Healthcare Quality Initiative within Navy Medicine

Healthcare Quality Initiative within Navy Medicine Captain James Oberman*, M.D., FACS, CAPT, MC, USN United States Navy *This perspective is based on CAPT Oberman s experience and not endorsed by BUMED/ DHA

Agenda

Patient Centered Caring Communication Initiative PCCCI is a four-hour, peer-to-peer, participative communications course complementary to TeamSTEPPS TeamSTEPPS is a initiative focused on medical teams to prevent patient harm (i.e. Wrong Site Surgery, Laboratory documentation) (Team Strategies & Tools to Enhance Performance and Patient Safety) Examples of topics / skills covered in the course include: Presence/Mindfulness Reflective Listening Why Better Communication matters Patient interviewing [exhaustive what else ] and mutual agenda setting PCCCI is designed to train doctors and staff on active listening, being present, overall feedback, effective communication, and the handling of difficult communication and interactions to provide a better patient experience.

Goal of PCCCI Goal is to incorporate Patient-Centered Caring Communication into the culture of continuous, outstanding patient care Increase Patient Experience Decrease adverse events Increase Safety Instill Zero Harm Enhance employee satisfaction, resiliency Peer-to-peer training model builds long-term sustainability as an in-house faculty is able to train new employees, conduct refresher courses, and pass on their skills to future faculty

Implementation of PCCCI Fort Belvoir Community Hospital (FBCH) Pilots PCCCI (Q3 FY14) Expansion of training to entire National Capital Region (NCR emsm) (Q2 FY16) Navy JAX Implements PCCCI Training Entire NCR emsm trained in PCCCI (FY 17) FBCH in 10 th Percentile with TRISS Nurse Communication Composite (Q1 FY15) Navy JAX reaches sustainment of PCCCI- Embedded 2012

Challenges Certain challenges have surfaced during implementation of PCCCI across the National Capital Region enhanced Multi- Service Market (NCR emsm) Lack of support from NCR emsm Military Treatment Facilities (MTFs) to provide sufficient number of providers to take Facilitator Training Lack of Local Champions across the NCR emsm Lack of understanding between TeamSTEPPS v. PCCCI at MTF Level No specific PCCCI metric methodology (currently leveraging TRISS/TROSS) Provider buy-in at MTF Level

Are You Familiar with the term Patient Centered Health Care? 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 90% 10% 0% Yes No Don't Know

Do you practice Patient Centered Health Care? 80% 70% 60% 50% 40% 30% 20% 10% 0% 70% 15% 15% Yes No Don't Know

How do you rate your ability to communicate with patients? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 50% 30% 20% 0 Excellent Above Average Average Below Average

In general, how do you rate your provider colleague s ability to communicate? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 52% 44% 4% 0% Excellent Above Average Average Below Average

Do you feel the need to improve your communication skills? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 82% Yes 18% No

Do you consider a workshop to improve your communication skills valuable to your career? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 50% 40% 10% 0% Essential Beneficial Little Value No Value

TRICARE Inpatient Satisfaction Survey (TRISS) Purpose To assess beneficiaries satisfaction with their inpatient care experiences for medical, surgical and obstetric services Data Satisfaction percentages are usually calculated using weighted data. Weighting accounts for mail survey design and non-response. Core questions Based on the Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) Survey designed by Agency for Healthcare Research and Quality (AHRQ) Questions are H-CAHPS and DoD specific National benchmarks are from CMS Total of 43 questions Frequency: Survey is fielded bi-monthly (with a quarterly rollup) for Direct Care (DC) and Purchased Care (PC) Mode: Mail and phone

TRISS Sampling Overview Sampling unit is the individual hospital Sampling plan targets at least 300 completed cases per year, for statistical analysis and compliance with HCAHPS protocol DC - 56 MTF inpatient facilities - Census of all DC patients PC - 73 of the largest civilian facilities - Selected based on volume of discharges Patients must be interviewed within a 42 day window after discharge Analysis compares Medical, Surgical, and OB patient experiences Maximum sampling resource of 187,000 sample items 75% of the sample allocated to DC, and 25 % allocated to PC

TRISS: Nurse Communication Composite 88% 86% 84% 82% 80% 78% 76% ***HCAHPS 10 th Percentile 85% FY12- FY15 TRISS Composite 1: Communication with Nurse ***HCAHPS 50 th Percentile 79% PCCCI Ft. Belvoir Pilot FY14 Q3 FY12 FY13 FY14 FY15 ** DC PC * Ft. Belvoir Jaxsonville 3% Increase Communication with Nurse Composite Survey 1. Never 2. Sometimes Highlights 3. Usually 4. Always Data reflects CMS standard of always replies Prior to PCCCI Pilot, Ft. Belvoir satisfaction in Communication with a Nurse rose 4% from FY 12 Q1 to FY14 Q3. An additional 3% increase in satisfaction occurred post implementation to place Ft. Belvoir in the 10 th percentile Jacksonville has maintained Communication with Nurse satisfaction in the 10 th percentile for the past 3 FY *Ft. Belvoir implemented PCCCI pilot FY14 Q3 ** DC shares the same trend from FY12-FY15 as PC ***Percentile Ranking based on end of 2014 data

TRISS: Doctor Communication Composite 88% 87% 86% 85% 84% 83% 82% FY12- FY15 TRISS Composite 2: Communication with Doctor ***HCAHPS 10 th Percentile 88% PCCCI Ft. Belvoir Pilot FY14 Q3 ***HCAHPS 50 th Percentile 82% FY12 FY13 FY14 FY15 ** DC PC * Ft. Belvoir Jaxsonville Communication with Doctor Composite Survey 1. Never 2. Sometimes Highlights Both Ft. Belvoir and Jacksonville have trended above the HCAHPS 50 th Percentile Benchmark since implementation Jacksonville FY12 Ft. Belvoir FY14 Q3 3. Usually 4. Always Data reflects CMS standard of always replies *Ft. Belvoir implemented PCCCI pilot FY14 Q3 ** DC shares the same trend from FY12-FY15 as PC ***Percentile Ranking based on end of 2014 data

Overall Hospital Rating ***HCAHPS 10 th Percentile 81% FY13 QTR 2-FY 15 QTR 3 Overall Hospital Rating Overall Hospital Rating Survey 1. Never 2. Sometimes 3. Usually 4. Always ***HCAHPS 50 th Percentile 70% Data reflects CMS standard of always replies Highlights San Antonio and the National Capital Region (NCR) have continued to trend higher near the 10 th Percentile in Overall Hospital Rating ***Percentile Ranking based on end of 2014 data

Recommend the Hospital ***HCAHPS 10 th Percentile 83% FY13 QTR 2-FY 15 QTR 3 Recommend the Hospital Recommend the Hospital Survey 1. Never 3. Usually 2. Sometimes 4. Always Data reflects CMS standard of always replies ***HCAHPS 50 th Percentile 72% Highlights NCR and San Antonio have consistently ranked in the 10 th percentile for Recommend the Hospital Puget Sound and Oahu rank among the 50 th percentile ***Percentile Ranking based on end of 2014 data

PCCCI Progress to date Communication Faculty have taught 80 classes to date FBCH pilot site for National Capital Region (NCR) OCT 14 150 staff trained MHS wide (NHJAX, FBCH, NMW, NHC)~1252 providers trained since 2012 Jan 16 NCR expansion 1 st of three sessions to train new facilitators completed Feb 16 17 new facilitators in NCR, total of 38, with 5 master trainers for sustainment (Goal: 80 to train 11,000 staff in 2 yrs) Second facilitator training session held at FBCH 16-18 March & 21-22 April. 80-100 attendees divided between four classes on 22 nd Additional PCCCI Implementation throughout the Navy NAVMEDWEST - PCCCI launched 2 NOV 15, Piloting at NHCP NAVMEDEAST Possible July expansion to Navy MTFs located in NC

PCCCI Progress to date Future facilitator training dates Biannual facilitator training for 11 region-wide military treatment facilities (MTFs) for sustainment 11 MTFs utilize pool of 80 trained facilitators to roll-out 4 hour CIH course to respective staff Goal to train 11,000 personnel (providers, mid-levels, allied health, ancillary, administrative staff) over 2 yrs FBCH holds PCCCI training monthly, MTF s in NCR will begin in April/May as they gain trained facilitators Problem communicators: Communication mentoring program (individual training) Coordination with DHA research department and Center for Naval Analysis for future research projects and metrics Working to establish additional metrics to measures impact PCCCI has on individual MTFs