Jennifer Berry Martin School of Public Policy and Administration University of Kentucky Master in Health Administration

1. An Evaluation of the Implementation of Code H (Help) And Its Impact on Patient Satisfaction Jennifer Berry Martin School of Public Policy and Administration University of Kentucky Master in Health Administration Capstone Project Spring 2008

2. Purpose • Identify the implementation process of Code H • Reveal if Code H is achieving its intended goals of increasing patient satisfaction • What changes can be made to Code H to improve its effectiveness and increase patient satisfaction?

3. Background • An infant died due to narcotic misuse, severe dehydration, and multiple breakdowns in communication • UPMC Shadyside initiated a rapid response team called Condition Help

4. Condition Help • Condition codes usually are activated by health care providers This code is different. It asks patients and visitors to be part of the care team by alerting caregivers to clinical changes.

5. What is Condition H? • Provides a hotline for hospital patients and their family members to call when there is: • a noticeable, clinical change in the patient and the health care team is not responding to the patient’s or visitor’s concerns • a breakdown in how care is being managed or confused • The Lexington hospital modeled its program after UPMC and called it Code H.

6. Why was Code H implemented? • In response to : • Medical errors • Joint Commission • National Patient Safety Goals • Speak Up

7. Significance of Project • Proper implementation of Code H= • Increased patient satisfaction • Evaluation will inform the hospital of actions it can take to increase the effectiveness of change in the future.

8. Data Sources • Personal Observation: Field Notes • Code H Log Sheet • Patient Interviews • Code H Follow-Up Questionnaire

9. Gustafson Change Model • Tension for Change • Mandate • Change agent commitment • Tension level • Data on severity (collected & communicated) • Feedback • Measures (outcome & intervening variables) • Pilot test • Safety • Decision & Plan • Troubleshoot • Commit to change • Superior Alternative • Benchmarking • Multiple options • Evidence of superiority • Complexity • Radicalness • Change Attempt • Pilot tests • Individual actions • Support • Social Process • Power group ▪ Simplify • (involvement & endorsement) ▪ Funds • Middle management ▪ Instructions/Rules • (involvement & endorsement) ▪ Materials • Respect for change agent • Relative threat to supporters • and opponents • Ability • Skills • Assess qualifications • Training plan • Self efficacy • History of change • Perceived chance of success • Change agent prestige

10. Methods • Each element in the Gustafson Change Model is important but at a different degree. The “level of importance” was assigned based on the organization and change itself. • Levels of Importance as shown in the Likelihood of Success Table: • critical • adequate • minimal

11. Methods • Unmet= hospital did not take any action • Partially met= hospital achieved approximately half of the Gustafson requirements • Met= achieved at least 90% or more of the Gustafson requirements

12. Likelihood of Success

13. Likelihood of Success

14. Results: Field Notes

15. Results: Field Notes

16. Results: Field Notes

17. Results: Field Notes

18. Level of importance Critical Mandate Tension level Data on Severity Change agent commitment Troubleshoot Pilot test Pilot test Training plan Measures Instructions Middle mgmt. Simplify Commit to change Partially Met/ Adequate Ind. actions Safety Unmet Met Level of achievement Respect for change agent Funds Materials Power group Threat Category Tension for Change Superior Alternative Support Ability Decision & Plan Change Attempt Feedback Complexity Radicalness Evidence of superior Multiple options Benchmark Assess qualifications History of change Chance of success Change agent prestige Minimal Results: Plotted Graph Results

19. Results: Code H Log Sheet

20. Results: Follow-Up Questionnaire

21. Results: Patient Interviews

22. Problem 1 • Critical and unmet element- Pilot test • Solution: Conduct at least one mock Code H every quarter

23. Problem 2 • Critical and partially met elements- Instructions/Rules and Troubleshooting • Solution: Ensure that these areas are discussed thoroughly before implementing any change • Flow chart • Contact person

24. Problem 3 • 24% of Code H calls were classified as pain control/medication related • Solution: Ensure that all staff are responding to medication needs in a timely manner • Check sheet • Medication log

25. Problem 4 • 64% of interviewed patients did not receive information on Code H upon admission • Solution: Monitor and verify that all patients receive Code H information upon admission • Check sheet

26. Problem 5 • Questions on Code H protocol and response • Solution: Increase Code H education • Flow chart • FAQ’s • Breeze module • Validation tool

27. Limitations • Participant-observation • Subjective study • Time

28. Conclusion • Gustafson provides a model which should be utilized for any future changes the hospital implements • Code H data should continued to be gathered in order to see what impact it has had on patient satisfaction

29. Thank You • Dr. Wackerbarth, chair • Dr. Talbert, second chair • Dr. Hankins, reader • Lynn Kolokowsky, J.D., Director of Risk Management/Patient Safety, outside adviser

30. Questions?