Enhancing Communication Skills: A Catalyst for Organizational Cultural Transformation Presented by William Maples, MD, Chief Medical Officer, Professional Research Consultants and Executive Director, The Institute for Healthcare Excellence, Galen Perdikis, MD, Faculty, The Institute for Healthcare Excellence, Chadi Ibrahim, MD, Medical Director of Medical House Services, Connie O Malley, Chief Operating Officer and Amanda LaVoie, M.S., R.D., Director of Service Excellence and Environmental Services, Beaumont Hospital Troy
Defining Patient Experience - The Beryl Institute www.theberylinstitute.org 2
April 13-15 Sheraton Dallas Hotel Dallas, Texas Keynote Speakers Ronan Tynan Cynthia Mercer Montel Williams Kelly Corrigan Breakout Sessions Three Pre-Conference Gatherings Patient Advocacy Community Physician Community Pediatric Community Three Pre-Conference Workshops Networking Dinner & Reception The Margot and Bill Winspear Opera House at the AT&T Performing Arts Center The Environment of the Patient Experience: Proactive Design in Practice Lorissa MacAllister and Susan Mazer Coaching and Feedback to Enhance Communication Calvin Chou and Laura Cooley Leading Your Patient Experience Strategy tp the Next Level Wendy Leebov, Jill Golde and Dorothy Sisneros
Become a Certified Patient Experience Professional. Applicants should have a minimum 3 years of professional experience in a patient experience related role or completion of 30 Patient Experience Continuing Education Credits (PXEs). Learn more at www.pxinstitute.org
Housekeeping All participant phone lines are muted. The presentation will run 45-50 minutes with about 10-15 min for Q&A. Q&A will be conducted through the Q&A function. Please submit questions to the host for a facilitated Q&A after the presentation. Webinar materials and session recording will be available for all attendees. (receive an email notification with the appropriate link) A survey will be distributed following today s session. This program is pending approval for 1 PXE
PX Continuing Education Credits In order to obtain patient experience continuing education credit, participants must attend the program in its entirety and return the completed evaluation. The planning committee members and presenters have disclosed no relevant financial interest or other relationships with commercial entities relative to the content of the educational activity. No off label use of products will be addressed during this educational activity. This activity has received no sponsorship or commercial support. No products are available during this educational activity, which would indicate endorsement.
Our Speakers William Maples, MD Chief Medical Officer, PRC Executive Director The Institute for Healthcare Excellence Galen Perdikis, MD Faculty, The Institute for Healthcare Excellence Chadi Ibrahim, MD, Medical Director Medical House Services Beaumont Hospital Troy Connie O Malley Chief Operating Officer Beaumont Hospital Troy Amanda LaVoie, M.S., R.D., Director of Service Excellence and Environmental Services Beaumont Hospital Troy www.theberylinstitute.org 7
Communication in Healthcare
Why Communication in Healthcare Demonstrated Results Risk Adjusted Mortality ICU Length of Stay Patient Experience Overall Inpatient Physician Communication Scores 50% 1 day 33% 43%
Goals: 4-Hour Communication in Healthcare Curriculum Enhance Patient Experience Evolve a culture of safety Enhance Employee Engagement and Satisfaction Create a culture of mutual respect, safety, and teamwork through communication Decrease adverse events Improve patient compliance with treatment plans, thereby enhancing outcomes and decreasing rework resulting from unnecessary readmissions Decrease Staff Turnover Decrease Malpractice Events Restore joy for the practice of medicine Build resilience to meet the ever-changing healthcare environment
Program Design PROGRAM DESIGN Interactive Small Group Learning 1 Faculty per 6 Participants COURSE ELEMENTS Interactive/immersive training style Peer to peer teaching (e.g. MD to MD) 1 Faculty per 6 colleagues Didactic discussions and video Longitudinal experience CME accredited Mindfulness/Presence Active listening Information gathering Negotiating an agenda Connecting with patients and team Written communication Appreciative inquiry/debrief
Enhancing Communication Skills: A Catalyst for Organizational Cultural Transformation February 2016
Beaumont - Troy 458 Licensed Beds 4,675 Employees 1,348 Physicians Employed and Private 35,650 Admissions 93,332 EC Visits 3,736 Births 19,524 Total Surgeries
Why did we seek Communication Training? Desire to develop a curriculum that allowed staff to more strongly connect with patients, families and each other Looking for more than an initiative Culture shift to align with our vision
Why this concept? Learner centered approach Physician and allied health learning parallel learning Self sustaining model
What was the need? Maintain a high level of safety and quality Improve physician patient experience scores Improve overall patient experience scores Desire to improve communication between providers Desire to maintain our facility as the hospital of choice Doing the right thing
Challenge in getting physicians on board Not all physicians view patient experience as important aspect of patient care Generally viewed as softer side of medicine Docs don t think they have issues with communication We also didn t know where physician leaders are on the issue Difficult to get physicians interested in taking the lead on the issue
Why is physician involvement important? It became clear that the patient experience initiative wouldn t succeed without involving physicians Physicians are well respected by patients Physicians are well respected by others members of the team We have a stake in this Our reputation is on the line Improved job satisfaction
How do we involve physicians? The leadership must buy into it It has to be a physician who drives it We have to show physicians that this is a valuable skill It is a way to help improve how we practice medicine Will not take more time! The carrots: CME, Academic Credits, MOC credits Start the conversation Execution is the key!
Setting the vision Finding the right program Treading lightly with physicians Having the conversations are crucial Generating a buy in from leadership Leaders need to see these benefits: Improved quality of care, financially sound proposal and sustainability Inviting the right physician leaders to the table Rolling out the program in a stepwise approach
Sustaining the Vision Building on momentum Forming a team of advocates Creating ambassadors for the initiative Reaching a critical mass Requiring the skill Weaving into the culture
What does the work look like now? Physicians (includes mid-level providers) Monthly classes Allied health staff weekly classes Post-class Letters to homes requesting stories Caring Connections meeting Recognition
Patient Satisfaction Data 100 90 80 70 60 50 40 30 Communication with Nurses HCAHPS Domain 20 10 April: Initial training July: Training implementation began. 0 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Top Box 74.8 76.1 75.2 76.4 76.9 74.7 79.5 81.5 81.3 81.7 82.2 85.5 Percentile Ranking 13 19 14 21 24 13 44 62 61 64 68 87 Data displayed by date of service 2/4/2016 23
Patient Satisfaction Data 90 Communication with Doctors HCAHPS Domain 80 70 60 50 40 30 20 10 April: Initial training July: Training implementation began. 0 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Top Box 75.6 75.8 74.5 78.5 75.7 75.1 77.3 77.9 78.7 77.6 80.5 81.2 Percentile Ranking 13 13 9 27 13 11 19 23 28 21 42 47 Data displayed by date of service 2/4/2016 24
Patient Satisfaction Data 90 Global Rating HCAHPS Domain (9s and 10s) 80 70 60 50 40 30 20 July: Training implementation began. 10 April: Initial training 0 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Top Box 68 71.2 67.3 70.3 69.8 64.9 74 77.4 76.3 73.2 76.2 76.7 Percentile Ranking 30 45 27 41 38 19 57 73 69 53 68 70 2/4/2016 25 Data displayed by date of service
Learnings and Results From Institutions Engaged in the Communication in Healthcare Program
Critical Success Factors 1. Strong leadership commitment to supporting the program. 2. Curriculum developed to be significantly relevant to the practicing clinician. 3. Program designed to be financially feasible and sustainable. 4. Choose faculty to represent the diversity of the entire physician and allied health staff and are well respected by their colleagues 5. Conduct training sessions on a monthly basis to complete training for the entire faculty over a two year period 6. Physicians and allied health staff should be required or strongly encouraged to participate in the curriculum
Physician Program Evaluation Scale of 1-5 Overall, program useful 4.1 Is good for institution 4.5 Was worth the time for me personally 4.1 Ability to help learners become actively engaged 4.5 with exercise Ability to maintain a safe and trusting environment 4.6 Ability to help others accomplish learning goals 4.5
Patient Experience Results Outpatient Overall Quality of Care % Excellent 79 78 77 76 75 74 73 72 Health MCF System Year 1 Year 2 Year 3 Year 4 Year 5
Patient Experience Results Inpatient Overall Level of Safety % Excellent 80 70 60 50 40 30 20 10 0 Health MCF System Year 1 Year 2 Year 3 Year 4
Patient Experience Results Doctor's Involving Patient in Decision-Making Process 66 Doctor's Understanding and Caring 90 85 80 75 70 65 60 55 50 61 56 51 46 41 36 90 85 80 75 70 65 60 55 50 Doctor's Communication / Keeping Patient Informed 90 85 80 75 70 65 60 55 50 Nurse Listen
Patient Experience Results Outpatient Willingness to Recommend % Definitely Would 92 92 91 91 90 90 89 89 88 Health MCF System Year 1 Year 2 Year 3 Year 4 Year 5
Value Based Purchasing Patient Experience Mission Hospital Hospitals 86% 84% 82% 83% Communication with Nurses 85% 83% U.S. Top 10% U.S. Average 80% 78% 76% 79% 76% 79% 74% 2011 3/1/2011 2011 6/1/2011 2011 9/1/2011 2011 12/1/2011 2012 3/1/2012 2012 6/1/2012 2012 9/1/2012 2012 12/1/2012 2013 3/1/2013 2013 6/1/2013 2013 9/1/2013 2013 12/1/2013 2014 3/1/2014 03 06 09 12 03 06 09 03 06 09 12 03 Scheduled Quarterly Release Mar. 2011 June 2011 Sept. 2011 Dec. 2011 Mar. 2012 June 2012 Sept. 2012 Dec. 2012 Mar. 2013 June 2013 Sept. 2013 Dec. 2013 Mar. 2014 Data Collection Dates Jul. 1, 2009 - June 30, 2010 Oct. 1, 2009 - Sept. 30, 2010 Jan. 1, 2010 - Dec. 31, 2010 Apr. 1, 2010 - Mar. 31, 2011 Jul. 1, 2010 - June 30, 2011 Oct. 1, 2010 - Sept. 30, 2011 Jan. 1, 2011 - Dec. 31, 2011 Apr. 1, 2011 - Mar. 31, 2012 Jul. 1, 2011 - June 30, 2012 Oct. 1, 2011 - Sept. 30, 2012 Jan. 1, 2012 - Dec. 31, 2012 Apr. 1, 2012 - Mar. 31, 2013 Hospital Performance 79% 78% 78% 78% 78% 80% 80% 81% 83% 83% 84% 83% 83% U.S. Top 10% 83% 83% 83% 83% 84% 84% 84% 85% 85% 85% 85% 85% 85% U.S. Average 76% 76% 76% 76% 77% 77% 77% 78% 78% 78% 78% 78% 79% Jul. 1, 2012 - June 30, 2013 U.S. Rank 939 of 3809 1254 of 3811 1305 of 3826 1340 of 3836 1388 of 3850 927 of 3857 997 of 3866 840 of 3891 546 of 3903 558 of 3911 432 of 3923 596 of 3938 619 of 3974 State Rank 40 of 97 53 of 97 51 of 97 56 of 98 54 of 97 38 of 97 42 of 97 31 of 97 16 of 97 15 of 97 14 of 98 22 of 98 25 of 98 Applicable to the 2013, 2014, 2015 and 2016 VBP Programs.
Value Based Purchasing Patient Experience 82% Pain Management 80% Mission Hospitals Hospital U.S. Top 10% 78% 76% 74% 76% 78% 77% U.S. Average Scheduled Quarterly Release Mar. 2011 June 2011 Sept. 2011 Dec. 2011 Mar. 2012 June 2012 Sept. 2012 Dec. 2012 Mar. 2013 June 2013 Sept. 2013 Dec. 2013 Mar. 2014 Data Collection Dates 72% 70% 68% 72% 69% Jul. 1, 2009 - June 30, 2010 Oct. 1, 2009 - Sept. 30, 2010 Jan. 1, 2010 - Dec. 31, 2010 Apr. 1, 2010 - Mar. 31, 2011 Jul. 1, 2010 - June 30, 2011 Oct. 1, 2010 - Sept. 30, 2011 Jan. 1, 2011 - Dec. 31, 2011 Apr. 1, 2011 - Mar. 31, 2012 Jul. 1, 2011 - June 30, 2012 Oct. 1, 2011 - Sept. 30, 2012 Jan. 1, 2012 - Dec. 31, 2012 Apr. 1, 2012 - Mar. 31, 2013 Hospital Performance 72% 71% 71% 69% 71% 72% 71% 75% 76% 78% 81% 80% 78% U.S. Top 10% 76% 76% 76% 76% 76% 76% 76% 77% 77% 77% 77% 77% 77% U.S. Average 69% 69% 69% 70% 70% 70% 70% 70% 71% 71% 71% 71% 71% Jul. 1, 2012 - June 30, 2013 U.S. Rank 914 of 3807 1200 of 3810 1233 of 3826 1895 of 3836 1260 of 3850 1039 of 3856 1368 of 3864 513 of 3889 430 of 3900 251 of 3906 114 of 3921 151 of 3934 285 of 3969 State Rank 30 of 97 42 of 97 42 of 97 63 of 98 50 of 97 38 of 97 47 of 97 15 of 97 8 of 97 5 of 97 1 of 98 1 of 98 3 of 98 Applicable to the 2013, 2014, 2015 and 2016 VBP Programs. 71%
Value Based Purchasing Patient Experience Mission Hospital Hospitals U.S. Top 10% U.S. Average Scheduled Quarterly Release Mar. 2011 June 2011 Sept. 2011 Dec. 2011 Mar. 2012 June 2012 Sept. 2012 Dec. 2012 Mar. 2013 June 2013 Sept. 2013 Dec. 2013 Mar. 2014 Data Collection Dates 76% 74% 72% 70% 68% 66% 64% 62% 60% 58% 68% 60% 59% Jul. 1, 2009 - June 30, 2010 Oct. 1, 2009 - Sept. 30, 2010 Jan. 1, 2010 - Dec. 31, 2010 Communication about Medicines Apr. 1, 2010 - Mar. 31, 2011 Jul. 1, 2010 - June 30, 2011 Oct. 1, 2010 - Sept. 30, 2011 Jan. 1, 2011 - Dec. 31, 2011 Apr. 1, 2011 - Mar. 31, 2012 Jul. 1, 2011 - June 30, 2012 Oct. 1, 2011 - Sept. 30, 2012 Jan. 1, 2012 - Dec. 31, 2012 Apr. 1, 2012 - Mar. 31, 2013 Hospital Performance 59% 60% 60% 63% 66% 69% 69% 69% 71% 70% 72% 76% 75% U.S. Top 10% 68% 68% 69% 69% 69% 70% 70% 71% 71% 71% 72% 72% 72% U.S. Average 60% 61% 61% 61% 61% 62% 62% 63% 63% 63% 64% 64% 64% Jul. 1, 2012 - June 30, 2013 U.S. Rank 2036 of 3805 1815 of 3807 1896 of 3822 1181 of 3833 700 of 3846 413 of 3854 440 of 3862 515 of 3888 369 of 3899 475 of 3906 335 of 3920 158 of 3934 208 of 3967 State Rank 76 of 97 71 of 97 70 of 97 51 of 98 28 of 97 15 of 97 14 of 97 18 of 97 11 of 97 12 of 97 10 of 98 3 of 98 3 of 98 Applicable to the 2013, 2014, 2015 and 2016 VBP Programs. 75% 72% 64%
Value Based Purchasing Patient Experience 92% Discharge Information Mission Hospital Hospitals 90% 90% 88% 88% U.S. Top 10% 86% U.S. Average 84% 85% 85% Scheduled Quarterly Release Mar. 2011 June 2011 Sept. 2011 Dec. 2011 Mar. 2012 June 2012 Sept. 2012 Dec. 2012 Mar. 2013 June 2013 Sept. 2013 Dec. 2013 Mar. 2014 Data Collection Dates 82% 82% Jul. 1, 2009 - June 30, 2010 Oct. 1, 2009 - Sept. 30, 2010 Jan. 1, 2010 - Dec. 31, 2010 Apr. 1, 2010 - Mar. 31, 2011 Jul. 1, 2010 - June 30, 2011 Oct. 1, 2010 - Sept. 30, 2011 Jan. 1, 2011 - Dec. 31, 2011 Apr. 1, 2011 - Mar. 31, 2012 Jul. 1, 2011 - June 30, 2012 Oct. 1, 2011 - Sept. 30, 2012 Jan. 1, 2012 - Dec. 31, 2012 Apr. 1, 2012 - Mar. 31, 2013 Hospital Performance 85% 84% 85% 86% 87% 88% 88% 88% 89% 88% 88% 90% 90% U.S. Top 10% 88% 88% 88% 88% 88% 88% 89% 89% 89% 89% 90% 90% 90% U.S. Average 82% 82% 82% 82% 83% 83% 83% 84% 84% 84% 85% 85% 85% Jul. 1, 2012 - June 30, 2013 U.S. Rank 845 of 3806 1227 of 3808 972 of 3824 721 of 3834 518 of 3849 384 of 3856 432 of 3865 493 of 3890 346 of 3902 585 of 3911 656 of 3923 270 of 3936 330 of 3973 State Rank 25 of 97 40 of 97 32 of 97 19 of 98 13 of 97 9 of 97 8 of 97 7 of 97 8 of 97 15 of 97 15 of 98 4 of 98 5 of 98 Applicable to the 2013, 2014, 2015 and 2016 VBP Programs.
Staff Satisfaction 100 90 80 70 60 50 40 30 20 10 0 Respect between MD and AHS Service from colleagues Treat others with respect Year 1 Year 2 Year 3
Percentile Ranking Nationally 80% 70% 60% 50% * Very near / approaching bucket 40% 30% 20% 10% 0% 2012 2013
Reduced the use of Propofol (ICU) 600 Propofol Bottles Removed 500 400 300 200 100 Bottles Removed, Coli Linear (Bottles Removed, Coli) 0
Reduced Length of Stay (ICU) 6 FY11 Flu ABCDE Work 5 MSICU - Average Length of Stay (APACHE) 4 3 2 1 FY10 Flu IHI Projects Intensivist Model FY12 Flu 0 Oct' NovDecJan' Feb Mar Apr' Ma Jun' Jul' AugSep Oct' Nov DecJan' Feb Mar Apr' Ma Jun' Jul' AugSep Oct' NovDecJan' Feb Mar Apr' Ma Jun' 09 '09 '09 10 '10 '10 10 y'10 10 10 '10 '10 10 '10 '10 11 '11 '11 11 y'11 11 11 '11 '11 11 '11 '11 12 '12 '12 12 y'12 12 ALOS 4.8 2.9 4.6 5.4 3.1 5.1 3.4 3.1 2.9 3.6 3.6 3.8 3.6 2.4 3 4.2 3.8 3.7 3.6 3.2 2.2 3.3 2.3 3.5 2.6 2.9 3.8 2.6 3.0 3.2 2.3 2.7 2.5 Median 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 3.6 Goal 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 **ADT data x3mos
Risk Adjusted Mortality >500 FEWER Deaths per Year than 2010
Questions William Maples, MD Chief Medical Officer, PRC Executive Director The Institute for Healthcare Excellence Galen Perdikis, MD Faculty, The Institute for Healthcare Excellence Chadi Ibrahim, MD, Medical Director Medical House Services Beaumont Hospital Troy Connie O Malley Chief Operating Officer Beaumont Hospital Troy Amanda LaVoie, M.S., R.D., Director of Service Excellence and Environmental Services Beaumont Hospital Troy www.theberylinstitute.org 42
PX Continuing Education Credits This program is pending approval for 1 PXEs In order to obtain PXEs, participants must attend the program in its entirety and complete evaluation.
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