Rates of Change During Public and Private Reporting Cycles of Hospital Performance: Implications for Mechanisms Driving Quality Improvement

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Rates of Change During Public and Private
Reporting Cycles of Hospital PerformanceImplica
tions for Mechanisms Driving Quality Improvement

• Cathy E. Duquette, Ph.D., RN, CPHQ
• Vice President, Nursing and Patient Care Services
• Newport Hospital Newport, RI

June 27, 2006
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Acknowledgements

• Judith Barr, Tierney Giannotti, and Marcia
  Petrillo Qualidigm
• Shoshanna Sofaer Consultant/Baruch College
• William Waters RI Department of Health
• Deirdre Mylod and staff Press Ganey
• Hospital Association of Rhode Island
• Barr, J.K., Giannotti, T.E., Sofaer, S.,
  Duquette, C.E., Waters, W.J. and Petrillo, M.K.
  2006. Using Public Reports of Patient
  Satisfaction for Hospital Quality Improvement.
  Health Services Research 41(3), Part I (June
  2006) 663-682.

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Rhode Island Setting the Stage

• Small state just over 1,000,000 population
• 39 cities/towns very limited county government
• 1 State Department of Health
• 16 hospitals in the state
• 13 hospitals 10 acute care, 1 women infants,1
  adult psychiatric and 1 rehabilitation hospital
  participate in patient satisfaction survey and
  report
• 10 acute care hospitals participate in the
  clinical measures data collection and report
• All eligible hospitals were early participants in
  the Hospital Quality Alliance

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The Rhode Island Legislation

• Passed in July 1998 called for public reporting
  of
• Comparable, statistically valid patient
  satisfaction measures
• Standardized data set of clinical performance
  measures, risk-adjusted for patient variables
• Addressed the general health environment in RI
  and the potential impact on quality
• Impending mergers
• For-Profit vs. Not-For-Profit
• Applies to all licensed health care facilities in
  the state, starting with hospitals
• Director of the Department of Health (HEALTH) is
  responsible for program development and
  implementation

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Program Development - Structure and Process

• Director of HEALTH is responsible
• Steering Committee and Work Group structure
• Process very open and public
• Committee format consensus as goal
• Consumer, minority and interested party input
• Input and feedback incorporated into each step of
  program development
• Hospitals represented by Hospital Association of
  Rhode Island (HARI) through all stages of program
  development
• Opportunities to discuss issues and concerns
  among hospitals within HARI structure

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Program Development Considerations

• Outcome needed to address both public
  accountability AND quality improvement
• Aimed to balance desire to report on all
  patients/all conditions vs. what was feasible
• Needed to develop a report that was meaningful to
  consumers AND hospitals
• Report format and method of reporting needed to
  be determined before data were available
• Started with public reporting of patient
  satisfaction
• Hospital approach was collaborative vs.
  competitive

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Program Development - Outcome The Private
Reports

• All hospitals in RI had a mechanism for measuring
  patient perception pre-program
• Variation to method, process, frequency
• Hospitals agreed to select the same vendor and
  process to meet program requirements
• Transition to mail survey conducted by Parkside
  Associates and then Press Ganey
• Agreement to pilot data collection phase with
  each process change (2000 and 2002) to evaluate
  process and provide early data and information to
  hospitals to refine and target ongoing quality
  improvement efforts
• Process created to establish ongoing data
  collection and feedback for internal use between
  public reporting cycles

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Program Development - Outcome The Public
Reports

• Patient Satisfaction I Nov 2001
• Public General Report
• Public Technical Report
• Patient Satisfaction II Oct 2003
• Public General Report
• Public Technical Report
• Patient Satisfaction III TBD
• Currently participating in dry run
• Awaiting HCAHPS for public report

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Program Development - Outcome The Public
Reports

• Evaluation of Public Reporting on Hospital
  Patient Satisfaction in Rhode Island 2003
• Statewide Effort to Improve Hospital Patient
  Satisfaction Ratings - 2004

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Public Report Development

• State committee process Patient Satisfaction
  Public Release Work Group with hospital,
  consumer, and health care stakeholder input
• Hospital staff and leadership actively engaged in
  process
• Two types of public reports general public and
  technical
• Key reporting decisions made before results
  available
• Methods for translating raw data into different
  format
• Method and standard against which comparisons
  made
• Private report format designed for quality
  improvement and not appropriate for public
  reporting
• Draft reports went through formative testing
  process with consumers

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Sample Page from Public Report 2001
Patient Satisfaction Report Excerpt 2001
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Sample Page from Public Report 2003
Patient Satisfaction Report Excerpt 2003
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Findings RI Scores over Time

• Hospitals in RI started out and continue to be
  higher than national average score
• Steady improvement in RI score
• No spikes around or following public reporting
  time periods
• Rate of increase is not faster than that of
  national upward trend

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RI Trend Analysis vs. National
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Hospital Response

• Commitment to
• Quality Improvement

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Initial Responses

• Hospitals supportive of public reporting
• Hospital CEOs supported enabling legislation
• Hospital acceptance of program value in driving
  and coordinating quality improvement efforts
  statewide vs. influencing consumer choice
• Significant hospital involvement in process from
  the beginning of program development

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Quality Improvement Efforts

• Internal
• Senior leadership involvement and intense
  organizational commitment
• Reaching clinical staff and Boards of Trustees
• Increase in focus and coordination
• External
• Collaborative vs. competitive model
• Sharing of best practices
• Coordinated efforts through HARI
• Demonstrating improvement over time

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For More Information

• www.health.ri.gov
• RI Background Reports
• Public and Technical Reports and
• Evaluation Reports on Findings and Quality
  Improvement Efforts
• www.health.ri.gov/chic/performance/series.php
• Direct link to list of reports

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Questions?