Improving Patient Satisfaction with Minitab Christopher Spranger, MBA, ASQ MBB Preview Changing healthcare environment Patient satisfaction process Defining our opportunity Establishing a baseline Finding the right factors Implementing improvements Results & impact www.sprangerbusinesssolutions.com 1
Changing Healthcare Environment: Value Based Purchasing How the CAHPS System works Surveys administered by a 3 rd party Standardized questions Only top box counts Domains CAHPS = Consumer Assessment of Healthcare Providers and Systems www.sprangerbusinesssolutions.com 2
Improving HCAHPS Scores Project Title: Design a Patient Education Process Project Goal: Improve HCAHPS Dimension for discharge information Business Case: For Riverview Hospital, scoring below the Value Based Purchasing benchmarks represents a potential $4.5 million revenue loss over the next 5 years HCAHPS is 30% of VBP! If you pour all of your resources toward improving a domain, expect a 2-3% increase in top box scores within a year. -3 rd party survey administrator www.sprangerbusinesssolutions.com 3
Baseline Performance: Discharge Domain Let s develop a process to be performed in MSPI on admission that touches all different learning styles and focus on the needs of elderly, people who do not speak English as a primary language, and people with lower education levels. Define Measure Analyze Wait a second ~Chief Nursing Officer www.sprangerbusinesssolutions.com 4
Drilling in to find key factors Discharge Domain Have help you needed after you left the hospital? Symptoms or health problems to watch out for??????????? Let s test those assumptions The biggest opportunity must be Med/Surg/Peds Inpatients Patients with lower education levels Patients who do not speak English as a primary language Elderly patients Hypothesis H o : MSPI scores are no different than the rest of the inpatient units H a : MSPI scores are lower than the rest of the inpatient units H o : Patients with lower education levels score the same as the rest of the patients H a : Patients with lower education levels score lower than the rest of the patients H o : Non English speaking patients score the same as English speaking patients H a : Non English speaking patients score lower than the rest of the patients H o : Elderly patients score the same as the rest of the age groups H a : Elderly patients score lower than the rest of the age groups www.sprangerbusinesssolutions.com 5
What data is available? By using the Visit Identification number, we were able to correlate the survey responses to each patient s individual experience This helped us identify the key factors we needed to work on to improve our overall scores Electronic Medical Records Unit HCAHPS Survey Visit Identification Number Differences between Units 3 different units Medical / Surgical / Pediatric unit Birthing unit Critical Care unit Data from most recent 12 month period One-Way ANOVA using Minitab Assistant to detect differences between the 3 different units www.sprangerbusinesssolutions.com 6
ANOVA Output - Units Unit Sample Size Mean CCUI 23.6957 FBPI 247.8016 MSPI 859.8778 MSP a low performer? Differences in Education Level Seven different education levels recorded 4 year college graduate 4+ years college Some college High school graduate Some high school 8 th grade NULL Data from most recent 12 month period One-Way ANOVA using Minitab Assistant to detect differences between the different education levels www.sprangerbusinesssolutions.com 7
ANOVA Output - Education Differences in Language Three different primary languages recorded English Other NULL Data from most recent 12 month period One-Way ANOVA using Minitab Assistant to detect differences between primary language www.sprangerbusinesssolutions.com 8
ANOVA Output - Language Differences in Age Patients aged 18 to 98 years Data from most recent 12 month period One-Way ANOVA using Minitab Assistant to detect differences between age www.sprangerbusinesssolutions.com 9
% Yes Age Group Graphical Analysis: Patients Given Information About What to do At Home Interpretation of Results: Of the 18 age groups that answered yes less than 80% of the time, 7 were from age 29 to 37. Ages that answered yes less than 80% of the time: 20, 23, 24, 29, 30, 31, 32, 34, 36, 37, 43, 46, 62, 64, 80, 85, 89, and 90. 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 Age 40 35 30 25 20 15 10 5 0 % Yes Sample Size Age Group Comparison Chart of % Yes by Age group 1 00.00% 90.00% 86.72% 83.53% 87.32% 88.21% 88.84% 86.93% 91.30% 80.00% 71.54% 70.00% 60.00% 50.00% 1 8-27 28-37 38-47 48-57 58-67 68-77 78-87 88-97 Age Range www.sprangerbusinesssolutions.com 10
Age Group Analysis: Age Group Sample Size Mean 18-27 128.867 28-37 130.715 38-47 85.835 48-57 142.873 58-67 212.882 68-77 233.888 % of yes responses 78-87 153.869 88-100 46.913 Let s test our assumptions The biggest opportunity must be Med/Surg/Peds Inpatients Patients with lower education levels Patients who do not speak English as a primary language Elderly patients Hypothesis H o : MSPI scores are no different than the rest of the inpatient units H a : MSPI scores are lower than the rest of the inpatient units H o : Patients with lower education levels score the same as the rest of the patients H a : Patients with lower education levels score lower than the rest of the patients H o : Non English speaking patients score the same as English speaking patients H a : Non English speaking patients score lower than the rest of the patients H o : Elderly patients score the same as the rest of the age groups H a : Elderly patients score lower than the rest of the age groups www.sprangerbusinesssolutions.com 11
Our Ah Ha Moment What did we learn? What our hunches told us MSP Patients Patients with lower education levels Patients who do not speak English as a primary language Elderly patients What the data revealed Family Birthplace Patients No differences in responses between education levels No differences in responses between different languages Patients aged 28 to 37 years Does Diagnosis Matter? DRG: Diagnosis Related Group www.sprangerbusinesssolutions.com 12
Targeting High Impact Opportunities Whole hospital average = 85.83% yes responses Project #1: Atrial Fib in Critical Care Unit and Med-Surg- Peds (66.7% yes responses) Project #2: Abdominal Hysterectomies in Med-Surg- Peds (78% yes responses) Project #3: Vaginal delivery patients in Family Birthplace (77.3% yes responses) Analyze Review the data analysis Map the process Voice of the customer Take Action! Key Problem How We Know it Contributed to the Y Timing of Education Involvement with Family Caregiver Expected Outcomes not Clear Voice of the Customer reoccurring themes www.sprangerbusinesssolutions.com 13
Improvement Strategies Key Problem Changes Implemented Timing of Education Redesign of education process into three phases Collaborate with primary care physician clinics Electronic checklist prompts nursing involvement every 8 hours Involvement with Family Caregiver Expected Outcomes not Clear Primary family caregiver is identified up front and engaged in the care management throughout the stay Question added to admission database Family caregiver prints to case management census sheets Clarified vague terms for the specific procedure. Excessive bleeding, etc. Remeasure www.sprangerbusinesssolutions.com 14
Remeasure www.sprangerbusinesssolutions.com 15
To: All Employees From: Director of Business Development Subject: ARHC Receives High Marks! We have received some great news, and I wanted to share it with you. Business Impact The Centers for Medicare and Medicaid Services (CMS) recently released a report that ranked ARHC in the 90 th percentile for patient satisfaction scores from January to December 2014. This means that ARHC ranked higher than 89% of hospitals nationwide that are subject to Value Based Purchasing (VBP) a CMS program that rewards hospitals for the quality of care patients receive. One of the VBP metrics used to score hospitals is their results on inpatient satisfaction surveys. The highest satisfaction scores were received in the following areas: Communications about medicines Patients reported that new medicines and their potential side effects were explained Hospital Environment Patients reported that their rooms and bathrooms were clean, and that the hospital was quiet at night Discharge Information Patients reported that they received and understood their discharge instructions Although the ARHC ranking is based on information from 2014, which is the most current information available, it is evidence of what can be achieved when we work as a team and put our patients first. Congratulations and thank you! www.sprangerbusinesssolutions.com 16
Lessons Learned Leveraging lessons learned across DRGs Data analysis of other HCAHPS dimensions to form additional improvement teams Finding and using the right data will ensure you are spending time and effort improving the right things Having teams work on smaller scoped portions of a larger problem simplifies the problem solving process and makes implementing change easier. Don t start an improvement event until you have a clearly scoped problem and supporting data! www.sprangerbusinesssolutions.com 17
@Chris24Spranger LinkedIn.com/in/christophermspranger facebook.com/sprangerbusinesssolutions/ SprangerBusinessSolutions.com cmspranger@sprangerbusinesssolutions.com 35 www.sprangerbusinesssolutions.com 18