Upload
sheena-brown
View
214
Download
0
Tags:
Embed Size (px)
Citation preview
HCAHPS Update and Impacting The Patient
Perception of Care January 28, 2009
Karen Cook, RN, BSNwww.studergroup.com
Nina Setia, Adm. Director, Service ExcellenceHackensack University Medical Center
Webinar Agenda
Understanding the Data
Priority Initiatives and
Cool Ideas
Hardwiring Excellence and
HCAHPS
What it is: An update on HCAHPS
data and overview of recommended
strategies to improve the patient
perception of care.
What it is NOT: A tutorial on the survey tool or
submitting data.
15 min
15 min
20 min
Commit to Excellence
Build a CultureAround Service
Measure theImportant Things
Create and DevelopGreat Leaders
Focus on EmployeeSatisfaction
Build IndividualAccountability
Recognize andReward Success
Communicateat All Levels
Align Behaviorswith Goals and Values
Nine Principles – A Culture of “Always”®
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…
41
21
20
19
Patient Experience Physician Decision
Hospital Reputation Location
HCAHPS Aligns with Industry Trends
“…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
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 is HCAHPS
Why is it important?
How will it be used?
What Do Patients Want From Us?
Communication with doctorsCommunication with nursesResponsiveness of hospital staffPain managementCommunication about medicinesDischarge informationCleanliness of hospital environmentQuietness of hospital environmentOverall rating of hospitalWillingness to recommend the hospital
Their perception of our
performance is a reportable and
tangible reflection
of yourreputation
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. Safe2. Effective3. Patient-Centeredness4. Timely5. Efficient6. Equitable
Institute of Medicine, Crossing the Quality Chasm: A new Health System for the 21st century, March, 2001
“Always” is the response scale
most highly associated with
loyalty
How Will HCAHPS Reinforce Focus on Quality?
Patient-Centered care is a quality indicatorQuality no longer the domain of just the cliniciansGives a voice to the patient perception of safetyHighlights communication issues/barriersPatient-centered care actively involves patients in their careMore senior leaders are engaged and interested in delivering patient-centered care
Physician- hospital relations
Disaster Preparedness
Patient Satisfaction
Governmental mandates
Financial Challenges
Personnel shortages
1%
2%
2%
9%
16%
22%
26%
30%
32%
41%
43%
77%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Patient Safety and Quality
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 Aligns with CEO’s Top Issues - (2008)
7%increase
Patient Satisfaction 5% increase
Care for the uninsured
Capacity
Technology
Issues about not-for profit status
Malpractice insurance
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
Standardization AcceleratorsMust Haves®
Performance Gap
Leader Evaluation
Leader Development
Foundation Breakthrough
STUDER GROUP:
Rev 11.07
Must Haves®
RoundingThank You NotesEmployee SelectionPre and Post Phone CallsKey Words at Key Times
(Principle 3, 5, 6, & 9)
Re-recruit high and middle performers
Move low performers up or out
(Principle 4)
Agendas by pillar
Peer interviewing
30/90 day sessions
Pillar goals
(Principle
1 & 2)
Leader Eval MgrSM (LEM)
Staff Eval MgrSM (SEM)
Discharge Call MgrSM (DCM)
Rounding MgrSM
Idea ExpressSM
Aligned Goals Aligned Behavior Aligned Process
Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results
(Principle 4 & 8)
Implement an organization-wide leadership evaluation system to hardwire objective accountability
(Principle 7)
Technology is Driving Change…
Consumers will have the same access to medical information as providers have… and more time to explore it80% of American population use internet - including Baby BoomersPatients will expect more and tolerate lessPublic reporting is forcing a new direction in patient-centered careMedicare will become the #1 customer of every hospital
Source: Health Management Technology, Aug 1999, Harris Poll, 2007 and Press, Ganey
QQUUAALLIITTYY
QQUUAALLIITTYY
SSEERRVVIICCEE
SSEERRVVIICCEE
GGRROOWWTTHH
GGRROOWWTTHH
PPEEOOPPLLEE
PPEEOOPPLLEE
FFIINNAANNCCEE
FFIINNAANNCCEE
Passion to make healthcare
betterServing the healthcare
needs of the COMMUNITY
Taking Better Care of Patients
MISSION
VISION
STANDARDS OF PERFORMANCE: VALUES
HCAHPS Aligns With A Balanced Approach
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 performanceFor 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 dataAs 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. FY2009: 1st reporting year for VBP
– Payment: 100% public reporting
– Measures reported are basis for FY2009 “attainment” scores; FY2008 provides baseline for “improvement” calculations
2. FY2010: 2nd reporting year
– Payment: 50% based on performance, 50% on public reporting (potential) (70% clinical quality and 30% HCAHPS metrics)
3. 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!
Media Coverage March 29, 2008
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
Quick Facts About HCAHPS
Scale - top box will be reportedAlways, 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 hospitalsCase 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
QuestionsRWHC
(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%
HCAHPS ComparisonApril 1, 2007 to March 31, 2008
Green SG Partners above US Average Yellow Yellow SG Partners equal US Average Red Partners below US Average
Sample of Board CommunicationHCAHPS results: 4th reporting period (April 2007-March 2008 discharges)
Oct 06 - Jun 07 Discharges
Oct 06 – Sept 07 Discharges
Jan 07 – Dec 07 Discharges
April 07 – March 08 Discharges
July 07 – Jun 08 DischargesSuppression linked to loss of APU
2007
Oc
tN
ov
De
c
Ja
nF
eb
Ma
r
Ap
r
Ma
yJ
un
Ju
l
Au
g
Se
p
Oc
tN
ov
De
c
Ja
n
Fe
bM
ar
Ap
r
Ma
y
Ju
n
Ju
ly
Au
g
Se
p
Oc
tN
ov
De
c
Ja
n
Fe
b
Ma
r
Ap
r
Ma
y
Ju
n
2006 2008 2009
Estimated Timeline We are here: Public Reporting data from April 2007-March 2008
Oct 07– Sept 08 Discharges
Jan 08– Dec 08 Discharges
Apr 08– Mar 09 Discharges
Ju
ly
Au
g
Se
p
Oc
t
No
vD
ec
….but we are REALLY here!
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
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 policyreflects “acceptability” of pain levelRe-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 itProvided education to standardize practice within each unit and across all unitsRounding with nurses
Pain Initiative: Unit 4 West
0
10
20
30
40
50
60
70
80
90
100
84
85
86
87
88
89
90
91
92
HCAHPS Pain 67 69 62 68 73 88
Patient Satisfaction Pain 87.8 87.4 86.6 88.2 89.6 90.9
1Q07 2Q07 3Q07 4Q07 1Q08 2Q08
HCAHPS:
•“How often was your pain controlled?
•“How often did the staff do everything they could to help you with your pain?”
Patient Satisfaction:
•“How well your pain was controlled”
Patient Care Initiatives
Quality Leadership Steering Committee for Service ExcellenceStandardize practices, materials and dashboardsDevelop internal coaching experts
Re-launched hourly rounding on all unitsPiloted 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 callsKey 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
Initiatives
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
1st reporting period: Oct 06-Jun 07 7th reporting period: Jan-Dec 08 8th reporting period: Apr 08-Mar 09
US Avg NJ Avg
Discharge follow up
phone calls
Re-launched hourly
rounding, assessed on
discharge phone calls
Increased discharge
calls,Re-launched
hourly rounding
Pain initiative
Hourly rounding,
key words, TCAB
“Quiet Time”
Key Initiatives to Deliver Patient-Centered Care
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
Top Priority
Ea
se o
f Im
ple
me
nta
tio
n
Har
der
E
asie
r
Impact on Patient PerceptionLower Higher
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 Nevero Sometimeso Usually o Always
Studer Group Tactics:
Individualized patient careSit at bedside to review care planWhite boards
Hourly RoundingBedside Shift ReportPeer Interview for communication and empathy talentsAIDETBehavior standards
Slide format adapted from Press, Ganey
Key Words at Key Times is a Must HaveInitiative #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
Source: The Physician Executive, June 2004
1. Focus on Issues: Rounding, AIDET, Key Words2. Educate the Patient: Rounding, AIDET, Managing Up3. Enlist the Patient: Rounding, Key Words4. Share Decisions: AIDET, Key Words
In this Article….
“The most common cause of malpractice suits is failedCommunication with the patients and their families.Explore ways that better communication could leadTo fewer malpractice claims and allow health careOrganizations to reduce litigation costs.”
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
A
I
D
E
T
Acknowledge
Introduce
Duration
Explanation
Thank You
Improved clinical outcomes and
increased patient and physician
satisfaction
DecreasedAnxiety
IncreasedCompliance
+
AIDET – Five Fundamentals of Communication
Key Words - Designed Handoff’s
I have worked with Cindy for over two years and she will take great care of you.
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?
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.
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?
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.
A
I
D
E
T
Manage Up Co-Workers by Communicating Skill and Training
Source: Sacred Heart Hospital, Pensacola, FL
Patient Satisfaction
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
Rounding on Rounding on Employees, Employees,
Patients, Patients, Physicians Physicians and Other and Other
DepartmentsDepartments
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”
Initiative #2
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
Direct reports – 100% monthly
(All staff are rounded at least once per quarter)
3 employees x 15 minutes = 45 min
+ 15 minute F/U
= 60 minutes/day
Concern and Care – relationship connection and open lines of communication
What is Working Well – focus on positives – 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
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.)
Study conducted by Dr. Gerald Graham, Management Professor at Wichita State UniversityMotivating Today’s Employees, Bob NelsonTalent+, 1998
Top Five Workplace Incentives
1. Written Thanks From Manager/Executive Team Leader
2. Personal Thanks From Manager
3. Promotion for Performance4. Public Praise5. Morale-Building Meetings
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…”
“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 PositiveCompliment to Criticism Ratio
3 to 13
compliments1 criticism
Positive!
2 to 12
compliments1 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 membersProvide quality information and feedbackEngage in higher level decision makingManage conflict skillfullyUnderstand their role and responsibilityReduce 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 communicationPromotes a sense of “well-being”Decreases anxiety Exceeds expectationsProvides “individualized” care
Do I take responsibility and ownership of my department?
Do I Manage Up my team and my organization?