Removing Complexity From The Post-Acute Patient Experience
Who I am and why I wrote a book about simplicity. Irene Etzkorn, Chief Clarity Officer, Siegelvision 2
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We live in an increasingly complicated world 4
Differences we can t discern 5
Experiences that raise anxiety 6
Signs we can t understand 22,000 parking tickets per day issued by NYC 7
Instructions we can t follow 8
Nursing homes particularly confusing and intimidating 9
Choices we can t make 10
Comparison charts only help if you know what matters 11
14,568 diagnostic codes from Medicare and Medicaid Services 12
Language we can t decipher 13
Distinctions not easily understood 14
Possibility of serious misinterpretation e ons 15
Too much data, too little context 16
Reams of statistics are hard to decipher without context 17
Consumers are becoming vocal 18
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How do you go from here Paper-based Complicated Impersonal Uneven Digital Simple Customized Consistent 20
to there Paper-based Complicated Impersonal Uneven Digital Simple Customized Consistent 21
Three key principles Empathize Perceive others needs and expectations 22
Empathize Perceive others needs and expectations. 23
Imagine context of use 24
Color-coded medicine bottles Concept and design: Debra Adler 25
Three key principles Empathize Perceive others needs and expectations Distill Boil down and customize what s being offered to meet needs 26
Distill Boil down and customize what s being offered. 27
First aid kit designed for single-hand use Gabriele Meldaikyte 28
Three key principles Empathize Perceive others needs and expectations Clarify Make the offering easier to understand, use and benefit Distill Boil down and customize what s being offered to meet needs 29
Clarify Make the offering easier to understand, use and benefit. 30
Before of Bed Retention Policy BED RETENTION POLICY Medicaid covered Patients/Residents of the Home who are transferred to the hospital for care lasting up to 15 days, with a possible 5 day extension, are assured that every effort will be made for them to return to their own room when they are released from the hospital. This policy applies only to patients/residents who have lived in the Home for at least 30 days and are recipients of Medicaid and have been Medicaid-covered during some portion of their stay at Jewish Home. Patients/residents whose stay is covered either by Medicare, other insurances, or private funds may have their bed reserved only if they pay the daily rate while they are in the hospital. The hospital medical staff makes the determination as to the probable length of stay and level of care required. The Home is notified by the hospital if a patient/resident will not return within 15 days. Medicaid regulations require that The Home discharge the patient/resident as of the date of such notification. Private payment arrangements can be made to reserve the bed of a Medicaid-covered patient/resident; however Medicaid regulations prohibit a spouse from making direct payments on behalf of a patient/resident. Patients/residents who are ready to return, but have lost their bed because of a long hospital stay, are given priority for readmission as soon as a suitable bed becomes available. When possible, an effort is made to re-admit to the same floor; re-admission to the same room is quite unlikely. 31
After of Bed Retention Policy Retaining your bed if you are Hospitalized If you are admitted to the hospital while you are our patient, we understand that you would like to return to your room at the Home. However, due to the high demand for care at the Home, we can rarely provide that. The length of your hospital stay and the type of insurance coverage you have affect the likelihood. The hospital determines your probable length of stay and notifies us. If you lose your bed here because of a lengthy hospitalization, you will be given priority for readmission when you are ready to return. When possible, we make an effort to re-admit you to the same floor; re-admission to the same room is quite unlikely. Medicaid patients. If you have lived in the Home for more than 29 days and were covered by Medicaid during some portion of your stay and will be hospitalized 15 days or less (sometimes with a 5-day extension), we will make every effort to give you the same room when you are released from the hospital. If you will be hospitalized more than 15 days, Medicaid regulations require that we discharge you as of the date of the notification. To reserve your bed, you can pay privately; however, Medicaid will not allow your spouse to make direct payments on your behalf. 32
Three key principles Empathize Perceive others needs and expectations Breakthrough Simplicity Clarify Make the offering easier to understand, use and benefit Distill Boil down and customize what s being offered to meet needs 33
Challenges facing all nursing homes Rising consumer demand for real-time and mobile access Increasing consumer choice Persistent and changing regulatory requirements Legacy systems High financial cost 34
Why is the patient experience so complicated? Medical community speaking to itself Unfamiliar, life-changing events Adherence to old processes; slow conversion to new technology Lack of empathy with emotional toll on patients and families Lack of communications expertise in plain language writing, information design and information architecture 35
We began with the brand
We found a sea of sameness Amsterdam Isabella United Hebrew Hebrew Home Alaris Health The Osborn Archcare Jewish Home Lifecare 37 Kings Harbor
Messaging that is indistinguishable to provide warm, nurturing care in a costeffective manner which preserves and enhances independence and dignity. provides healthcare services and assistance for elders recognizing each person as a unique individual, our care supports independence and respects human dignity. 38
Language that is repetitive Competitor Amsterdam House The Hebrew Home Archcare/ Manning Archcare/ Cooke Isabella United Hebrew MJHS Palisades Medical Center Kings Harbor Multicare Center The Osborn Cobble Hill The Kensington Alaris Descriptor Advanced Care in a Home-Like Setting Living Well Superior Nursing Care in an Elegant Setting Dignified Residential Care for the Elderly Welcome to Our Family The Art of Caring for Generations Caring Every Minute, Every Day Patients First: Everywhere. Every Time. Every One. NA This is Your Osborn We Keep Brooklyn Healthy, Happy Home Enhanced Care Delivered With Love Bridging Caring and innovation 39
Jewish Home s NY centric identity Jewish Home Lifecare is the eldercare network most capable of addressing the profound clinical and social challenges of aging for all New Yorkers. 40
The New Jewish Home s Purpose Statement Committed to transforming eldercare for New Yorkers so they can live meaningful lives in the place they call home. 41
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Experience Blueprint living up to the brand promise
What makes a good patient experience? Inform me Know me Ask me Care for me 44
What makes a good patient experience? Inform me Set clear expectations Anticipate needs and concerns Speak and write in plain language Know me Provide seamless handoffs during care transitions Provide customized material Make first impression a wow Ask me Ask me how I prefer to receive information Offer greater transparency and access for families Care for me 45
Rehab patient expectations Rehab patients come with expectations that are rarely met their frame of reference is often hospital rehab. Rehab patients expect: Three hours of rehabilitation daily including on weekends The staff to know immediately upon admission whether they can walk to the bathroom, sit in a chair, etc. To see a doctor daily To receive a written care plan with customized goals 46
Actual rehab patient journey CNAs and therapists were the highlights of the Rehab patient experience but the initial experience was poor and set a tone for dissatisfaction 47
Actual rehab patient journey 48
Actual rehab patient journey 49
Rehab employee journey The CNAs view themselves as the point person for patients taking a keen interest in treating patients as though they were family members. It is a calling for some, more than a job 50
Rehab employee journey The CNAs view themselves as the point person for patients taking a keen interest in treating patients as though they were family members. It is a calling for some, more than a job 51
Work across functional silos, interview all areas and levels Patient Nursing/direct care Technology and Operations Marketing Admissions Digital 52
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Typical Findings Patient experience often uneven across care levels Paperwork undermines all-important first impression Jargon and unfamiliar health care terminology cause confusion Lack of customization puts unrealistic burden on patients Communication directed at patients rather than reflecting them 54
Let s hear from the audience. Do you face these issues? 55
Who I Am And why I said YES!
Persons Served* Community, 8300, 62% Nursing Home Post Acute, 2774, 22% Nursing Home Long Term Care, 2179, 16% Post Acute Bronx: 628, 23% Manhattan: 1,618, 58% Sarah Neuman: 528, 19% Housing Day Care Programs 10% (Kittay, ALP, 202s) 9% SHP Care Management 30% HAPI 19% CHHA 19% LTHHC (Bronx, Manhattan) 2% Solutions @ Home 2% NORCs 9% Long-Term Care Bronx: 1,143, 52% Manhattan: 630, 29% Sarah Neuman: 406, 19% 2013 Persons Served: LTC 16%, Post Acute 26%, Community 58% 2012 Persons Served: LTC 18%, Post Acute 26%, Community 57% *Contains duplicate persons served **Community excluding Transportation 59
Total Persons Served by Telehealth Programs 1,742 Total JHL Home Care 447, 26% JHL Day Center 164, 9% Private Pay 7, 0.5% NYU 8, 0.5% Self Help 141, 8% JHL Nuring Home Post Acute Care Kiosk 975, 56% 60
Our Clinical Outcomes are THE BEST
Expectation Experience
When Experience Doesn t Match Expectation
Even The Biggest Cities Cant Hide
The Experience Feedback Loop
How Did We Get Here?
Removing Complexity
Culture of Permission
Person Directed Care
Shared Decision Making
The Experience Matches Expectation
Next Networking Lunch Lone Star AB Or Lunch & Learn Sessions Various Meeting Rooms 11:45-12:45 PM www.theberylinstitute.org