How Cleveland Clinic Uses Data to Transform the Patient Experience - HAS Session 4

James Merlino, MD

Session #4:“Voice of the Patient”

Using Data to Transform the Patient Experience

Chief Experience Officer, Cleveland Clinic

““Patients First….Patients First….””““Patients First….Patients First….””

Main CampusMain CampusNurse CommunicationNurse Communication

Main CampusMain CampusNurse CommunicationNurse Communication

%ile

Source: CMS and Dashboard 1.31.14

Nurse CommunicationNurse CommunicationNurse CommunicationNurse Communication

Data Time Frame: Discharges between Q2 2012 – Q1 2013

Main CampusMain CampusDoctor CommunicationDoctor Communication

Main CampusMain CampusDoctor CommunicationDoctor Communication

%ile

Source: CMS and Press Ganey 5.1.14

Largest Hospitals in USDoctor CommunicationLargest Hospitals in USDoctor Communication

Healthcare providers Healthcare providers understand what their understand what their

““customercustomer”” – the patients, – the patients, wantwant??

Healthcare providers Healthcare providers understand what their understand what their

““customercustomer”” – the patients, – the patients, wantwant??

1) True2) False

Poll Question #1Poll Question #1Poll Question #1Poll Question #1

Leaders SurveyLeaders SurveyTop prioritiesTop priorities

Leaders SurveyLeaders SurveyTop prioritiesTop priorities

• New facilitiesNew facilities

• Quiet-time to ensure restQuiet-time to ensure rest

• Private roomsPrivate rooms

• Food on demandFood on demand

• Interactive bedside computersInteractive bedside computers

• Eliminate visiting hour restrictionsEliminate visiting hour restrictions

Patient DesiresPatient DesiresPatient DesiresPatient Desires

RespectRespectCommunication between staffCommunication between staff

Happy peopleHappy people

Patient EmotionsPatient EmotionsPatient EmotionsPatient Emotions

• StressfulStressful• AnxietyAnxiety• Fear – Terror !Fear – Terror !• UncertaintyUncertainty• ConfusionConfusion

…And the Family

Scale of Importance on SatisfactionScale of Importance on SatisfactionScale of Importance on SatisfactionScale of Importance on Satisfaction

Staff CaredDoctor concern for ComfortDoctor ExplainedInfo to care for self at homeDoc kept pt InformedNurse kept pt InformedInfo about DelaysFamily & friends kept InformedNurses attn to NeedsDoctor ListenedPain ControlDoctor CourtesyRespect for PrivacyNurses ListenedCourtesy to family & friends

Most important

Communication & Information

Global Sat., Concern, Empathy

Wait time before DoctorNurse CourtesyNurse concern for Privacy Staff permitted family & friends to be w/patientCleanlinessHelpfulness of person first asking about conditionWait time for Radiology Comfort during blood drawWait time before treatment areaComfort during RadPersonal Ins PrivacyRad Staff CourtesyWaiting Area ComfortEase to provide insuranceCourtesy taking ins.Wait time of staff notice

Less important

Nursing / ED Staff, Wait Times

Ancillary Care, Comfort, Administrative

Staff Behavior and Pain

What is the What is the mostmost important important factor driving improvement factor driving improvement

in healthcare delivery?in healthcare delivery?

What is the What is the mostmost important important factor driving improvement factor driving improvement

in healthcare delivery?in healthcare delivery?

a) Data transparencyb) Financial incentives for performancec) Improved leadership / management skillsd) Both 1 and 2e) Both 2 and 3


Increasing AccountabilityIncreasing AccountabilityIncreasing AccountabilityIncreasing Accountability

Compared like Washing Machines

Quality – Based Payment Quality – Based Payment Reform InitiativesReform Initiatives

Quality – Based Payment Quality – Based Payment Reform InitiativesReform Initiatives

Inpatient Quality Reporting Requirement (IQR) 2% of APU

Value Based Purchasing 2%

Readmissions 3%

Meaningful Use 1%

Hospital Acquired Conditions 1%

VBP VBP

Hospital Acquired Conditions (DRG Demotions)

2010 201320122011 2017201620152014 2018

Every caregiver in an Every caregiver in an organization must be held organization must be held

accountable to accountable to organizational metrics?organizational metrics?

Every caregiver in an Every caregiver in an organization must be held organization must be held

accountable to accountable to organizational metrics?organizational metrics?

1) True2) False


The Episode

The The ““360360””The The ““360360””

Manage the 360 ContinuumManage the 360 Continuum

Before After

Pre-admissionPre-admission

activityactivity

AdmissionAdmission DischargeDischarge

ActivitiesActivities

Follow upFollow up

carecare

Ongoing relationshipOngoing relationship

managementmanagement

Access

Calls V

isits

Billin

g

Ambulatory

Inpatient JourneyInpatient JourneyInpatient JourneyInpatient Journey

Hospital StayEvents / Procedures

Inpatient flowInpatient flowCaregiver PerspectiveCaregiver Perspective

Inpatient flowInpatient flowCaregiver PerspectiveCaregiver Perspective

data along the Continuum

Enterprise

Business Unit

HospitalInstituteDepartmentCenter

Floor / Unit

Leader

Manager

Individual

data along the Continuum

Strategic

Tactical

Operational

data d

ow

n th

e vertical

Enterprise viewEnterprise view

Institute viewInstitute view

Center view – Physician specific metrics

Unit view – Nurse and team specific metrics

TrendingTrending

Score - ScorecardScore - ScorecardScore - ScorecardScore - Scorecard

DDI PhysiciansDDI PhysiciansDoctor communication vs. Hospital ratingDoctor communication vs. Hospital rating

DDI PhysiciansDDI PhysiciansDoctor communication vs. Hospital ratingDoctor communication vs. Hospital rating

Good doctorBad hospital rating

Low CommunicationLow RatingLow Reputation

Poor Doctor CommunicationHigh Hospital Rating

Patient comments – Patient comments – anecdotes and verbatims anecdotes and verbatims

– – alonealone, can drive , can drive improvement!improvement!

Patient comments – Patient comments – anecdotes and verbatims anecdotes and verbatims

– – alonealone, can drive , can drive improvement!improvement!

1) True2) False


VerbatimsVerbatimsVerbatimsVerbatims

• ““Never sure who my doctor was..Never sure who my doctor was..””• ““Surgeon never saw me – until I was very Surgeon never saw me – until I was very

criticalcritical””• ““Never saw my surgeon – only the fellowNever saw my surgeon – only the fellow””• ““Doctor had attitudeDoctor had attitude””• ““Doctor was rushedDoctor was rushed””• ““Too many doctors – I never new who was in Too many doctors – I never new who was in

charge.charge.””• ““ ----- group was backing out of the door as ----- group was backing out of the door as

my wife was asking questions – very rude.my wife was asking questions – very rude.””

Physician Patient CommentsPhysician Patient CommentsPhysician Patient CommentsPhysician Patient Comments

Negative49%

Positive43%

Mixed8%

N = 540

Opportunities for ImprovementOpportunities for ImprovementOpportunities for ImprovementOpportunities for Improvement

Coordination25%

Staff Dr Access24%

Explain20%

Attitude / Compassion

17%

Listening10%

Dr Time3%

Others1%

Doctor Communication Verbatims

72% Communication

• Purpose is transformationalPurpose is transformational

• Understand your customerUnderstand your customer

• TransparencyTransparency

• Collect data across the continuum and drive it Collect data across the continuum and drive it down the organizationdown the organization

• The The ““softsoft”” stuff counts! stuff counts!

Patients First….Patients First….Patients First….Patients First….

Analytic Insights

AQuestions &

Answers

Session Feedback Survey

38

1. On a scale of 1-5, how satisfied were you overall with the Glenn Steele / Geisinger session?

2. What feedback or suggestions do you have for the Glenn Steele / Geisinger session?

3. On a scale of 1-5, how satisfied were you overall with the Jim Merlino / Cleveland Clinic session?

4. What feedback or suggestions do you have for the Jim Merlino / Cleveland Clinic session?