Jason Helgeson: As the newly appointed orthopedic executive director of HSHS Eastern [Wisconsin] Division, one of my primary objectives was to standardize and grow our joint replacement program. Only one of our three hospitals had a dedicated joint coordinator, with each hospital having their own workflows, educational materials and program title (i.e., Ortho Camp, Joint Connections and Joint Camp). Fast forward three years and we have developed and branded the Joints inMotion program for our division with each hospital having their own dedicated coordinator.
Through Joints inMotion, our exclusive prep and recovery program, patients receive the support of their own Joints inMotion coordinator who ensures smooth sailing through their hospital stay, and contributes to their speedy recovery. As a patient-centric program, we make every effort to eliminate waste and add value to the patient experience. One example is how we coordinate the patients' lab draws, MRSA/MSSA testing, imaging, physical exam, therapy, anesthesia discussion, therapy visit and other education regarding joint replacement, all in a single two- to three-hour visit one to two weeks prior to surgery. This initiative, and more, is accomplished by meeting monthly with our physician-led Executive Joints inMotion Council that reviews meaningful agendas, dashboards, quality outcomes, financials, volumes, daily operations, etc.
The Joints inMotion program begins once the patient is in the physician office to discuss options for joint replacement, and we don't believe the program ever really ends. Once the patient is discharged they can benefit from our Joints inMotion lunch reunion, community education seminars and regular exercise programs designed exclusively for joint replacement patients.
Q: How has the program improved patient satisfaction scores? How was patient satisfaction measured?
JH: [St. Vincent Hospital], which has employed a dedicated Joints inMotion coordinator the longest, has had the best success with patient satisfaction. They routinely rank in the top 90 percent of all hospitals in the Press Ganey database for the likelihood of recommending (we run the report with specific [diagnosis-related groups] for joint replacements which allows us to compare similar patients). We put a great deal of stock in that particular question, as these are elective cases, and patient referrals are our best marketing tool.
The second hospital to employ a coordinator, [St. Mary's Hospital Medical Center,] was rarely if ever in the top 90 percent for their overall Press Ganey scores; however, four out of the first five quarters of having the coordinator in place moved this hospital into the top 90th percentile of Press Ganey.
The final hospital to hire a dedicated coordinator and adapt to the Joints inMotion philosophy, [St. Nicholas Hospital,] saw the most improvement going from an average of 45 percent for likelihood of recommending over the past 2.5 years, to a 99 percent ranking in the first quarter of implementation. As always, the challenge will be sustainability, but this hospital is off to a great start.
Q: What were the greatest challenges of implementing the program?
JH: Changing behaviors and workflows can always be a challenge; however, the physician-led council agreed from day one that everyone would check their egos at the door and keep this program 100 percent patient-focused. Oftentimes this means an inconvenience for a lab tech, the loss of a billable hour for a therapist, a physician changing how they manage pain or nurses needing to be more flexible and visible in the patient room, but at the end of the day, the patient experience will be the driving factor in our market share growth.
Q: How were you and others able to overcome these challenges?
JH: We try to keep a balance of managing our dashboards along with managing the patient expectations, as one cannot survive without the other. The Joints inMotion lunch reunions allow us to enjoy a meal with former patients and their coaches to learn more about what we could have done better. Actually hearing the patient concerns in person, whether it be in their hospital room, physician office or at the luncheon, the patient often validates what our course of action is, or should be. These comments, along with the post-discharge follow-up phone calls, are documented and discussed at our monthly council meetings.
Other steps we've taken to overcome challenges have been our ability and willingness to learn from other successful programs. We've attended a number of seminars/webinars, hired a consultant who currently directs a high-performing joint replacement program, and last year our fellowship-trained orthopedic surgeon/Joints inMotion Council champion, two joint coordinators and myself took a two-day trip to shadow what we recognized as one of the nation's premier joint replacement hospitals.
Q: What are your plans for the future of the program? Do you plan to expand it to other orthopedic services?
JH: We are currently in the process of using the infrastructure and framework for our Joints inMotion [program], and implementing them into our Sports inMotion and Spine inMotion programs. This will include, but not be limited to our dedicated councils, dashboards, outcomes surveys, luncheon reunions, educational binders, marketing strategies, dedicated coordinators, etc.
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