1. Starting the Discussion on Improving Scores among Member Institutions
AAMC HCAHPS Webinar:
Starting the Discussion on Improving Scores among Member Institutions
Presenters
James Merlino, MD (Cleveland Clinic)
Traci Hoiting, RN, MS (UCSF)
Andrea Swartz, MS (MUSC)
Joan Herbert, RN, MS (MUSC)
2:00 PM EST
Wednesday, March 14, 2012
USER NOTE: Webinar recording will start once in Slide Show mode. (Press F5 for PC users)

2. Additional Information
If you have not done so already, please dial-in to the webinar at:
Dial-in number:
Pass code:
AAMC Contact Information
Jennifer Faerberg Director, Health Care Affairs
Scott Wetzel
Program Specialist, Health Care Affairs

3. The Cleveland Clinic Experience AAMC Webinar 3-14-2012
James Merlino, MD
Chief Experience Officer

4. Read cartoon.
Say: wouldn’t it be great if it were this easy? Unfortunately it’s not reality.
Healthcare is probably the most intimate service that you can receive. It dynamic - changing constantly.
Give a personal example of how healthcare is different today than it was in the past.
Ask: One of the biggest changes is how we get our healthcare information today. How or where do we get our healthcare information?
Acknowledge responses, things like: internet, TV, friends/family, etc.
Say: that’s right! I was watching a news show that said that in the US, a patient’s perception of their healthcare experience is shaped by the medical shows that we see on TV. Shows like, House, ER, Scrubs, Gray’s Anatomy.
Ask: Do any of you watch these shows?
Give example of how these shows may lead to “unrealistic expectations” by citing specific examples from the shows.
Say: So if patient’s watch these shows, and things don’t happen the way they do on TV, they may be disappointed or frustrated or upset. Using the HEART model can help if you are faced with these situations. 4 4

5. Main Campus Patient Satisfaction
Source: Press Ganey and QDM Survey Vendors
Percentiles displayed based on scores unadjusted for patient mix and mode compared to all Press Ganey U.S. Hosp Clients
Overall Rating CC %ile th th rd th
Hosp Recomnd CC %ile th nd th th 5

6. Main Campus Patient Satisfaction
Source: Press Ganey and QDM Survey Vendors
Percentiles displayed based on scores unadjusted for patient mix and mode compared to all Press Ganey U.S. Hosp Clients
CC Percentile Rank Trend
HCAHPS Domains
D/C Info
Meds Comm
Pain Manage
Clean
Nurse Comm
Doc Comm
Quiet
Staff Repnse 6

7. Improve Patient Experience Domain Focused Teams
Clinical project manager
Consolidated efforts
Best practice driven
Metrics
Process metric
Outcome metric

8. Environment Quiet at Night

9. Elements of the Protocol
HUSH Champions
Patient expectations flier
HUSH Posters
Announcement at 9:00pm
Doors closed as appropriate
Hallway lights dimmed
Staff are counseled about noise
Floor auditing

10. Quiet at Night Weston
82.0%
90th

11. Responsiveness Nurse Communication
Emphasis on Hourly Rounding
Front line staff education & input
Metrics
Process
Outcome
Manager accountability
Audits

12. Did a Nurse Visit Every 2 Hrs
Main Campus
July – November, 2010

13. ‘Always’ Rounded

14. ‘Usually’ Rounded

15. ‘Sometimes’ Rounded

16. ‘Never’ Rounded

17. Top 20 Units: Nurse Rounds Every 2 Hours
July 2010 – January 2011
N size limited to > 60 returned surveys per unit

18. Nursing Plan Orientation and on-boarding
Nursing HCAHPS education brochure
Service excellence training
Standardize unit reporting
Regular manager meetings
Process auditing and feedback
Unit mystery shopping

19. Doctor Communication Physician leadership Education and Communication
Score transparency
Complaint transparency
Verbatim analytics
Task force
How do we “teach” improvement ?
Communication Champions
Peer physician coaches
Communication “guide”
House staff
Behavior

20. Scatter Plot

21. Inpatient Verbatim Themes
Domain
Negative
Positive
Total
Behavioral 15 40 55
Communication 38 11 49
Facility 33 2 35
Overall 4 28 32
Food 20 31
Pt Centered Services 17
Processes 22 24
Discharge 21 23
Noise
Visitors 8 6 14
Responsiveness 10
Wait 7 1
Cleanliness
Safety
Pain 5
New Medications
GI Total
228
118
346 21

22. Verbatims by Employee Group
All Comments
Negative Comments
Of the 346 verbatims, 159 were employee related
N = 159 comments 22

23. Physician Verbatims All Comments Negative Comments N = 63 comments
Of the 346 verbatims, 159 were employee related
N = 63 comments 23

24. Physician Communication Comments & HCAHPS Scores
Explain
I rec'd no report on the ERCP. In fact the nurse seized my folder/report from my son. My GP also did not receive the report.
Explain: Sometimes Listen: Usually Respect: Usually
Not enough discussion with doctors following any procedures.
Explain: Sometimes Listen: Sometimes Respect: Usually
Listen
Told dr. I had factor 5 & no note was made; was surprised about my clot at end of PICC line.
Explain: Sometimes Listen: Usually Respect: Usually 24

26. Noise Reduction
DEPARTMENT OF NURSING
Traci Hoiting
March 1, 2012

27. In August 2011 the University of California San Francisco agreed to participate in the UHC HCAHPS Collaborative on Noise Reduction.  Our Environment of Care staff council lead the effort and 6 pilot units were selected to participate, trial various strategies to noise reduction and then endorse best practices for broader implementation.

28. Our first intervention was the pilot implementation of the Yacker Tracker device which alarms when noise levels exceed set decibel levels.  It has a red, yellow green light visual alert.

29. Quiet time hours were set for several units
Quiet time hours were set for several units.  Notice sent to Hospitality and other departments to alert them to quiet time hours for adjustment of scheduling of floor buffing, cleaning etc.
Quiet time signs developed to be posted house-wide.

30. Further investigation undertaken of a NoiseMeter with data collection capabilities to rotate between pilot units.  Used to identify peak noise times and areas.
Collaboration with Material Services, Hospitality, Stericycle, Facilities/Construction to evaluate and consider noise reduction strategies e.g. wheels on carts, delivery times, fire door closings etc.
Unit councils evaluating nurse call workflows and usage, monitoring alarms, paging systems, conversation/rounds noise levels

31. Facilities and construction to provide noise reduction kits to units that are under construction.  Kit includes earplugs, eye covers, noise reducing headphones and white noise machines as appropriate and communication that we apologize for our construction noise and UCSF is working to improve our surroundings.
Full system noise assessment including delivery trucks, window replacements, loading docks, noise reduction curtains, noise muffling system (pilot on 1 unit), evaluate future purchases for wheel and cart noise.

32. Additional noise sources for AMCs due to variety of campus students using hospital areas, cafeteria, etc. but not a part of hospital. Need to engage Chancellor support to inform schools - Pharmacy, Dentistry, Nursing, PT, etc. - to be aware of their voices and behavior when in hospital zone.

33. Future:  Video/audio of actual noise in patient care areas to demonstrate how noisy our environment is and to heighten awareness, educate the medical center staff.
Communication posters to remind staff the medical center is a quiet zone for healing.
Consider Quiet Hospital Zone posters on street to begin educating visitors before they enter.
Manager Meeting Presentation with sharing of strategies, HCAHPS scores, benchmarks and impact on VBP.

35. Achieving Top HCAHPS Performance Service Excellence at Medical University of South Carolina Education, Collaboration and Accountability
Joan Herbert, RN, MS Director, Organizational Performance – Medical Center
Andrea Swartz, MS
Director of MUSC Excellence - College of Medicine/MUSC Physicians

37. About MUSC Medical University of South Carolina (Charleston, SC)
Established in 1824
First Medical College in the South
Academic Medical Center
709 beds
Six hospitals
Medical University Hospital
Ashley River Tower
Children's Hospital
Storm Eye Institute
Institute of Psychiatry
Hollings Cancer Center
11 Service Lines
Over 10,000 MUSC employees including the University staff
895 physicians & 617 residents

38. Provide Excellence in patient care, teaching and research
Mission of MUSC Medical Center
Provide Excellence in patient care, teaching and research
In an environment that is:
Respectful of others
Adaptive to change
Accountable for outcomes

41. How did we achieve these results?
Not overnight – a 6 year journey and we’re not done…
We did not focus on HCAHPS questions specifically, but launched a broader MUSC Excellence program.
Objectives of today’s webinar are to share:
Strategies to improve Physician Communication.

42. Key Variables
Collaboration between Hospital & College of Medicine/Faculty Practice Plan
Leadership Commitment
Champions:
Director of Organizational Performance
Director of MUSC Excellence COM/MUSC Physicians

43. Strategies Transparency Quarterly Reports –Patient Satisfaction
Mt Plsnt Cardiology
97.71
WA Cardiology
96.62
EC Pulmonary
96.38
Radiation Oncology Clinic
96.16
Children's Sickle Cell Clinic
95.83
Hollings Cancer Ctr Thoracic Surgery Clinic
95.72
Ear Nose and Throat
95.71
GI Medicine
89.62
Children's Pulmonary Clinic
89.16
Children's Neurosurgery Clinics 89
EC Neurology/Neurosurgery
88.92
Children's GI Clinic
88.82
Adult Neurology Clinic
88.46
CFC 30 Bee Street
88.16
Children's Neurology
87.98
Spec Care NC Allergy
87.44
Children's Cardiology Clinic
87.12
OB/GYN Resident Clinic
76.87
Transparency
Quarterly Reports –Patient Satisfaction
Physician Dashboards
Patient Comments Department and Physician Level
CMO reporting at MEC and Medical Staff Meetings

44. Strategies Education Department/ Division Faculty Meetings
Dean and Associate Dean presentations related to the importance of communication in a patient’s experience
Medical Staff Meetings
CMO presentations about Patient Satisfaction, Value Based Purchasing, HCAHPS, goals and results
Departmental Resident Meetings
Tailored education by the Champions related to the importance of communication in a patient’s experience, HCAHPS, and our results by specialty

45. Strategies Engaged Teams
Service Excellence Steering Committee
Outpatient
Radiology
ART Radiology
Main Radiology
RT Radiology
Ambulatory Surgery
ART OR
Main OR
RT OR
Laboratory
ST, PT, OT
Hospital Based Clinics
Inpatient
Main
Individual Unit Teams
ART
Psychiatry
Women's & Children
CH Inpatient Units
CH Inpatient Unit Teams
Peds ED
Women's Inpatient Services
Standards**
Communications
Reward & Recognition
Employer of Choice
Measurement
Strategies
Engaged Teams
Patient Experience Teams in every clinical area outpatient and inpatient
Physician participation

46. Strategies Recognition Clinics Units Physicians
I was diagnosed w/diabetes in July
I feel blessed to have gotten
an appointment with Dr. Kathie
Hermayer - as I understand she is in
charge of the diabetic center at
MUSC and is considered the best
diabetic physician in Charleston - I
am thrilled to have her to care for me
and my son, who is also a patient of
hers. She is wonderful!
Recognition
Clinics
Units
Physicians

47. Strategies Aligned Goals MUSC Medical Center Medical Administrative
Leaders Leaders
(?) Frontline Staff
There would not be success without alignment of goals and action plans across all areas of the service line and I will show you an example of this in just a minute.
Incentivizing physicians to achieve goals is now done in approximately 78% of organizations. In our organization all Medical Director’s pay is dependant upon achievement of aligned goals. Up to 30% of their pay is “at risk” dependant upon achieving goals.
Goals are cascaded down to managers as well as staff ultimatly and merit pay is dependant on achievement of these goals.

48. Future Directions?

49. HCAHPS (Oct-Dec 2011) Strategy Focus on Items Rather than composites
Location
Communication - MD
Courtesy
Listen
Explain
10 West
87.5
78.12
5 East
100 96
91.67
5 West
94.74
84.21
6 East
86.05
90.7
6 West
83.33 75
66.67
7 West
94.44
81.48
77.36
8 East 65 55
8 West
80.77 80
73.08
9 East
84.09
75.56
9 West
94.12
90.91
85.29
ART 3 West
93.33
85.11
82.98
ART 4 East
96.36
91.07
82.46
ART 5 East
92.86
ART 5 West
86.67
73.33
ART 6 East
95.83
ART 6 West
94.59
81.08
73.68
Joint Replacement
90.32
61.29
70.97
MUSC Medical Center
91.14
82.74
79.97
Legend
Benchmark
75th - Bnmk
< threshold
Strategy
Focus on Items
Rather than composites

50. Strategic Plan: Tactics
Continue to Align and Unify
Reinforce physician accountability and incentivize on key performance metrics
Differentiate through superior patient experience

51. Questions?

52. VBP Resources
CMS conducted a VBP dry run in February. Your simulated hospital specific reports for the dry run are now available on CMS hosted a National Provider Call on the dry run on February 28. The slides from the call can be found here. The AAMC has also distributed VBP simulated financial impact data to each COTH institution in February, 2011.

53. Presenter Contact Information
James Merlino, MD, Chief Experience Officer Cleveland Clinic Health System Traci Hoiting, RN, MS, Associate Director Patient Care/Nursing UCSF Medical Center Andrea Swartz, MS, Director of MUSC Excellence College of Medicine/MUSC Physicians Joan Herbert, RN, MS, Director of Organizational Performance MUSC Medical Center

54. Call Playback Information
The replay will be available for 7 days:
Dial-in:
Pass code: