PATIENT AND PHYSICIAN ENGAGEMENT IN VALUE-BASED CARE INNOVATION IN CHANGING HEALTHCARE MODELS Alison Tothy, MD University of Chicago Medicine and Biological Sciences
TRADITIONAL MAPPING
TRENDS WITH INCREASING IMPACT Patients becoming more informed consumers Growth of structured quality metrics Revenue driving consolidation New and alternative payment models Specialty drug use driving the cost of care Information technology innovations
To create satisfaction is to cause someone to be pleased or happy. Satisfaction is in the moment. It is how positive someone feels about the expectation of their experience. Experience is about something we have lived through. It is about something that happened and it is our living story.
THIS TAKES PRACTICE
BACKWARDS BIKE
BEST PRACTICE IMPLEMENTATION
ELEMENTS OF BEST PRACTICE Engage leadership Manage change, motivate, generate results Integrate care processes Work processes and flow that improve outcomes Empower clinicians and staff Train and support pursuit of success Deliver world class service Support every caregiver, every patient, every hour, every day
engage empower integrate deliver
LEADER ROUNDING CAPTURING PATIENT VOICE
APPROACH TO LEADER ROUNDING Challenges Lack of structure Lack of clarity or standard practice Unclear accountability Limited ability to capture concerns Unable to track or address trends Solutions Standardize practice Create alerts for support departments Capture events and act Outline expectations Report trends Reward and recognize
APPROACH TO LEADER ROUNDING
APPROACH TO LEADER ROUNDING
APPROACH TO LEADER ROUNDING Analysis: Patients who experienced nurse leader rounding had an Overall Rating of Care mean score of 93.62% (performing at the 91 ST percentile among the Press Ganey National database). Patients who did not answer favorably regarding daily nurse leader rounding scored the Overall Rating of Care at 80.83% (performing in the bottom 5 th percentile among the Press Ganey National database).
APPROACH TO LEADER ROUNDING Mean Score 100.00 95.00 90.00 85.00 80.00 75.00 70.00 Overall Rating of Care Aug 2015-Dec 2016 93.86 Nurse manager check on you daily - "Yes" (n=4391) 82.50 Nurse manager check on you daily - "No" (n=1124) Definition: These data reflect mean score for Overall Rating of Care. Patients with multiple visits with the same encounter type will only qualify for a survey 1 time per 90 day window. Time frame reflect the time which the survey was returned. Surveys are distributed by email and paper. Data Source: Press Ganey CONFIDENTIAL: FOR QUALITY IMPROVEMENT PURPOSES ONLY. PLEASE DO NOT DISTRIBUTE
DISCHARGE CALLS CAPTURING PATIENT VOICE
APPROACH TO DISCHARGE CALLS Elevate service to reduce readmissions Extension of service team Coordinating feedback related to service experience Supports a smooth transition for patients and families
APPROACH TO DISCHARGE CALLS Calls placed within 3-5 days post- discharge Forward compliments and complaints Service recovery as needed Confirm post care follow-up services Connect patients with additional services Coordinated with clinical services on clinical issues
APPROACH TO DISCHARGE CALLS
LESSONS LEARNED ON IMPLEMENTATION OF BEST PRACTICES Engage and excite leadership Explain the why Share stories Educate and involve frontline teams early Create a cross-departmental culture of collaboration and coordination Reward and recognize Consistently track, report, act and improve Hardwire improvement with technology strategies
FUTURE CONSIDERATIONS IN BEST PRACTICES Change in language Centeredness moving to collaboration and partnership Shift in technology Accessible, practical and externally-facing Expansion of transparency Use of data to enable more immediate impactful decisions Explosion in choice
TRANSPARENCY OF DATA
TRANSPARENCY OF DATA
TRANSPARENCY OF DATA
TRANSPARENCY OF DATA
TRANSPARENCY OF DATA COST DASHBOARD Physician to physician Patient awareness Drug/Procedure cost Patients are asking for the costs because they have to bear so much of it Patients can also chose where they want to get care
PRIORITY HEALTH TRANSPARENCY EFFORTS
CURRENT ENVIRONMENT
BURNOUT IS REAL Reduced sense of accomplishment I lose sleep over work issues I cannot enjoy my personal time without focusing on work matters The work I do makes a real difference My work is meaningful I am not able to disconnect from work I am not able to free my mind from work when I am away from it My work gives me a feeling of accomplishment
THE CLINICAL ENVIRONMENT IS RIDICULOUSLY COMPLICATED
ADVERSE EVENTS Each year in the United States: 35.1 million hospitalizations 3.7% result in an adverse event with harm (1,298,700) 13.6% of these (.5% of the total) result in death (176,623)
BURDEN OF NOT WANTING TO CRASH THE PLANE Average # of seats on a domestic 737 airplane is 158 3 domestic airline crashes per day, every day of the year
DOCTOR DISCONNECT There is a disconnect between the passion doctors feel about caring for their patients and the reality of the work environment Take care of the care giver Connect them back to what matters to them
HOW DO WE CHANGE THE WORLD?
CHANGE THE WORLD
WHAT DOES A POSITIVE PATIENT EXPERIENCE LOOK LIKE?
TOGETHER WE CAN HEAL HEARTS Each hand represents an individual and each finger a contribution to creating a positive patient experience. We empower families, provide active listening, offer appropriate choices to facilitate a sense of control. We encourage family involvement and provide opportunities for play. We normalize the hospital environment, educate patients/families on procedures and admissions, and show compassion and empathy. We establish trusting relationships by communicating effectively while still being honest, we instill confidence by providing opportunities and control, we respect family wishes and we validate all feelings (frustration, fear, anxiety). Most importantly, we create a positive patient experience through the involvement of the whole team.
MAKING A DIFFERENCE EVERY DAY VIDEO