'Disposable’ handbooks are timely and cleaner

System’s costs cut dramatically

What if you had 2,000 patient handbooks that needed replacing and virtually no budget with which to do so? That’s one of the challenges Marne Bonomo, PhD, inherited about a year and a half ago when she became regional director for patient access at Milwaukee’s Aurora Health Care.

Patient access traditionally had been responsible for providing the handbooks — placed in patient rooms throughout the multihospital system — but the project hadn’t been budgeted, Bonomo discovered. The handbooks, meanwhile, were more than three years out of date, the stock was depleted, and a Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) survey loomed, she notes.

"JCAHO requires that you provide certain information for your patients," Bonomo explains, "and I was afraid that something would be missing, that we would not be compliant."

The existing handbook — a trifold with flip-up laminated pages with text on front and back — was glossy and attractive, but each copy cost more than $20 and quickly became outdated as hospital information changed, she says. It was possible to send updated information to the vendor and have new pages made, Bonomo found, but then she would have been faced with having someone go around to every patient room and insert the new pages.

There were other problems with the old handbooks, as well, she points out. Good hygiene required that housekeeping staff wipe the pages between patient stays, a task that Bonomo describes as "a nightmare" and one that may or may not be done thoroughly each time.

To make matters worse, the handbooks tended to disappear at a fairly rapid rate, Bonomo adds. An estimated five-year supply ran out in about two years, she notes, because patients kept taking them along when they left the hospital.

When volunteers willing to take on the handbook project were not forthcoming, Bonomo enlisted the services of her assistant, Jennifer Huber, and began to brainstorm. "I kept tinkering, looking at costs, asking questions like, What would it take to do this in our print shop?’"

She and her assistant began writing copy for the handbook, sending it out to the various departments involved for feedback and piecing together the final product, she says. The text, previously written at a 12th-grade level, now is, for the most part, at the sixth-grade level and conforms to Americans With Disabilities’ (ADA) recommendations. Print size and font meet ADA standards for readability, Bonomo adds.

"What we had before was written very nicely, but there were [several] paragraphs about infection control and the health system’s values that people had to plow through to get to the gift shop hours," she notes.

Making it better

The new handbook is disposable — eliminating theft and hygiene concerns – and costs about 13 cents per copy to produce, she notes. It’s the size of a folded piece of paper and is teal (the health system’s signature color) with black print and a graphic design on the front. Plans are to use a cover photograph on subsequent versions.

If one is facing the book, it is written in English, but if it is flipped over, the information appears in Spanish, Bonomo says. The material is broken into two categories — "While You’re Here" and "Going Home" — and includes such topics as ATMs, cell phones, chaplains, flowers and balloons, and telephone translation, she explains. The book also briefs patients on such processes as financial counseling and ordering prescriptions, among many others. (See except)

Bonomo says she sent out an e-mail explaining the new handbook to top health system administrators with some trepidation, concerned they might not be happy with its more modest specifications. "I thought they might want some pretty, hotel-like thing," she adds.

So far she has received only positive responses, Bonomo says, including kudos from the president for Aurora’s metro region, who called the project "a classic example of making something better, reducing costs, and integrating it in multiple sites." The system’s infection control staff were "really delighted" with the disposable books, and at a time when the bottom line is a crucial consideration for health care providers, the cost savings were more than welcome, she notes.

While the old handbooks, which were outdated in six months, cost $75,000 for a two-year supply, Bonomo adds, the cost of the new ones is approximately $9,000 annually.

Adding to the good news, she notes, the handbooks were ready just in time for the JCAHO site visit.

(Editor’s note: Marne Bonomo an be reached via email at marne.bonomo@aurora.com.)