“We call it the 90-Plus Compliance Club,” says Hull.
This list of top performers is posted throughout the facility and is published regularly in the organizational newsletter. It is also sent to the CMO directly.
“It’s just a chance to congratulate them,” says Hull.
Still, improving compliance is a slow process—getting the right combination of communication and motivation. Physicians seem to be reacting well to the process, though.
“I take it when they contact me that they are looking to improve, otherwise they wouldn’t reach out,” says Hull. “I’ve had some contact me to say they thought they were doing better than they are, and that this made them more aware.”
Of course there will always be those who fight the process and remain non-compliant, but the vast majority took the report cards to heart.
Developing the form
In order to create the report card, Hull listened to “listserv chatter,” she says, in places like AHAP Talk, and found a wide range of ideas. Pikeville’s director of stroke crafted a report card of her own which would serve as the basis for the form now used at the facility.
“I discussed it with my supervisor, then with the vice-president, and then talked it over with the CMO,” says Hull. “We then put out what we were developing to each director so everyone was aware, and then sent out a letter to every physician.”
To put some weight behind the decision, this letter quoted not only Joint Commission standards on timing and dating of physician orders but also CMS requirements.
“We wanted to explain ahead of time” so as not to catch them off-guard, says Hull.
The next course of action is to continue preparing for Pikeville’s upcoming survey—including timing and dating of orders.
“What we’re doing is having the unit secretaries or nurses pull their orders to see what has or hasn’t been timed. The challenge right now is timing, not dating—our physicians are very compliant with dates. Timing remains a challenge.”
When a unit sees they have an issue with failing to time and order, they attempt to catch the physician while he is still on the unit to rectify the issue. If the physician has already moved on, they flag the record.
Another area being worked on is the electric time and date stamp. Pikeville is in the process of converting over to a completely electronic order submission program.
“We haven’t got there yet, but it’s just a process of getting it into place,” says Hull. “It takes a lot of time and training.”
It’s really about perseverance more than anything, she says.
“Stick to your guns. When you audit and see that physicians aren’t complying we need to bring that to their attention,” says Hull.
Get the idea, the concept for communication, and work your way through each individual department. Find out what time physicians make the rounds, and try to meet them on their unit face to face.
“I like to do things in person,” says Hull. “But being in person with hundreds of physicians can be nearly impossible. Still, I make every effort to meet them one on one. I think they perceive me better when we speak face to face rather than receiving a letter.”