'Patients First' initiative has access component

Brochure to be part of admission packet

The voluntary posting by Massachusetts hospitals of their staffing plans — a first-in-the-nation initiative — has sparked "wonderful feedback" on what the effort has meant to patients and hospitals, says Karen Nelson, RN, senior vice president for clinical affairs with the Massachusetts Hospital Association (MHA).

After the staffing information first was posted in late January 2006, hits on the "Patients First" web site (www.patientsfirstma.org) went from an average of 2,300 a month to about 20,000 in less than three weeks, Nelson adds. "It has generated a lot of interest, both locally and nationally."

Patient access directors are expected to be a key part of the program, especially in the distribution of an accompanying brochure titled "It Takes a Team," she says.

"[The brochure] addresses the fact that whether planned or not, a hospital stay can be confusing," Nelson notes. "It makes the point that a variety of providers are involved in your care, and that [the hospital] wants you to know who they are and what they do.

"Ideally, we're hoping to distribute it as part of the admitting process," she says. "We're asking [patient access and admitting departments] to include it in the admissions packet or materials, and we certainly would like it to be on [nursing] units and at points of entry."

The brochure, which is available in English and Spanish, is accessible on the web site and has been provided in reproducible form to every Massachusetts hospital, Nelson says. "We've also distributed samples to the Massachusetts Medical Society and the American Association of Retired Persons."

Hospitals can place their own logos on the brochure, she says.

While the initial target audience is Massachusetts, Nelson adds, the brochure also would make sense for patients elsewhere. "The questions are applicable inside and outside the state. There are questions on quality and safety, and about what to expect when you go to the hospital."

Dialogue opened up

The posting of staffing plans was "certainly meant to be a patient pleaser" and has created a dialogue between providers and patients, Nelson notes. "As a bonus side effect, it has opened up dialogues between nurses and among leaders in different hospitals about identifying best practices and sharing information. So it's a concentric circle."

The staffing plans "are like a budget for the year for every single unit in the hospital," she says. "Supplemental information explains how care is delivered, and who else is on the team.

"It gives patients a real picture of how care is delivered. It helps them understand that care needs to be customized to them, and makes the point that care needs to be flexible and that hospitals want to ensure that they receive the right care, not always the same care."

There is information describing the different types of intensive care units, medical and surgical units, and how rehabilitation hospitals differ from acute care facilities, Nelson adds. "It answers some questions and also possibly provokes more questions."

The staffing plan posting and the brochure were put together under the larger umbrella of "Patients First," an initiative dating back to 2005 that began with MHA and the Massachusetts Organization of Nurse Executives, she says.

"The hospital association and the nursing executives got together and said, 'What can we do about some of our common concerns about quality and safety and staffing issues?'" Nelson says.

The idea of posting the staffing plans was vetted with hospitals and nursing organizations, she notes. "There was a variety of responses 'Should we do this? Are there any risks?' We felt it was important to be transparent about our quality and safety agenda and particularly what our staffing looks like. It took courage, but eventually every hospital agreed to participate.

"This is the culmination of a year-long effort, but it's just the beginning of where Massachusetts hospitals are going," adds Nelson. "We are continuing to build on our quality and safety agenda by implementing National Quality Forum [NQF] measures related to nursing care."

Massachusetts hospitals have agreed to participate in NQF measures such as patient falls, prevalence of pressure sores, and incidence of infection from central catheters, she says.

"We hope to learn lessons such as, 'How does one pilot these measures statewide in terms of standardization?' We will publicly report at least two measures."