Time efficiency paramount for one-person department

Finding efficiency amid the chaos

B.J. Hansen-Wingert, MS, RN, patient education specialist for OhioHealth in Columbus, is a one-person department with its own budget.

As such, she does not directly supervise any staff but works closely with clinical educators, such as those in the Women’s Health Department that teach parenting classes. The clinical educators report to the service line in which they specialize, and Hansen-Wingert reports to the director of Employee Education Services.

The position, which she was recruited for in 1995, entails overseeing documentation related to patient education, helping to develop educational materials for patients and having written copy translated into other languages, and communicating with stakeholders on compliance with the patient education standards created by the Oak-brook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations.

She coordinates activities and functions with other education services within OhioHealth and supports all disciplines to develop and coordinate programs across the continuum.

OhioHealth is a not-for-profit, faith-based organization providing a full range of care services. OhioHealth’s Columbus hospitals include Doctors Hospital, Grant Medical Center, and Riverside Hospital. Within the city, it has 20 neighborhood health centers and also offers home health, long-term care, and hospice services. These central Ohio hospitals have 15,000 employees and 2,300 physicians that served 85,300 inpatients and 847,000 outpatients last year. In addition, there are four regional and six affiliate hospitals within the OhioHealth system, but Hansen-Wingert is not responsible for the patient education in these hospitals.

The educational requirements for the job include being a licensed RN in the state of Ohio, having a bachelor’s degree in nursing, as well as a master’s degree in nursing or a health-related field.

Hansen-Wingert has 10 years of nursing experience in transplant, renal, cardiac, and peripheral vascular care.

In a recent interview with Patient Education Management, she provided information about her job, which she described as chaotic at times. The following are excerpts from that interview:

Question: What is your best success story?

Answer: "I like starting from scratch and creating a booklet with a very professional appearance that helps both the clinicians and the patients," says Hansen-Wingert. "I also love taking a complex, busy piece and making it easier to read and visually appealing."

A good example is the diabetes book she created for all three campuses with the aid of diabetes educators. Most of the content was written with the help of literature searches, however some information was taken from the existing folders being handed out at the hospitals. For example, there was a sheet that listed all the diabetes education programs in Ohio that had been kept up to date. Some copyrighted information, such as the diabetes food guide pyramid and diabetes activity pyramid, was added even though the committee had to pay money to the copyright holder to include the information.

The medication sheet was brought up to date now is updated once a year because diabetes medications change rapidly. A special section allows clinicians to individualize the instructions on care to each patient.

Question: What is your area of strength?

Answer: "I work well with chaos/multiple projects at one time, which is needed in my position," says Hansen-Wingert. "I also have a personality that can work well with a variety of clinicians. Another strength is my ability to decrease the reading level of material and make it easy to read and format it to make it visually appealing."

It is challenging in a one-person department to meet many needs in a time efficient manner. To help organize the multitude of projects, she is working on at any given time, Hansen-Wingert keeps all active projects in folders on her desk. They are organized according to priority with the tasks to be done during the current week in the prominent position.

Hansen-Wingert is able to write and revise patient education materials fairly quickly because she has fully grasped the concept of something that is easy to read. She knows that well-written educational pamphlets should have short sentences, bullets, words under three syllables, formatting that skips the use of all capital letters and italics and has short paragraphs with headlines that explain the topic.

Last year, she took the Health Insurance Porta-bility and Accountability Act privacy notice that was created by a consultant team hired by OhioHealth and brought it from a 12th-grade reading level to an eighth-grade level. The legal department had to review it to ensure that none of the legal meaning had been changed. Hansen-Wingert always has the appropriate staff review the content of materials she has reworked to reduce the reading level. In this way, she can be sure that reducing the reading level has not changed the meaning of the material.

Question: What lesson did you learn the hard way?

Answer: "To try to take the politics out of patient education," Hansen-Wingert replies. "It is about the disease, condition, or test — not the doctor or hospital providing the care. Also, to negotiate clear objectives before starting a project or else you have a lot of rework."

It is very challenging at times to get people to agree on something and when the hospitals first merged and the written materials had to be the same across campuses there were turf wars, she says. To remedy this, Hansen-Wingert emphasized that the project was about educating patients about diabetes or heart disease. Often she would merge information from the pamphlets of each institution by selecting the portions that were worded the best.

Hansen-Wingert also uses national standards and research-based information to create material. Most people involved in the process of creating materials will not argue a point if best practice is followed.

An incident where she did not create clear objectives and explain good writing practices before beginning a project ended up taking a lot of extra time. Hansen-Wingert was working with a pre-existing committee on the revision of a booklet, and after making notes on what the members wanted in the booklet she merged information and reworked the material. However, when she presented it to the committee they said it was too much information. She had to rework the booklet because the objectives were not clearly understood at the start of the project.

Question: What is your weakest area?

Answer: "I am one person for three hospitals, and I can create and implement processes; but I can not communicate, provide inservices, and follow up on what the staff is working on," she explains. "It’s very challenging to meet many needs in a time-efficient manner."

Without follow-up, it is difficult to know if teaching sheets are being used once they are created, she says. Also, it is difficult to improve teaching or documentation of patient education without the time to conduct inservices.

Often, one of the hospital campuses will ask Hansen-Wingert to write a teaching sheet on a topic, such as trauma. Although it is specific in many ways to that particular campus, it is of benefit to the other hospitals so it will be distributed throughout the health care system. However, there is no time to offer assistance on how to use the new piece to raise patient satisfaction scores or improve patient education. Although e-mails are sent to managers and often the educators, communication is limited.

Question: What is your vision for patient education in the future?

Answer: "I’d like to see a computerized printout of written material when orders or clinical pathways are initiated and computerized documentation of education," Hansen-Wingert says.

The current project at OhioHealth is a computerized version of the discharge communication form and discharge instructions. This will help to solve the legibility problem for discharge instructions.

All in-house patient education materials are being redesigned, and once they are finished, they all will be downloaded onto the computer so they can be printed on demand.

While physicians can pull up preprinted orders from the computer system and clinical pathways are printed off, the process does not initiate the printing of complementary education materials yet.

Question: What have you done differently since your last JCAHO visit?

Answer: "Clinical pathways have been implemented on one campus where teaching is incorporated into care and there is true interdisciplinary documentation," she explains.

The Joint Commission will survey OhioHealth in June 2004.

Question: When trying to create and implement a new form, patient education material, or program, where do you go to get information/ideas from which to work?

Answer: "I collect examples from other hospitals and do a literature search on the topic. Also I get a team together to look at best practices and talk about the process."

She finds it easy to uncover information on the Internet and usually goes to such medical web sites as WebMD (www.webmd.com) or MedLine, the medical library to which her institution subscribes.

Source

For more information about the issues discussed in this profile, contact:

B.J. Hansen-Wingert, MS, RN, Patient Education Specialist, OhioHealth, Patient Education Department, 3535 Olentangy River Road, Columbus, OH 43214. Telephone: (614) 566-5613. E-mail: bhansen@ohiohealth.com.