Moments of Truth

Posted: Mon, Feb 2, 2015 08:49

How can you seamlessly handoff the patient between different departments, shifts, healthcare institutions, and home settings without dropping the ball because of poor communication, weak collaboration, and listless coordination of care?

Simple: you empower everyone to manage your patient’s “Moments of Truth.”

Consider This:

The concept of Moments of Truth comes from the book by Jan Carlson, president of Scandinavian Airlines.

A Moment of Truth is any interaction in which a patient comes in contact with the care transition process. A Cycle of Service is a combination of Moments of Truth, and a Reward Strategy pays off each Moment of Truth, and allows patient to have the very best experience at each point of contact.

Think of a grocery store (because everyone buys groceries). Is it conveniently located? Is there parking? When you grab a cart, is it jammed or rusted? Is customer service friendly and obliging? Of course, there’s the checkout: how long do you wait in line? When you get to the cashier, is s/he cheerful or surly?

That’s a simple example of a cycle of service - think about how many Moments of Truth there are in a hospital! Remember: every Moment of Truth involves a hand-off.

Pick any Transition of Care dissatisfier - something that you know is off the tracks. Do the “Cycle of Service” exercise to discover Moments of Truth that are going awry. Devise creative and lasting improvements to eliminate each dissatisfier, and hardwire them by making a checklist of essential actions from each Cycle of Service. 

I believe there are at least 10 top care transition cycles that must be successfully managed.

1. Admitting.
2. Medication Education.
3. Patient participation and commitment to care plan (as laid out by doctors and nurses).
4. Self-responsibility, including awareness of risks and pitfalls of being on your own at home, even with family caregivers.
5. The self-care that has to be mastered. 
6. Medication reconciliation that involves the pharmacist with patient and family.
7. Transition readiness for at-risk patients, such as the elderly or people with chronic conditions who are going to an SNF, let alone going home.
8. Hand-off to next caregivers, whether family or the people at a new facility.
9. The actual day of discharge. Is everyone ready for transition?
10. Post-discharge diligence including home visits and check-ups and new appointments.

These are ten very, very important cycles we all have to master. If you haven’t done so already, engage your staff to conduct the Cycle of Service exercise and create an SOP checklist of best practices to ensure your patients’ Medication Mastery. You want to involve everyone in developing the checklist! Then each staffer can teach anyone else who’s new in the department. Everyone can teach everybody else if they have ownership.

What would be the value of this conducting this “Cycle of Service” for each “dissatisfier” in your care transition process?

• When all staff are involved, it creates ownership. If your staff create it, they’ll care about it.
• Norms for staff behavior are set by determining what the cycle of service needs to be. Nobody has to be afraid of taking a false step, because it’s all there in the cycle.
• All staff are empowered as educators. This is a huge factor in health care: every nurse and caregiver is also an educator.
• Patients receive reliable “road maps” to recovery in this Cycle of Service.
• Family members are prepared to be confident support team members.
• Timely healing at home (or in a care facility the patient is moving to) is assured.
• Unnecessary readmissions are reduced (and isn’t that the point of this whole exercise?)
• Patients are more satisfied, which leads to fewer CMS penalties. 

Look for ways to improve each Moment of Truth. Brainstorm “Reward Strategies”. Create new systems for consistent service. Document your progress as you go. Give yourself a pat on the back and keep improving. Everyone can contribute.

The Take Away:

Remember that every shift change is a mini-Care Transition in itself. I still find hospitals that are not doing bedside reporting in front of the patient. They are missing out on so many opportunities!

“Hand-offs occur any time there is a transfer of responsibility for a patient from one caregiver to another. The fact is, patients don’t care that you’re employed by different departments, that you have different budgets, that you report to different bosses. They just want to have a seamless experience. The goal of the handoff is to provide timely, accurate information about the patient’s care plan, treatment, current condition, and any recent or anticipated changes.”

- Lee Ann Runy, “Hospitals & Health Networks,” 2008.

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