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team catharsis ca•thar•sis: a purifying or figurative cleansing of the emotions. A release of emotional tension, as after an overwhelming experience, that restores or refreshes the spirit.

Design for Service Fall 2007

Renna Alyassini • Christina Payne • Reina Takahashi • Diana Yu

UPMC Cath Lab


Team Catharsis is a group of 4 students from Carnegie Mellon University School of Design. As part of a service design project and an introduction through UPMC’s Quality Improvement, the team was assigned to design a better experience for those involved with the CHA through research, prototyping and ideation. We wanted to connect to the Cath Holding Area on an emotional level and found “catharsis” an appropriate, euphonic term.


An Introduction to the UPMC Cath Lab


ABOUT THE CATH LAB

cath•eter•ization the operation of introducing a catheter into the body.

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The Cardiac Catheterization Holding Area (CHA) at UPMC Presbyterian is located on the third floor. It services Catheterization patients (Cath), Trans-esophageal patients (TEE), Electrophysiology patients (EP) and emergency patients as a pre- and postprocedure holding area. The procedure is outpatient, although some patients may be admitted for observation

overnight. Additionally, the CHA will hold inpatients when there is an overflow. There are 14 bed spaces and a central nurses station. Each bed space has three walls with a front curtain, television and chair. The nurses’ station is rather cluttered with computers and files. There is a linen cart in plain view; however there are plans to build a closet.


ABOUT THE CATH LAB

The Check-in The waiting area is down the hall from the CHA and also primarily serves Gastrointestinal patients. There is a reception desk where CHA patients

must check-in. A private room labeled “Consult 1” is at the other end. There is another sign and door labeled “Consult 2”, however that is blocked off.

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PATIENT TOUCHPOINTS

Patient Pathway

Based on our first visit and information provided by the UPMC Quality Improvement team, the patient’s touchpoints and stakeholders through the CHA experience are identified and diagrammed.

Diagnosed/ Referred to UPMC

Contact Scheduler

Arrive in Oakland

Navigate Hallways & Find MPU

Check-In & Consult

Enter CHA Pre Procedure Tasks

Enter CHA Taken to Lab Pre Procedure Tasks

Return to CHA Post Procedure Tasks

Discharged or admitted to hospital

UPMC Actions

CHA ›

MD Office Check-Up

Send Materials Pre Procedure Call

MD

Home

EP Lab

touch•point: the point of contact, especially when products or services come in contact with a customer. 6

Pittsburgh UPMC ›

CATH Lab

TEE Lab


CATH LAB STAKEHOLDERS

lab work nurse/tech

referring doctor

upmc pre-visit contact nurse caller

appointment receptionist check-in receptionist

patient emergency

ep

patient

patient tee

cath

patient

patient

hospital care

admin doctor

consult room parking (valet)

family & friends

poha

technician nurse

nurse practitioner

stake•hold•er: someone who has a share or an interest in an organization.

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KEY STAKEHOLDERS

Key Stakeholders The primary stakeholders that affect the CHA everyday are separated into quadrants.

UPMC

Family & Friends

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CHA Staff

Patients


Cath Lab Research


OBSERVATIONAL RESEARCH

After our preliminary visit, we began the research phase for the CHA. We spent several hours observing all of the key touchpoints at UPMC. Observation: We walked through the physical touchpoints that the patients experience when they arrive at UPMC. We observed the signs used for wayfinding and where it might be confusing for patients and family.

way•find•ing: signs, maps and other graphic or audible methods to convey directions to travelers.

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OBSERVATIONAL RESEARCH

Storytelling and Interviewing We sat in the waiting area and spoke to patients and families who were there for the CHA. We asked questions about their morning before arriving and if they had concerns about the day. We observed the interactions of the patients and families waiting; did they read, watch television, sleep? Were they bored, frustrated and confused, or comfortable, relaxed and aware? We went the CHA and observed the actions of the staff during a morning shift on a Thursday, the day typically with the most patients scheduled. When they had a moment between patients, the nurses told us how the CHA works and what tools they use. Document Collection We wanted to understand what written communication was exchanged between stakeholders. We requested and received all the documents that are sent to CHA patients from the time their appointments are scheduled. We also collected the paperwork used by the nurses for post-procedure. Exploratory Research In addition to the research in the CHA, we looked at other service environments. We researched the amenities available in luxury hospitals and high-end hotels and brainstormed about what might be appreciated by CHA patients.

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OBSERVATIONAL RESEARCH

Exploratory Research (cont’d) We discovered a publication written for and by other hospitals’ CHA staff, called Cath Lab Digest. We researched some of the problems other Cath labs were facing, including patient flow and equipment shortage, and what improvements they made. Later in our research phase, we discovered the special surgery center at UPMC Montefiore. We were very surprised to find that many ideas developed in our first brainstorming session were already implemented. Not only were many of our ideas already in place, they were right across the bridge at Montefiore. We observed and documented the touchpoints for the surgery patients and compared and contrasted them with the CHA patients. From many of the design improvements already in place, patients there had a much different experience from patients at the Cath Lab.

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INTERACTIVE RESEARCH

To gain a true understanding of the CHA experience, it was essential for us to involve the key stakeholders and gain their trust and insight. We focused on our primary stakeholders in the CHA: staff, patients and family. In the waiting area, we used an existing bulletin board space to put up an interactive bulletin board for patients, staff, family and friends. With lightbulbshaped and speech-bubble shaped notes, and pens and tacks, we encouraged everyone in the waiting area to “tell us what you think.” CHA Patient Input Card On this card, please tell us your suggestions. _______ would make me feel more comfortable during my stay here. (for example: warm blankets, less noise, reading material...)

It was helpful that UPMC told me about _______ before I came today. (for example: information about my procedure, food restrictions...)

I wish I also knew _______ before I came here today. (for example: lab work needed, better directions to UPMC...)

I’d like to receive information about today in the following ways: (circle as many as you’d like) internet website mail

email

from my referral doc

phone call other____________ please tell us more a

IDEAS

Please Circle One: GI or CHA

We designed and distributed journal cards for patients, so they could write about how they feel throughout the process in the CHA.

in•ter•ac•tive: involving the communication or collaboration of people or things

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INTERACTIVE RESEARCH

For the staff, we designed cards for them to record their actual day in the CHA and the ideal day.

After my shift

During my shift

Before my shift

On an ideal day:

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On a typical day:


INTERACTIVE RESEARCH

We also gave staff feedback cards with topics such as “Work-Life Balance” and “Access to Clean Linens” and asked them to rate these topics according to their importance.

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PROTOTYPE

Prototyping Towards the end of our research phase, we began brainstorming idea solutions for the CHA. We created an Information Brochure for patients which included what to expect, the patient process, and where to find hospital amenities. We received very positive feedback from staff and staff suggestions, and decided to develop the content further.

What to Expect

Where can I find...

pro•to•typ•ing: the creation of a model and the simulation of all aspects of a product or concept.

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Food Services The UPMC Presbyterian Cafeteria is located on the 11th floor Daily: 6:30am–2:30pm For a recording of the daily menu call 412.647.4328

Gardens The UPMC Presbyterian provides the Spinola Garden, a restful outdoor haven located on the Unit 3E balcony. From the CHA waiting room exit toward the main hall and follow signs to Unit 3E.

The UPMC Montefiore Coffee Shop is located on their 7th floor in front of the Main Elevators Weekday: 7am–8pm Weekend: 8am–5pm See front of brochure for directions

UMPC Montefiore provides the Blair Crawford Courtyard Garden located on the 7th floor, near the coffee and giſt shops. Enjoy an outdoor gazebo and a heated solarium. See Walkway to Montefiore for directions.

Giſt Shops The UPMC Presbyterian Giſt Shop is located on the lobby level. Weekday: 9:30am–6pm Weekend: 11am–4pm The UPMC Montefiore Giſt Shop is a larger store and located on their 7th floor in front of the Main Elevators. Weekday: 7am–8pm Weekend: 8am–5pm See front of brochure for directions Banking ATMs are located in the following areas: • 11th floor near the cafeteria • Lobby level near the cashier • Ground level walkway near the Falk end Walkway to Montefiore From the CHA waiting room, exit toward the main hall, follow the walkway signs to Montefiore Hospital. You will arrive on the 6th floor of the Montefiore Hospital. Take the Main Elevators up to the 7th floor.

Pharmacy The Pharmacy will fill any prescription your loved one is given at the time of discharge. Payment may be made by cash, check or credit card. To fill a prescription, call the UPMC Presbyterian Pharmacy at 412.648.3123 Overnight Lodging Should your loved on need to be admitted into the hospital overnight, the following are nearby accommodations for you: Family House 412.647.7777 Holiday Inn 412.682.6200 Hampton Inn 412.681.1000 Quality Inn 412.683.6100 Wyndham Garden Hotel 412.683.2040 Parking Validation Discounts are available for parking 7 to 24 hours. Present your parking ticket at the Information Desk at UPMC Presbyterian on the first floor to see if you qualify.

Arriving at the CHA • For those visitors new to Pittsburgh or UPMC, the back of this guide provides some information on where to find conveniences during your visit. • It can be confusing navigating through the building. Do not hesitate to pick up a Cath Procedure Patient & Family tan-colored phone in the hallways, where someone will help direct you if you are lost. • Upon arriving, patients will need to register, and check in with the Consult nurse. • The waiting room serves both Gastrointestinal and CHA patients, so both will be called for their procedures.

INFORMATION SHEET

Before the Procedure • Patients may need to have lab work done if it has not been done prior to arriving. This may delay the procedure. • There can be long wait times up to several hours to accommodate scheduling and patient demand. • The CHA itself may become very busy, especially in the morning when there are the most patients. The CHA can become loud, please try and keep your voice down in the CHA to allow patients to rest.

During the Procedure • The procedure will take about an hour or so. Aſter the Procedure • Patients will need several hours or more to rest and recover aſter the procedure. • There is a chance patients may be admitted into the hospital overnight.

The patient process on the day of the procedure: Please note the times are an estimated average and may vary depending on patient status.

arrive at UPMC, check-in at reception

wait to speak with consult

speak with consult to verify information

pre-procedure prep in CHA

procedure and tests

post-procedure observation and recovery in CHA

5-10 minutes

15-30 minutes

10–20 minutes

30-60 minutes

60-120 minutes

60 + minutes

discharge or admit to inpatient bed


Cath Lab Research Findings


PATIENT TYPOLOGIES

While intending to learn more about the patient experience in the CHA, we found valuable feedback from the staff. We created typologies

ty•pol•o•gy: a systematic classification of types that have characteristics or traits in common and that is used to create personas.

Alice, 39

Dan, 74

Lee, 63

HR Executive

Retired auto mechanic

Small business owner

At the CHA for first EP procedure and possibly an ICD

At CHA for his third cardiac catheterization; first at UPMC

Pacemaker needs replacing immediately

Allergic to IV dye; has not received IV prep work No lab work done prior to procedure Lives within twenty minutes Uses the Internet at home

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of common profiles we saw, addressing similar patterns and varied situations in each persona.

Has had all of his lab work done prior to today Drove four hours with his wife from rural New York Dan and his wife use the internet at home

Taken directly to the EP lab Requires extra attention in Cardio Care bed Lives 40 minutes outside of Pittsburgh Uses the Internet at home


STAFF TYPOLOGIES

We also found it important to profile staff typologies as well, in order to understand the personas of those that work at the CHA.

Carol, 42

Jim, 63

Registered Nurse

Advanced Patient Care Tech

Has worked at UPMC for 14 years

Has worked at UPMC for 35 years

Has worked at the CHA for 2 years

Has worked at the CHA for 2.5 years

Needs access to clean linens and proper equipment daily

Work space is too crowded, CHA is too noisy and overstimulating

Has two young children, likes to be home for dinner when possible

Would like to get off work in time to go running 19


KEY FINDINGS: PATIENTS

Signage We went to UPMC Presbyterian and put ourselves in the patient’s shoes to see what their first impressions might be. In navigating through the system of buildings, we had a difficult time finding the CHA, and found the signs used for wayfinding to be confusing and inconsistent. Website When searching the UPMC website, we had a hard time finding the information we were looking for, such as what to expect, details about the procedure, and other details.

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KEY FINDINGS: PATIENTS

Waiting/Check-in Area In our observations, we found that the waiting area is shared by GI patients which often confuses and frustrates CHA patients. Patients do not know which door to enter, which receptionist to talk to, or who will be calling them for their appointment. Knowledge of the Procedure From patient interviews and patient feedback cards, we found that patients are often anxious or frustrated for various reasons. They do not know what’s next, do not know much about their procedure, do not know beforehand that they may stay overnight, and incur long unexpected wait times before and after the procedure.

“I wish I knew the procedure better before I came here today.” - CHA Patient

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KEY FINDINGS: PATIENTS

Patient Pathway

We mapped our overall findings of the patient journey with emotions they were experiencing in the Patient Emotion Blueprint.

Diagnosed/ Referred to UPMC

Contact Scheduler

Arrive in Oakland

Navigate Hallways & Find MPU

Check-In & Consult

Enter CHA Pre Procedure Tasks

Taken to Lab

Return to CHA Post Procedure Tasks

MD Office Check-Up

Send Materials Pre Procedure Call

EP Lab

Discharged or admitted to hospital CATH Lab

TEE Lab

Breakdowns

Emotions

UPMC Actions

CHA ›

Lab work not prescribed prior to procedure appointment

MD 22

Over-book day Sent inconsistent information

Home

Pittsburgh intimidating to non-locals

Poor signage

Pittsburgh UPMC ›

Shared w/ GI Confusing Unwelcoming

Noisy Noisy Overstimulating Overstimulating Long wait times Shortage of equipment

Noisy Overstimulating Long wait times Shortage of equipment


KEY FINDINGS: FAMILIES & FRIENDS

Family & Friends: ell s

Ha e an i ea or s

es ion

ell s a o

a

i

o

sin

in

e li

l

“Getting here was easy. Finding parking—not so easy.” Please Circle One: GI or CHA

Area and Facility Information After interviewing families and gathering comments from the bulletin board in the waiting area, we found that families and patients from out of town often find it intimidating to arrive in Pittsburgh for the first time. Families are often frustrated by the unexpected long wait times with limited places to go during this time. Many wished they were better informed about the process and what to expect.

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KEY FINDINGS: STAFF

Core Competencies From our observations, interviews, and interactive research, we discovered a consistent message that the core competency of the CHA is its people.

core com•pe•ten•cy: Effective coordination of skills benefiting patients

STRONG TEAM WORK

PRIDE IN THEIR EFFORT

PATIENT CARE

Nurses, technicians and nurse practitioners regularly meet throughout the day to coordinate tasks and review patients.

CHA employees take great pride in their flexibility and accommodation of patients and their families.

CHA employees take extra measures to comfort patients and their families.

upmc cha’s strength lies in the people

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KEY FINDINGS: STAFF

Non-Medical Tasks CHA staff face daily common issues that hamper them in doing their jobs. We analyzed the feedback we received from staff in listing their ideal day and their actual day, and interviewed and observed them. We found that staff must spend much time requesting and acquiring more supplies and linens. Equipment must often be borrowed from other areas of the hospital. Staff also spend much time dealing with upset families because the procedures took longer than families expected. They often deal with many ill-tempered patients because their lab work is not done, delaying their procedure. Hospital beds often are not accessible, and they must stay with patients until beds are made available.

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KEY FINDINGS: STAFF

Ideal Day

Before Shift

During Shift

After Shift

Linens stocked

Patients in respectful mood with labs completed

Shift ends on time at 7:30pm

Supplies stocked

Beds made by hospital staff

Rooms clean and stocked

Families informed about process; understand requirements if patient is checked in No need to overflow to other areas

Floor clean

Clean space available to work

No in-patients

Hospital beds available within an hour of check-in CHA is quite and calm. Only necessary people in area.

Typical Day

In-patients in the CHA. Requires extra work to get into hospital beds such as fax orders, etc.

Cha has too many non essential people, is disorganized and loud

Beds made by nurses at end of shift

Floors sticky and dirty

Patients often wait hours for hospital beds when checked-in

Rarely end on time. Often end as late as 11:30pm

Supplies in rooms usually low

Workslpace is disorganized

Not enough equipment available. Must check out equipment

Often have to overflow patients

Inadequate amounts of linens, calls made to restock 26

Families don’t know what to expect. Ask the same questions repeatedly Patients arrive ill-tempered and rude without lab work done.


KEY FINDINGS: STAFF

Staff Needs From the staff feedback cards, we found that staff most needed the following resources to help them provide quality care: accessible hospital resources,

Accessible Hospital Resources Patient Happiness

Manageable Workload

Sta ff 6

Sta ff 5

Sta ff 4

Sta ff 3

Sta

ff 1

ff 2

unimportant

Sta

Most Important items as Ranked by Staff

a manageable workload, and work-life balance. Staff also rated appreciation by management as one of their most important elements.

somewhat important

Appreciated by Management Functional Workspace Positive Atmosphere

moderately important

Supportive Co-Workers Enjoyment of Work

important

Downtime Work-Life Balance Manageable Stress Level Pay

extremely important 27


KEY FINDINGS: STAFF

Staff Pathway

In analyzing our findings and feedback from staff, we found that common process breakdowns increased negative emotions such as anxiety and frustration. We mapped these findings of the staff journey into the Staff Emotion Blueprint.

Get family out the door

Arrive in Oakland

Find hospital beds for in-patients

Call for linens, restock supplies, checkout equipment

Begin preprocedure. Overflow when needed

Take to lab. Answer family’s repeated questions

Begin postprocedure

Send Materials Pre Procedure Call

Breakdowns Emotions

UPMC Actions

CHA ›

Lots of traffic getting into Oakland

Home 28

Equipment Room

Fax orders Make calls Physically take them

Pittsburgh UPMC ›

Linens, supplies and equipment always inadequate

EP Lab

CATH Lab

Noisy Noisy Long wait times Overstimulating Overstimulating Too many non essential people Answer repeated questions

TEE Lab

Noisy Overstimulating Long wait times Shortage of equipment

Checkout or admit patients, Manage in-patients, Clean Work around in-patients. Take CHA patients to hospital beds

Less staff toward end of day. Navigate extra beds stored in CHA. Clean. End late


KEY FINDINGS: STAFF

The majority of communication flow filters through the staff, both for treating patients, and communicating with other parts of UPMC to request supplies or other necessities. The key issue is a balance of communication. UPMC

CHA Staff Enter Medical Info Lab Work Pre Procedure Prep Post Procedure Care Post Procedure Forms Checkout/Admit Patients Prep For Next Day

Patients Make Appointment Check-In Lab Work Pre Procedure Procedure Post Procedure Checkout/Admit

In-Patient Beds Linens Supplies Equipment Rental Janitorial Food Service Over Flow Areas Family & Friends Transport Patient Ask Questions Accompany Patient to CHA & Home 29


Proposed Solutions


PROPOSED SOLUTIONS: UPMC

Focus In a brainstorming session, we considered all possible solutions to enhance the CHA experience, from immediate to long-term. However, our focus is on the areas affected by communication. We also kept our focus within high-value, low cost solutions that can more easily become implemented.

patient comfort amenities

welcome sign

noise pads ambient lighting cha receptionist ambient cha style guide sound upmc greeter consistent signage linen supply new info pdfs on site comfortable information for patient waiting room chairs cha coordinator video of upmc visit new magazines for hotline staff masseuse waiting room more equipment

staff 32

coffee station

wireless internet

family

library cart


PROPOSED SOLUTIONS: STAFF

cost effective new magazines for waiting room good coffee station patient light music amenities dvd players in holding areas

low value

emmi on tvs

cha style guide info/flow chart booklet for patient

new info sheets hotline on website wireless staff suggestion internet forum consistent signage video of welcome sign upmc visit

1-800

cha linen supply cha staff masseuse receptionist coordinator extra equipment comfortable on hand waiting room chairs ambient ambient upmc greeter lighting sound computer lab digital nurse in touchscreen med-info library cart consult card 2nd bathroom in cha with check-in shower compatible kiosk upmc brand epic system consulting

high value

cost prohibitive 33


PROPOSED SOLUTIONS: UPMC

Style Guide The Cath Lab can greatly benefit from having a consistent brand and style. This key communication concept would be essential in giving the CHA its own identity not only with patients and visitors, but also within UPMC. This brand can be applied LOGO

cath lab cath lab HOLDING AREA

Pantone 193

Janson Regular

Use this version of the Cath Lab logo when information pertains to the Catheterization Lab as a whole

Janson Regular

Use this version of the Cath Lab logo when information pertains to a speciďŹ c section of the Catheterization Lab.

Helvetica Neue Regular, Smallcaps

Black 45%

TYPEFACES

Janson Regular Helvetica Neue Regular

TEXT

Headings in Helvetica Neue Regular Body text should be set in Janson Text Regular. Te eummod eu faciliquat. Dui esto etumsan ea feugue core facilit irilluptatio corem amet vel iure vel dolobor eetuerat velit nim in essim volor amet, consequi tat.

Headings of bodies of text should be set in Helvetica Neue Regular, in the UPMC trademark blue (Pantone 294).

Bodies of text should be set in Janson Regular. Pantone 294

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to wayfinding, the UPMC website, and written documents. Based on the standards from UPMC Corporate Communications, we have suggested a style guide to implement this vision and establish a consistent identity for the Cath Lab.

Black 100%


PROPOSED SOLUTIONS: UPMC

Signage The Cath Lab brand would also be the driver for consistent signage throughout the building. Since navigation through the building is often a visitor’s first experience with UPMC Presbyterian, consistent signs will greatly help patients and visitors find the Cath Lab and lessen emotions of LOGO VARIATIONS

cath lab

feeling lost or overwhelmed. Consistent signage would also display a concrete identity of the Cath Lab to visitors and staff alike at UPMC. To develop this further, the Cath Lab logo could be implemented as a branch for an overall identity of all cardiac areas.

SIGNAGE EXAMPLES

Signage should be labeled clearly with the logo denoting the appropriate Catheterization Lab section.

CHECK-IN

cath lab PATIENT & FAMILY ROOM

cath lab PARKING

cath lab HOLDING AREA

Logo is labeled underneath with the appropriate sections of the Cath Lab.

COLOR VARIATION

cath lab PATIENT & FAMILY ROOM

In some cases, the logo will be shown on a dark background. In these instances, the logo should be reversed, in white.

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PROPOSED SOLUTIONS: PATIENTS & FAMILIES

CHA Information Cards Many issues patients and families faced during their experience was due to the lack of information provided to them. They did not know what to expect next in the process, how long they would wait, where families could go during their wait, or what steps the procedure actually entailed. We propose using CHA Information cards as a solution to directly addresses these issues. The cards we have designed can provide

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consistent written information to patients and families so that they can feel more at ease throughout their experience. Designed as a colorcoded set of six with various information on each, the cards should be displayed near the check-in area in an acrylic literature holder. They can be posted on the wall in the waiting area for patients and families to choose based on their medical and personal needs.


PROPOSED SOLUTIONS: PATIENTS & FAMILIES

Website Our feedback showed that many patients and families were interested in accessing information about the CHA online. We had to search through multiple pages on different parts of the website to find this information. We also found that the information was structured in a format that

was hard to follow. As a new website design for the CHA, we propose that the information on the Cardiac Catheterization page is organized by content and colors consistent with the CHA Information Cards, putting key information all in one place and making it easier to find.

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PROPOSED SOLUTIONS: PATIENTS & FAMILIES

CHA Check-in Process Once patients arrive at UPMC Presbyterian and find the CHA waiting area, the check-in process is one of the key touchpoints with the CHA, and streamlining the efficiency is crucial. Because the CHA patients share the current waiting room with GI patients, CHA patients should be directed to the second door, utilizing the the Cath Lab brand and signage. A kiosk can be installed by the consult room where CHA patients can sign in and confirm information. This process

SEPARATE ENTRANCES

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was already in place and being used at UPMC Montefiore, where patients had a much easier time checking in. The proposed solutions are for temporary implementation until the new waiting room is built. We recommend that the CHA patients are separate from the GI patients, regardless of which room they eventually check-in.

EXTEND THE BRANDING

STREAMLINE CHECK-IN


PROPOSED SOLUTIONS: STAFF

CHA Coordinator We found many opportunities in which communication could be facilitated for UPMC, CHA staff, patients, and visitors (our key stakeholders.) The CHA staff is often overwhelmed with their primary responsibilities in addition to communicating between

stakeholders. Introducing a CHA Coordinator role will provide the support needed by the CHA staff so they can focus on providing quality care for their patients. The CHA Coordinator position is integral to improving the CHA experience for all stakeholders involved.

Opportunity: UPMC

CHA Staff

CHA Staff has to continuously interact with UPMC services throughout the day to make sure their unit is properly prepared for patient care.

Family & Friends

CHA Staff

CHA Staff has to answer the repeated non-medical questions of family and friends.

UPMC

Patients

Patients do not have a consistent experience of UPMC Presbyterian. 39


PROPOSED SOLUTIONS: STAFF

CHA Coordinator (cont’d) The CHA Coordinator will assume most of the non-medical responsibilities currently being handled by the CHA staff. This includes ensuring supplies and equipment for the CHA, assigning

in-patient beds during patient overflow, admitting and checking out patients, and answering questions posed from family and friends.

CHA Coordinator CHA Staff

UPMC

Communicate with coordinator Enter Medical Info Lab Work Pre Procedure Prep Post Procedure Care Patients Post Procedure Forms

Checkout/Admit Make Appointment Check-In 40

Family & Friends Ask Questions Transport Patient Accompany Patient to CHA & Home

In-Patient Beds Linens Supplies Equipment Rental Janitorial Food Service Over Flow Areas


PROPOSED SOLUTIONS: STAFF

CHA Coordinator (cont’d) We have listed some of the main job responsibilities of the CHA Coordinator, most of which are being handled currently by the CHA nurses:

Act as primary non-medical liaison to patients, family and friends. UPMC

CHA Staff

CHA Coordinator Family & Friends

Greet them and attend to their overall comfort. Direct them to hospital amenities. Provide them with applicable resources. Coordinate and work with scheduler, consult, and CHA staff to manage the smooth operation of the unit.

Patients

Manage daily schedules of linens, supplies, cleaning and food service. Manage daily equipment rental and coordination with over-flow areas. Coordinate overnight patients move to hospital beds. Handle all paperwork and transportation of patients to correct hospital units and beds. 41


PROPOSED SOLUTIONS: STAFF

Ideas Forum From our staff feedback cards and interviews, we discovered that staff has many valuable ideas on how to improve the CHA experience. In dealing with the daily responsiblities and knowing the varied situations in the CHA, the staff is in a credible position to propose solutions. However, we also found that they did not have a platform to allow their issues to be heard and therefore, sometimes felt unappreciated by management. We created the CHA Ideas Forum as a structure for CHA staff to propose ideas to upper management. CHA staff can post ideas and rate them on different dimensions, such as benefit to patients, benefit to staff, high value, low cost and staff favorite. The Ideas Forum can be a means to show which solutions are most important or relevant to the CHA.

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PROPOSED SOLUTIONS: STAFF

CHA Gear We found the core competency of the CHA to be its people, and this is a strength that should be externalized. CHA gear such as shirts, sweatshirts, or nametags emblazoned with the CHA logo can be a tangible symbol of the staff ’s strong teamwork, as well as indicate to patients the personalization of care provided.

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Moving Forward


FUTURE IDEAL SCNEARIO

Pre-Arrival Dan has been scheduled for his first catheterization procedure at UPMC Presbyterian. He is a bit nervous so he wants to find out more about the procedure before arriving. He visits the UPMC website and reads about the Cath Lab to gain a better understanding of what to expect. He finds that having his lab work done prior to arrival is rather important, and contacts his physician to ensure all his labs are in order. Arrival Dan and his wife drive four hours to Pittsburgh from their home. Upon arriving at UPMC, they use the valet service that they read about from the website. From the main entrance, they ask the greeter how to get to the CHA. They take the elevators to the third floor and follow the Cath Lab signs. Dan and his wife see the sign above the second door of the waiting room for Cath Lab patients. Check-in They enter the waiting room and check in at the kiosk. The CHA Coordinator helps them to check in and answers questions. She tells them about the cards on the wall to help them during their visit. They pick out the “What to expect,” “Cath,” and “Amenities” cards and learn that the entire wait time throughout the procedure may be several hours or more. In the waiting room they see rocking chairs, updated magazines, and games. A video outlining the UPMC visit is on TV. 46


FUTURE IDEAL SCENARIO

Cath Holding Area The CHA Coordinator brings Dan and his wife to the CHA, which is busy but quiet. Dan’s wife receives a pager, which allows her to be contacted in the building once the procedure is over. In the CHA, Dan gets changed and prepared for the procedure. He is anxious but is glad he knows more about the procedure itself from the UPMC website and from the “cath” card. Procedure During the procedure, Dan’s wife decides to visit the UPMC café and gardens mentioned in the cards. After several hours, she is alerted by the pager and returns to the CHA. After the post-procedure recovery is completed, Dan’s is discharged and they return home the same day.

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FUTURE STEPS

We have discovered that even minor changes can make a large difference to improving the experience for UPMC Presbyterian CHA stakeholders. In this book, we have focused on solutions that enhance communication flow and that can be implemented straightaway. In our ideal scenario, we illustrate other amenities that would be appreciated by patients and visitors. After researching in other UPMC hospitals, we have seen that these design solutions are feasible, effective and already in use. As UPMC grows, we feel it is essential to take the time now to perform an internal audit of all of the facilities. This will not only indicate areas in need of improvement, but perhaps more importantly provide key information for what are effective practices already implemented.

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Thank You We would like to give a warm thanks to the wonderful staff of the CHA. In addition, we would like to thank Rose for all of her stellar support and feedback. You went above and beyond in giving us access to the holding area as well as answered so many of our questions outside of work hours! Thank you to Judy, Gail and all the folks we worked with at the Center for Quality Improvement and Innovation. This has been a truly eye-opening experience and a pleasure to work with such dedicated people. Lastly, thank you to Shelley for being a fantastic teacher. Truly.

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UPMC  

UPMC Center for Quality Improvement & Innovation