Take proactive steps to keep funds from being slashed by the budget ax

Show that patient education funds are well spent; create cost savings

To justify the money allocated for patient education and hang onto it, spend the money in your budget, advises Kathy Ordelt, RN, patient and family education coordinator at Children’s Healthcare of Atlanta. If you don’t, when administrators work on the budget the next fiscal year, the amount that wasn’t spent probably will be slashed.

It is important, however, to show that the use of the money was deemed worthwhile by staff, patients and family, and the health care system as a whole, says Ordelt. Statistics that prove the worth of a program can be gleaned from customer service or satisfaction surveys.

The systemwide survey at Children’s Healthcare of Atlanta includes five patient education questions such as whether patients received materials written at a level they could understand and whether physicians and nurses explained procedures and treatments clearly.

"Our administration pays a lot of attention to our customer satisfaction survey results," says Ordelt. This includes staff surveys that determine if patient education is meeting employees’ needs.

To evaluate staff, Ordelt uses a software program from which she creates questions related to the resources produced and the inservices provided during a six-month period. She then distributes the questionnaire by e-mail to staff she has worked with during that time period. To complete the survey, they use a rating system between 1 and 5, with 5 being the best. There also is space for written comments after each question.

In one of her most recent surveys, Ordelt asked staff to:

  • rate the overall service you receive from patient education;
  • rate the courtesy given to you by patient education;
  • rate the staff education and inservices provided by the patient education department;
  • rate how well you are kept informed of the status of your project with patient and family education.

"At Children’s, every department is responsible for doing internal customer service surveys twice a year," says Ordelt. Surveys also are distributed following each inservice to get immediate feedback.

Continually assess patient needs to make sure that the education strategies are tailored accordingly. Also evaluate what already has been implemented on a continuous basis to ensure that it is still on target, advises Louise Villejo, MPH, CHES, director of patient education at M.D. Anderson Cancer Center in Houston.

Recently, patients at M.D. Anderson were asked to evaluate the chemotherapy education package, which consisted of a booklet, information sheets and other materials given to patients in a folder. The patients said that they wanted the information provided in a booklet with sections divided by tabs so specific details were easier to find. Although the booklets were more expensive, administrators gave the project the go-ahead because of the assessment that had been done beforehand.

Information on how to prepare for a diagnostic test now is included on an appointment reminder letter sent to patients because an evaluation of the education process revealed that many were showing up for tests unprepared.

Also, patients now can check out a video on chemotherapy because an assessment showed that they wanted to be able to watch it at home.

Consistent evaluation of programs, classes, resources, distribution methods, or teaching methods that result in improvements helps to prove that patient needs are being met especially when patients are involved in the process. "That is important as far as keeping your program vital and funded," says Villejo.

Be proactive

Another strategy for avoiding the budget ax is to be proactive in looking for ways to save money. Instead of being a stumbling block, become part of the team helping to look at budgetary concerns, advises Ordelt.

"It’s constantly reassessing and evaluating how to do things in a better or cheaper way," she explains. For example, 700 teaching sheets in both English and Spanish are available on the intranet at Children’s Healthcare of Atlanta. In this way, staff can quickly obtain handouts from the computer system, which can be updated easily.

However, it was determined that this method of distribution was not cost-effective for frequently used handouts. When teaching sheets are needed in bulk, the time spent at the copy machine as well as the toner that is used in the process of making copies is cost-prohibitive. As a result, high-volume teaching sheets, such as those on ear infections, are sent to a printer. Clinical staff order packets of 100 sheets right from their desktop and they are delivered the next day and billed to that department.

Although the cost savings does not directly affect the patient education budget, it does impact the overall budget. This method of printing high-volume sheets also has improved customer satisfaction because employees no longer have to stand at the copier for long periods of time, says Ordelt.

Demonstrate to administrators that you are looking at ways to reduce waste, agrees Dorothy Ruzicki, PhD, RN, director of the department of educational services at Sacred Heart Medical Center in Spokane, WA. Analyze processes to determine if they can be done with fewer staff or fewer steps. "I saved a position for the medical center by just cross-training some of my staff to do the same work," she says.

To prevent budget cuts, try to tie patient education into the main organizational objectives and look for ways to support other departments and initiatives, says Magdalyn Patyk, MS, RN, BC, a patient education consultant at Northwestern Memorial Hospital in Chicago.

This might include developing and obtaining appropriate patient education resources for systemwide patient safety and pain initiatives or helping all departments adjust the reading level of their pamphlets. When looking at replacing closed-circuit television systems, consider multiple needs. Rather than limiting the programming to patient education, evaluate the possibility of including patient surveys for quality improvement, menu selection for nutrition services, and staff education on demand for the staff development department, explains Patyk.

It’s vital to show that patient education supports the health care institution’s strategic plan, says Villejo. When the president of M.D. Anderson announced the new strategic plan and initiatives, Villejo’s supervisor instructed the patient education department to create a bulleted list of everything done to support the new initiatives.

"We listed the goal of the strategic plan and then our activities that supported the goal. A number of times when developing proposals to request funds for different projects I explain how it will support the strategic plan," says Villejo.

Keep leadership informed

Get administrators’ attention, and make sure they are consistently aware of accomplishments in patient education, says Villejo.

She issues a very short monthly report to keep leadership abreast of what patient education is doing. For example, the number of participants in classes at the learning center is listed. Also, major projects for the month are trumpeted. For example, during Fatigue Awareness Week, 900 people attended presentations and a health fair.

After evaluating a patient education program and presenting results to clinical leadership, Villejo met with members of that leadership committee on an individual basis as work was done to improve the program to get input on improvement strategies as well as to create champions for patient education. In this way, these leaders support patient education at key meetings, she says.

To gain support for programs or resources in the planning stages, make sure your ideas are known, advises Villejo. To do this, she includes these ideas in her budget even though she knows funding is a long shot.

"If you put your ideas on paper, they are there when the time is right," she says. For example, Villejo pitched a learning center for years, but when she finally obtained funding, there was no space available for the center.

However, because the need for a patient and family learning center was well publicized throughout the health care system, space eventually was obtained. Patient relations approached the patient education department offering to share space it had, and a small center was established.

Shortly after that, cancer prevention services obtained a large space and invited the patient education department to move the learning center. "We moved from a closet area to share their big space, and a couple years later they gave it to us," says Villejo.


For more information about strategies to prevent budget cuts, contact:

  • Kathy Ordelt, RN, Patient and Family Education Coordinator, Children’s Healthcare of Atlanta, 1001 Johnson Ferry Road N.E., Atlanta, GA 30342. Telephone: (404) 929-8641. E-mail: kathy.ordelt@choa.org.
  • Magdalyn Patyk, MS, RN, BC, Patient Education Consultant, Patient Education, Northwestern Memorial Hospital, 251 E. Huron, Suite 4-708, Chicago, IL 60611-2908. Telephone: (312) 926-2173. E-mail: mpatyk@nmh.org.
  • Dorothy Ruzicki, PhD, RN, Director, Department of Educational Services, Sacred Heart Medical Center, W. 101 Eighth Ave., Spokane, WA 99220-4045. Telephone: (509) 474-3390. E-mail: ruzickd@shmc.org.
  • Louise Villejo, MPH, CHES, Director Patient Education, M.D. Anderson Cancer Center, 1515 Holcombe-Box 21, Houston, TX 77030. Telephone: (713) 792-7128. E-mail: lvillejo@notes.mdacc.tmc.edu.