i-CARE: Improving Patient-Family Experience in Pediatric Ambulatory Orthopaedics

Issue/background: A key aspect of the Triple Aim in healthcare is improving care experience, including the ambulatory setting. Evidence describes how patients and providers define ambulatory quality care. They discovered that both groups identified clinical skills, communication, and rapport as factors important to quality care.

The Clinician and Group Consumer Assessment of Healthcare Providers and Systems Survey provides a standardized measure of ambulatory patient experience. At our institution, a sample of patients and caregivers are contacted within 3 days of their ambulatory visit to complete a survey via email or telephone, which includes an overall rating of the provider on a 10-point Likert scale.

Objective: The aim of this quality improvement project was to increase the overall orthopaedic provider rating in the ambulatory setting from 76% to 84% by June 30, 2018. The global aim was to optimize the experience of patients and families in the orthopaedic ambulatory care clinic.

Method: This quality improvement project, based on the model for improvement, took place at one Midwest tertiary-care children’s hospital. Key drivers included provider and staff engagement, clear provider and staff expectations, optimal communication, clear patient/family expectations, and timely service recovery. Multiple plan-do-study-act cycles were performed, focused on interventions theorized to have the greatest impact on these drivers. These included development of a framework for ideal care (i-CARE), education on staff/provider expectations and scripts, clinic huddles, real-time feedback by clinic staff, transparency of data, and documentation of patient/family expectations. The primary process measure was the percentage of patients, every 2 weeks, who rated their provider as a 9 or 10 (on a scale of 1-10). A statistical process control chart (p-chart) tracked the effect of interventions over time. Testing of key interventions was annotated and established rules for determining special cause were used.

Findings: This quality improvement project demonstrated an increase in overall provider ratings from a baseline of 76% to 84% by May, 2018.

Conclusions/implications for practice: As evidenced in the literature, improving ambulatory patient experience includes aspects of clinical care, communication, and rapport. In this quality improvement project, a multi-disciplinary team of nurses, physicians, business professionals, researchers, quality improvement specialists, and other healthcare professionals worked collaboratively to implement a patient experience toolkit, i-CARE, and to improve patient-family experience scores. Implications for practice include demonstrating that nurses are leaders in improving quality patient care. Additionally, toolkits are useful for healthcare providers as they work to improve quality patient care. Finally, a collaborative approach is useful for quality improvement in the outpatient setting.