iround for Patient Experience Advancing Accountability for Improving HCAHPS at Ingalls A Case Study Webconference
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4 Road Map 1 Laying the Groundwork 2 Building a System of Accountability 3 Deeper Insights Into the Success to Date
5 About Ingalls Health System Case in Brief 544-licensed beds; ADC 280 30 minutes south of Chicago in Harvey, IL Independent not-for-profit system founded in 1923 Includes network of four ambulatory care centers
6 A Challenging Marketplace New Leadership Charted a More Positive Course Demographics Declining population ( 15.4% since 2000) Low and declining median household incomes ( 9% from 2000 to 2011; 45% lower than IL average) Leadership Transformation Reduced RN vacancy rate from 22% to <1% Radically cut agency use Reduced RN turnover to below state average Transformed to a culture of transparency Minimal Funding High Medicaid/Self-Pay population Last Medicaid inpatient rate increase in Illinois was in 1995 Costly care with minimal reimbursement New Focus on Patients CEO led transition from physician centric to patient centric thinking Improved inpatient satisfaction scores from 6 th percentile to 39 th percentile (2008-2010)
7 Initial Steps in the Right Direction Organizational Imperative to Prioritize Patient Experience Ingalls Launched a Patient Experience Program in 2010 Trained staff on best practices Introduced nurse manager daily rounding Saw Temporary Improvements, But Overall Trend Not Positive 65% Overall Hospital Rating 9 59% 55% 70% 56% 64% 63% Created rounding logs CNO and other leaders reinforced focus on patient experience Q2 2010 Q3 2010 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011
8 But Early Efforts Didn t Have Desired Impact Shortage of Data, Lack of Accountability Prove Challenging No Easy Way to Document Rounds or Follow-Up Items Leadership Had No Tracking Mechanism Learning and Improvement Hindered Transferring rounding notes into spreadsheet-based rounding logs required an extra step that was often skipped Busy nurse managers would often identify a patient issue, walk out of the room, and forget to document or follow up on the issue Lacked a way to know if rounds actually occurred, how often, and for how many patients Had no mechanism to see what service issues existed or how/if they were being addressed We had implemented a rounding program based on the latest best practices, but we found that simply telling busy nurse managers to round just does not work. Since rounding logs were often not completed, there was no reliable historical data to learn from trends or pinpoint the most effective improvement opportunities Also lacked a way to track and follow up when staff were recognized for their efforts by patients, so staff recognition was inconsistent
9 Road Map 1 Laying the Groundwork 2 Building a System of Accountability 3 Deeper Insights Into the Success to Date
10 Made Decision to Invest in Technology Easy-to-Implement System Enabled Rapid Adoption March 2012 Was rounding on every unit with iround June 2012 Implemented ED rounding January 2012 Began implementing iround technology April 2012 Established goal to round on 80% of patients (M-F) Q3 2013 Received results from second VBP performance period Project Objectives: Use rounding to support the transition to a patient-centric strategy Enhance nursing engagement Continue to improve HCAHPS performance
11 A Brief Overview of the Technology iround for Patient Experience A Systems-Based Approach iround captures real-time data for: Real-Time Patient Satisfaction Data Patient feedback is captured daily at the bedside Tailored smart forms with quick-text and prompts uncover critical patient needs Detailed rounding data automatically uploads to backend analytical system Hardwired Service Recovery and Recognition Individual drivers of satisfaction addressed while patients are still in the hospital Responsible service department immediately notified of problems identified during rounds Issues are tracked to completion Accountability for Results Executives make decisions based on timely, robust data Real-time unit-level and aggregated metrics, historical trends, and key problems affecting performance highlighted Correlations revealed between HCAHPS and specific rounding data, service recovery trends Daily Patient Satisfaction Rounding Service Recovery Employee Recognition Executive Rounds
12 Two Distinct, Complementary Uses for iround Data Take Care of Patient Needs Today, While Driving Lasting Improvement Cross-Department Service Recovery Coordination Patient Experience Reporting and Analysis Addressing Patient Needs In-the-Moment Using Data to Improve the Organization Mobile Data Collection and Service Recovery Fostering Daily Conversations with Patients Strengthening Reputation and Financial Standing Analytics and Data-Driven Improvement Patient Satisfaction Rounding Data-Driven Improvement Initiatives
13 How iround Helped Ingalls Upgrade their Approach New Emphasis on Capturing, Reviewing, Using Patient Feedback Enabled Efficient, Effective Rounding Provided units with mobile devices to collect actionable patient experience data quickly Eliminated what had been an onerous data entry step for staff and instead made reporting automatic Set Expectations and Changed Behavior Leaders reviewed rounding dashboards in weekly meetings and followed up when compliance was low or issues were unresolved Leadership involvement drove cross-department collaboration on service recovery issues Leveraged More Comprehensive Data to Drive Decisions Trends were analyzed, allowing early detection of issues in key areas affecting HCAHPS performance New wealth of patient experience data enabled effective root cause analysis to ensure true problem was being addressed
14 Loftier Expectations Led to Increased Accountability Streamlined Rounding and Reporting Made Aggressive Goals Achievable Elevated expectations drove new behaviors At first post-implementation huddle, some managers had conducted few or no rounds Set new goal to round on 80% of all patients each weekday Combination of rounding tool and new expectation improved compliance rapidly Number of Rounds Conducted Not tracked 2,047 5,642 2011 Q1 2012 Q2 2012 New rounding goal created
15 Produced Lasting Impact on HCAHPS Score Improvements Achieved Across Many Dimensions Enhanced Communication Scores % of Patients Rating Overall Hospital Experience 9 or 10 72% % of Patients Rating Hospital Always Clean, Always Quiet 23% Increase in ranking1 on Communication with Nurses 63% 66% 55% 32% Increase in ranking1 on Communication with Doctors Pre iround 17 Months Post Implementation Pre iround 17 Months Post Implementation 37% Increase in ranking1 on Communication about Medications Corresponding National Percentile Rankings 1 39 th 70 th 23 rd 57 th 1) Estimated using CMS national HCAHPS database with performance through Q1 2013 the most recent period available and Ingalls survey data through Q3 2013.
16 Positively Affected Ingalls Financial Position Results of the Second Performance Period 1 100% Of at-risk base operating DRG amount returned through CMS s VBP program $250k+ Estimated FY 2014 Additional VBP Incentive Payment 1) Performance Period used to determine scores for FY 2014 was April 1, 2012 through December 31, 2012. Dollar value estimated by applying CMS VBP Percentage Payment figures to approximate Ingalls Medicare revenue.
17 Road Map 1 Laying the Groundwork 2 Developing a System that Enables Accountability 3 Deeper Insights Into the Success to Date
18 Actionable Data Enriched Weekly Huddles Decisions Driven by Better Information Teams reviewed trends by unit, identified drivers and patient-specific issues: 1. Rounding performance versus goal by unit and overall 2. HCAHPS correlation to iround data 3. Performance in key HCAHPS areas and overall 4. Deep dive on service recovery comments to identify unmet needs, as well as opportunities to recognize employees for stellar work Representative Patient Feedback a gentleman from housekeeping offered help when I was unsure of where I was going. He stopped, washed his hands and took me all the way to the unit. Exceptional.
19 Rapid Feedback Engaged Staff in Achieving Goals Improvements Made to Cumbersome Manual Processes 1 2 Real-time data engendered new levels of sensitivity New awareness of patient concerns and compliments increased responsiveness Incorporating staff feedback on rounding forms fostered ownership for outcomes Influencing patient experience and satisfaction scores became more achievable in minds of staff Leadership used the technology to round on staff Connecting Staff to Patient Complaints and Compliments Since I came, I have complained about this sticky floor on my left side of the bed, but nobody came to check or clean. Automatic tracking of quarterly one-on-ones improved compliance and drove accountability for the process Effectively capturing staff-generated ideas generated better targeted and more rapid improvements Efficient capturing of patient comments fueled more consistent staff recognition and more targeted coaching [Nurse] is a great teacher, she really explains everything I will write a letter about my great care.
20 Technology Enabled a High-Reliability System Removed Traditional Barriers that Hindered Performance Key Process Enhancements Capture pulse of current patients Fix issues in the moment Support new leadership goals Solve the right problems Previously relied on HCAHPS survey data received weeks (or months) postdischarge Helps ensure that service needs are assigned promptly and resolved while patients are still in our care Drives transparency and accountability for results, as well as staff satisfaction and engagement Lets us understand and manage the drivers of HCAHPS scores using a much broader and richer set of our patients experiences
21 Navigated a Bump in the Road The System Enabled a Quick Response to Dipping Scores Managed Through a Challenge Closed two units in late 2012 (one due to declining census, one for renovation) Most rooms became semi-private Dissatisfaction related to cleanliness, nurse communication, and physician communication began to emerge as drivers of overall satisfaction By presenting this data, Ingalls CNO was able to convince other leaders of the intense effect on several HCAHPS categories, leading to the mid-year reopening of the unit Clear Correlation to Patient Satisfaction Overall Hospital Rating 9 72% 74% 76% 69% 64% 62% 54% 60% 60% 66% 56% Oct '12 Nov Dec Jan Feb Mar Apr '12 '12 '13 '13 '13 '13 May Jun '13 '13 Jul Aug '13 '13 Closed E4 Reopened E4
22 Final Thoughts Hardwire Positive Behaviors with Technology 1 2 3 Simply telling staff to round will not improve results an infrastructure is required Holding staff accountable from front-line all the way to the executive level is key and this requires actionable data Cross-department cooperation and coordination are essential to fix service issues internal systems support is needed to close communication loop
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24 For More Information Lisa Hobart Senior Director hobartl@advisory.com (484) 690-0761