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Patient Experience: Empathy by Design

Lori Kondas, MBA Senior Director, Office of Patient Experience

• Organizational Culture and Experience • Leadership and High Performing Teams • Financial Risk and Reward

• Patients First: Empathy by Design

Beginning PE is on the organization’s agenda as a priority to address. Leaders are contemplating how to start a PE program with hopes of operationalizing efforts. Organizational awareness around ‘patient experience’ remains vague

Developing PE is an ad hoc and intermittent program driven by self-engaged leaders and individuals. Some leaders becoming identified as PE champions. Pilots underway. Pockets of improved patient ratings are emerging.

Operationalized PE is a growing focus across the organization. Best practices tools and standards are being shared & implemented. Education & awareness is spreading to caregivers. Caregivers beginning to grasp how they impact PE PE priority is making its way to senior leader agendas.

Advancing Cultural Competency PE is recognized as a competitive advantage for patient care and new caregiver recruitment. There is a sense of urgency / priority around PE. Efforts in place to engage providers. Patient ratings are shared transparently. PE is driven by leadership & survey performance is reviewed regularly. Managers becoming accountable.

True North PE is embedded in the culture. PE is a factor affecting the bottom line. Leadership lives it. Caregivers recognize & express PE as a guiding principle in their work and improvement initiatives. PE is the core organizational competency by which the Enterprise has become known.

Organizational Patient Experience Readiness

1 2

3

4 5

Organizational Culture

Cleveland Clinic Health System

- 49,000 caregivers - 3,400 physicians & scientists - 14,000 Nurses - 1,800 residents & fellows - 6.6 million outpatient visits - 167,000 hospital admissions - 10 regional hospitals - International locations:

- Canada, Abu Dhabi, London

Organizational Structure • Not for Profit

• Group Practice

• Physician Leadership

• Clinical Institutes

• Physicians

- Salaried

- Annual Professional Review

- 1 Year Contract

©2016 Cleveland Clinic Foundation All Rights Reserved

Organizational Values

• Established 96 years ago the values remain:

- Better care of the sick

- Investigation of their problems

- Further education of those who serve

• Since 1921, our goal has been consistent:

To put patients first

Enterprise Challenges

• Separate Community Hospital Model

• Large Academic Medical Center

• Specialty / Sub-Specialty Focus

• Complex Care with Highest Acuity

©2016 Cleveland Clinic Foundation All Rights Reserved

2005: New Leadership

“What was the key to our historical success, would not be adequate in the future…..”

©2016 Cleveland Clinic Foundation All Rights Reserved

Cleveland Clinic Performance HCAHPS Ratings: 2009

58

24 36

28 30 18

37 26

020406080

100

D/CInfo

DoctorComm

NursingComm

Clean PainControl

Response MedsComm

Quietat Night

CC National %ile Ranking

National Average

% Yes % Always

©2016 Cleveland Clinic Foundation All Rights Reserved

“Patients were coming to us for our high quality care, but they did not like us very much.”

- Toby Cosgrove, MD President & CEO

©2016 Cleveland Clinic Foundation All Rights Reserved

The Value of Experience

Organizational Culture

Leading Change

• Create Shared Vision

• Develop and Engage Leadership

• Create Transparency and Share Impact

• Involve, Connect, Engage and Equip

Caregivers

Leading High Performing Teams

Engage 43,000 Caregivers!

Shared Vision: 2010

Shared Vision: 2016

©2016 Cleveland Clinic Foundation All Rights Reserved

Sustain the Message Reinforce Shared Accountability “It’s because of all of you that our patients’ experience is improving. Thank you for keeping Patients First!”

Consistently Message the Vision

©2016 Cleveland Clinic Foundation All Rights Reserved

Leadership

Leading High Performing Teams Monthly Leadership Rounds

Leadership Rounding

Leadership

• Quality, Safety and Patient Experience Board Committee

• Person and Family Engagement Strategies

• Patient Experience Empathy and Innovation Summit

Leadership

Equip, Develop, Support and Engage Caregivers

“Well, right now I’m feeling a little uncomfortable”

“So, how are you feeling?”

R elationship:

E stablishment

D evelopment

E ngagement

The Cleveland Clinic R.E.D.E.SM Model

24

Windover AK, Boissy A, et al. JPE 2014;1:3-8.

©2015 Cleveland Clinic Foundation All Rights Reserved

CONCLUSIONS: System-wide relationship-centered communication skills training improved patient satisfaction, physician empathy, self-efficacy and reduced physician burnout.

Service Philosophy and Objectives

1. Increase the awareness of the impact of every patient, visitor and employee interaction

2. Understand the role of the employee is greater than the tasks associated with his/her job

3. Empower employees to deliver world-class care

PATIENT EXPERIENCE What is it?

• Safe Care • High Quality • Patient Experience / Engagement • Affordable

= High-Value Care

©2016 Cleveland Clinic Foundation All Rights Reserved

Patients First

1969 Rock Opera, Tommy

A Patient Perspective: Empathy

“Your title is caregiver but you are so much more than that…. It was you who gave quality care for my dying loved one with such amazing kindness and compassion…. You nourished us with gifts, love and compassion…. You gave us strength when our hearts were strained… I'd like to tell you what a difference you made. You probably don't know that your patients and their families fall in love with you. We love you.”

Source: Advisory Board

Preferred Primary Care Clinic Attributes

I can walk in without an appointment, and I’m guaranteed to be seen within 30 minutes

If I need lab tests or x-rays, I can get them done at the clinic

The provider is in network for my insurer

The visit will be free

The clinic is open 24 hours a day, 7 days a week

I can get an appointment for later today

Six out of the top 10 attributes were related to access and convenience.

Empathy in Design Access…Anytime, Anywhere

Empathy by Design Voice of the Patient

…and their loved ones

Organizational Culture of Improvement

A culture in which every Caregiver is capable, empowered, and expected to

make improvements every day.

Nursing Unit Project

33

23

0

5

10

15

20

25

30

35

Q1 & Q2

Patient Falls 2014 2015

0:00

0:14

0:28

0:43

0:57

1:12

1:26

1:40

1:55

2:09

12/1 1/26 3/23 5/18 7/13

Min

utes

Call Light Response Time

Savings $170,000

Cleveland Clinic Hospital Experience Ratings

58

24 36

28 30 18

37 26

88

66

80 77 72 61

72

38

90

020406080

100

D/CInfo

DoctorComm

NursingComm

Clean PainControl

Response MedsComm

Quietat Night

CareTrans

National %ile Ranking

% Yes % Always %

Strongly Agree

Financial Risk and Benefit

CEOs and senior leaders at 35 U.S. hospitals that place a high priority on patient experience cite: Lower staff turnover, higher retention, recruitment

of more highly qualified staff Greater patient loyalty Reduced costs from shorter lengths of stay Lower rates of re-hospitalization Better health outcomes, and fewer costly

procedures. An Agenda For Improving Compassionate Care: A Survey Shows About Half Of Patients Say

Such Care Is Missing . Beth A. Lown*, Julie Rosen and John Marttila doi: 10.1377/hlthaff.2011.0539 Health Aff September 2011 vol. 30 no. 9 1772-1778

Business Acumen Return on Investment

• In 2008, The Center for Medicare and Medicaid Services (CMS) began publishing HCAHPS scores on their hospital compare website

• In late 2012, a portion of each hospital’s acute care reimbursement became tied to its public performance on the HCAHPS survey, further elevating the importance of patient experience as a component of quality care.

Risk and Return on Investment

Risk and Return on Investment Value Based Purchasing

• Move from fee-for-service to pay for Performance - Hospitals that provide higher quality

care will receive reimbursement incentives

- Hospitals that provide a lower quality of care will be penalized

Patient Experience Key Messages

• Establish Culture and Build Accountability • Lead People: Create and Share the Vision

o Equip, Support and Engage Caregivers • Patients First: Empathy by Design Focus on What Matters Most

Office of Patient Experience

Best Practices

Volunteer Services

Research

Center for Healthcare

Communication

Business Development

Shared Medical

Appointments

Bioethics

Data Intelligence

Ombudsman

Service Excellence

Spiritual Care

End of Life

Empathy the Human Connection

Value Based Purchasing

Ties up to 2% of Medicare reimbursement to performance from four domains.

Process 10%

Outcomes 40%

Efficiency 25%

©2016 Cleveland Clinic Foundation All Rights Reserved

Patient Experience 25%

Share Impact: Themes Access to Care

7% Process to Care

12%

Delays 22% Communication

& Service 34%

Billing 17%

Environment 8%