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Bridging the Gaps: Reducing Communication Barriers in the Pediatric Hematopietic Stem Cell Transplant Program
Background
Hematopoietic Stem Cell Transplantation (HSCT) patients and their families interact with multiple clinical and administrative personnel throughout the course of their treatment. Existing communication barriers can complicate coordination of their care. Recently, new indications for transplant including non-malignant diseases and gene therapy protocols have caused a shift in our patient demographics. With a growing percentage of non-English speaking patients, these communication barriers affect our ability to provide high quality and compassionate care that is equivalent across cultural and geographic boundaries. This quality improvement project was developed to address gaps within the operational workflow of the Dana-Farber/ Boston Children's Hospital Pediatric HSCT Program, specifically communication gaps with non-English speaking families.
Scope
We addressed the pre-transplant phase of patient care. We evaluated the workflow beginning with patient registration through the day of admission for HSCT.
Methods
We first developed a process map of the pre-transplant phase of patient care. We then identified the key stakeholders and performed a gap analysis specific to non-English speaking patients in the pediatric transplant program. Interviews were conducted with applicable clinic staff at the start of the project. A survey using a 5 point Likert scale was used to quantify how clinic staff, interpreters, and physicians perceive the current system in which visits for these patients are conducted. Reports were analyzed to identify key issues including missed appointments, increased wait times, and miscommunications with clinic staff. The project's considerations were evaluated including assumptions, dependencies, constraints, and risks. Small working groups have been formed to implement changes in the workflow.
Goals
· Improve initial communication with the International Patient Registration Office
· Simplify the registration process
· Reduce patient wait time during initial consult
· Reduce missed appointments
· Provide patients with language appropriate educational and informational materials
· Improve communication between clinic staff and interpreter services
Conclusion
The project is currently in the implementation stage. Changes to the operational workflow will continue to be made over the next several months. The new processes and procedures will be reviewed at six months and twelve months post implementation. Stakeholders will be resurveyed and a gap analysis will be performed again. By reducing these gaps in communication we hope to improve current processes and procedures. The potential impact on cost savings, improved clinic flow, better overall care and patient satisfaction will be evaluated as well as the potential for adapting these processes in other disease centers throughout our institute.
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