HMC Patient Experience Center for Patient Experience and Staff Engagement

Transcription

1 HMC Patient Experience 2017 Center for Patient Experience and Staff Engagement

2 HMC Patient Experience 2017 Center for Patient Experience and Staff Engagement

3 Presenters Nasser Al Naimi Deputy Chief Quality Officer, Patient Experience Co-Director for Hamad Healthcare Quality Institute Hamad Medical Corporation Ben Panton Acting Assistant Executive Director Center for Patient Experience and Staff Engagement Hamad Medical Corporation Adil Ahmed Assistant Executive Director Customer Services Hamad Medical Corporation Ben Smith Project Director Center for Patient Experience and Staff Engagement Hamad Medical Corporation

4 Presentation Overview HMC and CPESE overview Interactive Patient Experience Quiz Defining Patient Experience Patient Experience Strategic Framework IHI Context Patient Experience Measurement Patient Journey Service Improvement Practical Tools Biggest Barriers

5 Nasser Al Naimi MBA Deputy Chief Quality Officer, Patient Experience and Co-Director for Hamad Healthcare Quality Institute Hamad Medical Corporation Over 24 years Healthcare experience Co Founder of Hamad Healthcare Quality Institute Key role in shaping quality across Hamad Medical Corporation Leads HMC s patient experience strategy Responsible for over 250 customer service staff

6 Center for Patient Experience and Staff Engagement The Center for Patient Experience and Staff Engagement (CPESE) is the driving force for engaging with patients and improving the patient experience at Hamad Medical Corporation (HMC) services and hospitals. HMC is the main provider of secondary and tertiary healthcare in the State of Qatar, and one of the leading hospital providers in the Middle East. The aim is to develop a complete and in depth understanding of our patients, and to build collaborative partnerships focused on delivering patient and family-centered care.

7 HMC/CPESE Patient Experience Strategy & Framework Development HMC aims to deliver the safest, most effective and most compassionate care HMC strategy underpinned by key elements of the IHI Triple Aim Better Care safe, effective, timely, patient centered Patient Experience strategy a primary driver for transformation and improvement

8 HMC/CPESE Patient Experience Strategy & Framework Development Patient Experience Strategy developed around 4 foundation pillars: 1. Patient Experience HMC patients receive world class treatment in a welcoming, comfortable, caring and safe environment 2. Patient Engagement HMC patients and their families are fully engaged in their care and our efforts to provide safe, high-quality care for every patient. 3. Patient Education HMC patients are educated and listened to as an equal partner in their care and provided with readily available information allowing them to make informed decisions about their treatment. 4. Staff Engagement HMC staff are supported, equipped and empowered to support the experience, engagement and education of patients and their families.

9 HMC/CPESE Patient Experience Strategy & Framework Development CPESE is the organizational department which supports development and delivery of the strategy: Interconnects with the Ministry and national patient experience requirements Supports hospitals with PE program delivery Listen to and understand our patients capturing feedback Listen to and support HMC staff Identify areas for development Support quality initiatives

10 CPESE Areas of Focus Corporate Initiatives Nesma ak Customer Service Staff Engagement Simulation

11 Corporate Initiatives Overseas Treatment Returning Patients Patient Experience Survey Patience Experience Mobile Application

12 Nesma ak Customer Service Nesma ak provides the patient with assistance at every step of their healthcare journey, and also checks on how patients feel about their experience by the undertaking of patient surveys and analysis of customer feedback. Using specially designed electronic tracking systems - Nesma ak is able to capture feedback from multiple sources including: comment cards, in person and over the phone feedback, via the HMC website and through ongoing monitoring of traditional and social media.

13 Staff Engagement The main work stream around staff engagement is the Stars of Excellence rewards and recognition program, which is led by CPESE. Stars of Excellence aims to reward staff whilst recognizing their efforts and celebrating the success of team-based improvement programs. The program objectives have been designed in collaboration with Her Excellency Dr. Hanan Mohamad Al Kuwari, Minister of Public Health in Qatar and Managing Director for HMC, and have been consistent since the program began in 2010.

14 Simulation Simulation gives quick and easy access to data in a controlled environment. Testing solutions without impacting upon services and getting accurate data has proved invaluable in planning for many services. Customized dashboards, flowcharts and visual models allow for complex data to be easily seen and understood and gives vital information to those that need it.

15 CPESE Next Steps and Future Developments Support and build initiatives around the 4 Patient Experience strategy pillars. Support expansion of HMC new hospital openings Staff Surveys/ Wellbeing Programs (Employee Support) Overseas Patient System Development (Experience) Family Advisory Councils (Engagement) Regional and international collaboration sharing of best practice Patient Stories learning from our patients Patient App listening to our patients Research Collaboration/ Partnership HMC Patient Experience Strategy Patient Experience Conference/ Forum (Education) Electronic App Enhancement (Experience) Patient Stories (Experience)

16 What does Patient Experience mean to me?

17 What does Patient Experience mean to me? Quality is everyone's responsibility. I believe that patient experience is an integral part of quality. Patient experience is about placing the patient at the heart of our healthcare system. Patients are welcomed, guided, supported, educated, reassured and ultimately shown compassion. Through hard work, continuous improvement and teamwork, we can make a positive difference to our patients Together we can support our patients on their journey to better health.

18 Empathy Put yourself in their shoes

19 Put yourself in their shoes

20 Lean Six Sigma: DMAIC

21 Patient Experience The Quiz

22 Quiz Question 1 Answer The IHI PDSA improvement methodology is well known: What does PDSA stand for? 0% A Propose, Design, Sustain, Assess 0% B Plan, Do, Study, Act 0% C Partner, Develop, Solution, Achieve 0% D Present, Determine, Simulate, Allocate

23 0% 0% 0% 0% Question 2 Answer Quiz According to the Beryl Institute, patient experience is defined as: A the sum of all interactions, shaped by patient perceptions, that influence an organization s culture across the continuum of care B the sum of all patient and staff interactions, that influence the continuum of care across an organization s culture C the sum of all interactions, shaped by an organization s culture, that influences patient perceptions across the continuum of care D the sum of all interactions, that influence an organization s culture across the continuum of care

24 0% 0% 0% Question 3 Answer Quiz According to the Centre for Geographic Information Systems, Doha (Ad Dawha), the capital city of Qatar, means: 0% A round bay B pearl C royal D sun

25 Quiz Question 4 What are the 3 aims of the IHI Triple Aim? Answer 0% A better care, better health, better value 0% 0% 0% B better quality, better safety, better efficiency C better access, better effectiveness, better safety D better cleanliness, better food, better waits

26 0% 0% 0% Question 5 Answer Quiz The Warwick Patient Experiences Framework (WaPEF) identifies seven generic themes that are important to a high-quality patient experience: - (1) patient as active participant, (2) responsiveness of services, (3) an individualized approach, (4) lived experience 0% A (5) care support, (6) empathy, (7) education B (5) humane treatment, (6) communication, (7) information and education C (5) continuity of care and relationships, (6) communication, (7) information and support D (5) continuity of care and relationships, (6) evidence based care, (7) information and support

27 Defining Patient Experience The Strategic Framework

28 Patient Experience Framework Patient experience is one of the 3 essential dimensions of the IHI triple Aim (A framework for optimizing health system performance) Improving the health of the population Reducing per capita cost of healthcare Improving patient care and experience

29 Defining Patient Experience A universally agreed definition of patient experience doesn t exist but

30 Parameters of Patient Centered Care What do Patients Want/Need? 1. Fast access to reliable healthcare advice 2. Effective treatment delivered by trusted professionals 3. Continuity of care and smooth transitions 4. Involvement of, and support for, family and carers 5. Clear, comprehensible information and support for self-care 6. Involvement in decisions and respect for patient's preferences 7. Emotional support, empathy and respect Source: Picker Institute

31 Parameters of Patient Centered Care What do Patients Want/Need? 1. Compassion, empathy and responsiveness to needs, values and expressed needs/preferences 2. Coordination and integration of care 3. Information, communication and education 4. Physical comfort 5. Emotional support, relieving fear and anxiety 6. Involvement of family and friends Source: Institute of Medicine, USA

32 Parameters of Patient Centered Care What do Patients Want/Need? HMC Patient Experience Aspiration HMC patients should receive world class treatment in a welcoming, comfortable, caring and safe environment. Our patients will be treated in a dignified and respectful manner, reassured, educated and listened to as an equal partner in their care and provided with readily available information allowing them to make informed decisions about their treatment.

33 HMC Patient Experience Framework Discharge Noise at Night Integrity OP Appointment & Registration Lab & X-Ray Admissions Pharmacy Key Performance Indicators Improving Patient Experience Care Transition Doctor Communication EDUCATION, CONSULTING & IMPLEMENTATION Hospital Environment Nurse Communication Medicine & After Care Communication Accountability Patient Journey & Systems Pain Management Staff Responsiveness

34 Patient Experience Framework Transformation foundations: 1. Leadership at CEO/Board Level 2. Strategic vision 3. Involvement of patients and families 4. Supportive work environment for staff 5. Systematic measurement and feedback 6. Quality of the built environment 7. Supportive technology

35 Question which of the below does your organization most demonstrate in supporting change? 0% 0% 0% 0% 0% 0% Transformation foundations: 0% 1. Leadership at CEO/Board Level 2. Strategic vision 3. Involvement of patients and families 4. Supportive work environment for staff 5. Systematic measurement and feedback 6. Quality of the built environment 7. Supportive technology

36 Question which of the below does your organization least demonstrate in supporting change? 0% 0% 0% 0% 0% 0% Transformation foundations: 0% 1. Leadership at CEO/Board Level 2. Strategic vision 3. Involvement of patients and families 4. Supportive work environment for staff 5. Systematic measurement and feedback 6. Quality of the built environment 7. Supportive technology

37 Supportive work environment for staff When organizational transformations succeed, managers typically pay attention to people issues, especially fostering collaboration among leaders and employees and building capabilities McKinsey Global Survey

38 Define Patient Experience Set bespoke definition/objective (based on what your patients tell you what are their expectations?) Framework build and communication Recognize that experience delivered at a series of interactions and touch points Measurement

39 Measuring Patient Experience

40 Measuring Patient Experience From a Patient s Perspective, what are the top 3 issues that matter most to patients? 0% 1. Access to service 0% 0% 0% 0% 0% 0% 0% 0% 2. Comfort 3. Communication 4. Facility 5. Nursing service 6. Other staff attitude and knowledge 7. Physician services 8. Quality of services 9. Privacy

41 The Fundamentals The Center for Patient Experience and Staff Engagement (CPESE) introduced Nesma ak as a key department to support patient experience at HMC: Enabling an environment for collecting patient feedback Introducing standardized processes to handle patient feedback Introduction of Supportive Technology Analysis & sharing of patient experience data

42 Capturing Patient Feedback Key is getting the right balance activity across the organization Appropriately informing different decisions Capturing views at the right point in the patient journey New service development Public meetings Qualitative Local Accountability Patient stories Feedback websites Walking the floor On-line communities Focus groups Kiosks Mystery shoppers Comment cards Hand-held technology Mobile App Compliments Telephone surveys Complaints Online surveys Performance Benchmarking Quantitative Face-to-face surveys Commissioning Service improvement

43 Patient feedback at HMC With a new Customer Service Program Nesma ak, came new services: A new Feedback Call Center (16060) launched 7 days a week, covering 15 hours a day. Dedicated Comment Cards & Surveys for Inpatient, Outpatient, Emergency Department, Pharmacy, Laboratory, Imaging and Rehabilitation Therapy SMS acknowledgement of patient feedback Electronic system to capture all patient feedback Timely response to all patient feedback received through media Over 275 patient experience staff working across HMC facilities

44 Standardized Processes

45 Process Maps

46 HMC e-feedback Management System

47 Sharing of Information with Stakeholders Monthly, quarterly and yearly dashboards for all HMC Facilities: Patient Surveys Comments & Compliments Complaints Nesma ak Operational Performance Patient Experience Score to be introduced in Q Direct Interaction: Monthly Quality Meetings at facility level Executive Management Committee & Patient Experience Committee Real Time access to feedback data Face to face meetings with patients

48 Patient Survey HMC Inpatient PATIENT SATISFACTION SURVEY Inpatient Department HAMAD MEDICAL CORPORATION

49 Patient Survey HMC Outpatient PATIENT SATISFACTION SURVEY Outpatient Department HAMAD MEDICAL CORPORATION

50 HMC Dashboard HMC CORPORATE COMPLAINTS MONTHLY DASHBOARD

51 Comments / Compliments Dashboard COMMENTS/COMPLIMENTS MONTHLY DASHBOARD HAMAD MEDICAL CORPORATION

52 How we do determine the areas that need improvement? Complaints by themes YTD/ Monthly breakdown: Q Privacy/Comfort Facility Access to service Oct Nov Dec Quality of service Communication Staff attitude/knowledge Nursing service Physician service

53 How we do determine the areas that need improvement? Complaints by themes YTD/ Monthly breakdown: Q Privacy/Comfort Facility Access to service Jan Feb Mar Quality of service Communication Staff attitude/knowledge Nursing service Physician service

54 Monitoring the Improvement CLOSED COMPLAINTS: JUNE 2016 CLOSED COMPLAINTS: MARCH % 52% Complaints closed within SLA timeframe 24% Complaints closed within SLA timeframe Closed complaints that did not meet SLA timeframe 76% Closed complaints that did not meet SLA timeframe

55 AMOC Legal Finance Department/Hos pital Monitoring Improvement Medical Director Complainant/No response AMOC Legal Finance Department/Hospita l Medical Director/Hospital Complainant/No response Reason for overdue vs. levels JULY 2016 Reason for overdue vs. levels OCTOBER L3 L2 L3 L2 After setting a new processes of communication, a sufficient improvement noticed in reducing the overdue cases

56 Monitoring Improvement Indicator Notes Q Q Q Reason 1 Patient Satisfaction Level 83% 83% 86% Overall services improvements, positively affect he satisfaction level. 2 3 Complaints Received Thanks Received Delivered by phone, , letter, in person, etc Action taken by stakeholders on most recurrent issues, lead to decreasing in the complaints. Sufficient increment in the compliment received for improved services.

57 Checklist Turning Patient Feedback to Meaningful Resource for Care Delivery Gather feedback from your patients regularly and systematically Understand your findings Share results widely throughout your organization Get stakeholders involved Action plan with service users and staff Maintain progress Continuous innovation to improve customer services

58

59 Patient Journey

60 Patient Journey

61 Patient Journey: Why is it important? Each patient has a different journey through the system Every patient journey matters Every patient wants to have a good experience Every patient has a different perspective on their experience

62 Patient Journey 80% of the of the problem is in the system, not the people - Dr. W. Deming

63 Patient Journey: No one way

64 Patient Journey: Not just the care Build comprehensive understandings of entire patient journeys from the patient perspective Co-created (with patients & healthcare stakeholders) strategies and tactics to address journey gaps See what they see and what you can do to improve

65 All-round Experience Many providers ignore the non visual aspects of a patients experience Pre Hospitalization Website Patient Portals Call Centers Social Media Word of Mouth Hospitalization Non clinical experiences Parking Food Location Signage Customer services Post Hospitalization Scheduling Communication Payments Insurance Appointments Therapies

66 Touchpoints A touchpoint is the interaction between your hospital and those you serve Patient touchpoints or interactions with health care facilities and professionals define patient centered care They determine the total patient experience and satisfaction, affecting not only the clinical tasks but patient outcomes

67 Touchpoints There are more nonclinical patient touchpoints with patients than there are clinical Touchpoints can occur on the phone, thorough a website, at a OPD visit, in an emergency Touchpoints happen: Before the patient comes into a hospital At the hospital After the patient is discharged Touchpoints affect the experience of: Patients Family Friends Care Givers

68 Touchpoints for Inpatient Journey Scheduling Admitting Signage/Way finding Theatres/Surgery Physicians Nurses Technicians Hospital Room Facilities Testing Facilities Patient transport Porters Food Treatment/Procedure Communication/updates Patient information Discharge Payment/ Billing Parking

69 Hospital Room Touchpoints Level of privacy Single or shared room Cleanliness Bathroom facilities Visiting hours/policies Noise levels Entertainment (TV/Radio/Newspaper) Temperature Comfort Storage Security Lighting Accessibility Communication links to staff

70 Improvement

71 How Do We Improve? National: National policies, infrastructure, budget Organizational: Strategies, Performance and monitoring, macro-management Team and Individual: Individual accountability, clinical service provisions

72 How Do We Improve? National: National policies, infrastructure, budget MOPH form national policies for all healthcare facilities to adhere towards National Patient experience/ satisfaction surveys IHI Triple Aim

73 How Do We Improve? Organizational: Strategies, Performance and monitoring, macro-management Monthly feedback Reliable on-hand data Near real time Complaints feedback Board reviews Fast access to results Motivation and Communication Patient stories Face to meeting with patients and staff Complaints and compliments

74 How Do We Improve? Team and Individual: Individual accountability, clinical service provisions Management, Quality improvement and monitoring Comparisons between own services/ departments and others Frequent, near real time data Targets and measures Motivation Stories and personal accounts to motivate staff Complaints and feedback Face to face involvement Empathy No blame culture

75 Start What we do CPESE Process Mapping We map the system from the patients perspective and follow their journey Prepared by: Center for Patient Experience and Staff Engagement e-referrals Implementation and Patient Crowd Reduction Baseline Flow Optimized Flow Start Reception Reception Qatari Patient? Qatari Patient? No No Cashier Yes Cashier Yes Assessment Assessment Room Room Consultation Consultation Schedule for follow-up? Yes Reception (scheduling for the next follow up appointment) Schedule for follow-up? Yes Doctor s Room (scheduling for the next follow up appointment) No No EXIT EXIT

76 What we do CPESE Process Mapping This helps staff understand how complex and confusing some patient journeys are Estimate that 30-70% of work doesn t add value for the patient Up to 50% of process steps involve a hand-off, leading to error, duplication or delay No one person is accountable for the patient s end to end experience All processes need to be joined up

77 What we do CPESE Simulation Simulation is the process of replicating the behavior of a complex system (like the healthcare system) using a computer program. It is considered as an operational research technique that allows the end user (hospital administrators, managers) to assess the efficiency of existing health care delivery systems, to ask what if? questions and to design new systems, if necessary.

78 What we do CPESE Simulation What can simulation do? Simulate hospital processes, model length of stay and patient flows Perform bottleneck analysis to discover where improvement work is necessary Test facility design and building layouts without committing resources for their acquisition or construction Test ideas without limits and costs involved Forecast the impact of changes in patient flow Forecast how changes in staffing, referral patterns, or patient mix affect a unit in a future state

79 What we do CPESE Simulation Insert simulation video clip

80 Strategies for Improvement

81 Strategies for Improvement Take a holistic approach Look beyond just the care given, take every touchpoint into consideration before, during, and after care

82 Strategies for Improvement Simplify Find ways to simplify the patient journey and integrate accuracy, timeliness and compassion into every patient interaction

83 Strategies for Improvement Make it personal From admission to discharge, every interaction by every stakeholder should be focused on how best to satisfy the patients needs

84 Strategies for Improvement Improve communications Strong communications create clarity, understanding and consistency leading to higher patient engagement and increased satisfaction

85 Strategies for Improvement Benchmark Benchmark against the leaders in the field and against other departments Set new standards of care

86 Strategies for Improvement Involve users Patients and Families are essential partners in quality improvement and health care redesign

87 Barriers

88 Barriers What are the barriers to providing good patient experience?

89 Barriers A lack of good decision-making processes Leadership is crucial they must be engaged and willing to improve - Bad leadership and management will create a barrier Systems Providers must have clear systems for improvements

90 Barriers A lack of accountability Everyone must be accountable from top to bottom Employees must be held to account

91 Barriers The wrong attitude Staff must be motivated to provide a good experience Culture plays an important role a positive working culture will improve staff morale and ultimately improve patient experience

92 Barriers A lack of patient focus Patients must be at the forefront of all members of staff Patient care must take precedent over other matters such as finance Patient must be at the center of all decisions made throughout the facility

93 Barriers Conflicting Priorities Too often there are too many priorities for an organization A focus must be placed on patient experience for it to see benefits Other priorities must run alongside improving experience

94 Tools

95 TOOLS: Effective Communication Improves patient satisfaction Like et al., 1987; Kaplan et al., 1989; Ong et al., 1995; Weinman et al., 1998 Decreased patient emotional stress Roter, 1995 Improves adherence/compliance DiMatteo et al., 1993; Squier et al., 1990; Brashers et al., 2000; Ciechanowski et al., 2001 Improves health outcomes Woolley et al., 1978; Patrick et al., 1983; Stewart et al., 1995 Reduces medical errors and malpractice Levinson et al., 1997; Lester et al., 1993; Beckman et al., 1994; Sutcliffe et al., 2004 Improves physician satisfaction Suchman et al., 1993,Educ for Health,

96 TOOLS: Effective Communication S T A R T Smile and greet Tell your name/role/what to expect Active Listening/Assistance Rapport and relationship building Thanks H Hear the story E Empathize A Apologize R Respond to the problem T Thank them

97 Triple Aim The most direct route to the Triple Aim is patient and family centered care in its fullest form Don Berwick (2012)

98 Additional Information Beryl Institute Planetree Picker Institute Press Ganey