An additional lesson learned, which was actually a process of learning, was how important it is for self-care college team members to be active listeners. As opposed to the didactic approach, where clinicians provide instructions to patients, the self-care college team learned to ask questions of the patients and to actively listen to the responses, filling in the gaps where necessary. Interestingly, we found that this was also a learning process for the patients, many of whom are unaccustomed to engaging in dialogue with their doctors and to being active participants in their health care. They were not all initially comfortable with the concept of simulation, but our staff learned different ways to introduce patients to it, so that ultimately most seemed to enjoy the program.
Take-Away Points
For health care organizations considering implementing a self-care college or similar initiative, we offer a few key points:
- Consider the benefits beyond reducing readmissions: at NMHS, we have found that the self-care college has positively impacted patient satisfaction. For the past 2 years, our HCAHPS scores have consistently been well above the top performance threshold, a top quartile performer in Premier’s quality database (Premier, Inc., a health care performance improvement alliance of approximately 3000 U.S. hospitals). While it is difficult to correlate patient satisfaction scores with any one initiative, we hear from patients, physicians, and nursing staff that the self-care college greatly increases effective communication between provider and patient. We have also found that some of our biggest advocates are now the cardiologists who refer patients.
- Analyze your operational readiness: this is a low-tech but high-touch program. While it requires a minimal financial investment, it does require strong organizational leadership and staff buy-in to make it successful. Nursing staff are likely to buy into the program because they will not have to deliver discharge education to patients in addition to the many other responsibilities they have. Administrators should see that patient satisfaction will improve and readmissions will decrease. Ultimately, it is up to the program “champion” to make it clear to key stakeholders what the advantages are, and to include them in the process of developing the self-care college.
- This is the future of medicine: The self-care college is just one example of a team-based approach to medicine. Most of the disciplines on our team did not know each other prior to the program. We now have established a line of communication that permeates throughout the hospital to the outpatient setting.
Based on our success with the CHF self-care college, the next logical step will be to create self-care colleges for other common disease states, such as asthma/COPD or diabetes. However, while the value of this model for patient education has clearly been demonstrated, the team has also contemplated its application for staff training. Many large hospitals already use patient simulation manikins in nursing education, but the cost of this high-tech equipment is out of reach for many smaller, community hospitals. The possibility to create low-cost, low-tech simulation training experiences for clinicians similar to that provided by self-care college for patients bears examination.