Delivering New & Improved Experiences
In person, online or in anticipation, associates across Nemours view every interaction as an opportunity to enhance relationships with families and improve patient outcomes. During 2020, the ability to augment both relationships and outcomes was demonstrated through new physical spaces, and quality and patient experience improvements, along with finding new ways to leverage data and technology to support better, more equitable health.
Nurturing An Improvement Mindset
In May 2020, Nemours launched Quality Champions, an internal continuing education program designed to train healthcare professionals in quality improvement design and implementation. The framework, focused at the unit level, is intended to advance Nemours’ Mission Zero quality and safety initiative. Sixty-two individuals completed the 10-month program, earning Institute for Healthcare Improvement (IHI) basic certification in quality and safety, developed a capstone project and prepared a storyboard for submission to IHI. Nemours covered the cost for each participant and ensured it was a truly interdisciplinary experience by enabling “non-exempt” associates to credit their Quality Champions coursework toward their working hours.
In addition to the Quality Champions course, culture of safety work continued throughout Nemours. With commitment at the highest levels of the organization, Nemours’ Board of Directors, Boards of Managers, and hospital leaders participate in core leadership and safety training through Solutions for Patient Safety, and have access to, and training in reading, Nemours’ safety dashboard. Clinical associates across the enterprise continue training in core quality and safety skills with error prevention training. This work builds on techniques — such as closed-loop communication — that facilitate highly reliable safety practices in all clinical areas and continue teaching associates a common language to improve error prevention.
Putting Patient Experience First
Even the pandemic couldn’t stall Nemours associates’ efforts to advance patient experience. More than 650 associate teams’ focused efforts resulted in 191 improvement projects with goals to enhance the patient experience and positively impact patient safety and health outcomes.
Examples of associate-led improvement projects designed and implemented in 2020 included:
- increasing the number of registered dieticians providing telehealth visits
- developing the proficiency of staff in applying waterproof casts
- improving patient access to imaging services
- reducing overall wait times
- enhancing communication about infection control and prevention
- engaging parents in improving feeding outcomes for newborns in Cardiac ICU
- establishing a new process for associate certification in medical interpretation services
Collaborating with Families to Navigate the Financial Side of Care
Out-of-pocket medical expenses, even for families with health insurance coverage, have steadily increased over recent years. While Nemours provides Financial Assistance programs that offer discounts to uninsured families as well as payment plans, there was a lack of a centralized, consistent approach to partnering proactively with families before services were rendered. Talking about money may be uncomfortable, but realizing the undue burdens placed on families by not having conversations upfront led Nemours to embark on a Continuous Improvement (CI) project to ensure Financial Advocacy begins at scheduling.
Beginning in 2016, a phased approach was used throughout the five-year journey to assess, educate, improve, and test new communications, processes and resources. This included 14 separate process improvement events and Nemours’ first-ever fully virtual improvement event in 2020. The CI project was led by a cross-functional, enterprise team of executives, clinicians, and associates from finance, scheduling, information systems and communication. Patient families were engaged throughout the project in a variety of ways: direct interviews, quick surveys, formal patient experience surveys, process observation, in-person and virtual input from Family Advisory Councils, family feedback on family-facing documents, and family input on the assessment of tools, resources, vendor demos and recommendations. Families were also incorporated into the training program for current and new Nemours finance associates.
Additional work is now underway to increase the accuracy of price estimates based on a family’s current coverage or benefits. New technology is also being leveraged to increase families’ access to financial information, including online check-in and form submission along with a new Bill Pay option through the Nemours App.
Results of Financial Advocacy CI:
- From 7 to 1: decreased the average number of appointments for Medicaid application
- 1,469 self-pay patient families were able to obtain federal healthcare coverage and/or additional financial assistance earlier in their care journey
- 99% of Nemours charity care-eligible patients are enrolled prior to their first day of service
- Patient Responsibility Family Advisory Group is being formed to provide ongoing feedback