An Evaluation of the Implementation of Code H (Help)
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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. Purpose.

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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


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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?


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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


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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.


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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.


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Why was Code H implemented?

  • In response to :

    • Medical errors

    • Joint Commission

      • National Patient Safety Goals

      • Speak Up


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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.


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Data Sources

  • Personal Observation: Field Notes

  • Code H Log Sheet

  • Patient Interviews

  • Code H Follow-Up Questionnaire


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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


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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


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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








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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





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Problem 1

  • Critical and unmet element- Pilot test

  • Solution: Conduct at least one mock Code H every quarter


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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


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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


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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


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Problem 5

  • Questions on Code H protocol and response

  • Solution: Increase Code H education

    • Flow chart

    • FAQ’s

    • Breeze module

    • Validation tool


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Limitations

  • Participant-observation

  • Subjective study

  • Time


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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


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Thank You

  • Dr. Wackerbarth, chair

  • Dr. Talbert, second chair

  • Dr. Hankins, reader

  • Lynn Kolokowsky, J.D., Director of Risk Management/Patient Safety, outside adviser



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