Melissa Taylor Director, Patient Access/Pre-Access Cleveland Clinic Creating a Positive Patient Experience Driven Culture Melissa Taylor Director, Patient Access/Pre-Access Cleveland Clinic

Cleveland Clinic – About us Located in Cleveland, Ohio Nonprofit multispecialty academic medical center, integrating clinical and hospital care with research and education Main Campus 8 Community Hospitals 18 Family Health Centers Lou Ruvo Center for Brain Health Cleveland Clinic Florida Cleveland Clinic Canada Cleveland Clinic Abu Dhabi (2013)

Cleveland Clinic - Statistics 1,300 beds on main campus More than 4,400 beds system-wide 4.2 million outpatient total visits 167,100 admissions 191,500 surgical cases 2,700 physicians and scientists

Patient choice! State of Healthcare Reimbursement CMS – Value Based Purchasing Pay for Performance – reimbursement contingencies Quality Efficiency Patient Satisfaction Transparency Published clinical measures HCAHPS Pricing Informed Consumers Patient choice!

HCAHPS - Goals Three goals Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Three goals Meaningful comparison for consumers Public reporting is incentive for hospitals to improve Enhance accountability by increasing transparency of quality Source: www.hcahpsonline.org

Eight critical aspects of care, referred to as the HCAHPS Domains HCAHPS – The Survey 18 questions about patient care, four screening questions and five demographic questions Eight critical aspects of care, referred to as the HCAHPS Domains Communication with doctors Communication with nurses Communication about medicine Responsiveness of hospital staff Cleanliness and quietness of hospital environment Pain management Discharge information Overall hospital rating and recommendation Source: www.hcahpsonline.org

ALL OF IT! What is Patient Experience? “One bad interaction can define the impression. This is well documented in retail and other service business.” James Merlino, MD Chief Experience Office, Cleveland Clinic Quote Source: HealthLeaders Media, February 24, 2012

Office of Patient Experience Video Placeholder

Where is Patient Access in HCAHPs? Overall rating Would you recommend Vendor Supplemental Questions Speed of Admission Process Courtesy of the person who admitted you

Organizational Efforts Cleveland Clinic Experience Exceptional Employee Experience + World Class Patient Experience = Cleveland Clinic Experience Caregivers Caregiver Awards Pre-hire survey – cultural fit START with HEART ® Patient Advisory Councils Employee Engagement Survey

Empower employees to be a part of the solution Patient Access Focus Empower employees to be a part of the solution Minimize calls post-service due to registration issues Pre-Registration Patient wait times Registration times Affect and behaviors Non-patient interfacing registrants in registration area Parking situation

Waiting room as first impression Impact on department through-put Pre-Registration Waiting room as first impression Impact on department through-put Set standard as 95% pre-service registration for scheduled services Opportunity – Busiest surgery center in enterprise Delaying patients to OR Registered patients at point of decision for surgery Provided business cards with Express Regi phone # Leveraged online registration Supported call center with onsite registration downtime capacity Used autodialer to contact patients 35% pre-registration rate to 97% - Sustained!

Customer Service Call Reduction We’re #1!

Comprehensive Scorecard

Future: Copay Contribution, Customer Service, Productivity Scorecard Elements Quality Denials Insurance Ad Hoc Coaching Score = Future: Copay Contribution, Customer Service, Productivity

Patient Tracking Software - Benefits Elimination of paper sign-in sheets Identification of bottleneck via dashboard and reporting Real-time staff monitoring with opportunity to adjust Real-time patient flow technology Constant spotlight on patient experience in Patient Access

On demand and scheduled reporting Robust Reporting Patient wait times Summary Detail to patient level Patient flow Productivity On demand and scheduled reporting

Registration Through-put Monitoring Patient Check-In Patient to be greeted by person, not clipboard Patient checked into software tracking tool by greeter Clock begins to measure patient wait times Simple and easy to use

Real-time Dashboard

Ability to prioritize patients Dashboard Features Ability to prioritize patients Area and priority color-coding for easy detection Patient Wait Times on dashboard turn colors as service urgency thresholds met Manager access to all service locations Alerts Via text or email Patient wait extends threshold Patient volume increase to adjust staffing Registrant in particular status for extended period

Patient Names Appear Here for Encounter Specific Detail Drill-down Reporting Reg Wt Time Patient Names Appear Here for Encounter Specific Detail Reg Time

Creative Utilization of Tool - ED ED Tracking Board Extension of patient tracking beyond registration Radiology – Baseline 65th percentile Current 90th percentile Call center return call monitoring SUCCESS!! Radiology Example – Patient movements, count for drinking barium, sent to lab, etc. Success

Additional Software Features Monitor patient flow and wait times Registration Ancillary Check Points Anticipate patient arrival in ancillary areas Identify scheduled or walk-in patients using "Visit Type" drop down menu Prioritize by appointment time Require delay code Monitor patient flow and wait times at any registration point including ancillary areas  Create a customizable survey Anticipate patient arrival - Procedure drop down allows ancillary areas to prepare prior to patients arrival Identify scheduled or walk-in patients using "Visit Type" drop down menu Prioritize by appointment time Require delay code if expected time is expected to start or complete a registration and when sending patient from one location to another Patient Encounter report provides detailed view of survey responses and full patient experience Key Factors reports provides breakdown by visit type along with average processing times High Level Dashboard provides a way to see all hospitals, lobby areas, and current wait times

Additional Software Features (Cont’d.) Customize patient surveys Detailed view Report by visit type with average processing time Utilize high-level dashboard to see all locations at enterprise level - hospitals, desks, and current wait times

Empowerment and Accountability Scripting Customer Service Standards Policy Engagement in annual goals and monthly review of performance against metrics – as a team and individual Accountability Statement

Real-time patient feedback Patient Survey trays Real-time patient feedback Focused on experience with registration and the registrant Paging to manager if patient ranks low on “compassion and sincerity” for real-time service recovery Download nightly Reporting - online Individual Department Facility By question

Cleveland Clinic HCAHPs – Top Box (Current – not yet published) Results Customer Service Tray Scores (registration specific) – above 95% Satisfaction Cleveland Clinic HCAHPs – Top Box (Current – not yet published) Rate Hospital 82% Recommend Hospital 86% Specific Domains As high as 15% improvement in one year – 2010 to 2011

QUESTIONS?