Arizona Critical Access Hospital Quality Network Working to Improve the Patient Experience June 27, 2013 10:00-11:30a.m. Arizona Rural Hospital Flexibility Program
AZ-CAH Quality Network Benson Hospital CAH Teresa Vincifora Participants Ora Goodman Amanda Osuna Carondelet Holy Cross Hospital Lloyd Brown Debra Knapheide Cobre Valley Community Hospital Kara Holcomb Copper Queen Community Hospital Claudia Romo Sadie Maestas Hopi Health Care Center Hu Hu Kam Memorial Hospital LeeAnn Beach Sarah Wolterman Little Colorado Medical Center Sonia Ybarra Leslie Fusaro Northern Cochise Community Hospital Page Hospital Susan Cazaux Parker Indian Health Center Sherry Killingsworth Lily Shimahara Sage Memorial Hospital Christi El-Meligi Southeast Arizona Medical Center Annie Benson Robi Berry White Mountain Regional Medical Center Cherie Passalacqua Wickenburg Community Hospital Linda Brockwell Judy Carroll
Purpose of Today s Webinar Strengthen the AZ-CAH Quality Network Support hospitals in selecting QI project to improve patient satisfaction Discuss process for sharing HCAHPS Scores Identify next steps
Agenda I. Welcome and Introductions II. Updates and discussion of current AZ-CAH use of HCAHPS AZ-CAHs HCAHPS Scores Experience with vendors Aims Statements Data Exchange Plans to improve the patient experience III. Pt. Satisfaction QI Projects a. Benson Hospital Pain Management b. Discussion of projects IV. AZ CAH Awards and recognitions V. Introduction to Wendy Perrell VI. Next Steps - August 1 st Workshop VII. Summary & Evaluation
HCAHPS Reported by Hospitals Established New to HCAHPS Not currently Carondelet Holy Cross Benson Hospital Hopi Health Care Center Cobre Valley Reg. Medical Ctr. Hu Hu Kam Memorial Hospital Little Colorado Medical Center Copper Queen Comm. Hospital Northern Cochise Comm. Hospital Parker Indian Health Center Page Hospital White Mountain Reg. Med. Ctr. Sage Memorial Hospital Wickenburg Comm. Hospital Southeast Arizona Medical Ctr.
Discussion How are you receiving HCAHPS data? What frequency? What format? What kinds of reports? How are you using HCAHPS information? Who receives reports? What hospital areas Are you satisfied? Examples of use Suggestions for improvement? What questions do you have?
HCAHPS Survey: Nurse Communication Nurses Communication K I Arizona B J D A H 0 10 20 30 40 50 60 70 80 90 100 % Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor Data
HCAHPS Survey: Doctor Communication Doctors Communication K Arizona I A J D B H 65 70 75 80 85 90 95 % Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data
HCAHPS Survey: Cleanliness of Room/bathroom Cleanliness of Room/bath room K Arizona B I D A H J 0 10 20 30 40 50 60 70 80 90 100 % Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data
HCAHPS Survey: Quietness at night Quietness at night Arizona I A K H B J D 0 10 20 30 40 50 60 70 80 % Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data
HCAHPS Survey: Responsiveness from Hospital Staff Responsiveness from Hospital Staff K A Arizona B J I H D 0 10 20 30 40 50 60 70 80 90 % Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data
HCAHPS Survey: Pain Management Pain Management K B J I Arizona A D H 0 10 20 30 40 50 60 70 80 90 % Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data
HCAHPS Survey: Communications about Medications Communications about Medications A I K Arizona D J H B 0 10 20 30 40 50 60 70 80 90 % Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data
HCAHPS Survey: Discharge Information Discharge Information H A I B Arizona D K J 0 10 20 30 40 50 60 70 80 90 100 % Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data
HCAHPS Survey: Willingness to Recommend Hospital Willingness to Recommend Hospital I D Arizona J H A K B 0 10 20 30 40 50 60 70 80 90 100 % Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data
HCAHPS Survey: Overall Rating of Hospital Overall Rating of Hospital I J D K A Arizona H B 0 10 20 30 40 50 60 70 80 90 % Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data
Effective Aim Statements Answer the question, What are we trying to accomplish? Communicate expectations Are time specific Are measureable Define the specific population or populations affected Are clear and unambiguous Can be used in your elevator speech They aim BIG Source: Dr. Andrea Silvey, HSAG, adopted from Institute for Healthcare Innovation
QI Projects Presentations How did you select the project? What data did you use? Who was / is involved? How will QI project information be monitored? How does it fit into existing hospital QI projects Is there an Aim Statement?
AZ-CAH Example Benson Hospital HCAHPS Improvement Project: Pain Management
Identifying the Project Inpatient Discharge Surveys 4 th Quarter 2012 HCAHPS Scores 4 th Quarter 2012 Sometimes Usually Always N/A How often was pain well controlled? 2% 26% 66% 6% Adjusted N (Statbase) Top Box HSTM DB Top Box How often was pain well controlled? 7 43% 67% How often did staff do everything to help with pain? 7 86% 80% Benson Hospital
Moving Forward AIM Statement: By December 2013, 85% of Benson Hospital inpatients will report that their pain was always well controlled throughout their hospital stays. Performance Improvement Team Created Chief Clinical Officer, Nursing Supervisor, Clinical Nurse Educator, Case Manager Benson Hospital
Plan Thorough pain history/assessment on admission Establishing a pain goal with each patient Use of white boards for communication Hourly rounding Patient education Follow up Benson Hospital
White Board Information Room # Date PAIN GOAL: MEDICATION: LAST DOSE GIVEN NEXT DOSE AVAILABLE RN: CNA: Benson Hospital
Monitoring One full week of hourly rounding has been completed by staff All admission assessments since implementation have an established pain goal, and all shift assessments compare the current pain level to the pain goal Progress is being communicated to CEO and others at the monthly PI/CAH meeting Benson Hospital
Best Practices: Pain kk Management Patients who reported that their pain was "Always" well controlled Tactics that make Always responses more likely 1. Use Individualized Patient Care to Manage Patient Perception of Pain 2. Conduct Hourly Rounding to Consistently Address Pain 3. Pain Poster Source: The HCAHPS Handbook, Studor (2010)
Hospital Recognition Rural Route, June 2013 CAH Recognition Certificate Recipient for June: Page Hospital, Page, Arizona Congratulations to Page Hospital in Page, Arizona recipient of the Critical Access Hospital (CAH) Recognition Certificate for quality from the National Rural Health Resource Center (The Center). Page Hospital was nominated by Arizona Flex Coordinator Kevin Driesen who pointed out the following ways Page Hospital is deserving of recognition. "I am pleased to nominate Page Hospital to receive public recognition for having demonstrated excellence and innovation in the area of quality," said Driesen. Page Hospital has demonstrated its leadership and innovation among Arizona's rural hospitals. It is well-managed, provides high quality patient-centered care, and operates in a unique rural environment. Publicly reporting to Hospital Compare and participating in MBQIP including HCAHPS Leadership has remained stable, and the Hospital employs a strong management team. The Hospital signed a Medicare Beneficiary Quality Improvement Project (MBQIP) Agreement with the AZ-Flex program in 2011 and regularly submits Hospital Compare quality data for pneumonia, heart failure, surgical care, outpatient, and patient satisfaction metrics. Demonstrated excellence in quality initiatives with documented outcomes The Hospital maintains accreditation through The Joint Commission and its quality outcomes and operational performance rates high relative to peers. In celebration of the 2012 NOSORH National Rural Health Day, ivantage Health Analytics completed an assessment using national health datasets to identify high performing hospitals, those in the top quartile of its ivantage Hospital Strength Index. For this assessment, Page Hospital was Arizona's highest performing hospital, receiving recognition in three-of-four quality-of-care categories: (i) Excellence in Quality (for HF, PN, SCIP, and OP); (ii) Excellence in patient satisfaction (HCAHPS "Willingness to Recommend" and "Overall Quality"); and (iii) Excellence in Efficiency (Cost-to-Charge index). Not surprisingly given Page Hospital's high quality rankings, the Hospital also performs well on financial and operational performance metrics as documented by the Flex Monitoring Team. Specifically, Page Hospital's profitability, cost, and capital structure metrics compare well with peers. Demonstrated Innovation Page Hospital demonstrates innovation through participation in different initiatives. For example, Page Hospital participates in the Centers for Medicare and Medicaid (CMS) Partnership-for-Patients initiative through the Premier Hospital Engagement Network (HEN). Recently, the Hospital opened an Intensive Care Unit, using eicu Technoloy, a remote monitoring system that uses a two-way, audiovisual communication system to allow staff to see and speak directly with the patient in a room while the patient can see and hear a nurse on a monitor located across from their beds. Page Hospital staff has participated in various AZ-Flex quality initiatives including a collaborative to improve medication reconciliation and efforts to achieve designation as a Level IV Trauma Center.
Copper Queen Community Hospital recognized for Quality Copper Queen Community Hospital HCAPHS Strategies Use of Press Ganey as our patient satisfaction consultant and implementing recommended tactics to improve performance in low scoring areas Manager evaluations were developed which incorporated patient satisfaction into the performance review process Tracking and reporting patient satisfaction scores monthly through our quality assurance process improvement committee Incorporation of patient satisfaction into the strategic planning of the hospital and holding all parties accountable Making patient satisfaction one of the 3 key pillars of focus which is discussed at numerous meetings, from the departmental level up to the Board of Directors Press Ganey is able to provide how we score on the Value Based Purchasing scale so we are also using those indicators to focus our improvement efforts. These strategies have helped us begin to change the corporate viewpoint and culture of the organization.
Hospital Recognition
Hospital Recognition
Next Steps Communication develop project ideas - Flex staff and AZ-CAH Quality Network peers - Situational analyses with your hospital teams Identify QI projects - Aim Statements Introduce Wendy Perrell Attend AZ-CAH workshop August 1 Technical Assistance available Share HCAHPS data
Upcoming Events Working to Improve The Patient Experience Workshop Learning Objectives: This workshop will provide a hands-on opportunity with an expert, working to get the most from your HCAHPS data. Logistics: Date: August 1, 2013 Time: 9-3:30 pm Location: T-Health Institute 550 E Van Buren, Phoenix, AZ (3rd floor) Moderator: Wendy Perrell SyncroDestiny Coaching Preparation: Please bring vendor log in & password Hotel Information: A block of rooms have been reserved at the Marriot Springhill Suites. 802 E. Van Buren. Phoenix AZ 85006, 602-307-9929 for July 31. Please use code AZ-CAH Quality Network. Parking is free at the hotel and is in walking distance to workshop. Travel reimbursement available upon request Tele-conference connection: Available for those who can t attend in person. Please contact Jill Bullock by July 15, 2013 for system testing RSVP: Jill Bullock 520-626-3722 bullock1@email.arizona.edu
Homework Please send HCAHPS scores / reports Develop your QI projects Communicate TA service needs AZ-CAH Workshop (August 1, 2013 T-Health Institute) Preparation: Please bring vendor log in & password Send Aims Statement to Jill Bullock Show/share vendor quality reports workshop presentations Discuss strategies to improve pt. satisfaction Discuss strategies to analyze data
Medicare Beneficiary Quality Improvement Program (MBQIP) Participation Agreements signed 11 AZ-CAHs 1,139 National CAHs Encourage participation in Hospital Compare / HCAHPS Phase 01 Measures (Pneumonia / HF) Phase 02 Measures (HCAHPS, Outpatient) Phase 03 Measures (ED & Pharmacy, Sept 2013) AZ-Flex working in collaboration with HSAG Second MBQIP report release (June 2013) Data Aggregated for four quarters to increase #s Summary quality reports will be distributed at August 1 st Quality Network
Thank You! Please call us / your peers with any related thoughts / feedback Arizona Rural Hospital Flexibility Program This webinar is made possible through funding provided by the Health Resources and Service Administration, Office of Rural Health Policy, Medicare Rural Hospital Flexibility Program