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© 2016 The Center for Health Design
How Facilities Can Improve HCAHPS
ISHE Fall Conference
Lynn Kenney, Director of Industry Relations
The Center For Health Design
© 2016 The Center for Health Design
Improving the connection between health
and the built environment…
© 2016 The Center for Health Design
Learning Objectives
1. Why we do what we do-improve health & safety
2. HCAHPS and patient satisfaction and how it impacts hospital reimbursement and reputation
3. Review the people, process, place framework
4. Review case studies and examples that illustrate how facilities professionals impact HCAHPS and patient experience
5. Review resources and tools
© 2016 The Center for Health Design
Where to Begin?
Experience Your Facility Through the Eyes
of the Patient
© 2016 The Center for Health Design
What Is Involved?
© 2016 The Center for Health Design
HCAHPS – Hospital Consumer Assessment of Healthcare Providers and Systems Survey
32 Survey Questions Measure Patient
Experience of Care Dimensions
1. Communication with Nurses
2. Communication with Doctors
3. Responsiveness of Hospital Staff
4. Pain Management
5. Communication about Medicines
6. Cleanliness and Quietness of Hospital
Environment
7. Discharge Information
8. Overall Rating of Hospital
© 2016 The Center for Health Design
The CMS HCAHPS Survey
http://hcahpsonline.org/files/March%202016_Survey%20Instruments_English_Mail.pdf
© 2016 The Center for Health Design
Survey of Patient Experiences http://www.medicare.gov/hospitalcompare
© 2016 The Center for Health Design
So many phrases and terms… • Patient-centered design
• Patient-centered care
• Patient and staff satisfaction
• Patient and family experience
• Px
• HCAHPS
• CAHPS
© 2016 The Center for Health Design
Why is there so much emphasis on patient-centered care?
ACA
ROI/Reimbursement
Outcomes
The HCAHPS Impact
Reputation/
Branding
Staff, Patient and Family Experience
© 2016 The Center for Health Design
Hospital Value Based Purchasing Domains:
• Patient experience measured using the
HCAHPS survey
• Clinical Process of care measures
• Outcome measures - Patient
safety/mortality indicators
• Efficiency Measures beginning in FY 15 - Medicare Spending/ Beneficiary
Efficiency Outcomes
Patient Experience
Processes of Care
Can Lose up to 2.0% of Medicare payments by FY 17
Slide by Eileen Malone
Patient experience & safety outcomes are now tied to reimbursement
© 2016 The Center for Health Design
Expansion of the CAHPS Survey Program
Hospitals Hospital Consumer Assessment of Healthcare Providers and Systems Survey
(HCAHPS)
Outpatient facilities Outpatient and Ambulatory Surgery CAHPS (OAS CAHPS)
Emergency Departments Emergency Department Patient Experiences with Care (EDPEC) Survey
“The surveys provide patient experience data that enables comparison of facilities across the nation and promotes effective communication and coordination.” www.cms.gov
© 2016 The Center for Health Design
Why is there so much emphasis on patient-centered care?
Patient-
Centered Care
More Transparency More Consumer-driven More Competitive Reimbursement tied to
performance across the continuum of care
© 2016 The Center for Health Design
Patient Experience (Px)
People-A Culture of Caring
Place-Physical Environment
Process-Process Improvement
© 2016 The Center for Health Design
Solving a Common Hospital Problem: Noisy at Night
Infrastructure (Place) Culture (People) (Process) Reengineering
Building •Single patient rooms •Use of sound absorbing materials •Design to separate noisy entities (ice machine)
Identify Desired End-State • Identify current state: decibel level, HCHAP score, & staff satisfaction re: noise •Establish sense of urgency •Identify target goals
Staff Interventions •Nighttime care guidelines •Quiet voices •Resupply and equipment movement
Technology •Hands-free communication •Beepers on vibrate •No overhead paging
Develop Noise Reduction Campaign Plan •Set the stage using research and best practices •Clarify values, vision
Patient Interventions •Rights •Earplugs •Television and radio headphones
Equipment •Fix squeaks •Decrease equipment volumes – link to hands-free devices
Measure and Reward Progress •Celebrate successes •Find and tell the best stories
Visitor Interventions •Orientation to noise reduction •Cell phone use
© 2016 The Center for Health Design
Patient Experience/HCAHPS Case Studies
• Quiet/Privacy (question 9) • Responsiveness (question 4) • Communication (questions 1,2,5,6,7) • Cleanliness (question 8)
•
© 2016 The Center for Health Design
Quiet-Privacy (Question 9)
© 2016 The Center for Health Design
Key elements for improving the patient experience
The Beryl Institute
© 2016 The Center for Health Design
Survey of Patient Experiences http://www.medicare.gov/hospitalcompare
© 2016 The Center for Health Design
“How am I supposed to sleep with all this
racket?”
© 2016 The Center for Health Design
Reducing noise
Private rooms reduce exposure to
noise levels that can cause stress and
negative health effects Ulrich et al., 2008.
Reduced noise levels improved sleep
and mood, better pain tolerance Janssen et al., 2000
© 2016 The Center for Health Design
Columbia-Bassett Medical School Quiet Project
© 2016 The Center for Health Design
Quiet - PRIVACY Case Study by Dr. Lorissa McAllister at Enviah
ROOM or UNIT modification for
Improved Outcomes COMMUNITY HOSPITAL-
MICHIGAN
© 2016 The Center for Health Design
1,600 people didn’t like our
physical surroundings –
#1 Sound and #2 Privacy
complaints
10
% D
islik
ed
Quiet – PRIVACY COMMUNITY HOSPITAL-MICHIGAN
© 2016 The Center for Health Design
Pre-Panel Comments Related to Sound
Jan-May 2012 (study conducted by Enviah)
• Arbor Question:
WAS THERE ANYTHING ELSE ABOUT THE HOSPITAL'S PHYSICAL SURROUNDINGS THAT YOU FOUND UNPLEASANT? (IF YES) PLEASE EXPLAIN:
• Patient Comment: “The emergency room is pretty old. The rest of the hospital is updated and modern looking. The emergency room is not. There is not a lot of patient privacy. Most of the rooms have two beds in them. You can hear other patients' responses to questions and all of their personal information. I do not feel that is good.”
Quiet – PRIVACY COMMUNITY HOSPITAL-MICHIGAN
© 2016 The Center for Health Design
• Arbor Question:
DID YOU FEEL THAT THE HOSPITAL TOOK ADEQUATE PRECAUTIONS FOR
YOUR SAFETY? (IF NO) PLEASE EXPLAIN:
• Patient Comment: “I do not think that people being able to hear all of your information is safe”.
Quiet – PRIVACY COMMUNITY HOSPITAL-MICHIGAN
Pre-Panel Comments Related to Sound
Jan-May 2012
© 2016 The Center for Health Design
June 2012 –
1st Month Post Panels
Improvement!
Zero negative comments
about sound.
5%
dissatisfied
Quiet – PRIVACY COMMUNITY HOSPITAL-MICHIGAN
© 2016 The Center for Health Design
Privacy for Ambulatory Surgery Patients at Bassett Healthcare
© 2016 The Center for Health Design
Responsiveness (Question 4)
© 2016 The Center for Health Design
No Passing Zone Codes
Call Lights:
Red Flashing Bath, toilet or shower / Staff assist Door will typically be closed, knock on door to let patient know that you hear them and will get help. If restroom is empty, ok to cancel call light.
White Steady Normal calls Flashing Bulb, Cord, Bed, Pillow speaker Pulled Out & Bed Exit alarm
Blue Flashing Code Blue Calls Support Services can help by removing equipment, chairs or other guests.
Green Flashing RN Service Needed Solid RN in Room
Yellow Flashing PCA Needed Solid PCA in Room
No Passing Zone-Bassett
Support & Ancillary Services Mobilized!
© 2016 The Center for Health Design
Logistics and Supplies Matter
© 2016 The Center for Health Design
Communication (Questions 1,2,5,6,7)
© 2016 The Center for Health Design
Expansion of White Boards and the 5-10 Rule…
© 2016 The Center for Health Design
Wayfinding: Reducing Anxiety
NSHE
© 2016 The Center for Health Design
Wayfinding
© 2016 The Center for Health Design
ROOM or UNIT modification for Improved Outcomes
VIRGINIA Communication - ENGAGEMENT Case Study
© 2016 The Center for Health Design
ROOM or UNIT modification for Improved Outcomes HOSPITAL- FLORIDA
Communication - ENGAGEMENT Case Study
© 2016 The Center for Health Design
Rooms that have hand wash
sinks that face patients have an
increased mean scores of 1.3-
7.31
point
Lorissa MacAllister 2014, All rights Reserved, Do not distribute or cite
Location of the first encounter-communication
Study by Dr. Lorissa McAllister
© 2016 The Center for Health Design
Rooms that have the head
of the bed inside the room
have an increased Mean
Score of 4.55 points
Head of the bed at the door
Head of the bed in the room
Lorissa MacAllister 2014, All rights Reserved, Do not distribute or cite
Location of head of bed
Communication - ENGAGEMENT
Study by Dr. Lorissa McAllister
© 2016 The Center for Health Design
Cleanliness (Question 8)
© 2016 The Center for Health Design
Continuous Improvement
Cleanliness and Clutter
Cleanliness and Lighting
© 2016 The Center for Health Design
Before
After
ROOM modification=Improved Outcomes DOW HEALTH SERVICES-MICHIGAN Satisfaction improved by 25%
CLEAN – PRIDE Case Study by Dr. Lorissa McAllister
© 2016 The Center for Health Design
Tools, resources, and next steps…
© 2016 The Center for Health Design
Make Patient Experience Part of Routine Activities
1. Get involved in the PI committee
2. Accreditation – Look at Px elements during EOC Rounding
3. Offer Ideas and Suggestions
1. Get involved in HCAHPS committees
4. Know Your Scores! http://www.medicare.gov/hospitalcompare
5. Familiarize yourself with best practices
© 2016 The Center for Health Design
Know your “HCAHPS” scores
and make sure your solution
provider know them too! http://www.medicare.gov/hospitalcompare
© 2016 The Center for Health Design
HCAHPS Worksheet
Infrastructure (place) Culture (people) Process Reengineering
Building Identify Desired End State Staff Interventions
Technology Develop A Campaign
Patient Interventions
Equipment Measure and Reward Progress Visitor Interventions
© 2016 The Center for Health Design
Refer to the list in the HPOE Guide…
Source: The HPOE Guide www.hpoe.org/physicalenvironment
© 2016 The Center for Health Design
Material Selections That Support Px, Maintenance and EVS Processes
Limiting Paint Selections
• To decrease confusion in matching when doing touch ups as well as limiting stored paint
Ceiling Tiles
• Understanding how often ceiling tiles are moved around as they need to gain access to above –ceiling pipes, etc. and planning tiles to make their lives easier. (Less edges to break)
Lighting Strategies
• Sharing lighting success strategies related to LED advancements, and understanding the process in switching an all-fluorescent facility over to LED
Flooring
• Choose dark colored flooring or flooring with specks to reduce the appearance of shoe marks which can impact perception of cleanliness
Source: The HPOE Guide www.hpoe.org/physicalenvironment
© 2016 The Center for Health Design
Words and actions to live by…
The trick to remembering the big picture is to remember to keep experiencing your facility through the eyes of the patient.
People, Process, Place
© 2016 The Center for Health Design
Resources
www.hope.org www.ashe.org
www.healthdesign.org/knowledge-repository
© 2016 The Center for Health Design
Thank you for all that you do to
improve the patient experience!
Resources are available at: www.healthdesign.org/knowledge-repository www.ashe.org www.hpoe.org [email protected]