Achieving Medicine of the Highest Order – Cultural Transformation Based on “Horton Hears a Who

” Bradford C. Berk, MD, PhD May 22, 2013 Faculty Institute for Teaching and Learning

May 30, 2009

Back to work

Thanksgiving 2009

I’ve learned what’s important

• Treating patients and families with dignity and respect • Showing compassion and attentiveness • Valuing the patient and family as an integral part of the health care team • Listening to our patients and their families

2007-12 URMC Mission and Vision

• •

Mission:

Using Education, Science and Technology to Improve Health.

Vision:

Develop a high quality, cost-effective patient centered healthcare delivery; lead by our world class researchers, educators and clinicians.

2013-18 URMC Mission and Vision

• •

Mission:

The University of Rochester Medical Center is a home of healing, learning, research and innovation committed to improving health and quality of life for our patients, families and community.

Vision:

To be nationally recognized by 2020 for improving community health through transformative approaches in compassionate care, education and research.

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Strategy Map

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People and Culture Key Component of Strategic Plan

Enhancing Standard HR duties — benefits, hiring, payroll New Implement Business Partners:  who understand the specific HR challenges that their clients face   to learn time-tested tactics for fostering employee engagement to be able to help managers structure incentives that drive peak performance Talent management software to function with existing HRMS system Boost Evaluation Process and Tools 11

The healing power of touch

  Compassion –

We need to show we care

Attentiveness –

show we care We need to pay attention to

My personal experiences

: • as a leader, • a care provider and • a patient

Patient and Family Centered Care (PFCC)

A set of principles and values that when implemented successfully improve quality, safety, and long-term outcome. In addition, data shows improvement in patient, family, care provider, and staff satisfaction.

Transforming a culture

Patients and families are repeatedly telling us we need to do better in these areas: • Response to your concerns/complaints • Staff addressed your emotional needs • Staff included you in decisions regarding treatment • Nurses and Physicians kept you informed • Staff worked together to care for you • Time physician spent with you

Communication, Compassion and Attentiveness are Critical

URMC components of PFCC

Safety Courage Patient and Family Centered Care Quality Caring

Creating value enhances PFCC

   Create Value (Quality/Cost) by implementing LEAN process improvement strategy Eliminate waste in our system without diminishing the patient experience • remove extra steps in patient flow • simplify operational processes • eradicate duplicate and unnecessary paperwork

results in better patient and staff satisfaction

Utilize LEAN approach to help create a patient and family-centered care culture

Building a PFCC Culture

Areas of Focus: • Facility • Medical Advances • Information Technology • Delivery of Care • People

Facility

PFCC requires a comfortable supportive environment  private rooms with family sleeping spaces  atmosphere that promotes healing • Cancer Center Expansion • New Children’s Hospital • Upgrade of Current Facilities

Information Technology

 eRecord will promote PFCC provides immediate and more thorough understanding  provides improved communication among providers  can identify high-risk patients to ensure comprehensive care plan and enhanced communication  can encourage attentiveness and compassion o i.e. electronic sticky notes can enhance patient and provider’s bond by reminding care providers to engage in topics most important to patient

“I am very sorry to know that you recently lost a loved one” “I understand you are anxious to return home to care for your cat”

Transforming the way we Deliver Care

      encourage patient/ family involvement promote practices to improve patient/family and provider communication (i.e. rounding and shift change at the bedside) breakdown silos – enhance communication among providers and multidisciplinary care teams develop specialized Hospitalists to promote efficient, but compassionate care shift from episodic approach to care to full continuum of care advanced medical homes

People are the most important part of PFCC

Train all medical staff and employees to be respectful and offer compassion • How we

communicate

determines how effectively we convey compassion and attentiveness • We need to convey to our patients compassion and attentiveness by communicating about things that matter to them • The healing power of touch

Caring for the caregivers

Our employees need to feel cared for to provide patient/family-centered care Staff need to be:  treated with respect  supported   empowered recognized

PFCC across URMC delivery system

Patient and Family Members URMC PFCC Steering Committee SMH Highland VNS Highlands at Brighton Highlands at Pittsford GCHAS

Creating an ICARE Culture

I ntegrity C ompassion A ccountability R espect E xcellence

Influences on Patient Experience

 Personal – behaviors/culture  Operational – systems/processes  Physical – environment/facility

focus of PFCC initiative Coordination of 3 broad efforts

- medical center-wide - department/unit level 26

PFCC efforts are making a difference

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2010

- 2 of the 8 HCAHPS domains at national average •

2012

- 6 of the 8 HCAHPS domains exceeded national avg.

  Hospital Environment Pain Management Making progress but still below national average •

2013

- Hospital wide rollout – next stage of PFCC initiative   Clearly defining ‘desired patient experience’ Focus on ‘consistent delivery’ of the experience 27

Patients’ Overall Score for Hospital is Improving HCAHPS Overall Hospital Rating Strong Memorial Hospital 74

73

72 70

69,4 70,5 69,9 70,4

68 66 64

65,7 67,6 67 Achievement Threshold 63,1

62 60 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012

Achievement Threshold

= CMS Value Based Purchasing minimum (National Median) / 50th Percentile Displayed by Discharge Date / All Surveys 28

Nursing Communication continues to rise

HCAHPS Nurse Communication Strong Memorial Hospital 84 82 80 78

77,9 78 78,7 77,7 78,9 76,5

76 74 72

71,7 73,6 75,3 Achievement Threshold

70 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012

Achievement Threshold

= CMS Value Based Purchasing minimum (National Median) / 50th Percentile Displayed by Discharge Date / All Surveys 29

Staff Responsiveness exceeds national average HCAHPS Staff Responsiveness Strong Memorial Hospital 54 52 50 48 46 66 64 62 60 58 56

52,7 51,6 56,5 53,7 58,6 61,2 62,1 64 64 Achievement Threshold

Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012

Achievement Threshold

= CMS Value Based Purchasing minimum (National Median) / 50th Percentile Displayed by Discharge Date / All Surveys 30

Employee Engagement/Commitment Scores

Measuring Workforce Commitment

Workforce Commitment Item 43. I am proud to tell people I work for this organization.

49. I would recommend this organization to family and friends who need care.

56. I would like to be working at this organization three years from now.

59. I would stay with this organization if offered a similar job elsewhere for slightly higher pay.

64. I would recommend this organization as a good place to work.

65. Overall, I am a satisfied employee.

2012 URMC Clinical Entrprs 4.38

4.34

4.34

3.71

4.29

4.10

% Unfav 3% 3% 5% 15% 3% 6% Natl UHC Avg Difference from: Natl HC Avg 2011 URMC Clinical Entrprs +.02

+.05

+.08

.00

+.14

+.06

+.02

+.01

+.06

-.01

+.11

+.03 +.06

+.05

+.06

+.07

+.10

+.09

Top 10 NYS value based / readmission penalty

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“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” - Maya Angelou

Thank You