The Patient Experience: The Good, the Bad, the Ugly

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The Patient Experience The Good, the Bad, the
Ugly
Jeffrey Beers RN, BSN, MA Manager, Clinical Risk
Management and Patient Safety UHCMC
Hiloni Bhavsar, MD Internal Medicine Chief
Resident UHCMC
Henry Koon, MD Director, Medical Oncology
Cutaneous Malignancy Program Seidman Cancer
Center UHCMC
Lynda Reilly, BS Ed, RN, BSN Sr. Clinical Content
Analyst UH Electronic Medical Records Physician
Design Team University Hospitals
Jane Dus, ND, RN, NE-BC Vice President, Medical
Surgical Services UHCMC
Maureen Broscoe, RD, PMP Manager Core Team
Electronic Medical Record University Hospitals
Marcie Manson, Esq. Associate General
Counsel University Hospitals
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Objectives

• Understand changes that have taken place to
  improve patient satisfaction across the system
• Understand patient perception/perspective
• Identify specific action items for implementation
  in practice

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Her Name is Ruth
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• HCAHPS
• Hospital Consumer Assessment of Healthcare
  Providers and Systems

University Hospitals
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• HCAHPS
• CMS partnered with Agency for Healthcare Research
  and Quality (AHRQ) to develop it
• 2. The first national, standardized, publicly
  reported survey of patients experience of care
• 3. Three items used to adjust for the mix of
  patients across hospitals

University Hospitals
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• HCAHPS
• 4. Two items relate to race and ethnicity
• 5. AHRQ carried out a rigorous and scientific
  process to develop this
• 6. In 2005, the HCAHPS survey was endorsed by the
  National Quality Foundation (NQF)

University Hospitals
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• Eligible Patients
• Adult
• Medical, surgical or maternity care
• Overnight stay or longer
• Alive at discharge

University Hospitals
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• Eligible Patients
• Excludes hospice discharges, prisoners, foreign
  addresses patients discharged to nursing homes
  or skilled nursing facilities
• Excludes Pediatric, Psychiatric Specialty
  Hospitals
• Encompasses 85 of patients

University Hospitals
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• HCAHPS Administration
• Random sample of adult patients
• UH does 100 sampling
• Between 48 hrs and 6 weeks after discharge
• Not restricted to Medicare
• Hospitals may use vendor or collect their own data

University Hospitals
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• HCAHPS Administration
• May use email, telephone, mail with telephone
  follow up or interactive voice recognition
• Hospitals can use HCAHPS alone or
• include questions after the core items
• Must survey throughout all months
• Available in several languages

University Hospitals
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• Prohibited Actions
• Attempt to influence answers
• Indicate the hospital will be rewarded
• Offer incentive
• Indicate hospitals goal of high rating

University Hospitals
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• HCAHPS Content
• 27 questions
• 18 core - critical aspects of patient experience
• 4 direct patients to relevant questions
• Answer choices
• ? Never ? Yes
• ? Sometimes OR ? No
• ? Usually
• ? Always

University Hospitals
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Final HCAHPS Measures for VBP FY 2013

• Communication with Nurses
• Communication with Doctors
• Responsiveness of Hospital Staff
• Pain Management
• Communication about Medicines
• Cleanliness and Quietness of Hospital Environment
  
• Discharge Instructions
• Overall Rating of Hospital

University Hospitals Case Medical Center
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Medicine Quality SummitHCAHPS Questions

• COMMUNICATION WITH DOCTORS
• During this hospital stay, how often did Doctors
  treat you with courtesy and respect?
• During this hospital stay, how often did doctors
  listen carefully to you?
• During this hospital stay, how often did doctors
  explain things in a way you could understand?

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UH Wholly Owned HospitalsValue Based Purchasing
Patient Satisfaction
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Physician Satisfaction (Geneva)

• Monthly CMO report to all physicians with tips on
  patient satisfaction. (Press Ganey HCAHPS
  primer /UHC Webcast)
• Physician Satisfaction discussed at each MEC
  meeting with hard data sharing.
• Quarterly individual scores with each patient
  answer shared with each physician (ED included)
• Data is extracted from the PG website
• Follow up with poor performers (lt 50th
  percentile)
• Expectations made clear (ED- reimbursement tied
  to scores)

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UH Richmond Physicians Plan

• Attending Physicians
• Share personal data
• Post data publicly
• Encourage compliance
• Hospitalists
• Monthly reporting and discussion of scores
• Direct Observation initiative
• Simulation training
• HCAHPS training videos (CWRU psych dept)
• Payment incentives
• Resident Staff
• Direct Observation plus training videos
• Continued education
• HCAHPS
• Professionalism

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UHCMC In-patient 2012 PlanPatient Satisfaction
Bundle Processes
Interventions/Processes
Introduce/shake hands Use names Make eye
contact/sit White board
Aim To consistently achieve excellence in
patient experience as measured by top quartile
outcomes on HCHAPS and Press Ganey surveys
Drivers Connect with me Communicate and
involve me in my care Check on me Teach
me Follow-up with me
Daily rounds Dont interrupt/watch tone
Show empathy Speak with families
Daily rounds Stay up to date on tests
Explain meds in a complete way Explain
diagnosis Teach back methods
Recommendations for treatment Explain the
clinical course
Clear follow up appts Explain how to get
advice/help Follow up phone call
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• UHCMC Resident Pilot Data 199 patients and 58
  physicians comparative study

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How much time do you want your physician to spend
with you daily?

1. 5-10 minutes
2. 10-15 minutes
3. 15-20 minutes
4. 20-30 minutes
5. Greater than 30 minutes

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What percentage of patients could name their
physician?

1. 5
2. 10
3. 20
4. 30
5. 50
6. 70
7. 100

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UHCMC Resident Pilot Data 199 patients and 58
physicians comparative study
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UHCMC Resident Pilot Data 199 patients and 58
physicians comparative study
October 27, 2012
University Hospitals
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UHCMC Resident Pilot Data 199 patients and 58
physicians comparative study
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Patient Advocate Data

• 2012 Jan - Sept
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• Total of Patient Advocate Entries  2996
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• Complaint  2063
• Compliment  79
• Grievance  293
• Request Info  145
• Non-patient issues/visitor  416

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Patient Advocate Data

• Communication Issues play a part in 1947
  complaints
• Of those, the top 5 breakdown issues under
  communication
• General Communication Issue  947
• Rude Behavior  399
• No Clinical Feedback  165
• Lack of information  95
• Miscommunication  65

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Advocate Office

• Complaint
• Lack of information regarding treatment
• Poor pain control
• Dont know name of attending
• MD response to Advocate
• I round everyday
• Complaints ridiculous

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Advocate Office

• Complaint
• MD asked about patients HIV meds with visitors
  in room
• Visitors unaware of patients HIV status
• Compliance Office
• Office of Civil Rights follow up in similar case

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Patient Advocate

• Complaint
• Called office nurse and MD lines 3-4 times
  without call back
• Went to ED for treatment
• After ED visit called office without return call
• Did get MD office appointment
• At visit MD states unaware patient ever called
  office

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Patient Advocate

• Complaint
• MD not listening to pain issues
• Request another physician
• Now with planned surgery patient concerned
  regarding surgical pain and chronic pain

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Thank You.