Massachusetts General Hospital Always Events Project: Always Responsive

The "Always Responsive" initiative continues and builds upon our efforts to create a culture that is committed to always meeting the most basic needs of our patients and families. The aim of this quality demonstration project is to improve the safety and quality of care through the implementation and evaluation of seven organizational development strategies using a pre-post intervention design. The seven strategies will be implemented on two pilot units and include: hourly safety rounding, care team face sheets, patient and family
communication white boards, patient care team communication boards, learning coaches, and the development of a video welcoming our patients and their families to the MGH. The staff of the two pilot units, White 8 and Phillips House 20, provides care to a general medical patient population. The goal of the "Always Responsive" demonstration project is to ensure that patients' and families' needs are met in a timely fashion by a responsive unit care team staff. The seven strategies are defined below:
 Hourly Safety Rounding: Nurses have always assessed their patients on a regular basis. What's new about hourly safety rounds is that they are evidence-based, predictable, need‐driven, and scripted for consistency.
The rounds will involve patients, families, nurses, patient care associates, and the other members of the care team. Rounding will occur every hour between 6:00AM and 10:00PM and then every two hours between 10:00PM and 6:00AM.
 Care Team Face Sheets: These sheets include photos and the names of the care team and describe their roles on the team and what patients and families can expect from them. Face sheets will be given to every patient and family by a member of the care team.
 Patient- and Family-Centered White Communication Boards: These dry erase boards will be placed in each patient room and will identify their nurse, doctor, and other pertinent information to facilitate better communication between the patient, family, and care team.
 Care Team Communication Boards: These dry erase boards will be located in the nurse's stations to communicate the monthly, quarterly and year-to-date patient satisfaction scores including "Staff Responsiveness."
 Support Service Report Cards: This feedback tool was developed and implemented at Newton-Wellesley Hospital, a Partners HealthCare facility. It is designed to provide feedback to service departments that support unit-based care and will be adapted for the MGH environment.
 Patient and Family Welcoming Video: This video will be produced in English and Spanish and include closed captioning. It will be designed to welcome patients and their families to the MGH, explain the care environment, introduce the care team, and explain our commitment to their care and well-being. It will also outline the purpose of safety rounds and communication boards in order to inform patients that we are committed to listening and responding to their needs and monitoring their safety.
 Learning Coaches: MGH is implementing hourly safety rounding on all inpatient units. The two pilot units identified for this project will implement hourly safety rounds and the other strategies noted above and serve as our laboratory where we will continuously monitor and evaluate the implementation process. Unit staff 4 will be able to engage and receive live and virtual support from learning coaches during the entire project period.
The impact of the "Always Responsive" demonstration project will be evaluated using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questions related to staff responsiveness. In addition, we will review quarterly fall rates and pressure ulcer rates. The expected outcomes are an improvement in the aggregate MGH Always Responsive HCAHPS top-box percentage scores, with a target of 72% and a decrease in patient fall and pressure ulcer rates.

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