Melissa TaylorDirector, Patient Access/Pre-Access Cleveland Clinic

Creating a Positive Patient Experience Driven Culture

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

• CMS – Value Based Purchasing• Pay for Performance – reimbursement contingencies• Quality• Efficiency• Patient Satisfaction

• Transparency• Published clinical measures• HCAHPS• Pricing

• Informed Consumers

Patient choice!

State of Healthcare Reimbursement

Three goals1. Meaningful comparison for consumers

2. Public reporting is incentive for hospitals to improve

3. Enhance accountability by increasing transparency of quality

HCAHPS - Goals

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

Source: www.hcahpsonline.org

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!

“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

What is Patient Experience?

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 Questions1. Speed of Admission Process

2. 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

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

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

Scorecard Elements

Quality

Future: Copay Contribution, Customer Service, Productivity

Ad HocDenials Insurance Coaching Score=

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

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

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

Drill-down Reporting

Patient Names Appear Here for Encounter Specific Detail

Reg Wt Time

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!!

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

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

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

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?