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Rates of Change During Public and Private Reporting Cycles of Hospital Performance: Implications for Mechanisms Driving Quality Improvement

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Title: Rates of Change During Public and Private Reporting Cycles of Hospital Performance: Implications for Mechanisms Driving Quality Improvement


1
Rates of Change During Public and Private
Reporting Cycles of Hospital Performance Implica
tions for Mechanisms Driving Quality Improvement
  • Cathy E. Duquette, Ph.D., RN, CPHQ
  • Vice President, Nursing and Patient Care Services
  • Newport Hospital Newport, RI

June 27, 2006
2
Acknowledgements
  • Judith Barr, Tierney Giannotti, and Marcia
    Petrillo Qualidigm
  • Shoshanna Sofaer Consultant/Baruch College
  • William Waters RI Department of Health
  • Deirdre Mylod and staff Press Ganey
  • Hospital Association of Rhode Island
  • Barr, J.K., Giannotti, T.E., Sofaer, S.,
    Duquette, C.E., Waters, W.J. and Petrillo, M.K.
    2006. Using Public Reports of Patient
    Satisfaction for Hospital Quality Improvement.
    Health Services Research 41(3), Part I (June
    2006) 663-682.

3
Rhode Island Setting the Stage
  • Small state just over 1,000,000 population
  • 39 cities/towns very limited county government
  • 1 State Department of Health
  • 16 hospitals in the state
  • 13 hospitals 10 acute care, 1 women infants,1
    adult psychiatric and 1 rehabilitation hospital
    participate in patient satisfaction survey and
    report
  • 10 acute care hospitals participate in the
    clinical measures data collection and report
  • All eligible hospitals were early participants in
    the Hospital Quality Alliance

4
The Rhode Island Legislation
  • Passed in July 1998 called for public reporting
    of
  • Comparable, statistically valid patient
    satisfaction measures
  • Standardized data set of clinical performance
    measures, risk-adjusted for patient variables
  • Addressed the general health environment in RI
    and the potential impact on quality
  • Impending mergers
  • For-Profit vs. Not-For-Profit
  • Applies to all licensed health care facilities in
    the state, starting with hospitals
  • Director of the Department of Health (HEALTH) is
    responsible for program development and
    implementation

5
Program Development - Structure and Process
  • Director of HEALTH is responsible
  • Steering Committee and Work Group structure
  • Process very open and public
  • Committee format consensus as goal
  • Consumer, minority and interested party input
  • Input and feedback incorporated into each step of
    program development
  • Hospitals represented by Hospital Association of
    Rhode Island (HARI) through all stages of program
    development
  • Opportunities to discuss issues and concerns
    among hospitals within HARI structure

6
Program Development Considerations
  • Outcome needed to address both public
    accountability AND quality improvement
  • Aimed to balance desire to report on all
    patients/all conditions vs. what was feasible
  • Needed to develop a report that was meaningful to
    consumers AND hospitals
  • Report format and method of reporting needed to
    be determined before data were available
  • Started with public reporting of patient
    satisfaction
  • Hospital approach was collaborative vs.
    competitive

7
Program Development - Outcome The Private
Reports
  • All hospitals in RI had a mechanism for measuring
    patient perception pre-program
  • Variation to method, process, frequency
  • Hospitals agreed to select the same vendor and
    process to meet program requirements
  • Transition to mail survey conducted by Parkside
    Associates and then Press Ganey
  • Agreement to pilot data collection phase with
    each process change (2000 and 2002) to evaluate
    process and provide early data and information to
    hospitals to refine and target ongoing quality
    improvement efforts
  • Process created to establish ongoing data
    collection and feedback for internal use between
    public reporting cycles

8
Program Development - Outcome The Public
Reports
  • Patient Satisfaction I Nov 2001
  • Public General Report
  • Public Technical Report
  • Patient Satisfaction II Oct 2003
  • Public General Report
  • Public Technical Report
  • Patient Satisfaction III TBD
  • Currently participating in dry run
  • Awaiting HCAHPS for public report

9
Program Development - Outcome The Public
Reports
  • Evaluation of Public Reporting on Hospital
    Patient Satisfaction in Rhode Island 2003
  • Statewide Effort to Improve Hospital Patient
    Satisfaction Ratings - 2004

10
Public Report Development
  • State committee process Patient Satisfaction
    Public Release Work Group with hospital,
    consumer, and health care stakeholder input
  • Hospital staff and leadership actively engaged in
    process
  • Two types of public reports general public and
    technical
  • Key reporting decisions made before results
    available
  • Methods for translating raw data into different
    format
  • Method and standard against which comparisons
    made
  • Private report format designed for quality
    improvement and not appropriate for public
    reporting
  • Draft reports went through formative testing
    process with consumers

11
Sample Page from Public Report 2001
Patient Satisfaction Report Excerpt 2001
12
Sample Page from Public Report 2003
Patient Satisfaction Report Excerpt 2003
13
Findings RI Scores over Time
  • Hospitals in RI started out and continue to be
    higher than national average score
  • Steady improvement in RI score
  • No spikes around or following public reporting
    time periods
  • Rate of increase is not faster than that of
    national upward trend

14
RI Trend Analysis vs. National
15
Hospital Response
  • Commitment to
  • Quality Improvement

16
Initial Responses
  • Hospitals supportive of public reporting
  • Hospital CEOs supported enabling legislation
  • Hospital acceptance of program value in driving
    and coordinating quality improvement efforts
    statewide vs. influencing consumer choice
  • Significant hospital involvement in process from
    the beginning of program development

17
Quality Improvement Efforts
  • Internal
  • Senior leadership involvement and intense
    organizational commitment
  • Reaching clinical staff and Boards of Trustees
  • Increase in focus and coordination
  • External
  • Collaborative vs. competitive model
  • Sharing of best practices
  • Coordinated efforts through HARI
  • Demonstrating improvement over time

18
For More Information
  • www.health.ri.gov
  • RI Background Reports
  • Public and Technical Reports and
  • Evaluation Reports on Findings and Quality
    Improvement Efforts
  • www.health.ri.gov/chic/performance/series.php
  • Direct link to list of reports

19
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