Elaine Hopkins Hopkins Associates Training & Consulting, LLC

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1 Employee and Patient Satisfaction Elaine Hopkins Hopkins Associates Training & Consulting, LLC

Background why it matters The Centers for Medicare and Medicaid Services (CMS) effort to link Medicare s payment with incentives for doctors and hospitals to provide better care, both rewards and

2 Background why it matters The Centers for Medicare and Medicaid Services (CMS) effort to link Medicare s payment with incentives for doctors and hospitals to provide better care, both rewards and penalizes as a result of Values Based Purchasing. This program is driving what we want in health care. said Dr. Patrick Conway. Most hospitals have improved since the program began. However, even some hospitals that have gotten better are still losing money because they are not scoring as well as others or have not improved as much. Source: Kaiser Health News Conway is CMS Deputy Administrator for Innovation & Quality, and Chief Medical Officer

3 How it works Medicare reduces payment rates to all hospitals Sets the money aside in a pot for incentives Every hospital gets something back o Less than half recouped as much as they forfeited o Potential bonuses and penalties were higher in year 2 than year 1 To assess quality, Medicare considers: o how hospital scores compare to each other o how much each hospital improved from 2 years prior compared to other hospitals improvement rates. Use higher of the two scores to determine ranking and subsequently the bonuses and penalties. Measures how frequently hospital follows basic clinical standards of care; mortality rates; and how patients felt they were treated.

How it is measured Survey used: Hospital Consumer Assessment of Healthcare Providers & Systems or The HCAHPS Hospital Survey aka Hospital CAHPS or Hospital CAHPS http://www.medicare.

4 How it is measured Survey used: Hospital Consumer Assessment of Healthcare Providers & Systems or The HCAHPS Hospital Survey aka Hospital CAHPS or Hospital CAHPS should be in your favorites if it isn t already. The Fiscal Year 2015 Hospital Value-Based Purchasing Program (Hospital VBP) adjusts hospitals payments based on their performance in four domains: o Clinical Process of Care 20% o Patient Experience of Care 30% o Outcomes 30% o Efficiency 20%

5 30% of score based on Patients Experience of Care Patient Experience of Care Measures Measure ID HCAHPS Measure Description Performance Standard (Achievement Threshold) Benchmark Communication with Nurses 75.18% 84.70% Communication with Doctors 79.42% 88.95% Responsiveness of Hospital Staff 61.82% 77.69% Pain Management 68.75% 77.90% Communication About Medicines 59.28% 70.42% Cleanliness and Quietness of Hospital Environment 62.80% 77.64% Discharge Information 81.93% 89.09% Overall Rating of Hospital 66.02% 82.52% Final Achievement Thresholds & Benchmarks for the Fiscal Year 2013 Hospital Value-Based Purchasing Program Measures Source: Centers for Medicare & Medicaid Services

Medicare.gov Hospital Compare Tells you everything you need to know about how the 8 aspects of hospital quality which patients evaluate are measured.

6 Medicare.gov Hospital Compare Tells you everything you need to know about how the 8 aspects of hospital quality which patients evaluate are measured. Example: Responsiveness of hospital staff Shown as percentage of patients who reported that hospital staff were Always responsive to their needs. This means the patient was helped quickly when he or she used the call button or needed help in getting to the bathroom or using a bedpan. You don t have to wait for the outside survey results you can monitor with your own assessments.

From: Cleveland Clinic <survey@pressganeysurveys.com> Date: March 20, 2015 at 3:43:37 PM EDT To: jhopkins@msn.com Subject: SASHA ROSS, DMD wants your feedback!

com> Dear JOHN, Cleveland Clinic internal follow-up survey request (emailed) Signed by You recently visited Cleveland Clinic, and we need your feedback.

Your input will help us to understand what we do well and what we can do better. If you have received this email regarding a child s visit, please complete the survey on his or her behalf.

7 From: Cleveland Clinic Date: March 20, 2015 at 3:43:37 PM EDT To: Subject: SASHA ROSS, DMD wants your feedback! Reply-To: Cleveland Clinic Dear JOHN, Cleveland Clinic internal follow-up survey request ( ed) Signed by You recently visited Cleveland Clinic, and we need your feedback. Please take a few minutes to answer a brief survey and share your thoughts about your recent visit with SASHA ROSS, DMD. Your input will help us to understand what we do well and what we can do better. If you have received this regarding a child s visit, please complete the survey on his or her behalf. To ensure confidentiality, this survey is administered by an independent third-party, Press Ganey Associates, Inc. Your participation will help us to improve the quality of care that we provide to you, your family, friends, and neighbors. If clicking the above link does not take you to the survey or a verification screen, please copy and paste the entire link into your web browser. You can also go to and enter the following PIN: F2T4H9D5JH4V5X6G Thank you for your feedback. Sincerely, Delos M. Cosgrove, M.D Chief Executive Officer and President

8 Cleveland Clinic welcome to electronic survey letter After we take note of your answers and comments, they will become part of a confidential research registry being used to improve patient satisfaction. Signed by

9 Quality Measurables Accuracy -- error free, no mistakes Timeliness -- meet deadline, hour, date Responsiveness -- how quickly you respond Level of patient/family satisfaction survey (consumer)/(customer)

10 Six in Two Communication Responsiveness 1. With nurses 5. Of hospital staff 2. With doctors 6. With pain management 3. About medication 4. About discharge + 7. Clean and Quiet 8. Overall Satisfaction

11 Importance of Good Communication isn t new Guest Relations newsletter from the 80 s (When DRGs began & Infection Control WAS CQI )

12 100% of the Message 7% The sender does NOT control the message 55% 38% Words Non Verbals Listener's Perspective

13 Time for a Reality Check Perceived Influence Executive Leadership Actual Impact on the mission/patient Front Line Workers Front Line Workers Executive Leadership Where should your training efforts (and $) be spent to achieve the behaviors you want?

14 A model you can take to the bank Workforce-wide training Policies that foster engagement Senior Leadership commitment Outstanding Patient Experience of Care

15 Workforce Wide Training Every employee impacts patients Teach them Where they fit in the hospital s mission Goals of Patient Satisfaction efforts Relationship skills - empathy How to be part of a team How to analyze work Because Give empowerment and Get accountability Even basket ball practice is a team meeting

16 Training Results Two Stories A Mayo Clinic Story Finance Department Commits 1 FTE Serves like a business manager Office in Ex. Health Area Assists with referrals (recruitment) Responds to billing & financial questions with same care physician responds to medical questions (Accuracy & Responsiveness) A Call Center Story Scheduling 87 FTE s in 50 slots 24/7 Call Center Majority women, mothers of school age children and younger Goals: Adequate coverage, retain trained staff, accommodate child-care needs Gave team parameters,(flexshifts ok) List best hours & would ruin my life hours. Team set schedule & accommodated all (Timeliness & Empowered Team)

17 Policies that Foster Engagement Employee engagement does not mean employee happiness it does not mean employee satisfaction. Engaged employees actually care about their work and their company. Policies that Empower Engaged Workforce Satisfied Patient

18 Ideal Climate: Gallup Q12 1. I have the materials and equipment I need to do my work right. 2. At work, I have the opportunity to do what I do best every day. 3. I know what is expected of me at work. 4. In the last seven days, I have received recognition or praise for good work. 5. My supervisor or the person I report to seems to care about me as a person. 6. There is someone at work who encourages my development. 7. In the last six months, someone at work has talked to me about my progress. 8. At work, my opinions seem to count. 9. The mission/purpose of my company makes me feel my job is important. 10. My associates (fellow employees) are committed to doing quality work. 11. I have a best friend at work. 12. This last year, I have had opportunities to learn and grow. Gallup Question Productivity Retention Profitability Customer Satisfaction Mat. & Equipment + + Opportunity Expected + + Recognition + + Supv. cares - + Encourage Develop - Progress + My Opinions + Mission/job + + Commit Quality + Best Friend + + Learn & grow + Two books related to this study : First Break all the Rules, Buckingham & Coffman & Now Discover Your Strengths, Buckingham & Clifton

19 The problem with employee satisfaction is that it sets the bar too low. Mike Packnett, CEO Parkview Health Without employee engagement, you re never going to get the kind of ultimate patient experience you re hoping for.... Many people make the mistake of confusing employee engagement with trying to make workers satisfied or even happy. This confusion causes healthcare leaders to underinvest their time and $ in engagement initiatives thinking engagement is a nice to have rather than an enabler of their most important goals.

20 Say that again When it comes to patients experience of care, some things matter more than others... It s the quality of human interactions that matters most, and compassion is the quality patients value most... Being told bad news in an inappropriate way, without having family or friends there for support, can be unforgettable. NHS England Director for Patient Experience, Neil Churchill, Improving patient experience means engaging and supporting staff, March 11, 2015

21 ... and again MedStar Health, largest health care delivery system in Maryland and D.C, offers excellent example of how to understand and improve employee engagement Key initial step was to conduct system-wide engagement survey on topics from leadership to communication & elements of patient experience... Leaders had to make decisions that would make an engaging work experience part of the organizational fabric...set a 5-year goal & launched 4-day training session for 2,000 managers, & shifted to a single performance management system. It s working & survey results verify improvement. They will reach 5-year goal to change workplace climate. Employee Engagement Drives Health Care Quality and Financial Returns, Rick Sherwood, Harvard Business Review October 30, 2013

22 Senior Leadership Commitment Model the behaviors you want Sincerity Acknowledge others including those you don t know Circulate, check in, take an interest in what matters to others Employees deliver what they perceive is important to you Motivate #1 Say, Thank you #2 Give people the feeling they are in on things Empower members of the team you coach Follow Through - Trust is everything

23 Constant reminders It s a campaign Literature, signs, programs, promotions Name tags, cafeteria menu, awards Screensavers...

24 Patients First Patients first guides our work Exam Room Screen Saver - Sample 1 Cleveland Clinic

25 Exceptional Employee Experience + World Class Patient Experience = Cleveland Clinic Experience Exam Room Screen Saver Sample 2

26 Jane s story Created perception of general incompetence o o o Only 1 nurse could perform ostomy bag procedure correctly Doctor confused her with a heart patient Told family to prepare for the worst, then removed tracheal tube the next day Made family feel guilty o o Son drove to medical supply store to purchase stoma adhesive, etc. Nurse said to patient, with children there: Your sons should give you a break. Refused to honor patient s wishes when they could have o o Wanted son to hold her hand during catheter removal, tricked him out of the room Wanted son to stay in her room longer, Nurse: Sorry, honey, have to follow the rules. Dehumanized the patient o o o Surgeon, You re lucky to be alive, you d feel better if you got your hair done. Talked about her in her presence as if she had hearing problems Portrait in costume, her voice singing, in Italian, Pirate of Penzance, Family sign: This is the person our mother really is.she is so much more than the person she appears in this bed.please remember that as you treat her. Family said attitudes changed!

27 Jim s story Created perception no-one at the hospital cares o Not sure when someone can take a look at him o Language was combative Well he s not on YOUR insurance, he s too old. Added to stress through public embarrassment o Next level supervisor, with bigger badge and clipboard, while others in waiting room: Who is with the motor cycle patient, age 28, with no insurance? o Jane s sons were among the others waiting, overheard, and comforted parents. Added to the feelings of parents despair o Unable to provide any sense of empathy or connect parents with chaplain or advocate for seven days when the victim died.

The Patient Experience at Florida Hospital Learning Module for Students

The Patient Experience at Florida Hospital Learning Module for Students 1 Introduction Adventist Health System and its East Florida Region hospitals welcome the privilege to provide a wellrounded learning