Nearly a decade ago, the University of Rochester Medical Center launched the Unit-Based Performance Plan (UPP), intended to help inpatient units better coordinate their improvement efforts around patient safety and operational efficiency.
Now, as hospitals across the country have started to implement Diversity, Equity and Inclusion (DEI) plans into their standards of care, one inpatient unit at GCH has gone above and beyond to ensure that families from historically underrepresented groups get the highest quality treatment.
Unit 8 South (8S) started this effort in 2021 when the care team witnessed that families were experiencing added stress and discomfort during their inpatient stays after surgical procedures.
“Our project started really organically. We noticed that some of our patients and families felt unprepared for their admission and stay on 8 South or had a lot of questions and concerns that our team could have addressed prior to them coming in for surgery,” said Amy Keller, nurse manager for 8S.
In response, the 8S team engaged in a comprehensive plan to improve their level of care, including conducting a thorough internal assessment. The assessment included meeting with Katherine Greenberg, M.D., associate director for Equity and Inclusion at URMC, along with Krystle Ellis, DEI consultant with GCH, to see how they could integrate best practices for improving health equity and reducing safety disparities.
One of the first — and most significant — actions the 8S team took was to examine the length of stay for patients by race and ethnicity to determine whether certain demographic groups had different outcomes. This analysis was done by Anne Fallon, M.D., who leads GCH’s Digital Health efforts.
“The team found that families with English as a second language had a longer length of stay, and that could be due to some delays in getting a translator,” said Jan Schriefer, M.B.A., M.S.N., Dr.P.H., director of Quality Improvement for GCH and a coach for multiple unit-based performance teams.
This data was corroborated by what 8S caregivers were noticing in their interactions with patient families, and the team implemented a comprehensive plan to address this gap in preparation, including inviting a translator to join the team. The 8S care coordinator, members of the nursing team, and child life specialist also started calling families who planned to stay on 8S after surgery in advance to ensure all of their concerns were met. They collaborated with these families and children to craft strategies and figure out cultural preferences and special needs.
“At the time, it was more pre-op communication work than was standard. It gave the care team a lot more time to obtain the interpreter ahead of the admission and ensure translated patient education materials were in place,” said Schriefer.
Working closely with families to understand their special needs and preferences in the pre-op phase is a prime example of incorporating equity into treatment, according to Ellis, because this approach acknowledges that not all families enter a hospital setting with the same level of comfort.
Ellis also played a critical role building the pre-operative toolkit through her questioning and understanding of quality assurance, patient relations, and health equity. The toolkit guarantees that all families are being asked the same questions, and the provider is fully educated on how to interpret responses. “The beautiful thing about this team and its leadership is that they are willing to do everything in their power to create the most equitable environment, and prior to the start of this work, they understood transformation must first start with the provider. 8 South’s efforts to work with individual families not only helps with creating a great healthcare experience, but it also helps to reduce the level of fear and anxiety a family may feel,” said Ellis.
While this effort initially focused on families who speak English as a second language, universal pre-op collaboration with families helps bridge gaps with underrepresented communities — particularly Black families — “because of past history of mistreatment by health systems through research experimentation or neglect,” said Ellis, whose daughter Brooke has been a recent surgical patient of 8S.
In addition to helping families with the pre-admission process, 8S also took several additional steps to welcome families from different backgrounds. They have incorporated a greater variety of haircare products for personal hygiene and worked to ensure that the Spanish translations of existing GCH education videos were accurate and easy to understand. Catherine Lyndacker, a fourth-year medical student who is fluent in Spanish, was on the UPP team and assisted with the video reviews.
Thus far, going this extra mile has been appreciated by families. “The feedback we have received from this program tailored to 8 South has been extremely positive,” said Keller. “Families have loved the opportunity to be involved with the planning and coordination of their care before they get to the hospital.”
The success of these initiatives reflects the level of thought and effort put into serving the needs of diverse families, according to Greenberg.
“The depth of the things they noticed in caring for patients and thought about improving processes — even the more mundane observations — was amazing. They could serve as a model for other units,” she said.