone calls to five members a week who had not refilled their prescriptions in more than four months. As part of the discussion they included talking points about the benefits of inhaled corticosteroids. They used trackers and scoreboards to monitor the outreach and keep everyone informed.

The seven asthma care coordinators were spread throughout the region, so they held weekly phone huddles to share progress and best practices. They highlighted the convenience of the mail order pharmacy, and provided members with prescription refill numbers as well as the telephone number to the pharmacy. This information helped patients refill their medications more promptly.

The team also had communicated regularly with pediatric physicians and other staff by phone, conversations, meetings, and email.

None of it happened overnight, but the team discovered the collaborative effort really helped the process. In all, they reached 1,100 patients.

“Give the process the time it needs,” said Asthma Care Coordination manager Leah Brines. “Resist the temptation to come up with solutions for the team and instead, guide the conversation, and encourage participation and discovery. The team, given the time and confidence, will find the solution.”