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Transportation LInks to Improved Quality of Life

September 1, 2000
by Long-Term Living Editors
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(2000 OPTIMA Award Winner) Submitted by Kings Harbor Multicare Center, Bronx, New York
  "Transportation Links to Improved Quality of Life" is an initiative the facility started to explore in January 1997. We were able to follow the data, measuring the impact for more than two years. The tools used and the data and information derived from these tools provided us with sufficient information to determine the success of the initiative, as well as its sustainability.

Adapted from the submission by Kings Harbor Multicare Center, Bronx, NY. Alexander Stern, Administrator

  The Problem
The first indication of a need to analyze this situation arose when families and affiliate hospitals initiated conversations with various staff members stating, in so many words, that "families' ability to receive transportation by the facility van [there was one with limited availability at the time] made resident visitation a reality." Personal financial difficulties or reliance on mass transit puts an extreme burden on some people. This realization grew when the facility received a certificate of need for outpatient rehabilitation; it became clear from input from various staff members that there was a need for free transportation by outpatient rehabilitation clients.

Furthermore, the facility has many residents who either enjoy going out on trips or would like to conduct personal business outside the facility. One van on a limited schedule could not accommodate all these needs. Finally, as outpatient rehabilitation geared up, the facility began to experience an increase in short-term residents and, with it, a potentially increased need for visitor transportation.
  An exhaustive review of the literature yielded little information specific to the type of transportation initiative we had in mind. We would have to break new ground. We needed to establish a process, and then analyze whether it improved residents' quality of life. To further structure and organize our plan, the facility's Performance Improvement Department used the FOCUS performance improvement model-Plan, Do, Check, Act (PDCA) (table 1).

There were three important factors to be considered: (1) Personnel: An individual would have to commit to organizing and scheduling resident trips, family/significant other transportation and outpatient transportation. Also, the number of drivers would have to increase. (2) Budgeting: There would have to be a financial allocation to purchase more vehicles and meet the cost of routine maintenance. (3) Administration: The availability of the increased transportation would have to be managed safely and effectively.

Objectives and Planning
The initiative had several objectives: providing a better quality of life for residents; maintaining and increasing the trips in the various categories; and doing all this with financial viability. The team formulated a plan and continually followed it.

The facility's ability to involve staff in the initiative was based on two approaches: (1) asking staff to be involved in the process, and (2) assigning appropriate staff to undertake certain tasks. Underlying the success of this approach, as it developed, was the facility's traditional interdisciplinary and team approach.

The specific performance measure used would be quality of life. The team asked, would increased availability of transportation allow residents to see their loved ones more? Would it increase customer satisfaction for outpatient rehabilitation clients? Would it allow for more individualized resident needs to be met? 1. Are the drivers courteous?
2. Do you feel safe riding with the driver?
3. Was the individual scheduling your transportation pleasant and cooperative?
4. Were you picked up/delivered in a timely manner?
5. Were your transportation needs met?
6. Has transportation made a difference in your ability to visit? (where applicable)
7. Did this program influence your decision to either admit yourself or your family member/significant other? (where applicable)
8. Do you feel this program should continue? 1. Are the drivers courteous?
2. Do you feel safe riding with the driver?
3. Were your transportation needs met?
4. Has transportation made a difference in your ability to have visits, and did the visits, and did the visits add to your feeling more like you were at home? (where applicable)
5. Do you feel this program should continue?

Tools used for planning and data analysis were the FOCUS-PDCA performance improvement model, the customer and resident satisfaction surveys, and transportation statistics, which were kept monthly and reported quarterly. We also kept a time line that tracked specific events, such as data collection periods and scheduling of drivers.