Background:
The Hospital Outcomes Program of Excellence (HOPE) Initiative is an effort to improve the inpatient medical care provided at the Ann Arbor VA Medical Center. Our goal is to expand and enhance the systems redesign efforts at the Ann Arbor VA Medical Center by building on a current commitment to Lean principles and through a series of hospitalist‐led initiatives intended to improve interdisciplinary communication and teamwork, patient flow, and patient outcomes.
Purpose:
To prioritize and focus our efforts, we first conducted a thorough needs assessment to gain feedback from all levels of the organization on ways to improve the inpatient medical care provided.
Description:
We conducted a total of 64 semistructured qualitative interviews of patients (n = 10) and staff (n = 54) from all levels of the organization, including senior leadership. The goal was to gather opinions about what we are doing well and what needs improvement. The field notes from the semistructured interviews were analyzed by a multidisciplinary team of health services researchers to identify major themes. The 5 “successes” and 5 “challenges” were determined to be most important. The 5 successes are: (1) overall, we provide excellent patient care and have dedicated staff; (2) the satisfaction of our hospitalized patients is high; (3) we provide broad‐based support services that address the various needs of the veteran; (4) the computerized medical record system used by the VA is a clear strength; (5) new developments, including a new director, Nursing Shared Governance, and the HOPE Initiative, are viewed as positive steps to overcome several challenges. The 5 Challenges are: (1) a subpar administrative infrastructure makes it challenging to provide high‐quality care; (2) problems with coordinating care cause delays in patient care; (3) the discharge process needs improvement; (4) there is a systemic avoidance of conflict, which contributes to and is reinforced by the existence of silos; (5) relationships at our facility between nurses and physicians are generally good and improving, but important challenges remain.
Conclusions:
Gathering input from all stakeholders requires great time and effort but provides crucial information. Informed by the feedback from the needs assessment, we have started several novel initiatives focused on improving health care worker communication, such as posting physician team photos on the unit and introducing “circle of concern” rounds, which include the charge nurse on morning rounds. We have also conducted multidisciplinary Lean workshops in an attempt to improve the discharge process, compiled a list of “nifty fifty” key inpatient‐oriented articles for our learners (http://www.va-hope.org), and hold bimonthly meetings at which hospitalist attendings discuss relevant books in management and leadership (e.g., Good to Great). If proven successful after quantitative and qualitative assessment, several of the initiatives will hopefully be spread throughout the VA.
Disclosures:
K. E. Fowler ‐ none; S. L. Krein ‐ none; J. Forman ‐ none; C. P. Kowalski ‐ none; M. Harrod ‐ none; S. Saint ‐ none