There are hundreds of different kits supplied by Help Hospitalized Veterans (HHV), including leather items, suncatchers, paint-by-numbers, latch-hook rugs, poster art, plastic and wood models/crafts, and many more. The kits are rehabilitative devices designed to restore coordination and impaired motor skills, improve attention spans and concentration, and relax frayed nerves. They are also used as diversion therapy and entertainment outlet for those veterans who are facing extended hospitalization. HHV is the nation’s largest supplier of therapeutic arts and crafts kits used within the Department of Veterans Affairs (VA) and military hospitals, and furnishes products to homebound veterans as well. All products are provided free of charge.
Accountability and Performance Measurement
In today’s environment, accountability is an especially pressing concern. Organizations are competitive; each must be prepared to demonstrate empirically that their program is appropriate, available, timely, effective, safe, efficient, continuous, respectful, and caring. Therefore, HHV took a far-reaching step by initiating a performance measurement study to determine the effectiveness of its programs and promote understanding and support for hospitalized veterans. Measurement is by no means unfamiliar in healthcare, as VA, military, and private sector health organizations routinely measure responses to therapy, staffing levels, and cost.
The following, as reported by Health Care Data, Inc. (HCD) measured the HHV program in a study performed at 13 VA hospitals and state veterans nursing homes. It clearly demonstrated to veteran patients, host hospitals, and HHV’s generous donors that there is indeed a therapeutic value of the HHV arts & crafts program. And to the knowledge of HCD, no organization similar to HHV has ever conducted a study on arts and crafts used in a therapeutic setting.
Four levels of difficulty were assigned to each craft kit category, with level one being the simplest and four the most difficult, as evidenced by the average number of hours it took a patient to complete a particular kit.
This voluntary initiative allowed HHV to quantify its craft kit program performance with measures of patient health outcome, satisfaction, and effectiveness its program.
Each medical facility was given a user manual and computer disk to use in the collection of data. Outcome measurement data were collected during one week of each quarter by staffers and submitted to HCD.
Innumerable outcomes could produce meaningful data. This initial data collection system targeted only 10 outcome measures. These 10 were chosen for their general applicability and the perceived need for accurate data in these areas:
Performance measure based on collection and accumulation of data about many events. The events may be desirable or undesirable, and the data may be reported as a continuous variable or as a rate.
- Functional Assessment/Health Status
Method of measuring patient improvement and effectiveness of the treatment plan. (Did the patient improve, remain the same, or regress.)
- Risk Adjusted
Process for reducing, removing, or clarifying the influences of confounding patient factors that differ among comparison groups.
- Patient Satisfaction Surveys
Overall patient impressions of how HHV and the medical centers met their expectations.
Benchmarking and Trending Data
The repeated measures of performance will provide trend data by indicator, allowing HHV to establish a benchmark and compare performance of the craft kit program and the participating hospitals. By using comparative data from the reference database, HHV will be able to detect variations in performance. Such variations in benchmarking will assist in the improvement of the HHV craft kit programs and processes.
Each outcome measure was compared with that of all the reporting medical centers. Many medical centers may have had a small size monitored for a particular outcome measure.
Patient Satisfaction Survey
As part of the performance measurement program, a patient satisfaction survey was conducted and analyzed. The survey was given to patients upon completion of each craft kit. Patient perceptions were compared with the clinical evaluations to see whether a balance existed between patient satisfaction and quality outcomes.
In addition to HHV, each participating medical center received summary statistics for each outcome measure. The report showed the results of the participating medical centers as compared with all others in the study. HHV received data displays using the appropriate statistical quality control technique (e.g., tables, line graphs, and histograms). From this report, HHV and the medical facilities will focus resources and attention on those areas that may require a more intensive assessment.
Duration of Study and Reporting
The first year of the study was a trial period for testing the survey instruments and ensuring data were collected with the same methodology. Although we feel we have good data for the first year, many changes were made as a result of receiving input from staff.
The veteran patients that received HHV craft kits and staff assistance were overwhelmingly satisfied with the craft kit program, and had a positive response rate of 98.6 percent. HHV was shown to be one of the top three volunteer organizations with activities in the medical centers that reach 98.7 percent of the veterans.
Also apparent was that the ease or difficulty of craft kits completion varied among patients participating in craft activities based on risk, adjusted by disease (i.e., anxiety disorder, dementia, etc.).
This information proved to be extremely helpful when staffers assigned or assisted patients in craft kit selection. The medical center treatment team may also use this information as an integral part of the multidisciplinary patient treatment plan.
One of the most important measures within this study was the functional improvement of the patient resulting from craft kit therapy. Craft Care Specialists, as members of each medical center’s multidisciplinary patient treatment teams, participated in defining policies and developing a total care plan for their patients. For this purpose, the CCS’s assessed each of their patients to determine if functional improvements had occurred. They found the following improvements in patients:
When compared with the patient’s overall perception of the impact of the craft kit therapy program in relation to their wellness, 89.6 percent of the patients felt HHV craft therapy helped maintain or improve their physical capabilities. Patients with a good mental attitude and outlook toward treatment have better chances for improvement. We found it remarkable to witness how HHV’s program had indeed helped patients in functional improvement, both physically and mentally. Patients’ comments reinforced that data. We could see by these comments that many of the veterans gave intrinsic responses, which were measured under the motivation category.
In terms of craft kit difficulty, 46.7 percent stated that the kits they were working on were somewhat difficult to very difficult. With this quantifiable information and the average time to complete a kit by level of difficulty, CCS’s are better able to guide and select an appropriate kit for patients.
We saw that veterans not only appreciated HHV but also willingly thanked the donors who make the program possible. Most–96.8 percent–wrote notes of appreciation to the donors directly by completing the “Thank You” postcards that come attached to each craft kit. Often, these postcards are the avenue through which pen-pal relationships form between the donors and hospitalized veterans.
Through the generosity of its donors and the leadership of the board of directors, HHV will continue to support VA’s efforts to foster a healthy and rewarding life for America’s veterans and will continue to do all it can to help hospitalized veterans in their recovery and rehabilitative goals.