Using HCAHPS data to improve the quality of patient care

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Using HCAHPS data to improve the quality of
patient care

• Tenet Healthcare
• Cindy Larkin, Senior Director Measurement

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Discussion Points
Tenet OverviewTransition to HCAHPSService
Strategy Measurement System Redesign
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Tenet by the numbers

• 60,000 employees
• 1M Admissions
• 18,149 licensed beds
• 64 free-standing outpatient centers
• 12 states
• 54 acute care
• 2 rehab hospitals

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Tenets Patient Satisfaction System

• Tenet has been conducting patient satisfaction
  surveys since 1982
• Approximately 100,000 telephone surveys conducted
  annually by Field Research Corporation, founded
  in 1945
• Programs
• Inpatient
• Outpatient Surgery
• Outpatient Services
• Emergency Department
• Inpatient Rehab
• Outpatient Rehab
• Mental Health

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Discussion Points
Tenet OverviewTransition to HCAHPSService
Strategy Measurement System Redesign
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Transition to HCAHPS

• Piloted the questionnaire at eight hospitals in
  the fall of 2004
• Reviewed our system to ensure all CMS guidelines
  were met. Other than the questionnaire change,
  few modifications were necessary since Tenets
  system already met virtually all of CMSs
  specifications
• Participated in focus groups with the Agency for
  Healthcare Research and Quality (AHRQ)
• In January 2005, transitioned to the HCAHPS
  questionnaire

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Communication is key

• Selected one person from each hospital as the
  HCAHPS liaison, responsible for internal
  communication and training
• Explained rationale for transition, which was to
  prepare for public reporting as soon as possible
  
• Shared results of the pilot study to prepare
  hospitals that the scores would likely be lower
  due to question and scale changes rather than
  performance
• Based on the pilot results, estimated the
  potential score impact for each hospital
• Developed training materials to help hospitals
  understand the reasoning behind various
  guidelines, such as adjusting the results based
  on patient characteristics, etc.

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Questionnaire design

• Transitioned entirely to HCAHPS rather than
  conducting two separate studies
• Involved key hospital personnel in questionnaire
  design to obtain buy in
• Selected custom questions to address issues not
  included in HCAHPS
• JCAHO issues Privacy and safety
• High impact areas Teamwork and sensitivity to
  family needs
• High use areas Patient Access
• Outsourced areas Food and Nutritional Services
• Redesigned other questionnaires (OP Surgery, OP
  Services, and ED) to HCAHPS format

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Survey design changes
Adjusted sample to delete non-HCAHPS patients
that would continue to be included in Tenets
system i.e., proxy interviews non-medical,
surgical, or OB patients interviews conducted in
non-HCAHPS approved languages. Unaccepted
interviews need to be accounted for at each
hospital to ensure we reach the minimum required
sample size.
Hospital Current Sample size Adjustment Factor Adjustment Factor Adjustment Factor Adjustment Factor Post-Adj Sample Size
Hospital Current Sample size Proxies Language Service Line Adj Total Post-Adj Sample Size
A 400 32 10 8 50 350
B 400 18 20 9 47 353
C 400 64 0 5 69 331
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Keep current with CMS guidelines
Composite/ Category
Adjustment
Changed the scoring methodology to include the
mode adjustment. While we cannot at this time
mirror CMS results exactly, we modify our system
when new guidelines are published.
Nurse Communication -4.2
Doctor Communication -1.4
Physical Environment -5.9
Responsiveness of Staff -4.8
Pain Management -4.9
Comm about Meds -4.0
Discharge Information -1.4
Willing to Recommend -4.5
Hospital Rating Question -3.0
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Discussion Points
Tenet OverviewTransition to HCAHPSService
Strategy Measurement System Redesign
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Service restructuring

• Added a corporate-based Service Team to
• Directly consult with hospitals
• Collect the tools and resources hospitals were
  using
• Changed priority focus
• Adjusted key words used in initiatives

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Previous service focus
PATIENT SATISFACTION QUESTIONS r
Willing to Recommend 0.759
Staff worked together as a team 0.571
Nurses listened carefully 0.564
Staff helped with pain 0.551
Nurses courtesy and respect 0.545
Staff sensitive to families' needs 0.515
Staff provided safe patient care 0.511
Nurses explanations clear 0.505
Call button answered 0.500
Staff helped with bathroom needs 0.496
Room and bathroom kept clean 0.428
Staff explained medicine 0.426
Staff clearly described side effects 0.417
Pain well controlled 0.415
Staff clearly explained financial/insurance matters 0.412
Staff respected patient privacy 0.409
Admissions staff courtesy and respect 0.402
Doctors listened carefully 0.386
Doctors explanations clear 0.360
Doctors courtesy and respect 0.349
Satisfaction with food service 0.344
Area around room kept quiet at night 0.335
Staff discussed discharge help 0.289
Written symptom/health info provided 0.261
r correlation coefficient
Focus areas
Questions having a high correlation with overall
satisfaction
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Current service focus
PATIENT SATISFACTION QUESTIONS r
Willing to Recommend 0.759
Staff worked together as a team 0.571
Nurses listened carefully 0.564
Staff helped with pain 0.551
Nurses courtesy and respect 0.545
Staff sensitive to families' needs 0.515
Staff provided safe patient care 0.511
Nurses explanations clear 0.505
Call button answered 0.500
Staff helped with bathroom needs 0.496
Room and bathroom kept clean 0.428
Staff explained medicine 0.426
Staff clearly described side effects 0.417
Pain well controlled 0.415
Staff clearly explained financial/insurance matters 0.412
Staff respected patient privacy 0.409
Admissions staff courtesy and respect 0.402
Doctors listened carefully 0.386
Doctors explanations clear 0.360
Doctors courtesy and respect 0.349
Satisfaction with food service 0.344
Area around room kept quiet at night 0.335
Staff discussed discharge help 0.289
Written symptom/health info provided 0.261
r correlation coefficient
Focus areas
All areas that will be publicly reported
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Avoid trying to Boil the Ocean
PATIENT SATISFACTION QUESTIONS r
Willing to Recommend 0.759
Staff worked together as a team 0.571
Nurses listened carefully 0.564
Staff helped with pain 0.551
Nurses courtesy and respect 0.545
Staff sensitive to families' needs 0.515
Staff provided safe patient care 0.511
Nurses explanations clear 0.505
Call button answered 0.500
Staff helped with bathroom needs 0.496
Room and bathroom kept clean 0.428
Staff explained medicine 0.426
Staff clearly described side effects 0.417
Pain well controlled 0.415
Staff clearly explained financial/insurance matters 0.412
Staff respected patient privacy 0.409
Admissions staff courtesy and respect 0.402
Doctors listened carefully 0.386
Doctors explanations clear 0.360
Doctors courtesy and respect 0.349
Satisfaction with food service 0.344
Area around room kept quiet at night 0.335
Staff discussed discharge help 0.289
Written symptom/health info provided 0.261
r correlation coefficient

• Introduced initiatives that were broad in scope
  and would address several question areas
• AIDET
• Hourly Rounding
• Empathy Training
• Focused on Discharge Information the only area
  Tenet scored slightly below average compared to
  the HCAHPS Chartbook data

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White Boards

• Some hospitals purchased eye-catching, customized
  white boards to reinforce initiatives such as
• Communication
• Pain goals
• Hourly Rounding

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AIDET
Five simple steps to make a positive first
impression and to ensure continuous positive
interaction throughout the patients experience
First step in forming a relationship with the
patient. Be attentive to and greet your patient
in a positive manner with a warm and friendly
smile. Upon introduction give the patient your
name and the purpose for the encounter. Manage
the patients expectations by educating them about
the length of time a particular procedure or
request will take. Better to over-estimate than
under-estimate. Make sure the patients are
knowledgeable and involved in their treatment.
Use easily understood terms when providing
information. Ask if they have any
questions. Thank patients for waiting,
providing information, choosing your facility,
etc.
Acknowledge
Introduce
Duration
Explanation
Thank You
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Hourly Rounding
PCAs round on the even hours Licensed staff
round on the odd hours Documentation is kept on a
clipboard outside of the room Use the Three
Ps Pain Position Personal Needs
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Discharge Information
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Emphasis throughout all initiatives is
continuous, positive, caring communication with
the patient, family members, and each other.
For example, rather than simply handing
patients written instructions or brochures, tell
them what they are for, what they include, what
they should do with them, and ask if they have
any questions.
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Discussion Points
Tenet OverviewTransition to HCAHPSService
Strategy Measurement System Redesign
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Highlighted HCAHPS questions in previously
existing reports
HCAHPS area more than 5 below the norm
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Used a back to basics approach to help
hospitals systematically review HCAHPS results
Overall Score
GENERAL
Category Average
Begin by analyzing the high-level results to
identify problems, then drill down to pinpoint
what specific area is driving the score
Question Score
Unit Report
Patient Information
SPECIFIC
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Redesigned our reporting system to complement the
approach and push the data into the hospital
New System Goals

• Expand employee access
• User-friendly (three screens to learn)
• Link Measurement and Service
• Reduce report turnaround time
• Identify problem areas
• Benchmark with high performers

This is not just a Tenet program. We helped
Field Research design it, but it is being offered
to other clients
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Screen One Starting with the general results,
the home page of the reporting system provides an
overview of hospital results including comparison
to previous month, previous year, and Tenet
Targets.
Internal Star rating system
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Screen Two Provides drill down to category,
question, unit, and patient level to identify
problem areas. A white light bulb indicates
the question scores at or above average, a red
light indicates a problem area. Easily creates
an Excel file from any screen shot.
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Clicking on a light bulb accesses the
improvement suggestion section, Ideas with
Impact. Clicking on the links in the
Additional Resources section accesses a toolkits
or other resources they can use or refer to.
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Links to a 103 page workbook describing exactly
how to implement empathy training
Written by Wendy Leebov
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Screen Three Very Interactive. View any
program, category, question, unit, by any time
period selected with a click of a button. Helps
hospitals track the specific service initiatives
they are working on. Easily creates a PDF report
to email or post.
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Tenet-wide success in using HCAHPS results to
improve the patient experience!!!
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Contact Information
Cindy Larkin [phone] cindy.larkin_at_tenethe
alth.com