Improving Communication in Home Based Primary Care
Last updated
Share PrintTo provide the Veteran with more timely access to care, as well as the reassurance that their care team is working as a cohesive unit to address their concerns and resolve their needs.
Origin:
September 2021, James H. Quillen Department of Veterans Affairs Medical Center (Mountain Home, Tennessee)
Adoptions:
1 successful
Awards and Recognition:
James H. Quillen VAMC HeRO Award June 2022, Recognized by VISN 9 Continuous Readiness Review (CRR) Team May 2022 as highest performer for Quality Improvement within VISN 9 Geriatr ... James H. Quillen VAMC HeRO Award June 2022, Recognized by VISN 9 Continuous Readiness Review (CRR) Team May 2022 as highest performer for Quality Improvement within VISN 9 Geriatrics and Extended Care
Recent Updates
Overview
The problem
Throughout the pandemic, Home Based Primary Care (HBPC) experienced challenges with effective communication due to remote working, staffing shortages, employee and Veteran stress, and fragmentation in workflow processes. These challenges resulted in declining patient satisfaction scores for communication between providers and patients, as well as consistent
...
Throughout the pandemic, Home Based Primary Care (HBPC) experienced challenges with effective communication due to remote working, staffing shortages, employee and Veteran stress, and fragmentation in workflow processes. These challenges resulted in declining patient satisfaction scores for communication between providers and patients, as well as consistent complaints from staff regarding poorly dispositioned incoming telephone calls.
The HBPC Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Summary Reports: Patient Satisfaction Score for “Communication Between Providers and Patients” decreased from 86.30% Q2FY20 to 81.20% Q2FY21, resulting in a patient satisfaction ranking within VA Facilities for Communication Between Provider & Patient to the 40th percentile. Note: the term “provider” is not inclusive to the physician and/or the Nurse Practitioner, but to any HBPC team member. Additionally, there was not a standardized process, across all HBPC teams, for how calls were received and dispositioned most effectively to meet the Veteran's needs. This resulted in staff/Veteran dissatisfaction and delayed Veterans care. See more
The HBPC Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Summary Reports: Patient Satisfaction Score for “Communication Between Providers and Patients” decreased from 86.30% Q2FY20 to 81.20% Q2FY21, resulting in a patient satisfaction ranking within VA Facilities for Communication Between Provider & Patient to the 40th percentile. Note: the term “provider” is not inclusive to the physician and/or the Nurse Practitioner, but to any HBPC team member. Additionally, there was not a standardized process, across all HBPC teams, for how calls were received and dispositioned most effectively to meet the Veteran's needs. This resulted in staff/Veteran dissatisfaction and delayed Veterans care. See more
Images
Above:
Current State Before Project
Videos
Above:
Improving Communication in Home Based Primary Care (video created by Lee Liguore)
The solution
After assessing deficiencies in communication between the Veteran and the HBPC team, as well as between the HBPC team members, the workgroup streamlined the phone calls coming into HBPC, developed a Wellness Checkup tool to guide Veterans and caregivers as to when and how to contact their team, and created a standardized tool for how the clerical staff shoul
...
After assessing deficiencies in communication between the Veteran and the HBPC team, as well as between the HBPC team members, the workgroup streamlined the phone calls coming into HBPC, developed a Wellness Checkup tool to guide Veterans and caregivers as to when and how to contact their team, and created a standardized tool for how the clerical staff should disposition calls to each discipline within the care team or elevate the call to the Triage Nurse. Standardization of these processes facilitated more effective communication resulting in decreased delays and improved satisfaction for Veterans and caregivers served by the HBPC team.
See
more
Images
Above:
Wellness Check-Up Tool
Above:
HBPC Incoming Call CPRS Alert Notification Guide
The results
Improving communication within the HBPC team directly impacts the Veterans and caregivers served. The implementation of standardized processes resulted in the disposition of calls being sent to the team member who could most efficiently address the problem. This provided the Veteran with more timely access to care, as well as the reassurance that their care
...
Improving communication within the HBPC team directly impacts the Veterans and caregivers served. The implementation of standardized processes resulted in the disposition of calls being sent to the team member who could most efficiently address the problem. This provided the Veteran with more timely access to care, as well as the reassurance that their care team is working as a cohesive unit to address their concerns and resolve their needs. Additionally, providing the Veteran and caregiver with a user-friendly tool that guides them on
which medical concerns should be reported to their HBPC team versus when they should call 911. This tool has improved communication between the Veteran/caregiver and the HBPC team, resulting in decreased delays in care. HBPC staff also benefited from the standardization of the communication processes. The HBPC team members have reported satisfaction with the improved processes, decreased view alerts, and increased available time to organize their daily work. See more
which medical concerns should be reported to their HBPC team versus when they should call 911. This tool has improved communication between the Veteran/caregiver and the HBPC team, resulting in decreased delays in care. HBPC staff also benefited from the standardization of the communication processes. The HBPC team members have reported satisfaction with the improved processes, decreased view alerts, and increased available time to organize their daily work. See more
Images
Above:
Confirmed State- Outcomes
Above:
Follow Up Data-Maintenance
Files
- HBPC A3 Improving Communication in HBPC April 2022 HBPC A3 Improving Communication in HBPC April 2022
Metrics
- HBPC Satisfaction Survey: Communication Between Providers and Patients scores are pulled using the VSSC HBPC Patient Satisfaction Survey Report. This report reveals the ranking of our facility in comparison to other VHA facilities for the particular metric. James H. Quillen VAMCs HBPC ranking was 40th percentile Q4FY20. This score is tracked using a bar graph with the last data point revealing an improvement to 73rd percentile Q4FY21. Additionally, during Q4FY20, the facility was at 81.3%. This score is tracked using a line graph with the last data point available revealing an improvement to 83.9% Q4FY21. Ongoing monitoring is planned quarterly.
- The baseline quarterly chart audits revealed that HBPC incoming calls were correctly dispositioned 45.5% of the time (prior to process improvement). Use of a split bar graph has enabled us to track improvements with the last chart audit revealing an improvement to 89.3% of incoming calls being correctly dispositioned.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
2-4 weeks
Consolidate all incoming HBPC telephone lines into one main number. -
2 months
Replicate standardized tool for how to disposition incoming telephone calls. -
2 months
Replicate “Wellness Check-Up Tool” for Veterans/caregivers to use as a guide for when, how and why there is a need to contact their HBPC Team. -
2-4 weeks after completion of tools
Educate all HBPC staff on new communication tools. -
2-4 weeks after completion of tools
Disseminate "Wellness Check-Up Tool" to all currently enrolled Veterans by mailing the tool and enclosing a letter that explains the reason for tool, how the tool is used and recommendations for posting it in their home for quick access (recommended posting on refrigerators/another location that is easily accessible on a daily basis). -
Within 6 weeks after "Wellness Check-Up Tool" mailed to Veteran
RN Care Manager will follow-Up and complete in-person education on the tool with the Veteran and/or caregiver. -
Before Initiating Project and Quarterly After Completion
Chart audits on clerical staff intake and disposition of incoming calls. -
Post Education on Tools and Quarterly
Follow up with staff via email on utilization of both tools to solicit feedback on their effectiveness and/or issues.
Departments
- Extended care and rehabilitation
- Education and training
- Quality control
- Information technology
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Files
- This guide is used to direct frontline staff, mostly Program Support Assistants (PSAs), in how to disposition calls based on the Veterans and/or Caregivers voiced needs. It includes a trigger list of signs, symptoms and incidences that should be immediately transferred to the Telephone Triage RN, a guide for emergent mental health crisis calls, and a disposition tree for all other needs that indicates which discipline needs to receive the view alert for the particular request. HBPC Incoming Telephone Call Disposition Guide
- This tool assists Veterans and their caregivers in monitoring their level of wellness as well as any signs and symptoms they should report to their HBPC care team. The colorful stop light visual indicates when all is well (green), when they should call their care team (yellow) and when they should call 911 (red). HBPC Wellness Check Up Tool
Optional Resources
| Resource type | Resource description |
|---|---|
PROCESSES |
|
TOOLS |
|
Risks and mitigations
| Risk | Mitigation |
|---|---|
| Staff Buy-In | Buy-in from frontline clerical staff and HBPC administration is important. To mitigate this barrier, include the frontline staff in creating the tools and finding solutions for the deficiencies and seek approval from program and leadership at the when the project charter is initiated. |
| Lack of Designated Telephone Triage RN | Use of a RN that is on light duty due to injury or who needs a Reasonable Accommodation related to a disability or vaccine status. |
| Lack of Printing Program/Department | Use of colored printer and purchasing of laminator. Program Support Clerk staff can be utilized to print and laminate Wellness Check-Up Tool. |
| Space for Key Staff: Program Support Clerk & Telephone Triage RN | Telework agreements if space unavailable. |
About
Origin story
Throughout the pandemic, the James H. Quillen VAMC Home Based Primary Care (HBPC) program experienced challenges to effective communication due to remote working, staffing shortages, employee and Veteran stress, and fragmentation in workflow processes. These challenges resulted in declining patient satisfaction scores for communication between providers and
...
Throughout the pandemic, the James H. Quillen VAMC Home Based Primary Care (HBPC) program experienced challenges to effective communication due to remote working, staffing shortages, employee and Veteran stress, and fragmentation in workflow processes. These challenges resulted in declining patient satisfaction scores for communication between providers and patients as well as consistent complaints from staff regarding poorly dispositioned incoming telephone calls. The team set out to address these deficiencies to make improvements in both Veteran experience and staff satisfaction.
Original team
Angela Hope Ledford MSN, RN
Program Director HBPC
Kelli Jones MSN, RN, CDCES
Nurse Manager, HBPC
Dr. Bryan Watson
Medical Director, HBPC
Rebecca Haynes BSN, RN
RN Care Manager
Shannon Rider MSN, RN
Telecare RN
Ruth Quejada MSN, RN, CNL, CCRN
RN Care Manager
Larry "J.R." Wilkins
PSA
Torrey McClurg
PSA
Debbie Smith-Sisto
PSA
Dr. Daniel Bulger
Clinical Pharmacy Specialist
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