How We Know What Residents Really Want OCTOBER 26, 2011 ARKANSAS

Transcription

1 How We Know What Residents Really Want OCTOBER 26, 2011 ARKANSAS

2 Mary Tellis-Nayak RN, MSN, MPH Vice President of Quality Initiatives

3 Outline» What do Arkansas residents and family members want?» How do residents wants align with families?» What do staff say about their work?» The importance of frontline caregivers in meeting residents wants and needs

4 To provide long-term care leaders evidence-based management tools to better achieve their organization s goals

5 Evaluate outcomes: measure variation Collect data: ensure validity, organize Turn plan into action: improve process My InnerView s evidencebased path to quality Turn data into information: benchmark, study variation Turn knowledge into plan: apply new wisdom to process Turn information into knowledge: study current process

6 Complaints that reach you: Tip of the iceberg! 5% complain to management 45% complain to frontline staff 50% have problem, yet don t complain Good quality is good business (TARP studies)

7 My InnerView» 9,500+ providers in all 50 states and District of Columbia use our tools» Skilled team of professionals with extensive senior care operational, clinical, regulatory and academic experience» Sent more than 2 million surveys in 2009» Recommended by: 5 national associations 41 state associations

8 Meeting the desires of residents

9 What matters most to patients?» What do you think are the issues related to patient satisfaction that have the highest correlation with their likelihood to recommend your home/community to someone else?

10 Understanding the patient s mind» Satisfaction and loyalty are not won on field of best clinical quality Clinical and process outcomes is not where battle for consumer s mind is being waged» Residents judge their experience by the way they are treated as a person, not by how they are treated for their disease» Perceptions of personal treatment are more highly correlated than clinical competence

11 I hope for the day when everyone who lives in any long-term care situation knows there is someone waiting for him or her each morning after the journey of sleep one takes each night. And I yearn for the day when each staff person most especially CNAs know that there are people who are waiting for a morning greeting, interested in learning how the CNA fared in the hours they were apart. CARTER WILLIAMS

12 When you don t remember anything, you re satisfied! Loyalty is generated by memorable things that happen that we didn t expect

13 The Law of Memorable Events» Though it takes somebody doing something special beyond what is expected, it doesn t take everybody doing something special all the time» It takes only one brief experience on only one day of a stay to determine dissatisfaction or loyalty

14 Loyalty comes from compassion What words on comment cards made the residents love the staff?

15 COMPASSION 2/3rds of adjectives used Compassion synonyms:» Caring, cares, cared +32» Kind, kindness +24» Compassionate +15» Help, helpfulness +15» Concerned +6» Listens +4» Loving +3» Empathy +3 Courtesy synonyms:» Friendly +8» Professional +9» Attention, attentive +7» Sweet +3» Respect +3» Polite +3» Patient +3» Smiling +2

16 If one were to pick out the synonyms for compassion, there is an amazing consistency in the qualities that have the greatest impact on patient loyalty

17 Compassion» Questions from survey companies that have questions with care, compassion or concern in them have the highest correlation with overall satisfaction and loyalty» Compassion dramatically influences overall satisfaction

18 Competence synonyms were the least mentioned

19 Courtesy and competency are expected Doing what is expected does not earn unsolicited raves

20 Loyalty is often expressed because of the actions of one nurse on one shift!

21 It is the compassionate connection between a caregiver and a resident that elevates common courtesy into something more tender and unforgettable than good, routine care

22 Compassion, caring, comforting and kindness these make up the bulk of the adjectives linked to loyalty they are all rooted in empathy The capacity for empathy is the ability to share in another s emotions or feelings When people receive empathy, they feel loved and cared about

23 For long-term care not to teach the role of empathy, or inspire compassion, is a colossal omission, because empathy has the capacity to heal by its effect on stress, and compassion is the primary influence behind patient loyalty.

24 What do residents want?

25 AN EXERCISE: What Matters Most

26 QUADRANT ANALYSIS: TWO KEY CONCEPTS 1. How residents, families and staff rate your care and services Your average score on each item: 0 3: Poor Fair Good Excellent Rank order all items by average score: 1 100: Lowest to highest ranking score 2. How much each item influences residents, families and staff to recommend to others Correlate each item with Recommendation: 0 1: No correlation to strongest correlation Rank order all items by correlational strength: 1 100: Lowest to highest ranking correlation

27 QUADRANT AND ACTION PRIORITIES Recommendation You can meet customer expectations 1 - Lowest to highest ranking score 100 A. Secondary strengths C. Secondary opportunities B. Primary strengths D. Primary opportunities Successes Challenges Item score Lowest to highest ranking correlation You have little control over customer expectations

28 ARKANSAS Voice of Residents and Family Members

29 RESIDENTS SAY: WHAT MATTERS MOST IN A NURSING HOME

30 SKILLED NURSING RESIDENT AND FAMILY Survey items 1 Choices/preferences 2 Respectfulness of staff 3 Respect for privacy 4 Resident-to-resident friendships 5 Resident-to-staff friendships 6 Meaningfulness of activities 7 Religious/spiritual opportunities 8 Quality of RN/LVN/LPN care 9 Quality of CNA/NA care 10 Quality of rehabilitation therapy 11 Adequate staff to meet needs 12 Attention to resident grooming 13 Commitment to family updates 14 Competency of staff 15 Care (concern) of staff 16 Responsiveness of management 17 Safety of facility 18 Security of personal belongings 19 Cleanliness of premises 20 Quality of meals 21 Quality of dining experience 22 Quality of laundry services

31 ARKANSAS RESIDENTS What matters most 14 - Competency of staff 15 - Care (concern) of staff 16 - Responsiveness of management 1 - Choices/preferences 17 - Safety of facility 5 - Resident to staff friendships 13 - Commitment to family updates 6 - Meaningfulness of activities 8 - RN/LVN/LPN care 21 - Quality of dining experience

32 ARKANSAS FAMILIES What matters most 14 - Competency of staff 8 - RN/LVN/LPN care 9 - CNA/NA care 17 - Safety of facility 15 - Care (concern) by staff 11 - Adequate staff to meet needs 16 - Responsiveness of management 1 - Choices/preferences 19 - Cleanliness of premises 12 - Attention to resident grooming

33 Why is willingness to promote your company such a strong indicator of loyalty and growth? FREDERICK RIECHHELD: THE ONE NUMBER YOU NEED TO GROW

34 Because when customers recommend you, they re putting their reputation on the line. They will take that risk only when they are loyal.

35 The importance of Recommendation» Provides crucial information Tells you loyalty of respondents Correlates to other quality outcomes: All items in survey Occupancy Quality indicators Employee satisfaction» That is why this question is used for Priority Action Agenda

36 If you want to grow your business exponentially, you must get serious about building and maintaining loyal relationships with your customers Loyal customers are easiest customers to serve Long-term customers tend to spend more with you than new customers Happy, loyal customers purchase other products or services in company s line Satisfied, loyal customers recommend company s products or services FREDERICK RIECHHELD: THE LOYALTY EFFECT

37 In most of the industries studied, the percentage of customers who were enthusiastic enough to refer a friend or colleague perhaps the strongest sign of customer loyalty correlated directly with differences in growth rates among competitors.

38 ARKANSAS Voice of Residents and Family Members

39 ARKANSAS RESIDENTS Response Rate 57% 52% 40% Facilities Surveyed Surveys Received

40 Why look at Excellent?

41 Loyalty is generated by memorable things that happen that we didn t expect. These cause person to give score of Excellent, not Good

42 Research shows that, in most industries, there is a strong correlation between a company s growth rate and the percentage of its customers who are raving fans that is, those who say they are extremely likely to recommend the company to a friend or colleague. For My InnerView users, this is Excellent

43 ARKANSAS RESIDENTS Response Rate 57% 52% 40% Facilities Surveyed Surveys Received

44 RESIDENT PERCENT EXCELLENT AND GOOD FOR GLOBAL SATISFACTION ITEMS Overall Satisfaction Recommendation to Others 90% 89% 91% 88%

45 RESIDENT GLOBAL SATISFACTION RATINGS BY DOMAIN

46 ARKANSAS FAMILIES Response Rate 39% 37% 38% Facilities Surveyed Surveys Received ,668

47 FAMILY PERCENT EXCELLENT AND GOOD FOR GLOBAL SATISFACTION ITEMS Overall Satisfaction Recommendation to Others 86% 87% 87% 87%

48 FAMILY GLOBAL SATISFACTION RATINGS BY DOMAIN

49 RESIDENT

50 FAMILY

51 PRIMARY STRENGTHS PRIMARY OPPORTUNITIES A B RESIDENT FAMILY C D SECONDARY OPPORTUNITIES SECONDARY STRENGTHS

52 RESIDENT Safety of facility Choices/Prefere nces 2 9 FAMILY CNA/NA care 8 1 Care (concern) of staff RN/LVN/LPN care Competency of staff B D PRIMARY STRENGTHS PRIMARY OPPORTUNITIES

53 RESIDENT FAMILY Adequate staff to meet needs Quality of dining experience Meaningfulness of activities Responsiveness of management SECONDARY OPPORTUNITIES C D PRIMARY OPPORTUNITIES

54 Resident Satisfaction Studies have repeatedly confirmed that residents and their family members value the quality of the relationships they have with the frontline caregivers higher that the quality of the medical care and the quality of the food. NCCNHR, Public Health Institute

55 RESIDENT EXCELLENT, GOOD, FAIR OR POOR RANKED BY PERCENT EXCELLENT

56 FAMILY EXCELLENT, GOOD, FAIR OR POOR RANKED BY PERCENT EXCELLENT

57 Quadrant B RESIDENT Choices/Preferences (1) Safety of facility (17) Commitment to family updates (13) CAN/NA care (9) RN/LVN/LPN care (8) FAMILY Competency of staff (14) Choices/Preferences (1) Care (concern) of staff (15) RN/LVN/LPN care (8) Safety of facility (17) Respectfulness of staff

58 RESIDENT COMPARISON TO PREVIOUS SURVEY QUADRANT B

59 FAMILY COMPARISON TO PREVIOUS SURVEY QUADRANT B

60 Quadrant D RESIDENT FAMILY Competency of staff (14) Care (concern) of staff (15) Responsiveness of management (16) Resident to staff friendships (5) Meaningfulness of activities (6) CNA/NA care (9) Adequate staff to meet needs (11) Responsiveness of management (16) Cleanliness of premises (19) Attention to resident grooming (12) Quality of dining experience (21)

61 RESIDENT COMPARISON TO PREVIOUS SURVEY QUADRANT D

62 FAMILY COMPARISON TO PREVIOUS SURVEY QUADRANT D

63 Demographics and background information

64 FAMILY DEMOGRAPHICS AND BACKGROUND INFORMATION Gender of resident Female 70% Male 30% Age of resident 19 or under 0% 20 to 29 0% 30 to 39 0% 40 to 49 1% 50 to 59 4% 60 to 69 8% 70 to 79 16% 80 to 89 44% 90 or older 27%

65 FAMILY DEMOGRAPHICS AND BACKGROUND INFORMATION Homes visited None 30% Only this one 13% Two 31% Three 16% Four 5% Five or more 4% Reason for choosing Convenient location 32% Good reputation 28% Doctor or hospital 15% Relative or friend 11% Insurance requirement 1% Other reason 13% 54%

66 FAMILY DEMOGRAPHICS AND BACKGROUND INFORMATION Length of stay Less than 1 month 2% 1 to 3 months 11% 3 to 6 months 7% 6 months to 1 year 14% 1 to 3 years 36% 3 or more years 30% 66% Relationship to resident Spouse 15% Child 57% Brother or sister 11% Grandchild 1% Friend 3% Other relationship 13%

67 FAMILY DEMOGRAPHICS AND BACKGROUND INFORMATION Person visiting most Spouse 16% Child 55% Brother or sister 13% Grandchild 1% Friend 5% Another person 10% How often visited Less than one a year 0% Once a year 1% Once every 3 months 4% Once a month or more 12% Once a week or more 47% Almost daily 37% 83%

68 AVERAGE SCORES RECOMMENDATION TO OTHERS BY DEMOGRAPHICS Location type RESIDENT FAMILY

69 AVERAGE SCORES RECOMMENDATION TO OTHERS BY DEMOGRAPHICS Reason for choosing RESIDENT FAMILY

70 AVERAGE SCORES RECOMMENDATION TO OTHERS BY DEMOGRAPHICS RESIDENT How Often Visited FAMILY

71 AVERAGE SCORES RECOMMENDATION TO OTHERS BY DEMOGRAPHICS Length of Stay RESIDENT FAMILY

72 What does research have to tell us about the workplace?

73 Quality of leadership and quality of the workplace The voice of CNAs» Based on 2008 satisfaction surveys conducted by My InnerView: 78,547 CNAs/NAs 144,098 family members» 3,216 skilled nursing facilities ranked in four groups based on percentiles (lowest, 2nd lowest, 2nd highest and highest)

74 Indicators of quality workplace 1. Pay compared to other nursing homes 2. Safety of workplace 3. Adequate equipment and supplies to do your job 4. Work allows you to make a difference in people's lives 5. Co-workers work together as a team 6. Fair performance evaluations 7. Respect shown for resident by staff 8. Help you get to deal with job stress and burnout 9. Staff communication between shifts

75 Quality leaders produce a quality workplace Group averge score: 1-4 Leadership Workplace Leadership Workplace Leadership Workplace Leadership Workplace 20 Lowest 2nd lowest 2nd highest Highest Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.

76 Quality workplace earns staff recommendation Group averge score: 1-4 Workplace Recommendation Workplace Recommendation Workplace Recommendation Workplace Recommendation 20 Lowest 2nd lowest 2nd highest Highest Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.

77 Quality workplace earns family recommendation Group averge score: 1-4 Workplace Recommendation Workplace Recommendation Workplace Recommendation Workplace Recommendation 20 Lowest 2nd lowest 2nd highest Highest Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.

78 Quality workplace creates quality of life for resident Group averge score: 1-4 Workplace Quality of life Workplace Quality of life Workplace Quality of life Workplace Quality of life 20 Lowest 2nd lowest 2nd highest Highest Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.

79 As staff are treated, so will the elders be treated.

80 Quality workplace creates quality of care for resident Group averge score: 1-4 Workplace Quality of care Workplace Quality of care Workplace Quality of care Workplace Quality of care 20 Lowest 2nd lowest 2nd highest Highest Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.

81 Quality workplace creates quality of service for resident Group averge score: 1-4 Workplace Quality of service Workplace Quality of service Workplace Quality of service Workplace Quality of service 20 Lowest 2nd lowest 2nd highest Highest Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.

82 Quality workplace results in better state surveys Group averge score: 1-4 Workplace Compliance Survey citations Workplace Compliance Survey citations Workplace Compliance Survey citations Workplace Compliance Survey citations Lowest 2nd lowest 2nd highest Highest Based on My InnerView employee satisfaction surveys completed by CNAs/NAs in 2008.

83 Evaluate outcomes: measure variation Collect data: ensure validity, organize Turn plan into action: improve process My InnerView s evidencebased path to quality Turn data into information: benchmark, study variation Turn knowledge into plan: apply new wisdom to process Turn information into knowledge: study current process

84 We did the best we could, with what we knew, And when we knew better, we did better. MAYA ANGELOU

85 Thank you! Questions?