Low to High State Average Results in the “Percent

Transcript Low to High State Average Results in the “Percent

Creating A Culture of Always

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Slide 1

Low to High State Average Results in the “Percent of Patients that Rate the Hospital a 9 or 10”

VI Rating Category 1 Average Top Box 55%-67% DC NY NJ MD NM WV NV FL DE AK Rating Category 2 Average Top Box 68%-70% WY CT CA MT VA PA MA HI GA RI AZ ND AR OR IL Rating Category 3 Average Top Box 70%-72% NH MS NC AL VT MO MI OK KY WA SC TN OH Source: Hospital Compare August 2014, Patients discharged between 4Q12-3Q13 Rating Category 4 Average Top Box 73%-78% TX ID IN CO IA KS SD NE WI MN ME UT LA COPYRIGHT © STUDER GROUP

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Learning Objectives

1. Define a “Culture of Always” from an operational and service perspective (HCAHPS) 2. Describe seven skills great leaders use for high engagement 3. Ten questions to ask if you are not getting results

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CEO’s Top Ten Issues - 2013 RANK

2 3 3 5 6 7 8 9 10 11

ISSUE

Financial challenges Healthcare reform implementation Governmental mandates Patient safety and quality Care for the uninsured Patient satisfaction Physician-hospital relations Population health management Technology Personnel shortages Creating an accountable care organization

Ranked #1 concern for the last 10 years

Note: January 13, 2014; American College of Healthcare Executives; Top Issues Confronting Hospitals: 2013; 388 hospital CEOs

The Journey to Excellence

“

A culture of high performance means an organization consistently performs certain behaviors using various tools and techniques that create measurable, evidence-based quality outcomes at lower cost.

Creating a consistent highly reliable culture is the hardest thing anybody can do.”



Quint Studer

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The Culture Is Reflected In Leadership

“ It is implicit in our mission that our work, our care, and our decisions be guided by the needs of our patients. But to truly be guided by the needs of our patients, we must first LISTEN to them." Jeannette Ives Erickson, Senior Vice President for Patient Care and Chief Nurse, Massachusetts General Hospita l COPYRIGHT © STUDER GROUP

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Slide 6

Thirty Second Elevator Speech – CAHPS

C onsumer A ssessment of H ealthcare P roviders and S ystems

The CAHPS Surveys are standardized surveys to measure the patient perception of quality care. Only the most positive of responses to areas that are important to patients are publicly reported on the government quality website.

They were created to:  Increase the transparency of the quality of care provided by hospitals, providers, outpatient and home health agencies  Provide incentives for providers to improve the quality of care that they provide  Provide an avenue for the public to create objective and meaningful comparisons about the quality of care provided Slide 7 COPYRIGHT © STUDER GROUP

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http://www.medicare.gov/hospitalcompare

 Emergency Room  Hospital Outpatient Surgery Department  Ambulatory Surgery Center  Hospice  ACO/Physician Practice  Health Insurance Exchange  National Implementation in 2014-Inpatient Center Hemodialysis CAHPS  AND there’s an APP COPYRIGHT © STUDER GROUP

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Slide 8

Communication with Nurses is The Key Driver of Hospital-Patient Relationships Nurse Communication has highest correlation with Willingness to Recommend As Patients’ Perception of Care Increases, Their Willingness to Recommend Increases

Patient-level Pearson correlations with Definitely Recommend the Hospital for patients discharged between April 2012 and March 2013 3.1 million completed surveys 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,27 0,29 0,36 0,42 0,45 0,45 0,48 0,58 0 Discharge Information Quietness of Hospital Env.

Cleanliness of Hospital Env.

Comm. About Medicines Communication with Doctors

HCAHPS Composite

Responsiveness of Hosp. Staff Pain Management Communication with Nurses HCAHPS Patient Level Correlations. www.hcahpsonline.org. Centers for Medicare & Medicaid Services, Baltimore, MD. Originally posted January 16, 2014.

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Kansas Hospitals National Rank: 7 th in Responsiveness; 10 th in Nurse Communication; 13 th Communication about Meds; 20 th in Pain Management in

Kansas Acute Care vs Critical Access Hospitals Patient Experience of Care - National Percentile Ranking Acute Care Hospitals Critical Access Hospitals 90% 84% 77% 80% 74% 77% 73% 72% 70% 61% 60% 60% 59% 60% 55% 51% 47% 57% 51% 51% 57% 50% 50% 56% 73% 40% 30% 20% 10% 0% Patient Experience Composite COPYRIGHT © STUDER GROUP

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HCAHPS Measures Receiving HCAHPS Stars

 HCAHPS Composite Measures 1. Communication with Nurses (Q1, Q2, Q3) 2. Communication with Doctors (Q5, Q6, Q7) 3. Responsiveness of Hospital Staff (Q4, Q11) 4. Pain Management (Q13, Q14) 5. Communication about Medicines (Q16, Q17) 6. Discharge Information (Q19, Q20) 7. Care Transition (Q23, Q24, Q25)  HCAHPS Individual Items 8. Cleanliness of Hospital Environment (Q8) 9. Quietness of Hospital Environment (Q9)  HCAHPS Global Items 10. Overall Hospital Rating (Q21) 11. Recommend the Hospital (Q22)  Summary Star Rating  (Moving Up FY 2015 to FY 2016) COPYRIGHT © STUDER GROUP

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Score and Star Rating

 Each HCAHPS measure response is combined and converted to a 0-100 linear scaled score “Linear Score” (Not just top box)  Closely related to “Top Box”, “Middle Box”, and Bottom Box” scores publicly reported on Hospital Compare website  The HCAHPS Summary Star Rating combines the star rating of all the HCAHPS measures  7 Star Ratings from the HCAHPS Composites  Average of cleanliness and quietness  Average of Overall and Recommen d Slide 12 COPYRIGHT © STUDER GROUP

Excerpt slide from CMS National Provider Call 10-8-14

Example Calculation of HCAHPS Summary Star Ratings

Slide 13

Excerpt slide from CMS National Provider Call 10-8-14

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Distribution of HCAHPS Summary Star Rating in the Dry Run

Excerpt slide from CMS National Provider Call 10-8-14

Nurse Communication Drives Global Ratings in Kansas Hospitals

100% Rate Hospital 9 or 10 by Hospital Ranking in Nurse Communication 90% 86% 80% 70% 67% 60% 55% 50% 40% 30% 30% 20% 10% 0% 0-24th Percentile 25-49th Percentile 50-74th Percentile Nurse Communication Ranking 75-99th Percentile 90% Definitely Recommend by Hospital Ranking in Nurse Communication 80% 80% 70% 60% 60% 51% 50% 40% 35% 30% 20% 10% 0% 0-24th Percentile 25-49th Percentile 50-74th Percentile Nurse Communication Ranking 75-99th Percentile COPYRIGHT © STUDER GROUP

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Emergency Department Patient Experience With Care Survey (EDPEC Pilot Completed)

         Communication by Provider Type Doctors Listening to Your Concerns Doctors Using Words and Terms You Could Understand Doctors Involving You in Decisions about Your Care Doctor's Understanding and Caring Doctor's Instructions/Explanations of Treatment/Tests Nurses' Responsiveness to Your Needs and Requests Nurses' Understanding and Caring Nurses' Instructions/Explanations of Treatments/Tests  Instructions for Care at Home  Hospital Staff's Courtesy and Friendliness to You  Timeliness/Throughput  Transitions of care  Pain Management COPYRIGHT © STUDER GROUP

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Slide 16

ED Wait Times and LWBS

Kansas Acute Care vs Critical Access Hospitals Median Door to Doc Times in Minutes Kansas Acute Care vs Critical Access Hospitals Percent ED Patients LWBS Critical Access Hospitals 19,08 Critical Access Hospitals 2,00 Acute Care Hospitals 22,35 17,00 18,00 19,00 20,00 21,00 22,00 23,00 Acute Care Hospitals 1,40 ,00 Acute Care Hospitals ,50 1,00 1,50 2,00 Critical Access Hospitals 2,50 COPYRIGHT © STUDER GROUP

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Outpatient/Ambulatory Surgery Patient Experience of Care Survey (O/ASPECS)

 CMS is developing this survey and plans field test in 2014  Preparation for the surgery or procedure  Check-in and pre-operative processes  Cleanliness and privacy of the surgery facility  Surgery facility staff  Discharge from the facility  Preparation for recovering at home  Patient-reported health outcomes as a result of the surgery or procedure

Note: There is a Surgical Survey created by American College of Surgeons , but it

focuses on the surgeon, not the facility

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We Are In FY2016 Performance Period

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Measure in the New Efficiency Domain

 MSPB-1 Medicare Spending per beneficiary  A claims-based measure that include risk-adjusted and price-standardized payments for all Part A and Part B services provided from 3 days prior to a hospital admission (index admission) through 30 days after the hospital discharge http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment Instruments/PQRS/Downloads/NPC-MSPB-09Feb12-Final508.pdf

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Measure in the Outcomes Measures for 2015 AHRQ PSI-90

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Patient Safety

0,700 0,600 0,500 0,400 0,300 0,200 0,100 Kansas vs. Rest of Nation PSI-90 SAFETY RATE Complication/patient safety for selected indicators (composite) 0,660 0,601 0,410 0,510 0,580 0,000 Kansas Hospitals Nation 95th Percentile Nation 75th Percentile Nation 50th Percentile Nation 25th Percentile COPYRIGHT © STUDER GROUP

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Room Cleanliness Drives Procedural Outcomes As Patients’ Perception of Care Increases, Healthcare Associated Infections Decrease

Clostridium difficile (or C.diff.) Infections by Hospital Rating for Room Cleanliness 1,000 0,889 0,868 0,900 0,786 0,800 0,700 0,589 0,600 0,500 0,400 0,300 0,200 0,100 0,000 0-24th Percentile 25-49th Percentile 50-74th Percentile 75-99th Percentile Hospital Rating for Room Cleanliness Staphylococcus aureus (or MRSA) Blood Infections (Antibiotic-resistant blood infections) by Hospital Rating for Cleanliness 1,200 1,135 1,000 0,954 0,910 0,876 0,800 0,600 0,400 0,200 0,000 0-24th Percentile 25-49th Percentile 50-74th Percentile 75-99th Percentile Hospital Rating for Room Cleanliness COPYRIGHT © STUDER GROUP

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Overview – Hospital Acquired Condition Program

What is HAC Program

Beginning in October 2014, the Hospital-Acquired Condition Reduction Program, mandated by the Affordable Care Act, requires the Centers for Medicare & Medicaid Services (CMS) to reduce hospital payments by 1% for hospitals that rank among the lowest-performing 25 percent with regard to HACs. This is in addition to the maximum 1.5% Value Based Purchasing and 3% Excess Readmission Penalties for FY2015.

How will it be used?

Later this year, Medicare will release the final scores in this Hospital Acquired Condition Reduction Program. Hospitals getting the penalty will lose 1 percent of each Medicare payment from Oct. 1 through Sept. 30, 2015. Slide 24 COPYRIGHT © STUDER GROUP

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Healthcare Associated Infections

Kansas Hospitals Healthcare Associated Infections Kansas Hospitals Nation 75th Percentile Nation 50th Percentile Nation 25th Percentile 1,600 1,480 1,400 1,331 1,269 1,293 1,200 1,153 1,113 1,000 0,965 0,800 0,784 0,845 0,751 0,698 0,734 0,799 0,765 0,657 0,600 0,457 0,398 0,427 0,400 0,350 0,350 0,313 0,290 0,200 0,159 0,000 0,000 Catheter-associated urinary tract infection (CAUTI) Central-line associated bloodstream infection (CLABSI) Clostridium difficile (or C.diff.) Infections Staphylococcus aureus (or MRSA) Blood Infections (Antibiotic-resistant blood infections) Surgical site infections from abdominal hysterectomy (SSI: Hysterectomy) Surgical site infections from colon surgery (SSI: Colon) COPYRIGHT © STUDER GROUP

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Learning Objectives

1. Define a “Culture of Always” from an operational and service perspective 2. Describe seven skills great leaders use for high engagement 3. Ten questions to ask if you are not getting results Slide 26 COPYRIGHT © STUDER GROUP

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Seven Skills For High Engagement

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Seven Skills For High Engagement

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Nonverbal Communication and Empathy

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Seven Skills For High Engagement

1. Being Authentic – connect to the WHY 2. Having Empathy – this is HARD work 3.

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Seven Skills For High Engagement

1. Being Authentic – connect to the WHY 2. Having Empathy – this is HARD work 3.

Knowing when to push… and when to hold back 4. Move conversation back to point – mission driven

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Seven Skills For High Engagement

1. Being Authentic – connect to the WHY 2. Having Empathy – this is HARD work 3.

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Slide 32

Move Conversation Back to Point - WHY

WHY: We help to keep 492 patients from having to come back into the hospital.

What : “Your goal is achieve a readmission index of <1.0%” Target: Reduce readmissions of CHF patients (FY 1.07%) Metric : Improving “HCAHPS Medication Composite – (Explain Side Effects of Medications) Weight: 30% COPYRIGHT © STUDER GROUP

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Slide 33

High Patient Perception of Care Equals Lower Preventable Readmissions

1/5 of Medicare Beneficiaries are readmitted within 30 days with an annual cost of $17.4 Billion

2.6% Acute MI 3.1% Heart Failure 2.3% Pneum onia

Source: The American Journal of Managed Care; Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission Within 30 Days; 2011; Vol. 17(1)

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Readmissions

Kansas Acute Care vs Critical Access Hospitals 30-day hospital-wide all- cause unplanned readmission 17,0 16,5 16,0 15,5 15,0 14,5 14,0 13,5 13,0 14,4 15,4 15,4 15,9 16,0 16,5

Nation 95th Percentile Kansas Acute Care Hospitals Nation 75th Percentile Nation 50th Percentile

Comparison Groups

Kansas Critical Access Hospitals Nation 25th Percentile

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Relationship Between Percent of Patients that Rate Hospital a 9 or 10 and FY2015 Excess Readmission Penalties

0,70% 0,60% 0,50% 0,40% 0,30% 0,20% 0,10% Hospitals with Higher HCAHPS Patient Experience of Care Results for Percent of Patients that Rate Hospital a 9 or 10 Have Lower FY 2015 Readmission Penalties 0,61% 0,53% 0,46% 0,35% 0,00% 0-24th Percentile 25-49th Percentile 50-74th Percentile

Hospital Ranking for HCAHPS Patients that Rate Hospital a 9 or 10

75-99th Percentile There is a statistically significant difference between hospital groups as determined by one-way ANOVA (F (3,3235) = 24.5, p = .000). A Tukey post-hoc test revealed that Readmission Penalties are statistically significantly lower for hospital groups that patients rate highly for Rate 9 or 10 (p=.000). COPYRIGHT © STUDER GROUP

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CMS Patient Family Engagement Metrics

Best Practice Category PFE Metric Instruction

: For each of the following items, indicate if the hospital does this or does not do this. If you do not know, indicate so.

 Does=1  Does not=0  Unknown=u

Point of Care Policy & Protocol Governance 1.

Prior to admission, hospital staff provides and discusses a discharge planning check list with every patient that has a scheduled admission, allowing questions or comments from the patient or family (e.g., the planning checklist may be similar to the CMS Discharge Planning Checklist ).

2. Hospitals conduct both shift change huddles for staff and do bedside reporting with patients and family members in all feasible cases.

Hospital has a dedicated person or functional area that is proactively responsible for Patient and Family Engagement and systematically evaluates Patient and Family Engagement activities.

4. Hospital has an active Patient and Family Engagement Committee (PFEC) OR at least one former patient that serves on a patient safety or quality improvement committee or team.

5. Hospital has one or more patient(s) who serve on a Governing and/or Leadership Board and serves as a patient representative.

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Relationship Between Percent of Patients that Receive Discharge Instructions and FY2015 Excess Readmission Penalties

Hospitals with Higher HCAHPS Patient Experience of Care Results for Percent of Patients that Received Discharge Instructions Have Lower FY 2015 Readmission Penalties 0,70% 0,60% 0,50% 0,40% 0,30% 0,20% 0,57% 0,51% 0,48% 0,40% 0,10% 0,00% 0-24th Percentile 25-49th Percentile 50-74th Percentile 75-99th Percentile

Hospital Ranking for HCAHPS Patients Received Discharge Instructions

There is a statistically significant difference between hospital groups as determined by one-way ANOVA (F (3,3233) = 10.3, p = .000). A Tukey post-hoc test revealed that excess readmission penalties are statistically significantly lower for hospital groups that patients rate highly for providing Discharge Instructions (p=.000). COPYRIGHT © STUDER GROUP

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( http://www.nextstepincare.org

) Free Toolkit To Engage Family in Planning Transitions

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Tour of the online training tool

https://ccnm.thinkculturalhealth.hhs.gov/default.asp

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Seven Skills For High Engagement

1. Being Authentic – connect to the WHY 2. Having Empathy – this is HARD work 3.

Knowing when to push… and when to hold back 4. Move conversation back to point – mission driven 5. Breaking actions into understandable steps – aligned with the goals 6. Limiting and sequencing change – keep informed COPYRIGHT © STUDER GROUP

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Slide 41

Sequence Priority Initiatives

Leadership Evaluations Aligned to Goals 2.

Peer Interviewing/Selection 3.

Round for Outcomes 1.

Round on staff 2.

Nurse leader rounding on patients 4.

Key words at key times (AIDET and Individualized Patient Care) 5. Hourly Rounding ℠ 6. Bedside Report (Handover) 7.

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Managing Complex Change

Vision Vision Vision Vision Vision Vision Skills Skills Skills Skills Skills Skills Incentives Incentives Incentives Incentives Incentives Incentives Ambrose, 1987, Managing Complex Change Slide 43 Resources Resources Resources Resources Resources Resources Action Plan Action Plan Action Plan Action Plan Action Plan Action Plan

Change Confusion Anxiety Gradual Change Frustration False Starts

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Seven Skills For High Engagement

1. Being Authentic – connect to the WHY 2. Having Empathy – this is HARD work 3.

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Slide 44

“Rate honesty and ethical standards of people in these fields”

Gallup Poll: http://www.gallup.com/poll/159035/congress-retains-low-honesty-rating.aspx

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Most trusted but are we happy?

 Nursing rated #2 LEAST happy profession    Compensation Growth opportunities

Workplace culture

“

Nurses have more issues with the culture of their workplaces, the people they work with, and the person they work for”

CareerBliss.com

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Most trusted, but are we engaged?



Engaged

– work with passion and feel a profound connection to their company, drive innovation and move the company forward 

Not-engaged

– essentially “checked-out” or sleep-walking through their day, putting time in but not energy or passion in their work  

Actively dis-engaged-

not only unhappy at work but actively acting out their unhappiness.

Every day these workers undermine what their engaged co-workers accomplish.

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Business Case For Engagement

Median differences between top-quartile and bottom-quartile units in Associate engagement were:



-12% in customer ratings



-18% in productivity



-49% in safety incidents

 

-37% in absenteeism -41% in patient safety incidents

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#1 Strategy: Rounding for Outcomes on Associates

“Rounding on Associates allows us to truly connect with our most-

valued “asset” and gather feedback every day on our efforts to create a great place to work. But more important, it allows us to build relationships with and recognize each of our primary nurses for the meaningful work they do everyday.”

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Rounding on Staff: Leader WIIFM

Rounding questions Foster team development, take a pulse of the Department & provide insight into staff skills & behaviors 1. Personal Connection 2. What is working well? 3. Anyone I can recognize? Why?

4. What systems or processes are not working well?

5. What can we do to improve them?

6. Do you have the tools you need to do your job?

What’s one way we can improve… 8. Is there anything you need from me?

9. Thank you for making a difference!

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Slide 50

Rounding – WHY?

 Create strong personal relationships (caring)  #1 way to show you care about them FIRST – as a person  And SECOND – as their leader  Develops a culture of recognition with focus on positives (appreciative)  Creates better operational performance (efficiency)  Communicates 1:1 on key issues (responsible)  Promotes transparency (trustworthy)

Improved Employee Engagement

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Slide 51

Rounding on Staff Aligns With Creating Joy, Meaning and Workforce Safety

1. Am I treated with dignity and respect by everyone, every day, in each encounter?

2. Do I have what I need: education, training, tools, financial support, encouragement, so I can make a contribution to this organization that gives meaning to my life?

3. Am I recognized and thanked for what I do?

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Communication Tools For Employees



Employee Forums



Communication Boards



Stoplight Reports



Rounding



Huddles



Department Meetings



Newsletters



Supervisory Meeting Model

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High Impact Suggestion for Improvement # 1 – Elevate Accountability at ALL Levels

WHY ? We must engage the hearts and minds of all staff to promote effective communication and coordination of care. With a scale of Always, every interaction impacts the patient perception of quality care.



Accountability for Leaders

 Align evaluations to measureable outcomes 

Accountability for Staff

 Rejuvenate the behavior standards and be aggressive about managing people who do not uphold the values  Expand HCAHPS education to all staff and their role  Round on staff to promote engagement COPYRIGHT © STUDER GROUP

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Slide 54

High Impact Suggestion for Improvement # 2 – Use Key Words at Key Times

WHY?

Key words reflect a communication style that improves the quality of information provided by every person in every interaction. This makes care safer, patients less anxious and informed about their care.

 Identify key times (defining moments that occur during times of vulnerability that create memorable experiences (positive or negative)  Train and validate all employees on the concept of communicating with empathy and compassion, “managing up”, AIDET and Narrating Your Care COPYRIGHT © STUDER GROUP

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Slide 55

High Impact Suggestion for Improvement # 3 – Nurse Leader Rounding on Patients

WHY?

Rounding is the best way to PROACTIVELY connect with patients to ensure the delivery of quality care, validate staff behaviors, and recognize employees living the values.

 Every patient – every day with documentation of themes  Reduces variance in frequency of behaviors and ensures they are hardwired (real-time recognition or coaching)     Links to actionable information to drive results Hourly rounding Bedside handover White/care boards complete COPYRIGHT © STUDER GROUP

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Slide 56

Patient Care Model

Hourly Rounding

Nursing and Patient Care Excellence

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Slide 57

Learning Objectives

Define a “Culture of Always” from an operational and service perspective 2. Describe seven skills great leaders use for high engagement 3. Ten questions to ask if you are not getting results Slide 58 COPYRIGHT © STUDER GROUP

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Ten Questions To Ask If Not Getting Results

Was education provided to all involved regarding the expected behaviors?

Was the WHY over-communicated about the expected behavior?

How do you measure and communicate impact to goals?

Has leadership made it clear it is mandatory, not optional?

Is leadership role-modeling the behavior?

Has the behavior been taught using role-play/skill lab?

Are you measuring and validating competency?

Are leaders noticing and giving positive feedback?

Are leaders managing gaps in performance on the spot?

10.

Is it clear there are consequences for non-compliance, including termination ?

Do you have a culture of ALWAYS?

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Slide 59

References and Resources

www.hcahpsonline.org

www.cms.gov

Kotter, J.P. (2002). The heart of change. Boston: Harvard Business Press. Mackoff, Barbara and Pamela Kaluer Triolo. Ten Signature Behaviors of Great Nurse Managers Ritter, J. (2012). Resistance to change and change management. In N. Borkowski (Ed.), Organizational behavior in health care (pp. 373 397). Boston: Jones & Bartlett. Studer, Quint. A Culture of High Performance. Firestarter Publishing. 2013 COPYRIGHT © STUDER GROUP

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Slide 60

Kansas Hospitals National Rank for Improvement in One Year: 30 th in Responsiveness; 33 th in Nurse Communication; 26 th in Communication about Meds; 44 th in Pain Management

Kansas Acute Care vs Critical Access Hospitals Patient Experience of Care Improvement in One Year in Top Box Acute Care Hospitals Critical Access Hospitals 2,50 2,07 2,00 2,00 1,50 1,43 1,50 1,29 1,14 1,14 1,13 1,00 ,71 ,50 ,27 ,08 ,04 ,00 -,04 -,06 -,19 -,29 -,31 -,50 ,64 -1,00 -,85 -1,00 -1,50 Название оси COPYRIGHT © STUDER GROUP

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Medicare Spending Per Beneficiary

Kansas vs National Avg. Medicare Spending Per Beneficiary Kansas Average National Average 1 to 3 days Prior to Index Hospital Admission $255 $256 During Index Hospital Admission $10 865 $10 399 1 through 30 days After Discharge from Index Hospital $7 603 $8 049 The Complete Episode of Care $18 724 $18 704 $0 $5 000 $10 000 $15 000 $20 000 0,99 Kansas Hospitals vs National Average MSPB Efficiency Domain Score 0,98 0,98 0,97 0,96 0,95 0,94 0,93 0,92 0,94 Kansas Hospitals National Avg.

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Nurse Communication Drives VBP Results Both Clinical Process of Care and Patient Experience of Care VBP Scores Are Influenced by the Quality of Nurse Communication

63,0 62,0 61,0 60,0 59,0 58,0 57,0 56,0 65,0

Average VBP Clinical Process of Care Domain Score by Hospital Ranking in Nurse Communication

64,2 64,0 59,0 60,6 61,2 0-24th Percentile 25-49th Percentile 50-74th Percentile 75-99th Percentile Hospital Ranking in Nurse Communication 40 30 20 10 80

Average VBP Patient Experience of Care Domain Score by Hospital Ranking in Nurse Communication

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Nurse Communication Drives Financial Reimbursements or Penalties Both VBP and Excess Readmission Penalties Are Influenced by the Quality of Nurse Communication

0,25%

2014 Average Value Based Purchasing Bonus or Penalty by Hospital Ranking in Nurse Communication

0,22% 0,20% 0,15% 0,10% 0,05% 0,08% 0,00% -0,05%

0-24th Percentile 25-49th Percentile 50-74th Percentile 75-99th Percentile

-0,10% -0,03% -0,15% -0,20% -0,16% Hospital Ranking in Nurse Communication

2014 Average Excess Readmissions Penalty by Hospital Ranking in Nurse Communication

0,00% -0,05%

0-24th Percentile 25-49th Percentile 50-74th Percentile 75-99th Percentile

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Barriers to Communication Hospital Staff Responses to the 2012 Hospital Survey on Patient Safety Culture Agency for Healthcare Research and Quality (AHRQ)

 Staff feel free to question the decisions of those with more authority - 47%  Staff feel like their mistakes are held against them - 50%  Important patient care information is often lost during shift changes - 51%  We have enough staff to handle the workload - 56%  It is often unpleasant to work with staff from other hospital units - 59%  Staff are afraid to ask questions when something does not seem right 63%  My supervisor/manager overlooks patient safety problems that happen over and over - 76% COPYRIGHT © STUDER GROUP

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