Terri D. Nuss, MS, MBA Vice President, Patient Centeredness Baylor Health Care System HCAHPS PUBLIC TRUST
Best in Class, Best in Industry. To be trusted Zagat AAA 5-Star Diamond Awards First Class Siskel and Ebert! Good Housekeeping Consumer Reports JD Powers and Assoc Malcolm Baldrige and word of mouth from trusted sources 2
Roadmap Why HCAHPS equals trust Stories from patients and loved ones How we, consumers, perceive care Cultural changes that drive results Glimpse into the evolving landscape Wrap 3
Baylor Vision: Trust Be routinely listed as one of the Top 5 health care systems in the nation Vision 2015 Influence health care reform through patient-centered models of care Fully implement clinical transformation to create an ideal experience for patients and caregivers trusted to give and receive that the delivery of safe, quality, compassionate care prioritizes the tenets of patient-centered care 4
H-CAHPS cheat sheet Hospital - Consumer Assessment of Healthcare Providers and Systems First public reporting of patient experience Who qualifies: Inpatient discharges to home, nursing homes, etc. Acute care: obstetrics, medical and surgical DRGs Adults, all payers 5
The $takes $ 4M at-risk for Baylor annually 30% HCAHPS portion of Value-Based Purchasing Impact if lost 3% of system operating margin* Playing catch-up, losing confidence Quality = experience Loyalty = experience * Excluding JVNCI 6
STEEEP Trust Through Patient (Centered) Eyes Actively inviting patients and families to create ideal care experiences through all stages of life with = (centered) to = (focused) 7
Why Go to the Hospital? Relief from pain Understanding of situation Understanding of their options Freedom from fear Help managing situation Benefits 8
What Patients Expect Know me before, during, and after Respect me preserve my dignity and privacy Include me and those I need by me Inform me with everything relevant Comfort me so I can cope with all of this Help me return to my life and priorities Trust 9
HCAHPS Public Trust Defined 1. Nurse communication* 5. Responsiveness of hospital staff* 2. Doctor communication* 6. Communication about medications* 3. Pain management* 7. Cleanliness and quietness 4. Discharge instructions* 8. Overall rating * 6 domains involve communications 10
How Trust Rates Through Demonstrated Behaviors Relief from Pain (domain) Pain well controlled Usually Sometimes Never Staff do everything possible to help with pain 11
When is it not an Always good? Controllable Variation Delays Uninformed Discourteous staff Environment uncomfortable Errors with ( ) Loyal Silent, open to change Upset, birds are tweeting Always Usually Sometimes oooh, I m tweeting my life away. Gone but socially singing! Never 12
BHCS HCAHPS Composite Mean Scores by Quarter September 08 Aug 2011 Year 2 = 73.4 13
National Improvement 07-11 14
So in the midst of a Patient and Family experience Death Alone Serious diagnosis Injury Loss of function Uncomfortable treatments or procedures Naked Helpless, Fearful Patient Suffering Humiliated 15
Fear We Must Establish, Sustain Trust Help Husband Attitude Listen Daughter Describe Patient Respond Informed Respect Friend Step-Daughter Explain Pain Source: Psychometrics - Press Ganey, Inc and HCAHPS questions 16
So we are pursuing always Key words at key times (tell them first) Round for outcomes new patients, hourly (5 P s) Include patients/families In bedside hand-offs In rounds At the table Inform through communication boards* Standardize discharge planning and teach-back Make CARE calls to home 17
Strategy to Always Is About Reducing Variation HCAHPS Domain Nurse Communication Patient Expectations How often did we? Explain things so you could understand Keep informed Always Tactics Open access to loved ones Bedside shift report with family 18
But patients are vulnerable Stress, fear, loneliness Sleep deprivation Pain, pain medications Confusing jargon and names Strange environment Confusing choices and need help from people who know them and love them 19
Removing Visiting Restrictions at Baylor Goal 90 ED ICU Med Surg Women's Services Signage and Access Policy Primary Support Open Access is 24/7 Guidelines September 2011 Follow-Up Assessment Scores Based on Section Information (0-100) 20
Working on signage replacement 21
Mean Trends Question Nurses kept you informed Inpatient All My Sites Bed-side shift report Open access begins All My Sites The Pay-off? Displayed by Received Date
Mean Trends Inpatient All My Sites Question - Accommodations & comfort visitors All My Sites Chairs are helpful! Displayed by Received Date
What About Physician Communication? HCAHPS Domain Patient Expectations How often did we Always Tactics Doctor Communication Treat with courtesy, respect Listen carefully Keep informed Hourly rounding (AIDET, 5 P s) Open access to loved ones 24
Tools to Support Physicians Patient and Family Centered Self Assessment for Physicians Communication is done in a collaborative manner with patient and family (family as defined by the patient). All communication is confirmed for patient and family understanding using teach-back, paraphrase, or alternate method. Verbal Communication Yes is defined as 90% or more of your cases Answer: Y or N 1 Demonstrate the use of AIDET during each encounter with the patient and/or the patient's family H Uses AIDET Acknowledge by knocking, asking permission to enter and greeting patient and family 96.00% Introduce self 100.00% Duration 84.00% Explanation 100.00% Thank you 76.00% H Avoid interruption of patient/family when they are speaking 88.00% The Download - AIDET Verbal Communication see Reference #3 90.67% 25
Lives are touched from CARE calls (Sept 2011 data) Attempted Reached # Times Helped # Advised Return to ED or PCP Estimated Impact (Annualized) 37,282 17,667 2,527 > 346 346 x 12 > 4,152 lives 26
How important are the calls? my one week old daughter had been home for 3 days and had only one dirty diaper. Somewhere in my sleep deprived fog, I thought it was good that I did not have to change so many diapers. Fortunately someone from Grapevine called to check on us. When I told her about the lack of dirty diapers and how much my daughter slept all the time, she urged us to go to the doctor. I found out that my nursing was not effective and she had gone from 7.4 lbs to 6.1 lbs. the thought of what might have happened had I not received that call is scary. Raquel (Baylor Family) 27
CARE With A Call Not Flowers! HCAHPS Domain Medications Discharge instructions Patient Expectations How often did we Learn about side effects of new meds Understand discharge instructions Always Tactics Discharge teach back CARE calls + Side Effects Garland Section - CAHPS - Discharge Information Bundle 28
Clearing Up Confusion A (Not-so) Simple Talk with Joe Could be anyone of us or our folks.trust in action 29
Patients and Families At the Table 47 Patient Advisors > 200 hours per quarter at the table 30
WHAT is an advisor? A patient or supporting family/friend of patient who returns to help engage colleagues and catalyze change System Council Member Advisory Council Member Focus group/coffee clutches Support group Workgroup Informal/Incidental 31
It often starts with a Failure When I first got to the outpatient center, they told me to hop up on the bed Baylor patient Verna McDonald 32
Where do advisors serve? Patient and Family Workgroup Medication Quality Improvement Interdisciplinary Quality Improvement Council Committee on Infection Construction Design and Remodel Patient Communication Products Patient Centered Experience Councils 33
Leaving a Foot Print 34
The Prize? Speed of Trust Transparent Trust Ideal, Accountable Care 35
Accountable Care Requires Trust, Transparency, Support Patient Ability to understand Readiness to participate Resources to participate Knowledge to act* Achievement of effort Adaptability when stressors arise Accountability with provider for outcomes Colonoscopy? 36
And The Provider s Challenge? Provider Communication skills Willingness to include Willingness to empower* Ability to draw on resources (education, aids, colleagues) Ability to give population-level options/risk Ability to give patient-level options/risk Accountability with patient for outcomes Melanoma? 37
Emerging Trust Experiences INFORMED CONSENT: Knowing the clinical, quality of life, financial, and support implications of the recommended treatment SHARED DECISION: Patient and family hear all treatment/care options and decide on a plan together with the providers 38
Where Accountable is Headed? PATIENT PACT: Providers ask patients with heart failure to sign a contract to follow the treatment plan weighing daily, eating low-sodium diet, taking medications, calling when I need help 39
Sample Pact Communication Plan COMMITMENT TO INVOLVE MY FAMILY AND LOVED ONES [section] I will have a trusted family member or loved-one present with me during my hospitalization and clinic visits - to help support me during my care. I will work with Dr. Smith to develop a sensible plan for my transition from the hospital back to my home. I realize that my decisions and behavior have a significant positive impact on my long-term health. Because I want to become and stay healthy, I fully accept my role as a partner.. Sincerely, Terri Nuss, October 26, 2011 Geisinger Health System ProvenCare Compact (excerpt) 40
And the (Engagement) Beat Goes On CG CAHPS (Clinicians and Groups) Under testing in Minnesota and California www.medicare.gov/find-a-doctor/ launched by CMS PCMH (Patient Centered Medical Home ) CG-CAHPS NCQA launching January 2012 Adds questions on patient engagement 41
Consumer Reports BUMC Quality and Experience 42
And the Physicians? Contact Now, Quality to Follow 43
SUCCESS When EVERY Patient Says My doctors and nurses ALWAYS communicated well with me. My pain was ALWAYS well managed My medications and side effects were ALWAYS explained to me in a way I could understand I was able to understand ALL of my discharge instructions. 44
And You and I Receive the Full Benefit of Care Relief from pain Understanding of situation Understanding of their options Freedom from fear Help managing situation 45