Children's Hospitals Today - Fall 2024 - 15

IMPROVEMENT / FEATURE
Measuring the immeasurable
Three children's hospitals are quantifying intangible
measures with ingenuity and outside-the-box thinking.
By Chelsea Adams
G
auging a patient's pain level is a
critical bedside task. Pain offers
clues to the severity of an illness
or injury and guides clinicians to diagnoses
and treatments. Perhaps most
importantly, accurate pain assessments
enable effective pain management.
But the language of pain is subjective,
especially among
Clinical changes are measured by
vital signs, for example, while more
indefinable traits may manifest in staff
and patient engagement scores or even
safety outcomes. " Hospitals may see
these types of things showing up as
problem areas in complaints and grievchildren.
Without
a standard way to measure
pain, an assessment ultimately says
very little. Four decades ago, a pair of
nurses created the now ubiquitous
Wong-Baker FACES® Pain Rating Scale,
a validated tool to help children quantify
their level of pain.
The pioneering nurses' work exemplifies
how a seemingly immeasurable
characteristic can be assigned a number
to guide clinical interventions. The
need for this type of solution is common
in children's hospitals and vital
to ongoing improvement efforts, said
Aisha Furbach, CHA's vice president of
child health quality.
" Quantifying
qualitative
characteristics
helps children's hospitals be
proactive in areas that may not rise
to the level of inpatient quality indicators, "
Furbach said. " These types of
measurements can be vitally important
to pediatric patients' experiences
with the organization. "
These types of measurements can be vitally important to pediatric
patients' experiences with the organization. -Aisha Furbach
ances. When you explore the patient's
feedback and general point of view,
you may find concrete needs worth addressing, "
Furbach said.
Identifying those needs isn't always
clear cut, given the difficulty of developing
metrics for things that can't be
measured with a device or tool. Even so,
children's hospitals are finding ways to
measure difficult-to-define aspects of
clinical and operational processes.
Defining emotional harm
As a certified child life specialist,
Barbara Romito recognizes the longterm
health implications caused by
emotional harm in health care.
" There is a theory that emotional
harm has more of an impact on patients
and their families than physical harm.
Squibb Children's Hospital at Robert
Wood Johnson University Hospital.
To address emotional safety at the
same level as physical safety, BMSCH
created a way to classify emotional
harm events.
First, the team educated hospital
staff about emotionally safe care using
a framework developed by the
Association of Child Life Professionals'
Emotional Safety Initiative. " Our initial
goal was to get people hearing the
words 'emotional safety' so they could
put a name to what it means to cause
emotional harm, " Romito said.
Next was creating a way to measure
emotional harm. " We wanted to create
a system that aligned with our
existing safety event
classification
system, " Romito said. To that end, the
They may forget that needle stick, the
ouch. But they remember the emotions
associated with the ouch, and that's
what they're thinking about over and
over again after hospitalization, " said
Romito, director of child life and family
centered care at The Bristol-Myers
CHILDREN'S HOSPITALS TODAY Fall 2024
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Children's Hospitals Today - Fall 2024

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