your impact on hcahps sarah d. ponder improvement manager press ganey associates
TRANSCRIPT
Your Impact on HCAHPS
Sarah D. PonderImprovement Manager
Press Ganey Associates
HCAHPS 101
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Consumer Assessment of Healthcare Providers and Systems
Produces comparable data for public reportingCreates incentive for organizations to improveEnhances public accountability and transparency
Hospital CAHPSHome Health Care CAHPSClinician and Group CAHPS… more to come!
CAHPS provides an apples to apples metric for publicreporting—additional measurement may be needed for ongoingquality improvement activities and monitoring.
What is CAHPS?
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Consumers have access to the data
Consumers relate more easily to CAHPS ® data than to clinical data
Some use CAHPS ®
data to choose hospitals
CAHPS ® is in the public eye
Media coverage
Promotion by hospitals themselves
Participation linked to reimbursement
Will have volume, revenue, and reputation implications down the road
Why is CAHPS ® Important?
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HCAHPS Survey
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HCAHPS Survey Format
Evaluative Questions
Global Rating Questions Screening Questions
About You Questions
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Hospital EnvironmentDuring this hospital stay, how often were your room & bathroom kept clean?
Never, sometimes, usually, always
During this hospital stay, how often was the area around your room quiet at night?
Never, sometimes, usually, always Overall RatingUsing any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?
0-worst—10-best possible hospital
Would you recommend this hospital to your friends & family? Definitely no, probably no, probably yes, definitely yes
Questions you Impact
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Patient Eligibility
All payer types
18 years or older
At least one overnight stay in the hospital (admit date & discharge date cannot be the same)
All MS-DRGs except: Primary psychiatric diagnosis, discharged from rehab or from
skilled nursing
Alive at the time of discharge
Not sent to patients with an international address
Not sent to patients discharged to hospice or correctional facilities
New: Not sent to patients discharged to nursing home or skilled nursing
General Survey Guidelines
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Hospitals SHOULD
Encourage response to the survey
“It is permissible to notify the patient while in the hospital or at discharge that they may receive a survey after discharge.”
Improve the patient experience
Distribute the communication guidelines
Hospitals SHOULD NOT
Ask patients for a certain score
Indicate that their goal is to receive a certain score
New: Show the HCAHPS survey or cover letter to the patient prior to survey administration
New: Mail pre-notification letter or postcards
Communication Guidelines
Public Reporting
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DomainsCommunication with DoctorsCommunication with NursesResponsiveness of Hospital StaffPain ControlCommunication about MedicinesDischarge Information
QuestionsCleanliness of Physical EnvironmentQuiet of Physical EnvironmentOverall Rating of CareLikelihood to Recommend
HCAHPS Public Reporting
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Data are adjusted based on the following: Patient Characteristics (“patient mix adjustment”)–Examples
– Type of Service (Medical, Surgical, OB)
– Self Reported Health
– Age
– Education
– Language
– Emergency room admission
Mode of survey distribution (“mode adjustment”) Phone Mail Mixed mode- mail & phone Active Interactive Voice Response
General Guidelines: Adjustments
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Updated Public Reporting Schedule
April 2011: Discharges from July 2009 – June 2010
July 2011: Discharges from October 2009 – September 2010
October 2011: Discharges from January 2010 – December 2010
January 2012: Discharges from April 2010 – March 2011
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Tables- Distribution of Responses
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The yellow bars indicate the National & State averages.
The blue bars indicate the averages for facilities selected.
Graphs - Percentage of “Always” Responses
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Additional reporting programs through the states of California, Rhode Island, Minnesota, Ohio, Maryland, Maine
State Reporting Programs
Value Based Purchasing
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Common Terminology: Pay for performance or Pay for quality
Health Reform UpdatesValue Based Purchasing will start in fiscal 2013Current hospital VBP program will transition from “Pay-for-Reporting” to “Pay-for Performance”
Up to 2% of your Medicare reimbursement will be at stake Hospitals will lose reimbursement unless their performance is at benchmark
levels Includes HCAHPS performance and Core Measures Will start at 1% and this will be ramped up to 2% by 2017
Who will be reimbursed for HCAHPS performance? Top performing healthcare providers Greatest improving healthcare providers
Value-Based Purchasing
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Future Measures
AHRQ patient safety indicators, inpatient quality indicators and composite measures
Nursing sensitive care
AMI, heart failure and pneumonia mortality rates
Hospital Value Based Purchasing - Measures
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Nurse Communication Doctor Communication Cleanliness and quietness Responsiveness of hospital staff Pain management Communication about medications Discharge information Overall hospital rating
HCAHPS Measures Used In Value Based Purchasing
Copyright © 2011 Press Ganey Associates
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Hospitals will be awarded points toward their earn back of withheld DRG payments.
Earn Achievement Points based on your performance on HCAHPS publicly reported measures. The spread between the threshold to benchmark
Earn Improvement Points based on improvement from the baseline period. Baseline to 95th
HCAHPS 8 Measures – 80 Possible Points
1 Consistency Score- 20 Possible Points
Value Based Purchasing Model
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Up to 20 Points Based on Lowest Ranking HCAHPS Measure
HCAHPS “Consistency” Points
Copyright © 2011 Press Ganey Associates
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10 20 30 40 50 60 70 80 90 99
Percentile Rank •
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Proposed Timeline
Key Timeframes for VBP
The “Baseline Period” discharges July 1, 2009 – March 31, 2010. The “Performance Period” discharges July 1, 2011 – March 31, 2012.
Copyright © 2011 Press Ganey Associates
Moving from Measurement to Action: Improvement Strategies
So where do we do focus?
Patient Priorities
Lowest Ranking Question
Most Opportunity to Earn Money Back
Create Performance Improvement Teams Around Each Publicly Reported Measure
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National HCAHPS data by Service Line
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Step 1: Identify a Goal
[S] Specific. Exactly what is it you wish to accomplish?
[M] Measurable. Identify the means by which you will achieve each goal. How will you know when you have reached it? Keep in mind that you will always have more control over performance than you will over outcome so set performance goals whenever possible.
[A] Action-oriented. Describe your goals using action verbs. What will you do (step by step) to reach your goal?
[R] Realistic. Choose goals that are possible and achievable. Goals set too high will discourage while goals set too low will not challenge and motivate.
[T] Timed. Determine deadlines for each of your goals. Deadlines can be flexible & adjusted as needed but deadlines help keep you focused and moving.
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Look at patient comments for trends or patterns Conduct patient & employee focus groups Fishbone Diagram at a high level
“5 Why’s” What is causing area of poor performance? Root cause analysis Flowcharting What are the CTQs?
Step 2: Identify the Cause
Patient Expectations
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Thinking backwards from the score itself
What is the perception of patients? What do they experience? (long wait, conflicting information, being
alone, in pain, etc.) How does it make them feel? (unvalued, confused, lack of trust, lonely,
afraid, stressed, etc.)
Causes don’t create a score, they create an environment in which a patient feels a certain way- that is what shapes how they evaluate care
Determining cause is extremely important- it ensures you are efficient in your choice of strategy for improvement
Cause- Solution Relationship
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Make two columns: one with patient experiences & one with patient feelings
Then make chart (below)- with your own ideas
Then take this back to staff & get their input
Cause Solution Activity
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Selecting a Course of Action:
We have identified that we can impact the following causes:
Because we can either: Modify the cause itself Modify how patients feel
We are selecting the following viable practice to match the causes of the patients’ current experience:
It should address the experience of patient (i.e. reduce wait time) or change the way a patient currently feels (i.e. reduce anxiety):
Cause Solution Activity (cont.)
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Which causes are you trying to address? Which causes do you have control over? Will you modify a cause or shape perception?
Does the selected solution address the causes or perceptions you have control over?
Will the selected solution be visible to patients? Will it be big enough to change? Will it impact all patients?
Is there anything you need to fix first, before you can implement this solution?
Step 3: Recommend a Solution
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“During this hospital stay, how often were your room & bathroom kept clean?
Ask patients when leaving the room if the room meets their cleanliness standards & if they would like anything else cleaned.
Increase frequency of non-daily cleanings (i.e. washing walls, waxing the floor, etc.)
Reinforce cleanliness by emptying waste baskets multiple times a day, offering to change sheets, etc.
Make all staff accountable for the appearance, not just environmental services
Include environmental services on unit cross functional teams
Room & Bathroom Kept Clean
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“During this hospital stay how often was the area around your room quiet at night?”
Modify equipment: Foam on trash cans, squeaky wheels on carts fixed, oil on doors, no
overhead announcements, dim lights, phone ringers turned down Use a dosimeter to measure noise levels on unit & track for a
period of time Work cross functionally with other departments to get
feedback regarding building or equipment noise Provide patients with a welcome kit that talks about “Quiet
hospitals help healing” that contains ear plugs, eye covers, & note that says: “one who has a good night’s rest awakes to a glorious morning”
Quiet at Night
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“Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?”
“Would you recommend this hospital to your friends & family?”
Empower all staff with power to “make it right” with patients Hire for attitude over aptitude, it is easier to teach skills than
service Share data openly with all levels of the organization Focus on employee satisfaction, happy employees make for
happy patients Use multiple outlets for patient feedback, especially creating a
patient advisory council
Rate & Recommend this Hospital
Universal Viable Practices
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“Maintenance” Rounds Conducted a minimum of once per shift, environmental services staff
visit each patient on the floor to make sure the cleanliness of the room meets their standards
Introduction Rounds Each morning environmental services staff brings the morning paper to
the patient with a sticker on it that says the staff member’s name & a contact number if at any point the room needs attention
Appearance Rounds Once a day the building services director rounds on specific units &
areas to get feedback from unit directors & managers on their current needs (i.e. light is out in room 203 or heater is not operational in conf room)
Cross Functional Team Rounds A member of both the environmental services team & the building
services team should sit on the patient satisfaction committees throughout the organization to help address related patient needs
Rounding
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Key messages should be used when there is an important message all patients should receive
Make sure a key message is: Staff that are going to use the key messages help to develop them Clear, short, and easy to understand Sounds natural and can be customized by staff
Limit 4-5 key messages per staff member
Examples: Greeting patients and families Entering and leaving patient rooms Communicating about actions that protect privacy/safety Informing patients of hospital services Patient rounds
Key Messages
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Service Moments of Truth
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Keep it simple & easy for everyone to remember
Have one toolkit for every department
A no questions asked policy should be enforced for toolkit usage
Have tracking spreadsheet to look for service patterns
Not all complaints warrant toolkit usage, most issues just require a sincere apology
Employ a Service Recovery Strategy
“H.E.A.T.” Philosophy Hear Empathize Apologize Take responsibility
“H.E.A.R.T.” Philosophy Hear the patient Empathize with the patient Apologize to the patient Respond to the patient Thank the patient
“Relate” Philosophy Recognize concern Empathize Listen Apologize Take responsibility Explain what you are going to do
“6 A’s” Awareness Acknowledgement Apology Active Listening Action, Amendment Avoiding
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Read patient comments to see if your staff members are mentioned by name
Have a recognition program that allows staff members to nominate each other for going above & beyond
Have a service hero of the month in your department Customize your recognition to the individual staff member
In your one on one meetings with them ask them what their favorite food, restaurant, pasttime, etc.
Celebrate birthdays & recognize anniversaries Celebrate your improvement with banners or trophies Schedule team outings or treats (i.e. pizza parties or ice cream
socials) Hand written notes sent to their home
Reward & Recognition
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Have a bulletin board outside your department that contains: Patient satisfaction scores Patient comments that mention your department or staff Priority for the quarter or six month period Letters from patients Customer hero of the month Employee to employee recognition
Educate new staff members on the survey process & your goals
Create monthly electronic/printed dept. newsletters & dedicate a section to patient satisfaction data
Data Sharing
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“Director of First Impressions” Security, front desk staff, volunteers, etc.
“Fresh as a Daisy”
Color choices in patient rooms & hallways
No flyers/posters taped to the walls or elevators
Way-finding/signage
Employee satisfaction focus
Anticipate patient needs
Separate areas on the units for physician/family consults
Other General Practices
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Two main phases: 1. Preparation
a) Project team & roles
b) Communication
c) Development of training
d) Preparing measurement
e) Preparing accountability
f) Prepare logistics
2. Execution
a) Educate
b) Roll-out: follow through on your plan
Step 4: Implement a Solution
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Monitor: Measure Behavior Tracking Observation Self-Reporting Auditing Feedback
Review: Did you meet your Goal?
Yes Celebrate Increase Goal or Sustain
No Why Not?
Steps 5 & 6: Monitor & Review
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Thank you for attending!