improving patient satisfaction with minitabimproving patient satisfaction with minitab christopher...

Minitab Insights Conference 2016 September 12-13, 2016

www.SprangerBusinessSolutions.com 1

Improving Patient Satisfaction with Minitab

Christopher Spranger, MBA, ASQ MBB

Preview

• Changing healthcare environment

• Patient satisfaction process

• Defining our opportunity

• Establishing a baseline

• Finding the “right” factors

• Implementing improvements

• Results & impact



Changing Healthcare Environment: Value Based Purchasing

How the CAHPS System works

• Surveys administered by a 3rd party

• Standardized questions

• Only top box “counts”

• Domains

CAHPS = Consumer Assessment of Healthcare Providers and Systems



Improving HCAHPS Scores

Project Title: Design a Patient Education Process

Project Goal: Improve HCAHPS Dimension for “discharge information”

Business Case: For Riverview Hospital, scoring below the Value Based Purchasing benchmarks represents a potential $4.5 million revenue loss over the next 5 years…HCAHPS is 30% of VBP!

“If you pour all of your resources toward improving a domain, expect a 2-3% increase in top box scores within a year.”

-3rd party survey administrator



Baseline Performance: Discharge Domain

“Let’s develop a process to be performed in MSPI on admission that touches all different learning styles and focus on the needs of elderly, people who do not speak English as

a primary language, and people with lower education levels.”

~Chief Nursing OfficerDefine…

Measure…Analyze…Wait a second…



Drilling in to find “key factors”

Discharge Domain

Symptoms or health problems to

watch out for?Have help you needed after

you left the hospital?

????? ? ? ? ? ?

Let’s test those assumptions…

The biggest opportunity “must” be… Hypothesis

Med/Surg/Peds Inpatients Ho: MSPI scores are no different than the rest of the inpatient unitsHa: MSPI scores are lower than the rest of the inpatient units

Patients with lower education levels Ho: Patients with lower education levels score the same as the rest of the patientsHa: Patients with lower education levels score lower than the rest of the patients

Patients who do not speak English as a primary language

Ho: Non English speaking patients score the same as English speaking patientsHa: Non English speaking patients score lower than the rest of the patients

Elderly patients Ho: Elderly patients score the same as the rest of the age groupsHa: Elderly patients score lower than the rest of the age groups



What data is available?

Unit

Visit Identification

NumberHCAHPS Survey

Electronic Medical Records

• By using the Visit Identification number, we were able to correlate the survey responses to each patient’s individual experience

• This helped us identify the key factors we needed to work on to improve our overall scores

Differences between Units

• 3 different units

• Medical / Surgical / Pediatric unit

• Birthing unit

• Critical Care unit

• Data from most recent 12 month period

• One-Way ANOVA using Minitab Assistant to detect differences between the 3 different units



ANOVA Output - Units

Unit Sample Size Mean

CCUI 23 .6957

FBPI 247 .8016

MSPI 859 .8778

MSP a low performer?

Differences in Education Level

• Seven different education levels recorded

• 4 year college graduate

• 4+ years college

• Some college

• High school graduate

• Some high school

• 8th grade

• NULL


• One-Way ANOVA using Minitab Assistant to detect differences between the different education levels



ANOVA Output - Education

Differences in Language

• Three different primary languages recorded

• English

• Other

• NULL


• One-Way ANOVA using Minitab Assistant to detect differences between primary language



ANOVA Output - Language

Differences in Age

• Patients aged 18 to 98 years


• One-Way ANOVA using Minitab Assistant to detect differences between age



Age Group Graphical Analysis:

0

5

10

15

20

25

30

35

40

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96

Age

Patients Given Information About What to do At Home

% Yes Sample Size

Interpretation of Results: Of the 18 age groups that answered “yes” less than 80% of the time, 7 were from age 29 to 37. Ages that answered “yes” less than 80% of the time: 20, 23, 24, 29, 30, 31, 32, 34, 36, 37, 43, 46, 62, 64, 80, 85, 89, and 90.

Age Group Comparison

88-9778-8768-7758-6748-5738-4728-371 8-27

1 00.00%

90.00%

80.00%

70.00%

60.00%

50.00%

Age Range

% Y

es

91.30%

86.93%88.84%88.21%87.32%

83.53%

71.54%

86.72%

Chart of % Yes by Age group



Age Group Analysis:

Age Group Sample Size Mean

18-27 128 .867

28-37 130 .715

38-47 85 .835

48-57 142 .873

58-67 212 .882

68-77 233 .888

78-87 153 .869

88-100 46 .913% of “yes” responses

Let’s test our assumptions

The biggest opportunity “must” be… Hypothesis

Med/Surg/Peds Inpatients Ho: MSPI scores are no different than the rest of the inpatient unitsHa: MSPI scores are lower than the rest of the inpatient units

Patients with lower education levels Ho: Patients with lower education levels score the same as the rest of the patientsHa: Patients with lower education levels score lower than the rest of the patients


Ho: Non English speaking patients score the same as English speaking patientsHa: Non English speaking patients score lower than the rest of the patients

Elderly patients Ho: Elderly patients score the same as the rest of the age groupsHa: Elderly patients score lower than the rest of the age groups



What did we learn?Our “Ah Ha” Moment

What our hunches told us… What the data revealed…

MSP Patients Family Birthplace Patients

Patients with lower education levels No differences in responses between education levels


No differences in responses between different languages

Elderly patients Patients aged 28 to 37 years

Does Diagnosis Matter?

DRG: Diagnosis Related Group



Targeting High Impact Opportunities

Whole hospital average = 85.83% ‘yes’ responses

• Project #1: Atrial Fib in Critical Care Unit and Med-Surg-Peds (66.7% ‘yes’ responses)

• Project #2: Abdominal Hysterectomies in Med-Surg-Peds (78% ‘yes’ responses)

• Project #3: Vaginal delivery patients in Family Birthplace (77.3% ‘yes’ responses)

Analyze

Key Problem How We Know it Contributed to the Y

Timing of Education

• Voice of the Customer – reoccurring themesInvolvement with Family Caregiver

Expected Outcomes not Clear

Review the data analysis

Map the process

Voice of the customer

Take Action!



Improvement Strategies

Key Problem Changes Implemented

Timing of Education • Redesign of education process into three phases• Collaborate with primary care physician clinics• Electronic checklist prompts nursing involvement every

8 hours

Involvement with Family Caregiver

• Primary family caregiver is identified up front and engaged in the care management throughout the stay

• Question added to admission database• Family caregiver prints to case management census

sheets

Expected Outcomes notClear

• Clarified vague terms for the specific procedure. “Excessive bleeding”, etc.

Remeasure



Remeasure



Business ImpactTo: All EmployeesFrom: Director of Business DevelopmentSubject: ARHC Receives High Marks!

We have received some great news, and I wanted to share it with you.

The Centers for Medicare and Medicaid Services (CMS) recently released a report that ranked ARHC in the 90th

percentile for patient satisfaction scores from January to December 2014. This means that ARHC ranked higher than 89% of hospitals nationwide that are subject to Value Based Purchasing (VBP) – a CMS program that rewards hospitals for the quality of care patients receive. One of the VBP metrics used to score hospitals is their results on inpatient satisfaction surveys.

The highest satisfaction scores were received in the following areas:

• Communications about medicines – Patients reported that new medicines and their potential side effects were explained

• Hospital Environment – Patients reported that their rooms and bathrooms were clean, and that the hospital was quiet at night

• Discharge Information – Patients reported that they received and understood their discharge instructions

Although the ARHC ranking is based on information from 2014, which is the most current information available, it is evidence of what can be achieved when we work as a team and put our patients first.

Congratulations and thank you!



Lessons Learned

• Leveraging lessons learned across DRGs

• Data analysis of other HCAHPS dimensions to form additional improvement teams

• Finding and using the right data will ensure you are spending time and effort improving the “right things”

• Having teams work on smaller scoped portions of a larger problem simplifies the problem solving process and makes implementing change easier.

• Don’t start an improvement event until you have a clearly scoped problem and supporting data!



35

@Chris24Spranger

LinkedIn.com/in/christophermspranger

facebook.com/SprangerBusinessSolutions/

SprangerBusinessSolutions.com

[email protected]

http://www.linkedin.com/in/christophermspranger

https://www.facebook.com/SprangerBusinessSolutions/

http://www.sprangerbusinesssolutions.com/

mailto:[email protected]

improving patient satisfaction with minitabimproving patient satisfaction with minitab christopher...

Documents