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HCAHPS Update and Impacting The Patient Perception of Care January 28, 2009

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Title: HCAHPS Update and Impacting The Patient Perception of Care January 28, 2009


1
HCAHPS Update and Impacting The Patient
Perception of Care January 28, 2009
Karen Cook, RN, BSNwww.studergroup.comNina
Setia, Adm. Director, Service ExcellenceHackensac
k University Medical Center
2
Webinar Agenda
What it is An update on HCAHPS data and overview
of recommended strategies to improve the patient
perception of care.
Hardwiring Excellence and HCAHPS
15 min
15 min
What it is NOT A tutorial on the survey tool or
submitting data.
20 min
3
Nine Principles A Culture of Always

Commit to Excellence
Build Individual Accountability
Align Behaviors with Goals and Values
Measure the Important Things
Build a Culture Around Service
Communicate at All Levels
Recognize and Reward Success
Create and Develop Great Leaders
Focus on Employee Satisfaction
4
Times They are a Changing
  • No more denial, blaming rationalization, ignoring
    results, assuming or hoping

This does not apply to us we are the only
hospital in townthe IPPS payments dont apply
5
HCAHPS Aligns with Industry Trends
patients and doctors are more likely to base
their choice of hospital on non-clinical aspects
of a visit like communication.
6
HCAHPS Hospital Consumer Assessment of
Healthcare Providers and Systems
  • A standardized survey tool to measure the
    patients perception of quality care provided
    during their experience while a patient at an
    acute-care hospital.
  • The patient perception of care will be publicly
    reported with other quality metrics on the
    Hospital Compare website. www.hospitalcompare.hhs.
    gov
  • The information will be used to provide
    meaningful data for improvement efforts as well
    as provide comparisons between hospitals to help
    consumers choose a hospital.

What is HCAHPS
Why is it important?
How will it be used?
7
What Do Patients Want From Us?
  • Communication with doctors
  • Communication with nurses
  • Responsiveness of hospital staff
  • Pain management
  • Communication about medicines
  • Discharge information
  • Cleanliness of hospital environment
  • Quietness of hospital environment
  • Overall rating of hospital
  • Willingness to recommend the hospital

Their perception of our performance is a
reportable and tangible reflection of
your reputation
8
HCAHPS Aligns with Clinical Quality
  • Patient-Centeredness is one of the Institute
    of Medicines key dimensions of Quality and CMSs
    Quality Improvement Roadmap vision for Right
    Care, Right Person, Every Time
  • 1. Safe
  • 2. Effective
  • 3. Patient-Centeredness
  • 4. Timely
  • 5. Efficient
  • 6. Equitable
  • Institute of Medicine, Crossing the Quality
    Chasm A new Health System for the 21st century,
    March, 2001

Always is the response scale most highly
associated with loyalty
9
How Will HCAHPS Reinforce Focus on Quality?
  • Patient-Centered care is a quality indicator
  • Quality no longer the domain of just the
    clinicians
  • Gives a voice to the patient perception of safety
  • Highlights communication issues/barriers
  • Patient-centered care actively involves patients
    in their care
  • More senior leaders are engaged and interested in
    delivering patient-centered care

10
HCAHPS Aligns with CEOs Top Issues - (2008)
7increase
Financial Challenges
Patient Safety and Quality
Care for the uninsured
Physician- hospital relations
Personnel shortages
Patient Satisfaction 5 increase
Governmental mandates
Patient Satisfaction
Capacity
Technology
Issues about not-for profit status
Malpractice insurance
Disaster Preparedness
American College of Healthcare Executives, 2008,
Annual CEO Survey of Top Issues Confronting
Hospitals (Patient Safety and Quality are now
combined. They were shown separately in prior
years
11
HCAHPS Builds the Bridge Between Quality and
Service
  • Quality (Factual)
  • What actually happened in the care process
  • What was the clinical quality/outcome

Service (Emotional) How did the patient feel
about what happened How satisfied were they
HCAHPS
How often the patient perceived it happened
(Frequency of Process)
12
A Culture of Always and Evidence Based
Leadership (EBL) SM
Breakthrough
Foundation
STUDER GROUP
Leader Development
Leader Evaluation
Must Haves
Performance Gap
Accelerators
Standardization
Aligned Goals
Aligned Behavior
Aligned Process
  • Create process to assist leaders in developing
    skills and leadership competencies necessary to
    attain desired results(Principle 4 8)
  • Implement an organization-wide leadership
    evaluation system to hardwire objective
    accountability(Principle 7)
  • Must Haves
  • Rounding
  • Thank You Notes
  • Employee Selection
  • Pre and Post Phone Calls
  • Key Words at Key Times
  • (Principle 3, 5, 6,
  • 9)
  • Re-recruit high and middle performers
  • Move low performers up or out
  • (Principle 4)
  • Agendas by pillar
  • Peer interviewing
  • 30/90 day sessions
  • Pillar goals
  • (Principle
  • 1 2)
  • Leader Eval MgrSM (LEM)
  • Staff Eval MgrSM (SEM)
  • Discharge Call MgrSM (DCM)
  • Rounding MgrSM
  • Idea ExpressSM

Rev 11.07
13
Technology is Driving Change
  • Consumers will have the same access to medical
    information as providers have and more time to
    explore it
  • 80 of American population use internet -
    including Baby Boomers
  • Patients will expect more and tolerate less
  • Public reporting is forcing a new direction in
    patient-centered care
  • Medicare will become the 1 customer of every
    hospital

Source Health Management Technology, Aug 1999,
Harris Poll, 2007 and Press, Ganey
14
HCAHPS Aligns With A Balanced Approach
Passion to make healthcare better
Serving the healthcare needs of the COMMUNITY
Taking Better Care of Patients
VISION
QUALITY
SERVICE
GROWTH
PE O P L E
F I N A N C E
STANDARDS OF PERFORMANCE VALUES
MISSION
15
Financial Impact of HCAHPS
  • HCAHPS is voluntary but results must be included
    in the Pay for Reporting program to receive a
    full Inpatient Prospective Payment System (IPPS)
    payment update
  • Penalty does not apply to those not reimbursed by
    IPPS Yet.
  • Potential impact
  • Public reporting will impact patient perception
    and choice (Service, Quality, and Growth Pillars)
  • Potential downstream impact on revenue if it is
    tied to pay for performance (Finance Pillar)
  • Financial indicators such as turnover as
    employees want to work for a quality organization
    (People Pillar)

16
A comprehensive performance assessment model is
developed
  • The proposed methodology will score a hospitals
    performance and compute an overall VBP score,
    translating into an incentive payment
  • Will reward hospitals for performance based on
    attainment in the measurement year or improvement
    from the prior years baseline performance
  • For each measure with a broad differentiation of
    performance scores, each measure will have a
    benchmark (top 10) and an attainment threshold
    (50th percentile) based on national data
  • As scores improve nationally, the goals will
    change
  • There will be different measures for different
    purposes such as incentive payment, public
    reporting, and measure development

17
Potential Plans for Transition to Pay For
Performance (Baucus-Grassley Bill Draft)
  • FY2009 1st reporting year for VBP
  • Payment 100 public reporting
  • Measures reported are basis for FY2009
    attainment scores FY2008 provides baseline for
    improvement calculations
  • FY2010 2nd reporting year
  • Payment 50 based on performance, 50 on public
    reporting (potential) (70 clinical quality and
    30 HCAHPS metrics)
  • Impact on rural hospitals is unknown
  • The Secretary shall consult with small and rural
    hospitals on the application of the Program to
    such hospitals.
  • Who knows?? Bottom line is that we should proceed
    as if our pay WILL be tied to performance!

18
www.hospitalcompare.hhs.gov
19
Media Coverage
March 29, 2008
  • Real impact of public reporting will effect
    reputation
  • Patient choice and downstream revenue
  • Pride and turnover as employees want to work for
    a quality organization

20
  • Understanding Impacting the Data
  • Case Study
  • Hackensack University Medical Center

21
Quick Facts About HCAHPS
  • Scale - top box will be reported
  • Always, Definitely Yes, 9 and 10, Yes
  • Measures the frequency of events as perceived by
    the patients (how often or did xxxx occur?)
  • Never, Sometimes, Usually, Always
  • N 300 minimum per year
  • Inpatient Adults over 18 years of age acute care
    hospitals
  • Case and patient mix adjusted
  • Should be a complementary, not the only tool to
    be used in identifying performance improvement
    opportunities (leader rounding, DC Calls, focus
    groups, verbatim comments etc.)
  • Should not be considered a new program but
    rather a new method of reporting information

22
HCAHPS ComparisonApril 1, 2007 to March 31, 2008
Questions RWHC (all qrtr ave) United States SG Partners
Nurses always communicated well 78.4 74 75
Doctors always communicated well 83.7 80 79
Patients always received help quickly 72.4 62 62
Pain was always well controlled 71.6 68 70
Staff always explained about medicines 65.1 59 59
Rooms and bathrooms were always kept clean 78.9 69 69
Area around room was always quiet at night 67.4 56 52
Yes patients were given information about recovery at home 80 81
Patients overall rating of hospital (9 10) 64 67
Yes would definitely recommend this hospital 68 71
Green SG Partners above US Average Yellow SG
Partners equal US Average Red Partners below
US Average
23
Sample of Board CommunicationHCAHPS results
4th reporting period (April 2007-March 2008
discharges)
24
(No Transcript)
25
Estimated Timeline
We are here Public Reporting data from April
2007-March 2008
2007
2008
2009
2006
July
July
Aug
May
Aug
May
Aug
May
Sep
Nov
Dec
Nov
Dec
Mar
Jun
Sep
Oct
Nov
Dec
Feb
Mar
Jun
Sep
Nov
Dec
Feb
Mar
Jun
Oct
Jan
Feb
Apr
Apr
Oct
Jan
Apr
Oct
Jul
Jan
Oct 06 - Jun 07 Discharges
Oct 06 Sept 07 Discharges
Jan 07 Dec 07 Discharges
April 07 March 08 Discharges
July 07 Jun 08 Discharges Suppression linked to
loss of APU
Oct 07 Sept 08 Discharges
Jan 08 Dec 08 Discharges
Apr 08 Mar 09 Discharges
.but we are REALLY here!
26
Past and Current
Future
Raw Data reported every two weeks
27
Financial Impact
  • As of March 2009 non-participating hospitals
    Medicare payments run the risk of being reduced
    by at least 2 under market basket.

28
Senior Leaders Adopted Composites Action Plans
Report Quarterly
Composite Responsible Leader(s)
Communication with Doctors CMO
Communication with Nurses CNO
Pain Management Chairman of Pain Service Senior VP of Operations
Cleanliness of Hospital Environment VP of Operations
Quietness of Hospital Environment VP of Operations CNO
Responsiveness of Staff CNO
Discharge Information CNO
Communication about Medicines Administrator, Patient Safety
29
Nina Setia, featured in Hardwired 9 for the
HCAHPS Coaching Track for Nurse Managers
30
Leader Coaching Track
  • 1 hour a week for 12 weeks
  • Starts with signing a coaching contract
  • Covers Employee Satisfaction for first 2 weeks
  • Includes relevant handouts
  • Contains a competency check at beginning of each
    session
  • Homework given at last session
  • Evaluation sent and completed electronically
  • CEUs awarded (can be converted to Nursing
    contact hours)

31
(No Transcript)
32
Pain Initiative
  • Changed pain policy
  • reflects acceptability of pain level
  • Re-assessment within 1 hour
  • Pain Rule implemented because pain scores were
    poor
  • Red flag flashes on computer as a reminder to
    re-assess pain
  • Chairman, Pain Palliative Medicine began
    rounding on nursing units in 1Q08
  • Bring pain policy to life and enforced it
  • Provided education to standardize practice within
    each unit and across all units
  • Rounding with nurses

33
Pain Initiative Unit 4 West
  • HCAHPS
  • How often was your pain controlled?
  • How often did the staff do everything they could
    to help you with your pain?
  • Patient Satisfaction
  • How well your pain was controlled

34
Patient Care Initiatives
  • Quality Leadership Steering Committee for Service
    Excellence
  • Standardize practices, materials and dashboards
  • Develop internal coaching experts
  • Re-launched hourly rounding on all units
  • Piloted TCAB project (Transforming Care At
    Bedside) with a goal to increase nurses time at
    the bedside
  • Nurses are with me all the time.
  • Quiet Time for safe administration of
    medications
  • CEO Expectation on discharge phone calls
  • Key words For safety reasons, nurses will be
    checking your ID band frequently during your
    hospital stay.

Increase time at the bedside increase in
communication increase in HCAHPS scores
35
Unit based HCAHPS data
36
Initiatives
Discharge follow up phone calls
Hourly rounding, key words, TCAB
Re-launched hourly rounding, assessed on
discharge phone calls
Increased discharge calls, Re-launched hourly
rounding
Pain initiative
Quiet Time
37
Key Initiatives to Deliver Patient-Centered Care
Top Priority
Harder Easier
White boards Pre-printed Med Card Leader Rounding Key Words/AIDET Caregiver Engagement
Open visitation Noise Audits Quiet Time Private rooms Hourly Rounding Discharge phone calls Bedside Report/Handoffs
Lower
Higher
Ease of Implementation
Impact on Patient Perception
38
Communication with Nurses
  • Studer Group Tactics
  • Individualized patient care
  • Sit at bedside to review care plan
  • White boards
  • Hourly Rounding
  • Bedside Shift Report
  • Peer Interview for communication and empathy
    talents
  • AIDET
  • Behavior standards
  • Q1 During this hospital stay, how often did
    nurses treat you with courtesy and respect?
  • Q2 During this hospital stay, how often did
    nurses listen carefully to you?
  • Q3 During this hospital stay, how often did
    nurses explain things in ways you could
    understand?
  • Never
  • Sometimes
  • Usually
  • Always

Slide format adapted from Press, Ganey
39
Key Words at Key Times is a Must Have
Initiative 1
  • Key words reflect a communication style that
    improves the quality of information provided by
    every person in every interaction
  • Key times are defining moments that
  • Occur during times of vulnerability
  • Greetings first impression
  • Personal times - like bathroom needs
  • Handoffs
  • Goodbyes
  • Are what patients remember and impact the overall
    perception of the experience

40
Why are Key Words Important?
  • Reduce patient anxiety
  • Improve patient perception of care
  • Improve coordination of care
  • Decrease law suits

Being Kept Informed was the MOST important
characteristic when returning to a hospital for
future visits. 2007 McKinsey Survey of gt2,000
patients with commercial insurance or Medicaid
41
Key Words to Build Trust and a Culture of Safety
  • Weve been expecting you!
  • We have the best radiology department in the
    city.
  • At our hospital, nothing is more important than
    your safety.
  • During your stay it is important that each
    caregiver washes or disinfects their hands before
    contact with you. This will help decrease the
    spread of infections and keep you safe. Please do
    not hesitate to remind us if we forget to clean
    our hands. Have you seen the staff wash their
    hands?
  • You are in good hands with Dr. Jones.

42
Reducing Potential for Litigation Through Better
Patient Communication

In this Article. The most common cause of
malpractice suits is failed Communication with
the patients and their families. Explore ways
that better communication could lead To fewer
malpractice claims and allow health
care Organizations to reduce litigation costs.
  1. Focus on Issues Rounding, AIDET, Key Words
  2. Educate the Patient Rounding, AIDET, Managing
    Up
  3. Enlist the Patient Rounding, Key Words
  4. Share Decisions AIDET, Key Words

Source The Physician Executive, June 2004
43
Physician Keywords
  • I am washing my hands for your SAFETY.
  • I have TIME to answer your questions.
  • I want you to be INVOLVED in your treatment
    plan
  • I want to be sure I EXPLAIN everything to you
  • To protect your PRIVACY, let me close the
    curtain.
  • For your COMFORT, I ordered pain medicine...
  • I want to keep you INFORMED
  • I want to make sure we are THOROUGH
  • You are in good hands with the nurses on this
    floor.

44
The Key to Key Words is PRESENCE
  • Nonverbal behavior be fully present
  • Smile, establish and hold eye contact
  • Put warmth in your voice
  • Be at THEIR level whenever possible
  • Face squarely or heart to heart
  • Verbal behavior be fully present
  • Acknowledge, welcome and use their preferred name
  • Introduce self and role
  • Duration - say what youll do and what to expect
  • Explain I am part of the Albany Medical Center
    team
  • Thank them

Adapted from Heart to Heart Communication
Wendy Leebov
45
AIDET Five Fundamentals of Communication
Acknowledge
A
Decreased Anxiety
Introduce
I
Increased Compliance
Duration
D

Explanation
E
  • Improved clinical outcomes and increased patient
    and physician satisfaction

Thank You
T
46
Key Words - Designed Handoffs
Mrs. Jones you are doing so much better you can
now be on the step down unit. Do you mind if I
share a bit about you with Cindy?
A
I have worked with Cindy for over two years and
she will take great care of you.
I
It will take us about five minutes to discuss
your care because I want to make sure she is very
familiar with your care plan.
D
We want to make sure we keep you informed about
your care as well so we will do the report here
in the room if ok with you?
E
It has been a pleasure taking care of you and I
know you will do well. I am working tomorrow and
will check in on you.
T
47
Manage Up Co-Workers by Communicating Skill and
Training
Patient Satisfaction
Source Sacred Heart Hospital, Pensacola, FL
48
Key Words Written Material
Source Sierra Vista MC, San Luis Obispo, CA
49
Key Words
50
Key Words Manage UP Co-Workers
  • Managing UP uses keyword phrases to position
    something or someone in a positive manner
  • Conveys a spirit of teamwork
  • Aligns the organization and demonstrates pride
  • Instills confidence in ability to provide quality
    care
  • Co-workers appreciate the kind words and the
    vote of confidence as well
  • Mrs. Smith. This afternoon you will be going to
    the Cardiac Step-down unit which means you are
    closer to going home. This floor has excellent
    staff and state of the art monitors. They are
    aware you will be down there this afternoon and
    are well prepared for you

51
Key Words
  • Customize to reinforce initiatives such as
  • Individualized Patient Care
  • Rounding for pain goals
  • Managing Up
  • Aligned with other initiatives like Time Out

52
Rounding for Outcomes is a Must Have
Initiative 2
Rounding on Employees, Patients, Physicians and Other Departments Rounding is a process to PROACTIVELY engage, listen to, communicate with, build relationships with and support the most important customers Maintains TRANSPARENT communication Focuses on the positive and what is working well - which is a paradigm shift Is a requirement of all leaders Promotes SHARED Decision Making It is not reactive, focused on whats wrong, MBWA, or sporadic when there is time
53
Rounding for Outcomes on Staff
  • The number one person we round on is the
    employee. And if we skip the employee, were
    making a mistake.

Quint Studer, Author of Hardwiring Excellence
54
Rounding for Outcomes Employees
Rounding on Employees Direct reports 100 monthly (All staff are rounded at least once per quarter) 3 employees x 15 minutes 45 min 15 minute F/U 60 minutes/day Concern and Care relationship connection and open lines of communication
Rounding on Employees Direct reports 100 monthly (All staff are rounded at least once per quarter) 3 employees x 15 minutes 45 min 15 minute F/U 60 minutes/day What is Working Well focus on positives how did you make a difference today?
Rounding on Employees Direct reports 100 monthly (All staff are rounded at least once per quarter) 3 employees x 15 minutes 45 min 15 minute F/U 60 minutes/day People to Recognize specific people and actions (other depts, physicians etc.)
Rounding on Employees Direct reports 100 monthly (All staff are rounded at least once per quarter) 3 employees x 15 minutes 45 min 15 minute F/U 60 minutes/day Systems to Improve seek input (safety, rework, pet peeves) Trust but VERIFY behaviors
Rounding on Employees Direct reports 100 monthly (All staff are rounded at least once per quarter) 3 employees x 15 minutes 45 min 15 minute F/U 60 minutes/day Tools and Equipment barriers to efficiency
Rounding on Employees Direct reports 100 monthly (All staff are rounded at least once per quarter) 3 employees x 15 minutes 45 min 15 minute F/U 60 minutes/day Follow-up take notes
55
Rounding for Outcomes Patients Nurse Leader
  • Good morning, Mrs. Smith . . . I am Carol, the
    nurse manager on this unit. Would it be ok if I
    spent about 3 minutes with you? (sit at the
    bedside if possible)
  • I see from the whiteboard that Becky is taking
    care of you. She is an excellent nurse.
    (managing up is critical piece of leader
    rounding)
  • On our unit, the expectation is that a staff
    member is in your room every hour to check on
    you. Have you seen one of our team members
    approximately every hour? Have you had to use
    your call light to ask for pain medicine?
  • Thank you so much for your time. I will be sure
    to share your compliment with Becky. Is there
    anything you need before I go?
  • (Follow up with the staff . . . Either on the
    spot coaching or reward / recognition.)

56
Selection and Retention of TalentBehavior
Standards
Initiative 3
57
Top Five Workplace Incentives
  1. Written Thanks From Manager/Executive Team Leader
  2. Personal Thanks From Manager
  3. Promotion for Performance
  4. Public Praise
  5. Morale-Building Meetings

Study conducted by Dr. Gerald Graham, Management
Professor at Wichita State University Motivating
Todays Employees, Bob Nelson Talent, 1998
58
Recognition
  • Its not a natural skill
  • it must be taught!

65 of Americans reported that they received no
recognition for good work in the past year
Source How Full Is Your Bucket-Tom Rath, Donald
O. Clifton
59
Focus on the PositiveCompliment to Criticism
Ratio
3 to 1 3 compliments 1 criticism Positive!
2 to 1 2 compliments 1 criticism Neutral
1 to 1 1 compliment 1 criticism Negative
Source Tom Connellan, Inside the Magic
Kingdom, pgs 91-95
60
Behavior Standards A Culture of Always
  • Standards in recruitment and application process
  • Standard of the Month

61
Are YOU an Effective Team Member?
  • Better able to predict the needs of other team
    members
  • Provide quality information and feedback
  • Engage in higher level decision making
  • Manage conflict skillfully
  • Understand their role and responsibility
  • Reduce stress on team as a whole through better
    performance

http//teamstepps.ahrq.gov/abouttoolsmaterials.htm
62
HCAHPS Toolkit Aligning Actions to Create a
Culture of Always
  • Over 40 evidence-based recommendations to impact
    the patient perception of quality
  • Will be sent by Mary Jon
  • Order today at www.studergroup.com

63
The Right Thing to Do
  • Leader Rounding and Key Words/Managing UP
  • Ensures strong communication
  • Promotes a sense of well-being
  • Decreases anxiety
  • Exceeds expectations
  • Provides individualized care
  • Do I take responsibility and ownership of my
    department?
  • Do I Manage Up my team and my organization?

64
It is not about scores, financial indicators,
public reporting, of alwaysit is about
compassionate care and saving lives
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