How Facilities Can Improve HCAHPS ISHE Fall Conference Lynn Kenney, Director of Industry Relations The Center For Health Design
Improving the connection between health and the built environment
Learning Objectives 1. Why we do what we do-improve health & safety 2. HCAHPS and patient satisfaction and how it impacts hospital reimbursement and reputation 3. Review the people, process, place framework 4. Review case studies and examples that illustrate how facilities professionals impact HCAHPS and patient experience 5. Review resources and tools
Where to Begin? Experience Your Facility Through the Eyes of the Patient
What Is Involved?
HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems Survey 32 Survey Questions Measure Patient Experience of Care Dimensions 1. Communication with Nurses 2. Communication with Doctors 3. Responsiveness of Hospital Staff 4. Pain Management 5. Communication about Medicines 6. Cleanliness and Quietness of Hospital Environment 7. Discharge Information 8. Overall Rating of Hospital
The CMS HCAHPS Survey http://hcahpsonline.org/files/march%202016_survey%20instruments_english_mail.pdf
Survey of Patient Experiences http://www.medicare.gov/hospitalcompare
So many phrases and terms Patient-centered design Patient-centered care Patient and staff satisfaction Patient and family experience Px HCAHPS CAHPS
Why is there so much emphasis on patient-centered care? ACA ROI/Reimb ursement Staff, Patient and Family Experience Reputation/ Branding The HCAHPS Impact Outcomes
Hospital Value Based Purchasing Domains: Patient experience & safety outcomes are now tied to reimbursement Efficiency Measures beginning in FY 15 - Medicare Spending/ Beneficiary Efficiency Outcome measures - Patient safety/mortality indicators Outcomes Processes of Care Patient Experience Clinical Process of care measures Patient experience measured using the HCAHPS survey Can Lose up to 2.0% of Medicare payments by FY 17 Slide by Eileen Malone
Expansion of the CAHPS Survey Program The surveys provide patient experience data that enables comparison of facilities across the nation and promotes effective communication and coordination. www.cms.gov Hospitals Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) Outpatient facilities Outpatient and Ambulatory Surgery CAHPS (OAS CAHPS) Emergency Departments Emergency Department Patient Experiences with Care (EDPEC) Survey
Why is there so much emphasis on patient-centered care? Patient- Centered Care More Transparency More Consumer-driven More Competitive Reimbursement tied to performance across the continuum of care
Patient Experience (Px) People-A Culture of Caring Place-Physical Environment Process-Process Improvement
Solving a Common Hospital Problem: Noisy at Night Infrastructure (Place) Culture (People) (Process) Reengineering Building Single patient rooms Use of sound absorbing materials Design to separate noisy entities (ice machine) Identify Desired End-State Identify current state: decibel level, HCHAP score, & staff satisfaction re: noise Establish sense of urgency Identify target goals Staff Interventions Nighttime care guidelines Quiet voices Resupply and equipment movement Technology Hands-free communication Beepers on vibrate No overhead paging Equipment Fix squeaks Decrease equipment volumes link to hands-free devices Develop Noise Reduction Campaign Plan Set the stage using research and best practices Clarify values, vision Measure and Reward Progress Celebrate successes Find and tell the best stories Patient Interventions Rights Earplugs Television and radio headphones Visitor Interventions Orientation to noise reduction Cell phone use
Patient Experience/HCAHPS Case Studies Quiet/Privacy (question 9) Responsiveness (question 4) Communication (questions 1,2,5,6,7) Cleanliness (question 8)
Quiet-Privacy (Question 9)
The Beryl Institute Key elements for improving the patient experience
Survey of Patient Experiences http://www.medicare.gov/hospitalcompare
How am I supposed to sleep with all this racket?
Reducing noise Private rooms reduce exposure to noise levels that can cause stress and negative health effects Ulrich et al., 2008. Reduced noise levels improved sleep and mood, better pain tolerance Janssen et al., 2000
Columbia-Bassett Medical School Quiet Project
Quiet - PRIVACY Case Study by Dr. Lorissa McAllister at Enviah ROOM or UNIT modification for Improved Outcomes COMMUNITY HOSPITAL- MICHIGAN
Quiet PRIVACY COMMUNITY HOSPITAL-MICHIGAN 10% Disliked 1,600 people didn t like our physical surroundings #1 Sound and #2 Privacy complaints
Quiet PRIVACY COMMUNITY HOSPITAL-MICHIGAN Arbor Question: WAS THERE ANYTHING ELSE ABOUT THE HOSPITAL'S PHYSICAL SURROUNDINGS THAT YOU FOUND UNPLEASANT? (IF YES) PLEASE EXPLAIN: Patient Comment: The emergency room is pretty old. The rest of the hospital is updated and modern looking. The emergency room is not. There is not a lot of patient privacy. Most of the rooms have two beds in them. You can hear other patients' responses to questions and all of their personal information. I do not feel that is good. Pre-Panel Comments Related to Sound Jan-May 2012 (study conducted by Enviah)
Quiet PRIVACY COMMUNITY HOSPITAL-MICHIGAN Arbor Question: DID YOU FEEL THAT THE HOSPITAL TOOK ADEQUATE PRECAUTIONS FOR YOUR SAFETY? (IF NO) PLEASE EXPLAIN: Patient Comment: I do not think that people being able to hear all of your information is safe. Pre-Panel Comments Related to Sound Jan-May 2012
Quiet PRIVACY COMMUNITY HOSPITAL-MICHIGAN June 2012 1st Month Post Panels Improvement! Zero negative comments about sound. 5% dissatisfied
Privacy for Ambulatory Surgery Patients at Bassett Healthcare
Responsiveness (Question 4)
No Passing Zone-Bassett Support & Ancillary Services Mobilized! Call Lights: No Passing Zone Codes Red Flashing Bath, toilet or shower / Staff assist Door will typically be closed, knock on door to let patient know that you hear them and will get help. If restroom is empty, ok to cancel call light. White Steady Normal calls Flashing Bulb, Cord, Bed, Pillow speaker Pulled Out & Bed Exit alarm Blue Flashing Code Blue Calls Support Services can help by removing equipment, chairs or other guests. Green Flashing RN Service Needed Solid RN in Room Yellow Flashing PCA Needed Solid PCA in Room
Logistics and Supplies Matter
Communication (Questions 1,2,5,6,7)
Expansion of White Boards and the 5-10 Rule
NSHE Wayfinding: Reducing Anxiety
Wayfinding
Communication - ENGAGEMENT Case Study ROOM or UNIT modification for Improved Outcomes VIRGINIA
Communication - ENGAGEMENT Case Study ROOM or UNIT modification for Improved Outcomes HOSPITAL- FLORIDA
Location of the first encounter-communication Rooms that have hand wash sinks that face patients have an increased mean scores of 1.3-7.31 point Study by Dr. Lorissa McAllister Lorissa MacAllister 2014, All rights Reserved, Do not distribute or cite
Communication - ENGAGEMENT Location of head of bed Rooms that have the head of the bed inside the room have an increased Mean Score of 4.55 points Head of the bed at the door Head of the bed in the room Study by Dr. Lorissa McAllister Lorissa MacAllister 2014, All rights Reserved, Do not distribute or cite
Cleanliness (Question 8)
Continuous Improvement Cleanliness and Clutter Cleanliness and Lighting
CLEAN PRIDE Case Study by Dr. Lorissa McAllister After Before ROOM modification=improved Outcomes DOW HEALTH SERVICES-MICHIGAN Satisfaction improved by 25%
Tools, resources, and next steps
Make Patient Experience Part of Routine Activities 1. Get involved in the PI committee 2. Accreditation Look at Px elements during EOC Rounding 3. Offer Ideas and Suggestions 1. Get involved in HCAHPS committees 4. Know Your Scores! http://www.medicare.gov/hospitalcompare 5. Familiarize yourself with best practices
Know your HCAHPS scores and make sure your solution provider know them too! http://www.medicare.gov/hospitalcompare
HCAHPS Worksheet Infrastructure (place) Culture (people) Process Reengineering Building Identify Desired End State Staff Interventions Technology Develop A Campaign Patient Interventions Equipment Measure and Reward Progress Visitor Interventions
Refer to the list in the HPOE Guide Source: The HPOE Guide www.hpoe.org/physicalenvironment
Material Selections That Support Px, Maintenance and EVS Processes Limiting Paint Selections Ceiling Tiles Lighting Strategies Flooring To decrease confusion in matching when doing touch ups as well as limiting stored paint Understanding how often ceiling tiles are moved around as they need to gain access to above ceiling pipes, etc. and planning tiles to make their lives easier. (Less edges to break) Sharing lighting success strategies related to LED advancements, and understanding the process in switching an all-fluorescent facility over to LED Choose dark colored flooring or flooring with specks to reduce the appearance of shoe marks which can impact perception of cleanliness Source: The HPOE Guide www.hpoe.org/physicalenvironment
Words and actions to live by The trick to remembering the big picture is to remember to keep experiencing your facility through the eyes of the patient. People, Process, Place
Resources www.hope.org www.healthdesign.org/knowledge-repository www.ashe.org
Thank you for all that you do to improve the patient experience! Resources are available at: www.healthdesign.org/knowledge-repository www.ashe.org www.hpoe.org lkenney@healthdesign.org