Excellence Through Self-Administration
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Self-administration has also opened up opportunities for physicians, nurses, and respiratory therapists to reeducate their patients on how to use their medications—and some of those patients may think they're doing it correctly, but have fallen into bad habits over the years.
"I had one patient who kept getting readmitted and always said ‘yes' when I asked him about his medications," Cohen says. "But when I had the opportunity to see him self-administer in the hospital, I could see what he was doing wrong. From that I learned how to ask more specific questions and work with them to get better adherence."
Having dramatically reduced the time it takes to provide the care CF patients need has reduced the average length of stay in the hospital for CF patients to seven days from 11. The success of self-administration is also reflected in patient and professional satisfaction surveys: Satisfaction rates for both groups rose from less than 20% before the intervention to above 95%.
"There's no one-size-fits-all model when trying to build patient-centered care," says Boal, "but studies show that the more control patients have in the hospital, the better the outcomes. The way the culture changed around the care of CF patients is teaching us how to let patients with chronic illnesses be the experts they are."
The group, with most of its original members, continues to meet weekly and apply the clinical microsystems process to a range of other issues to perfect the care LIJ Medical Center delivers to its CF patients. This includes the self-administration of insulin for those patients with CF-related diabetes and helping residents use the redesigned order set with new EMRs. The group is also focusing on improving the transition of patients from pediatrics to the adult hospital and has turned its attention to how the staff can improve end-of-life care for patients and their families.
"What's remarkable is that this sophisticated work can only be done at ground level," explains Jaffrey. "People who do the day-to-day work can get through these issues with so much velocity. When we empower them to be the change agents, we're leveraging the largest untapped resource we have in healthcare."
This article appears in the April 2012 issue of HealthLeaders magazine.
Betty A. Marton is a contributing writer for HealthLeaders Media.
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