Building Trust at UChicago Medicine

In October 2021, UChicago Medicine’s Center for Healthcare Delivery Science and Innovation (HDSI) conducted a Choosing Wisely & Trust in Practice Challenge. The Challenge was a unique opportunity for UChicago Medicine faculty, staff and trainees to propose health system improvements to generate better health outcomes and promote trust in health care.

Health system priorities for the Challenge included:

• Patient Care in the New Normal
• Advance Care Planning
• Patient Care Coordination
• Patient Education
• Optimizing Telemedicine

These themes allowed staff and trainees to submit operational challenges or issues along with promising solutions for implementation at the medical center.

2021 Choosing Wisely & Trust in Practice Challenge winners:

• Streamlining Health Care Power of Attorney – This project will create a streamlined process to integrate health care Power of Attorney (HC-POA) document completion into the workflow of an ambulatory appointment. If a patient states that they have not completed HC-POA paperwork on their intake form, documents will be provided along with the steps needed to complete it.

• Implementing the Pause – This project aims to promote The Pause at UChicago Medicine – a shared silence that is practiced after the death of a patients. The Pause is an act of respect, recognizing a life that has ended.

• Improving direct admissions coordination – This project will standardize and optimize the direct admissions process to improve communication care plans among team members in order to improve patient safety, increase the patient and clinician experience, and ensure the appropriate utilization of resources.

Challenge results:

Challenge winners received support by UChicago Medicine and HDSI faculty to put their ideas into practice and test their innovative approaches to improving the delivery and building trust in health care.

Both the power of attorney project and direct admissions coordination have been implemented and launched in UChicago Medicine’s electronic medical records system. A pre-survey to assess clinicians experience with the projects has also been disseminated, and a post survey is planned for later in 2022.

In order to collect information to implement The Pause, Institutional Review Board exemption was needed. This permission was recently secured and The Pause has recently begun system-wide. A pilot “telephone Pause” was tested (without data collection) for use when COVID-19 safety precautions limit visitors. One family of a departed patient wrote a letter saying how appreciative they were that the staff took The Pause and how much it meant to them.

This Challenge built trust at UChicago Medicine in two ways: (1) Each of the innovations build trust in its own work. Additionally, holding the Challenge and prioritizing trust work demonstrated the importance of trust in the organization’s culture. As Micah Procheska, MD, Assistance Professor of Medicine at UChicago Medicine explained, “Before our Challenge and after our Challenge, we’re probably not going to move the needle very much because this [trust building] takes a long time. But working on little things builds up. It’s creating that culture, and so I think, helps participants realize what we can do is in the sphere that we have. We’re operating in our sphere of influence and the bigger spheres, will be slowly impacted by continually improving the smaller spheres of influence.”