The Link Between Patient Experience and Patient and Family ...€¦ · Patient and Family Engagement Learning Collaborative’s First Annual Patient and Family Engagement Summit Sari

HIIN Patient and Family Engagement Summit July 21, 2017

Florida Hospital Association 1

The Link Between Patient Experience and

Patient and Family Engagement

“Powerful Partnerships: Improving Quality and Outcomes”

Mission to Care Florida Hospital Association Hospital Improvement Innovation Network

Patient and Family Engagement Learning Collaborative’s First Annual Patient and Family Engagement Summit

Sari Siegel, Ph.D., CPHQ, Westat

July 21, 2017

Definition of “Patient Experience” vs. “Patient Satisfaction”

“Patient experience is the sum of all interactions, shaped

by an organization’s culture, that influence patient

perceptions across the continuum of care.” - Beryl Institute

– “Everything we say and do that affects our patients’ thoughts,

feelings, and well-being.” -Society of Hospital Medicine

“Patient satisfaction, on the other hand, is about whether a

patient’s expectations about a health encounter were met.” –Agency for Healthcare Research and Quality (AHRQ)

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How can we improve patient experience?

Cannot improve what we cannot measure: need data

CMS asked AHRQ to develop HCAHPS to:

– Provide objective and meaningful comparisons of domains of

hospital care that are important to patients

– Create incentives for hospitals to improve

– Enhance public accountability

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HCAHPS: Standard 32 questions

Topics include…

– Communication with nurses and

doctors

– Pain management

– Responsiveness

– Environment clean/quiet

– Discharge information

– Care transitions

– Overall rating

– Willingness to Recommend

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Limitations of HCAHPS in improving patient experience

Despite best efforts to standardize,

patient perceptions vary

HCAHPS data gives insight into

where to prioritize improvement,

but does not provide a strategy to

improve patient experience

HCAHPS does not offer data on

individual providers

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Value-based purchasing incentivizes patient experience

6 Source: Centers for Medicare & Medicaid Services, Hospital Value-Based Purchasing webpage

FY 2017 CMS Hospital VBP topics and weights

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/Hospital-Value-Based-Purchasing



Patient engagement is key to positive patient experience

“…even a score of high satisfaction on a

validated survey does not necessarily imply

high quality care has been provided. To be

successful in improving health services to

meet patients’ needs and preferences,

providers must have comprehensive

patient engagement strategies that

include the patient and/or their family

members as full partners in the enterprise.”

– Canadian Foundation for Healthcare Improvement

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“The emerging evidence is that patients who are actively

involved in their health and health care achieve better health

outcomes, and have lower health costs, than those who aren’t.”

- Susan Dentzer, Health Affairs, in “Rx for the ‘Blockbuster Drug’ of

Patient Engagement”

Cite: Dentzer S. "Rx For The ‘Blockbuster Drug’ Of Patient Engagement"; Health Aff February 2013 vol. 32 no. 2 202

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Patient engagement is key to positive outcomes



HCAHPS is “but one component” of patient engagement

“Collection of satisfaction and experience data is but one

component of a broader patient engagement strategy. To

overcome some of the limitations of [patient] surveys,

providers may begin asking more open-ended questions or…

form patient/family advisory councils, participatory models

that are reflective of genuine patient involvement. Patients can

also be intimately involved in efforts to (re)design care.”

– Canadian Foundation for Healthcare Improvement

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Low patient satisfaction and experience is a national problem

Source: D. Schulke & C. Brady, FHA AHRQ HCAHPS Learning Community, August 2013

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HCAHPS data from neighboring states vs. U.S.

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*Contains the average "top-box" scores for each of the eleven HCAHPS measures at the state and national level.

Source: Hospital Compare April 2017 upload

Critics and Counter-Arguments

Critics suggest

Patients are not clinical experts and

HCAHPS may reflect frustration if the

care does not match expectations

– J.J. Fenton, MD, MPH found

association between higher satisfaction

and 1) higher utilization, 2) higher

mortality

Patient experience is also influenced

by experience at home, after

discharge, so it is “beyond the scope of

hospital interventions”

Sources: “Using Information Therapy to Put Patients First” by A. Malpani, MD; Fenton JJ et al., The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Arch Intern Med 2012 March.12

http://www.hcahpsonline.org/Files/April_2017_ Summary Analyses_States.pdf



Rebuttals about importance of PFE on patient experience

PFAs counter

“The very argument that patients do not act in their best self-interest

is paternalistic on its face and is indicative of the challenges in

getting staff/physician buy-in on PFE.” – PFA

“Patients know when their environment is unclean or loud.” – PFA

“As average LOS decreases over time, transitions are rightfully a part of

our care experience.” - PFA

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Citation: PCORI Transitional Care Patient Partner Meeting, Nov 2016

Examples from Partnership for Patients Evaluation: Patient

safety and decreased readmissions linked with PFE

Among Vizient’s 146 HEN hospitals,

those meeting 4+ PFE metrics had

consistently lower rates of falls with

injury (vs. those meeting 0-3

metrics)

Minnesota’s HEN: hospitals meeting

4+ PFE metrics had consistently

lower rates of potentially

preventable readmissions (vs. those

meeting 0-3 metrics)

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RARE: Reducing Avoidable Readmissions

Effectively in Minnesota

Results:

7,030 readmissions avoided (as of Q3

2013)

– Exceeded original goal of 6,000

readmissions

Helped patients spend 24,844 more

nights sleeping comfortably in their own

beds

Reduced inpatient costs by an estimated

$55 million

2013 winner of the John M. Eisenberg

Patient Safety and Quality Award for

Innovation in Patient Safety and Quality

Source: Vizient, January 201615

HEN 1.0 Learning: Correlation of Adverse Event Areas & PFE

Adverse Event AreaPFE Total Score

(rs)Adverse Drug Events 0.03

Venous Thromboembolism 0.28*

Pressure Ulcers 0.17*

Injuries from Falls and Immobility 0.11*

Catheter-Associated Urinary Tract Infections 0.12*

Readmissions -0.03

Early Elective Deliveries 0.23*

Other Obstetrical Adverse Events 0.17*

Ventilator-Associated Pneumonia 0.20*

Central Line-Associated Blood Stream Infections 0.0001

Surgical Site Infections -0.04

*p<= 0.05; ** Spearman Correlation 16



PFE: simultaneously improving clinical outcomes and patient

& staff experience

CMS “5 Star Hospitals” (i.e., has

high HCAHPS scores) has fewer

hospital-acquired infections

Employee perception of

teamwork among units is

positively associated with patient

experience and negatively

associated with infection rates.

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Leveraging the “untapped

healthcare workforce”

(i.e., family and friends) has added

benefit: helps prepare family for

involvement in post-discharge care

When patients perceive their

hospital as clean, the actual rate of

infection is lower.

Source: Press Ganey

Beyond clinical outcomes, PFE improves patient experience

18 Graphic courtesy of Cancer Care Ontario

https://www.cancercare.on.ca/pcs/person_centred_care/



Engage patients and families

Engage staff to improve work environments

– “We can only treat patients as well as we treat

one another.”

- Barbara Balik, RN, Ed.D., IHI senior faculty member

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How do we improve patient experience?

Improving patient experience by improving staff experience

Kutney-Lee, McHugh, et al. examined

relationship between nursing and

patient satisfaction across 430

hospitals.

– Nurse work environment significantly

positively associated to all HCAHPS

patient satisfaction metrics

– Mean % who “would definitely

recommend”: 10% points higher in

hospitals with better vs. worse nurse

work environments (69.9% vs. 59.6%)

20 Source: Kutney-Lee A, McHugh MD, et al. Nursing: A Key to Patient Satisfaction. Health Affairs July/Aug 2009, vol 28, no 4.



Interdependence of staff & patient experience

Source: D. Schulke & C. Brady, FHA AHRQ HCAHPS Learning Community, August 201321

Teamwork Drives HCAHPS Likelihood to Recommend (LTR)

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High: Rm

Clean96.5% LTR

Low: Rm Clean

88.5% LTR

High: Rm Clean

85.4% LTR

Low: Rm Clean

72.8% LTR

High: DischPref

74.3% LTR

Low: DischPref

49.2% LTR

High: DischPref

51.0% LTR

Low: DischPref

20.1% LTR

6.9% of patients 31.6% of patients10.6% of patients 15.5% of patients14.3% of patients 2.8% of patients9.2% of patients 0.8% of patients

Low: RN Courtesy22.4% Top Box LTR

High: Staff worked together88.9% Top Box LTR

High: RN Courtesy53.1% Top Box LTR

Low: Staff worked together41.7% Top Box LTR

High: Disch Pref95.0% Top Box LTR

Low: Disch Pref80.2% Top Box LTR

27.5% of patients 40.3% of patients10.4% of patients 17,8% of patients

69.5% of patients28.4% of patients

All Patients74.8%

Top Box LTR (Definitely Yes)

© 2014 Press Gainey, Institute for Innovation



Evidence-based PFE Strategies to Improve Patient Experience

Establishing PFAC / patient &

family advisor (PFA) program

Patient rounding/shadowing

Leveraging PFAs’ experience in

– Document and signage review

– HCAHPS data review

– Staff/clinician education

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https://youtu.be/fm7w36VpLlU

HRET study: Having PFAC associated with

increased HCAHPS scores

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HRET’s research

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PFE PracticePercentage points of

patients rating a hospital 9 or 10

Statistical Significance

Committee EngagementHospital-wide patient & family advisory council compared to

no PFAC 1.5 pts. higher p<.05

Over 50% of PFAC is patient & family members compared to

under 50% 1.7 pts. higher p<.05

PFAC meets at least quarterly compared to less often or never 1.8 pts. higher p<.05

Inclusion of patients & family members in other hospital

committees above average compared to average or below 1.0 pts. higher p<.05

Associations Between PFE Practices & HCAHPS

Excerpted from: Health Research & Educational Trust. (2015, April). Patient and family engagement and patient satisfaction: Results of a national survey. Chicago, IL: Health Research & Educational Trust. Retrieved from www.hpoe.org.

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Excerpted from: Health Research & Educational Trust. (2015, April). Patient and family engagement and patient satisfaction: Results of a national survey. Chicago, IL: Health Research & Educational Trust. Retrieved from www.hpoe.org.

PFE PracticePercentage points of

patients rating a hospital 9 or 10

Statistical Significance

Patient Access to Information

24/7 access to online patient information portal compared to

no 24/7 access 1.8 pts. higher p<.05

Full access to health records in hospital compared to partial or

no access 2.0 pts. higher p=.053

High commitment to accommodating lower English literacy

compared to moderate or low commitment 1.9 pts. higher p<.05

Patient & Family Inclusiveness

24/7 unrestricted access to patients by family & partner across

all units compared to some or no units 3.0 pts higher p<.05

High levels of including patients & families in nurse shift-

change reports compared to moderate or no inclusion 1.3 pts. higher p<.05

Associations Between PFE Practices & HCAHPS

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AHRQ PFCC LC’s HCAHPS Data Analysis:

Methods

10 Florida hospitals submitted HCAHPS data

Date range of data: Sept 2014 – Dec 2015

– Various HCAHPS vendors: Press-Ganey, Avatar, Health Stream, PRC, National

Research Corp.,

– Data not available for all measures (number of measures included in datasets

ranged from 19 - 38)

– Half of datasets included only composite measures

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Organized monthly data submitted by hospitals

– Nurse communications

– Doctor communications

– Willingness to recommend

Used top box data with robust sample size

Developed scatter plots with linear trend lines to illustrate

trajectory over time

AHRQ PFCC LC’s HCAHPS Data Analysis:

Methods

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Data Analysis Limitations

Confounding factors likely (i.e., other initiatives may be affecting HCAHPS

scores)

Survey administrative time periods varied

Summary analysis groups together composite and individual measures

PFACs launched at different points in time

No control group

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Increased

No trend

Communication with Nurses

4 hospitals saw improvement over time (baseline to follow-up) on

top box measures of Communication with Nurses.

Decreased

*Data unavailable for 2 hospitals.32

Increased

No trend

Communication with Doctors

5 hospitals saw improvement over time (baseline to follow-up) on

top box measures of Communication with Doctors.

Decreased

*Data unavailable for 2 hospitals.33



Improved

No Trend

Willingness to recommend

6 hospitals saw improvement over time (baseline to follow-up) on %

who would “definitely” recommend hospital to family & friends.

Decreased

*Data unavailable for 3 hospitals.

No decrease

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Using LCs to Implement, Sustain PFE Gains that

Impact Experience

LCs can provide a rich collaborative environment that motivates organizational changes

Use of AHRQ’s Innovations Exchange to share solutions and experts helped create positive change

– Offered access to experienced innovators with “real-world” perspective is invaluable for implementation

– Provided proven PFCC strategies for LC members to adopt

– Shares resources (e.g., templates) to aid implementation

– Access to innovators, who offered ongoing guidance on implementation, sustainability

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AHRQ PFCC LC outcomes that enhance patient experience

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7 new patient/family advisor programs established (4 had existing patient family advisory councils that they expanded)

73 new patient and family advisors (PFAs) across the 11 LC member hospitals

– PFAs volunteered an estimated 3,700 hours to LC member hospitals between September 2015 and July 2016

8 established 24-hour welcoming policy

10 implemented evaluations of hospital processes or protocols

6 developed staff training on PFCC

7 implemented the use of a patient communication notepad

7 now include PFCC concepts in hospital policies

Value of LCs: AHRQ PFCC LC member satisfaction

on selected outcomes

70%

60%

90%

50%

70%

90%

90%

88%

0% 20% 40% 60% 80% 100%

Diffusing PFCC into the fabric of the culture

Higher patient satisfaction scores

Increased knowledge

Decreased readmissions attributed to better communications

Greater family involvement caring for loved ones

More empathetic team members

More knowledge of patient centeredness

Stronger, enhanced, & more meaningful PFACs

Percentage of respondents extremely or very satisfied3737



Previous FHA Activities on Patient Engagement and

Experience: Learning Communities

FHA/AHRQ HCAHPS Learning Community

– Goal: To support hospital teams in effectively using HCAHPS as a tool for

improving quality, safety, and the patient experience

AHRQ Patient- and Family-Centered Learning Community

– Goal: To support hospitals seeking to advance the practice of patient- and

family-centered care by implementing proven strategies

• Common link: better patient & family engagement

Building on its momentum: FHA’s PFE HIIN Learning Collaborative

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In Summary

HCAHPS is a critical aide, but by itself, it is just a measurement tool

– PFA review of data can provide powerful and actionable feedback to improve

care quality and the patient experience

Patient and family engagement is an evidence-based strategy to enhance

the patient experience

FHA’s HIIN PFE LC will provide members with the opportunity to learn about

PFE strategies that work, brainstorm challenges with faculty and other

members, and receive technical assistance in implementing PFE activities

– Review the Freedcamp site for additional resources, or contact FHA’s Allison

Sandera ([email protected])

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mailto:[email protected]



Questions?

email: [email protected]

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mailto:[email protected]

Documents

The Link Between Patient Experience and Patient and Family ...€¦ · Patient and Family Engagement Learning Collaborative’s First Annual Patient and Family Engagement Summit Sari