Transcript Presentation Objectives

HCAHPS Update and
Impacting The Patient
Perception of Care
January 28, 2009
Karen Cook, RN, BSN
www.studergroup.com
Nina Setia, Adm. Director, Service Excellence
Hackensack University Medical Center
Webinar Agenda
What it is: An
Hardwiring
Excellence and
HCAHPS
15 min
Understanding
the Data
What it is NOT:
A tutorial on the
survey tool or
submitting data.
update on HCAHPS
data and overview of
recommended
strategies to improve
the patient perception
of care.
15 min
Priority
Initiatives and
20 min
Cool Ideas
Nine Principles – A Culture of “Always”
®
Commit to
Excellence
Build Individual
Accountability
Measure the
Important Things
Align Behaviors
with Goals and
Values
Build a Culture
Around Service
Communicate
at All Levels
Create and Develop
Great Leaders
Focus on Employee
Satisfaction
Recognize and
Reward Success
Times… They are a Changing…
No more denial, blaming
rationalization, ignoring
results, assuming or
hoping…
This does not apply to us…
we are the only hospital in
town…the IPPS payments
don’t apply…
HCAHPS Aligns with Industry Trends
19
41
20
21
Patient Experience
Hospital Reputation
Physician Decision
Location
“…patients and doctors are more
likely to base their choice of
hospital on non-clinical aspects of
a visit – like communication.”
HCAHPS – Hospital Consumer Assessment of
Healthcare Providers and Systems
What is
HCAHPS
Why is it
important?
How will it
be used?
A standardized survey tool to measure the patient’s
perception of quality care provided during their experience
while a patient at an acute-care hospital.
The patient perception of care will be publicly reported with
other quality metrics on the Hospital Compare website.
www.hospitalcompare.hhs.gov
The information will be used to provide meaningful data for
improvement efforts as well as provide comparisons between
hospitals to help consumers choose a hospital.
What Do Patients Want From Us?
Communication with doctors
Their perception
Communication with nurses
of our
Responsiveness of hospital staff
performance is a
Pain management
reportable and
Communication about medicines
tangible
Discharge information
reflection
Cleanliness of hospital environment
of your
Quietness of hospital environment
reputation
Overall rating of hospital
Willingness to recommend the hospital
HCAHPS Aligns with Clinical Quality
“Patient-Centeredness” is one of the Institute of Medicine’s
key dimensions of Quality and CMS’s Quality Improvement
Roadmap vision for Right Care, Right Person, Every Time
1. Safe
“Always” is the
2. Effective
response scale
3. Patient-Centeredness
most highly
4. Timely
associated with
5. Efficient
loyalty
6. Equitable
Institute of Medicine, Crossing the Quality Chasm: A new Health System for the 21st century, March, 2001
How Will HCAHPS Reinforce Focus on Quality?
Patient-Centered care is a quality indicator
Quality no longer the domain of just the clinicians
Gives a voice to the patient perception of safety
Highlights communication issues/barriers
Patient-centered care actively involves patients
in their care
More senior leaders are engaged and interested
in delivering patient-centered care
HCAHPS Aligns with CEO’s Top Issues - (2008)
77%
Financial Challenges
43%
Patient Safety and Quality
41%
Care for the uninsured
32%
Physician- hospital relations
30%
Personnel shortages
26%
Governmental mandates
22%
Patient Satisfaction
16%
Capacity
Technology
7%increase
9%
Issues about not-for profit status
2%
Malpractice insurance
2%
Disaster Preparedness
1%
Patient
Satisfaction
5%
increase
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
American College of Healthcare Executives, 2008, Annual CEO Survey of Top Issues Confronting
Hospitals (Patient Safety and Quality are now combined. They were shown separately in prior years
HCAHPS Builds the Bridge Between
Quality and Service
Quality (Factual)
What actually
happened in
the care
process…
What was the
clinical
quality/outcome
HCAHPS
Service (Emotional)
How did the patient
feel about what
happened…
How satisfied were
they…
How often the patient perceived it
happened… (Frequency of Process)
A Culture of “Always” and Evidence Based
Leadership (EBL) SM
Foundation
STUDER GROUP:
Leader
Evaluation
Leader
Development
Must
Haves®
Performance
Gap
Aligned Goals
Aligned Behavior
Implement an
Create
Must Haves®
Re-recruit
organizationprocess to
high and
Rounding
wide
assist leaders
Thank You Notes middle
leadership
in developing
performers
Employee
evaluation
skills and
Selection
Move low
system to
leadership
Pre and Post
performers
hardwire
competencies
Phone
Calls
up or out
objective
necessary to
Key Words at
accountability
attain desired
(Principle 4)
Key Times
results
(Principle 7)
(Principle 3, 5, 6,
(Principle 4 & 8)
& 9)
Rev 11.07
Standardization
Accelerators
Aligned Process
Agendas
by pillar
Leader Eval
MgrSM (LEM)
Peer
interviewing
Staff Eval
MgrSM (SEM)
30/90 day
sessions
Discharge Call
MgrSM (DCM)
Pillar goals
Rounding
MgrSM
(Principle
1 & 2)
Idea
ExpressSM
Technology is Driving Change…
Patient Satisfaction
86
85
84
83
Source: Health Management Technology, Aug 1999, Harris Poll, 2007 and Press, Ganey
B
75
+
55
-6
5
65
-7
5
er
om
o
u
B
o
om
le
t
st
er
82
B
Consumers will have the same
access to medical information as
providers have… and more time
to explore it
80% of American population use
internet - including Baby Boomers
Patients will expect more and
tolerate less
Public reporting is forcing a new
direction in patient-centered care
Medicare will become the #1
customer of every hospital
n=1,007.612
HCAHPS Aligns With A Balanced Approach
Passion to make
healthcare better
Taking Better Care
of Patients
S
E
R
V
I
C
E
Serving the healthcare
needs of the COMMUNITY
VISION
Q
U
A
L
I
T
Y
P
E
O
P
L
E
F
I
N
A
N
C
E
G
R
O
W
T
H
STANDARDS OF PERFORMANCE: VALUES
MISSION
Financial Impact of HCAHPS
HCAHPS is voluntary but results must be included in the Pay for
Reporting program to receive a full Inpatient Prospective Payment
System (IPPS) payment update
Penalty does not apply to those not reimbursed by IPPS… Yet.
Potential impact:
 Public reporting will impact patient perception and choice (Service,
Quality, and Growth Pillars)
 Potential downstream impact on revenue if it is tied to pay for
performance (Finance Pillar)
 Financial indicators such as turnover as employees want to work for
a quality organization (People Pillar)
A comprehensive performance
assessment model is developed…
The proposed methodology will score a hospital’s performance
and compute an overall VBP score, translating into an incentive
payment
Will reward hospitals for performance based on attainment in
the measurement year or improvement from the prior year’s
baseline performance
For each measure with a broad differentiation of performance
scores, each measure will have a benchmark (top 10%) and
an attainment threshold (50th percentile) based on national
data
As scores improve nationally, the goals will change
There will be different measures for different purposes such as
incentive payment, public reporting, and measure development
Potential Plans for Transition to Pay For
Performance (Baucus-Grassley Bill Draft)
1.
2.
FY2009: 1st reporting year for VBP
–
Payment: 100% public reporting
–
Measures reported are basis for FY2009 “attainment” scores;
FY2008 provides baseline for “improvement” calculations
FY2010: 2nd reporting year
–
3.
Payment: 50% based on performance, 50% on public reporting
(potential) (70% clinical quality and 30% HCAHPS metrics)
Impact on rural hospitals is unknown
–
“The Secretary shall consult with small and rural hospitals on
the application of the Program to such hospitals.”
Who knows?? Bottom line is that we should proceed as if our pay
WILL be tied to performance!
www.hospitalcompare.hhs.gov
Click this link to find more
information on the HCAHPS tool.
Media Coverage
Real impact of public
reporting will effect
reputation
Patient choice and
downstream revenue
Pride and turnover as
employees want to
work for a quality
organization
March 29, 2008
Understanding & Impacting
the Data
Case Study:
Hackensack University Medical Center
Quick Facts About HCAHPS
Scale - top box will be reported
Always, Definitely Yes, % 9 and 10, Yes
Measures the frequency of events as perceived by the
patients (“how often or did xxxx occur?”)
Never, Sometimes, Usually, Always
N – 300 minimum per year
Inpatient Adults over 18 years of age; acute care hospitals
Case and patient mix adjusted
Should be a complementary, not the only tool to be used in
identifying performance improvement opportunities (leader
rounding, DC Calls, focus groups, verbatim comments etc.)
Should not be considered a new “program” but rather a new
method of reporting information
HCAHPS Comparison
April 1, 2007 to March 31, 2008
Questions
RWHC
(all qrtr ave*)
United
States
SG
Partners
Nurses always communicated well
78.4%
74%
75%
Doctors always communicated well
83.7%
80%
79%
Patients always received help quickly
72.4%
62%
62%
Pain was always well controlled
71.6%
68%
70%
Staff always explained about medicines
65.1%
59%
59%
Rooms and bathrooms were always kept clean
78.9%
69%
69%
Area around room was always quiet at night
67.4%
56%
52%
Yes patients were given information about recovery at home
80%
81%
Patient’s overall rating of hospital (9 & 10)
64%
67%
Yes would definitely recommend this hospital
68%
71%
Green SG Partners above US Average
Yellow SG Partners equal US Average
Red Partners below US Average
Sample of Board Communication
HCAHPS results: 4th reporting period
(April 2007-March 2008 discharges)
Estimated Timeline
Oct 06 - Jun 07 Discharges
Oct 06 – Sept 07 Discharges
Jan 07 – Dec 07 Discharges
April 07 – March 08 Discharges
July 07 – Jun 08 Discharges
Suppression linked to loss of APU
Oct 07– Sept 08 Discharges
Jan 08– Dec 08 Discharges
….but we are REALLY
here!
Apr 08– Mar 09 Discharges
Nov
Dec
Oct
Sep
Aug
July
Jun
May
Apr
Mar
Feb
Jan
Dec
Oct
Nov
Sep
2009
Aug
July
Jun
May
Feb
Mar
Apr
Jan
Oct
Nov
Dec
Sep
2008
Aug
Jul
Apr
Mar
Jan
Feb
May
Jun
2007
2006
Oct
Nov
Dec
We are here: Public Reporting
data from April 2007-March 2008
Past and Current
Raw Data
reported every
two weeks
Future
Financial Impact
As of March 2009 non-participating hospitals’ Medicare
payments run the risk of being reduced by at least 2%
under market basket.
Senior Leader’s Adopted Composites: Action
Plans Report Quarterly
Composite
Responsible Leader(s)
Communication with Doctors
CMO
Communication with Nurses
CNO
Pain Management
Chairman of Pain Service
Senior VP of Operations
Cleanliness of Hospital Environment
VP of Operations
Quietness of Hospital Environment
VP of Operations
CNO
Responsiveness of Staff
CNO
Discharge Information
CNO
Communication about Medicines
Administrator, Patient Safety
Nina Setia, featured
in Hardwired 9 for the
HCAHPS Coaching
Track for Nurse
Managers
Leader Coaching Track
1 hour a week for 12 weeks
Starts with signing a coaching contract
Covers Employee Satisfaction for first 2 weeks
Includes relevant handouts
Contains a competency check at beginning of each
session
Homework given at last session
Evaluation sent and completed electronically
CEU’s awarded (can be converted to Nursing contact
hours)
Pain Initiative
Changed pain policy
reflects “acceptability” of pain level
Re-assessment within 1 hour
“Pain Rule” implemented because pain scores were poor
“Red flag” flashes on computer as a reminder to re-assess pain
Chairman, Pain & Palliative Medicine began rounding on
nursing units in 1Q08
Bring pain policy to life and enforced it
Provided education to standardize practice within each unit and
across all units
Rounding with nurses
Pain Initiative: Unit 4 West
100
92
HCAHPS:
90
91
•“How often was your
pain controlled?
80
•“How often did the
staff do everything they
could to help you with
your pain?”
90
70
60
89
50
88
40
87
30
Patient Satisfaction:
•“How well your pain
was controlled”
86
20
85
10
0
HCAHPS Pain
Patient Satisfaction Pain
1Q07
2Q07
3Q07
4Q07
1Q08
2Q08
67
87.8
69
87.4
62
86.6
68
88.2
73
89.6
88
90.9
84
Patient Care Initiatives
Quality Leadership Steering Committee for Service Excellence
Standardize practices, materials and dashboards
Develop internal coaching experts
Re-launched hourly rounding on all units
Piloted TCAB project (Transforming Care At Bedside) with a goal to
increase nurses time at the bedside
“Nurses are with me all the time.”
“Quiet Time” for safe administration of medications
CEO “Expectation” on discharge phone calls
Key words “For safety reasons, nurses will be checking your ID
band frequently during your hospital stay.”
Increase time at the bedside = increase in
communication = increase in HCAHPS scores
Unit based HCAHPS data
Initiatives
Discharge
follow up
phone calls
Hourly
rounding,
key words,
TCAB
85%
80%
Re-launched
hourly
rounding,
assessed on
discharge
phone calls
75%
70%
Increased
discharge
calls,
Re-launched
hourly
rounding
Pain
initiative
65%
“Quiet
Time”
60%
55%
50%
45%
40%
ha
rg
e
is
c
D
et
ne
ss
nl
in
e
le
a
C
m
om
C
Q
ui
ss
s
Pa
re
:m
ed
in
s
en
es
si
v
on
es
p
R
m
om
C
C
om
m
w
w
do
/n
ur
se
ct
or
s
s
35%
1st reporting period: Oct 06-Jun 07
7th reporting period: Jan-Dec 08
US Avg
NJ Avg
8th reporting period: Apr 08-Mar 09
Key Initiatives to Deliver Patient-Centered
Care
Easier
Harder
Ease of Implementation
Top Priority
White boards
Pre-printed Med Card
Leader Rounding
Key Words/AIDET
Caregiver Engagement
Open visitation
Noise Audits – Quiet
Time
Private rooms
Hourly Rounding
Discharge phone calls
Bedside Report/Handoffs
Lower
Higher
Impact on Patient Perception
Communication with Nurses
Q1 During this hospital stay, how often
did nurses treat you with courtesy
and respect?
Q2 During this hospital stay, how often
did nurses listen carefully to you?
Q3 During this hospital stay, how often
did nurses explain things in ways
you could understand?
o
o
o
o
Never
Sometimes
Usually
Always
Slide format adapted from Press, Ganey
Studer Group Tactics:
Individualized patient care
Sit at bedside to review
care plan
White boards
Hourly Rounding
Bedside Shift Report
Peer Interview for
communication and
empathy talents
AIDET
Behavior standards
Key Words at Key Times is a Must Have
Initiative #1
Key words reflect a communication style that
improves the quality of information provided
by every person in every interaction
Key times are defining moments that:
Occur during times of vulnerability
–
Greetings – first impression
–
Personal times - like bathroom needs
–
Handoffs
–
Goodbyes
Are what patients remember and impact
the overall perception of the experience
Why are Key Words Important?
Reduce patient anxiety
Improve patient perception of care
Improve coordination of care
Decrease law suits
“Being Kept Informed” was the MOST important
characteristic when “returning to a hospital for
future visits.”
2007 McKinsey Survey of >2,000 patients with commercial insurance or Medicaid
Key Words to Build Trust and a Culture of Safety
We’ve been expecting you!
We have the best radiology department in the city.
At our hospital, nothing is more important than your safety.
During your stay it is important that each caregiver washes
or disinfects their hands before contact with you. This will
help decrease the spread of infections and keep you safe.
Please do not hesitate to remind us if we forget to clean our
hands. Have you seen the staff wash their hands?
You are in good hands with Dr. Jones.
Reducing Potential for Litigation Through
Better Patient Communication
In this Article….
“The most common cause of malpractice suits is failed
Communication with the patients and their families.
Explore ways that better communication could lead
To fewer malpractice claims and allow health care
Organizations to reduce litigation costs.”
1.
2.
3.
4.
Focus on Issues: Rounding, AIDET, Key Words
Educate the Patient: Rounding, AIDET, Managing Up
Enlist the Patient: Rounding, Key Words
Share Decisions: AIDET, Key Words
Source: The Physician Executive, June 2004
Physician Keywords
“I am washing my hands for your SAFETY.”
“I have TIME to answer your questions.”
“I want you to be INVOLVED in your treatment plan”
“I want to be sure I EXPLAIN everything to you…”
“To protect your PRIVACY, let me close the curtain.”
“For your COMFORT, I ordered pain medicine...”
“I want to keep you INFORMED…”
“I want to make sure we are THOROUGH”
“You are in good hands with the nurses on this floor.”
The Key to Key Words is PRESENCE
Nonverbal behavior – be fully present
– Smile, establish and hold eye contact
– Put warmth in your voice
– Be at THEIR level whenever possible
– Face squarely or “heart to heart”
Verbal behavior – be fully present
– Acknowledge, welcome and use their preferred name
– Introduce self and role
– Duration - say what you’ll do and what to expect
– Explain “I am part of the Albany Medical Center team”
– Thank them
Adapted from: Heart to Heart Communication – Wendy Leebov
AIDET – Five Fundamentals of Communication
A
Acknowledge
I
Introduce
D
Decreased
Anxiety
Increased
Compliance
Duration
+
E
Explanation
T
Thank You
Improved clinical
outcomes and
increased patient
and physician
satisfaction
Key Words - Designed Handoff’s
A
I
Mrs. Jones you are doing so much better – you can now be on the
step down unit. Do you mind if I share a bit about you with Cindy?
I have worked with Cindy for over two years and she will take
great care of you.
D
It will take us about five minutes to discuss your care because I
want to make sure she is very familiar with your care plan.
E
We want to make sure we keep you informed about your care as
well so we will do the report here in the room if ok with you?
T
It has been a pleasure taking care of you and I know you will do
well. I am working tomorrow and will check in on you.
Manage Up Co-Workers by Communicating
Skill and Training
Patient Satisfaction
98
100
72
80
Percentile
60
40
27
20
0
Baseline Oct06
1Q07
QTD 2Q07
Source: Sacred Heart Hospital, Pensacola, FL
Key Words: Written Material
Source: Sierra Vista MC, San Luis Obispo, CA
Key Words
Key Words: Manage UP Co-Workers
Managing UP uses keyword
phrases to position something or
someone in a positive manner
Conveys a spirit of teamwork
Aligns the organization and
demonstrates pride
Instills confidence in ability to
provide quality care
Co-workers appreciate the kind
words and the “vote” of
confidence as well
“Mrs. Smith. This afternoon
you will be going to the
Cardiac Step-down unit
which means you are closer
to going home. This floor
has excellent staff and state
of the art monitors. They
are aware you will be down
there this afternoon and are
well prepared for you…”
Key Words
Customize to reinforce
initiatives such as:
Individualized
Patient Care
Rounding for pain
goals
Managing Up
Aligned with other
initiatives like Time
Out
Rounding for Outcomes is a Must Have
Initiative #2
Rounding on
Employees,
Patients,
Physicians
and Other
Departments
Rounding is a process to PROACTIVELY
engage, listen to, communicate with, build
relationships with and support the most
important customers
Maintains TRANSPARENT communication
Focuses on the positive and what is working
well - which is a paradigm shift
Is a requirement of all leaders
Promotes SHARED Decision Making
It is not reactive, focused on “what’s wrong,
MBWA, or sporadic when there is “time”
Rounding for Outcomes on Staff
“The number one person we
round on is the employee.
And if we skip the employee,
we’re making a mistake.”
Quint Studer, Author of
Hardwiring Excellence
Rounding for Outcomes – Employees
Rounding on
Employees
Concern and Care – relationship connection
and open lines of communication
What is Working Well – focus on positives –
Direct reports –
100% monthly
(All staff are
rounded at least
once per quarter)
how did you make a difference today?
People to Recognize – specific people and
actions (other depts, physicians etc.)
Systems to Improve – seek input (safety,
rework, pet peeves) Trust but VERIFY behaviors
3 employees x 15
minutes = 45 min
+ 15 minute F/U
= 60 minutes/day
Tools and Equipment – barriers to efficiency
Follow-up – take notes
Rounding for Outcomes – Patients
Nurse Leader
Good morning, Mrs. Smith . . . I am Carol, the nurse manager on this
unit. Would it be ok if I spent about 3 minutes with you? (sit at the
bedside if possible)
I see from the whiteboard that Becky is taking care of you. She is an
excellent nurse. (managing up is critical piece of leader rounding)
On our unit, the expectation is that a staff member is in your room
every hour to check on you. Have you seen one of our team
members approximately every hour? Have you had to use your call
light to ask for pain medicine?
Thank you so much for your time. I will be sure to share your
compliment with Becky. Is there anything you need before I go?
(Follow up with the staff . . . Either on the spot coaching or reward /
recognition.)
Selection and Retention of Talent
Behavior Standards
Initiative #3
Top Five Workplace Incentives
1.
2.
3.
4.
5.
Written Thanks From
Manager/Executive Team
Leader
Personal Thanks From
Manager
Promotion for Performance
Public Praise
Morale-Building Meetings
Study conducted by Dr. Gerald Graham, Management Professor at Wichita State University
Motivating Today’s Employees, Bob Nelson
Talent+, 1998
Recognition
It’s not a natural skill…
it must be taught!
“65% of Americans reported that they received no recognition for
good work in the past year…”
Source: How Full Is Your Bucket-Tom Rath, Donald O. Clifton
Focus on the Positive
Compliment to Criticism Ratio
3 to 1
3
compliments
1 criticism
Positive!
2 to 1
2
compliments
1 criticism
Neutral
1 to 1
1 compliment
1 criticism
Negative
Source: Tom Connellan, “Inside the Magic Kingdom”,
pgs 91-95
Behavior Standards – A Culture of “Always”
Standards in
recruitment and
application
process
Standard of the
Month
Are YOU an Effective Team Member?
Better able to predict the needs
of other team members
Provide quality information and
feedback
Engage in higher level decision
making
Manage conflict skillfully
Understand their role and
responsibility
Reduce stress on team as a
whole through better
performance
http://teamstepps.ahrq.gov/abouttoolsmaterials.htm
HCAHPS Toolkit –
Aligning Actions to Create a Culture of Always
Over 40 evidence-based
recommendations to impact
the patient perception of
quality
Will be sent by Mary Jon
Order today at
www.studergroup.com
The Right Thing to Do
Leader Rounding and Key Words/Managing UP
Ensures strong communication
Promotes a sense of “well-being”
Decreases anxiety
Exceeds expectations
Provides “individualized” care
Do I take responsibility and ownership of my department?
Do I Manage Up my team and my organization?
It is not about scores,
financial indicators,
public reporting, % of
always…it is about
compassionate care
and saving lives