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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)
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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
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The Cleveland Clinic Experience AAMC Webinar 3-14-2012
James Merlino, MD Chief Experience Officer
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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
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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
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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
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Improve Patient Experience Domain Focused Teams
Clinical project manager Consolidated efforts Best practice driven Metrics Process metric Outcome metric
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Environment Quiet at Night
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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
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Quiet at Night Weston 82.0% 90th
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Responsiveness Nurse Communication
Emphasis on Hourly Rounding Front line staff education & input Metrics Process Outcome Manager accountability Audits
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Did a Nurse Visit Every 2 Hrs
Main Campus July – November, 2010
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‘Always’ Rounded
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‘Usually’ Rounded
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‘Sometimes’ Rounded
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‘Never’ Rounded
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Top 20 Units: Nurse Rounds Every 2 Hours
July 2010 – January 2011 N size limited to > 60 returned surveys per unit
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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
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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
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Scatter Plot
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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
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Verbatims by Employee Group
All Comments Negative Comments Of the 346 verbatims, 159 were employee related N = 159 comments 22
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Physician Verbatims All Comments Negative Comments N = 63 comments
Of the 346 verbatims, 159 were employee related N = 63 comments 23
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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
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Noise Reduction DEPARTMENT OF NURSING Traci Hoiting March 1, 2012
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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.
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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.
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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.
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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
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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.
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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.
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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.
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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
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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
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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
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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.
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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
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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
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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
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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
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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
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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.
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Future Directions?
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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
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Strategic Plan: Tactics
Continue to Align and Unify Reinforce physician accountability and incentivize on key performance metrics Differentiate through superior patient experience
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Questions?
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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.
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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
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Call Playback Information
The replay will be available for 7 days: Dial-in: Pass code:
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