03/24/2017. Measuring What Matters to Improve the Patient Experience. Building Compassion Into Everyday Practice

Transcription

1 Building Compassion Into Everyday Practice Christy Dempsey, MSN MBA CNOR CENP FAAN Chief Nursing Officer First OUR GOAL: OUR GOAL: Prevent suffering by optimizing care delivery Alleviate by responding to Inherent patient needs Measuring What Matters to Improve the Patient Experience 2014 Press Ganey Associates, Inc. 3 1

2 What Do Patients Really Value? 19% of patients Low: Confidence in Provider 74.6% Fail to Recommend All Patients 15.7% Recommendation Failure Rate 81% of patients High: Confidence in Provider 1.9% Fail to Recommend 14% of patients 5% of patients 8% of patients 72% of patients Low: Worked Together 90% Fail to Recommend High: Worked Together 28% Fail to Recommend Low: Worked Together 11% Fail to Recommend High: Worked Together 1% Fail to Recommend 11.4% of patients Low: Courtesy 92.8% Fail 2.5% of patients High: Courtesy 78.2% Fail 0.8% of patients 3.4% of patients Low: High: Listens Listens Carefully Carefully 45.7% 24.7% Fail Fail 2.4% of patients 5.9% of patients Low: High: Concern Concern for for Worries Worries 22.3% 6.3% Fail Fail 3% of patients 68.4% of patients Low: High: Concern Concern for for Worries Worries 5.6% Fail 0.6% Fail High Risk Low Risk 4 Drivers of Likelihood to Recommend - Inpatient 5 Attributes That Differentiate Rating of Center 0-10 All Patients: 9+10 Staff Cared About You: No 65.1 Staff Cared About You: YES Center Clean: No Center Clean: YES Center Clean: No Center Clean: YES

3 Higher Patient Experience Reliability Scores Link to Higher Quality (quintiles of performance) 7-10% -5% 0 5% 10% PAIN CLINICAL EXCELLENCE DISCHARGE PREP Disch info symp CARING BEHAVIORS COURTESY INFORM CHF Patients Have Different Needs CHF vs. Medical PERSONALIZE EMPATHY OPERATIONAL EFFICIENCY WAIT ENVIRONMENT 2014 Press Ganey Associates, Inc. GLOBAL 8 How Patients Experience Care Empathy Personalize Courtesy Privacy Inform Caring Behaviors Choice Service Recovery Discharge Prep Clinical Skill Pain Control Clinical Excellence Operational Efficiency Environment Wait Amenities Culture Teamwork 9 3

4 Compassionate Connected Care Themes Acknowledge Suffering We should acknowledge that our patients are suffering, and show them that we understand. Body Language Matters Non verbal communication skills are as important as the words we use. Anxiety is Suffering Anxiety and uncertainty are negative outcomes that must be addressed. Coordinate Care We should show patients that their care is coordinated and continuous, and that we are always there for them. Autonomy Reduces Suffering Autonomy helps preserve dignity for patients Caring Transcends Diagnosis Real caring goes beyond delivery of medical interventions to the patient 10 Pain Control: Staff Have More Influence Than Meds Did you get meds for pain? Yes, Definitely Did you get meds for pain? No Top Box Percent Yes, definitely Yes, somewhat No Yes, definitely Yes, somewhat No Did doctors/nurses do everything to help with pain? 11 Rate ED 0-10 Recommend ED What is Correlated with Likelihood to Recommend? 12 4

5 Best Practice Strategies Courtesy/Respect Promptness in Response Skill of the nurses/doctors Help at Home Cleanliness Attention to Special/Personal Needs Accommodation and Comfort for Visitors 13 Staffing and Work Environment Patient Loyalty and Nurse Loyalty Are in Sync Patient Likelihood to Recommend (For Treatment) Mean Score Patient Likelihood to Recommend vs RN Likelihood to Recommend R² = RN Likelihood to Recommend (For Employment) Mean Score 15 5

6 Nurse Job Enjoyment Is Related to Patient Loyalty Patient Likelihood to Recommend vs RN Job Enjoyment th percentile (the cliff) Patient Likelihood to Recommend Mean Sore Low Job Enjoyment Levels Above 25th Percentile for Patient LTR Higher Job Enjoyment Levels RN Job Enjoyment Score - Percentiles 16 Nursing Structure, Process & Perceptions Total Staffing HPPD Intent to Remain Status of Nursing RN Perception Job Satisfaction.370**.784**.763** Quality in General.354**.682**.779** Patient Experience Rate Hospital **.330**.678** Nurses Listen.190**.342**.634** Prompt Response.199**.392**.609** Patient Outcomes Unassisted Falls -.202** -.248** -.558** CLABSI -.168** -.142** -.383** HAPU II -.189** -.202** -.500** 17 Composite Measures using NDNQI Data Staffing Composite measures Nurse Staffing and Expertise RN Hours per Patient Day, RN Skill Mix, and Education and Certification of Nurses Emphasis on RNs rather than non RNs, Education (higher % BSN prepared nurses) and Certifications (higher % of certified nurses) Hospitals categorized as above the median or below the median Nursing Work Environment Composite measures quality of work environment Uses 4 of the subscales of the RN Practice Environment Survey: Foundations for Nursing Quality of Care Nurse Manager Leadership and Ability Nurse Participation in Hospital Affairs Nurse Physician Interactions (Staffing and Resource Adequacy omitted staffing factors isolated in Staffing Composite) Hospitals grouped according to quartile from least favorable to most favorable work environment 18 6

7 Does Work Environment Trump Staffing? Fall Rate by Quartile of Work Environment 2.65 Fall Rate Work Environment 19 Does Work Environment Trump Staffing? Pressure Ulcer Rate 1.64 Work Environment 20 Does Work Environment Trump Staffing? Work Environment and Staffing have Similar Impact on RN Perception of Quality RN Perception of Quality (Mean) 3.5 Work Environment 21 7

8 Safety and Surveillance Theoretical Model: Antecedents: (not measured) Hospital and Nursing Leadership Unit Type Unit RN Surveillance Capacity Practice Environment RN-MD, Foundations, Hospital Affairs, Resources, Manager RN Characteristics Education, certification, tenure, number of patients Nursing Unit Safety Programs Safe patient handling & mobility program System for safe staffing & patient assignments, Anti-fatigue schedule and meal break system, collaborative RN-RN interaction program Lucian Leape Institute, 2013: Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams. 23 RN Outcomes Make Contribution Job Enjoyment Intent to stay Patient Outcomes RN report of missed care RN report of quality of care Falls Pressure Ulcer Patient Experience Nurse Domain Issues Domain Overall hospital rating Likelihood to recommend Pay for Performance Hospital Star Ratings Hospital acquired condition Penalty Readmissions-Heart Failure Readmissions-Pneumonia Readmission Penalty Value based purchasing Score VBP experience VBP efficiency VBP process Safety and Job Enjoyment Job Enjoyment Safety Surveillance 24 8

9 Safety and Intent to Stay Intent to Stay Safety Surveillance 25 Safety and Meaningful Work Meaningful Contribution Safety Surveillance 26 Safety and Clinical Outcomes 1.7 Pressure Ulcers 1.9 Fall Rate Safety Surveillance Safety Surveillance 27 9

10 Nurse Perceptions of Surveillance Capacity and RN Safety, and Patient Overall Ratings of the Hospital Overall Rating of Care Given At Hospital Safety Surveillance 28 Safety, Surveillance, and Star Rating Star Rating Safety Surveillance 29 Caregivers 10

11 Relationship Between Engagement and Experience National Percentile Rank Based on Employee Engagement Scores (1) 100 Average National Percentile Rank Nurse Responsiveness Physician Pain Medication Discharge Rating Top Quintile of Employee Engagement Bottom Quintile of Employee Engagement 1. Based on Engagement data from 36 projects, year HCAHPS data from 2014 PG Database. Created by Healthcare Metrics Team. 31 What Stress & Harm Do Providers Cope With? Role Stress of clinical role - complexity, high stakes activities Sympathy overload - secondary traumatic stress of witnessing suffering Emotional labor of caregiving role Inherent Job Emotional labor of employee demands Stress of interruptions, multitasking and task switching Stress of pace of change in organization and larger industry Lack of education/support to prevent/address compassion fatigue Moral distress arising from inability to provide level of quality desired Lack of appreciation Lack of resources Communication break downs, lack of needed information Lack of trust in leadership Harm Lack of respect Emotional abuse (bullying, humiliating, demeaning behaviors) Back or musculoskeletal injuries Unprotected exposure to blood-borne pathogens Physical violence Lack of safe refuge to report physical and psychological harm Avoidable 32 The Burden of Emotional Labor Emotional labor or emotion work is an element of job that requires an employee to display required emotions toward customers or others. Creates an emotional cost embedded in the role. Requirement to not display (turn off) an emotion you are feeling Stress, surprise, disgust, fear, uncertainty, sadness, grief Requirement to display an emotion you are not feeling Deference, optimism, assurance, compassion Much of clinician training requires the turning off of felt emotions and then we compound that emotional work by asking to simultaneously turn on the positive emotional displays

12 The Process of Emotional Labor Emotional labor or emotion work is an element of job that requires an employee to display required emotions toward customers or others. Surface Acting - the process of displaying behaviors that would be congruent with the required emotion. Associated with burnout Deep Acting - the process of creating an internal emotional state that is congruent with the required action. 34 How Caregivers Experience Care Cared About Belong Respect Enjoy Work Recognition Connected Trust Job Security Providing Quality Care Providing Safe Care Clinical Excellence Operational Excellence Job Fit, Clarity, Pay/Benefits Work Training, Development Physical/Staff Resources Good Management Input, Feedback, Autonomy Leadership Communication Culture Mission/Values Teamwork Patient-Centeredness 35 Improvement Focus Safety as a Priority Compassionate Connected Care for the CareGiver We should acknowledge the complexity and gravity of the work provided by caregivers It is the responsibility of management to provide support in the form of material, human, and emotional resources Teamwork is a vital component for success Empathy and trust must be fostered and modeled Caregivers' perception of a positive work/life balance reduces compassion fatigue Communication at all levels is foundational 36 12

13 Key Drivers of Engagement 1. I feel like I belong in this organization. 2. This organization provides high-quality care and service. 3. I have confidence in senior management's leadership. 4. This organization treats employees with respect. 5. The amount of job stress I feel is reasonable. 6. My pay is fair compared to other healthcare employers in this area. 7. My work provides me an opportunity to be creative and innovative. 37 Best Practice Strategies Work toward a culture of caring Know people Develop leaders formally Not simply the tasks for management Coaching Mentoring Succession planning Frequent senior leader rounding Assure transparency 38 Remember the Patient Remember: your patient is scared Remember: your patient has lost almost all control Remember: they hurt and they are the ONLY judge that matters Remember: YOU are likely their only means of information Remember: they need compassion 39 13

14 and the CareGiver Remember: caregivers are working hard Remember: they are members of a team Remember: they need information Remember: they need resources Remember: they need compassion 40 What is causing the suffering in nurses? Sometimes we want to reduce that to a phenomenon called compassion fatigue. But you know what? It s the opposite of that. It s that nurses are working in systems that keep them from having these moments with [patients] a caring occasion, a moment where two people see each other, and meet in a place that is beyond time and space. JANET QUINN PhD nurse, Lyons, CO 41 This is Why it Matters 14

15 Thank You! Christy Dempsey, MSN MBA RN CNOR CENP FAAN SVP, Chief Nursing Officer 15