Getting to Always is What Matters to Patients: The Care Experience Journey in the Consumerism Era

Deborah Romer, Vice President, Kaiser Permanente National Service Quality Michelle Munn, Sr. Director, Kaiser Permanente National Service Quality Copyright © 2015 Kaiser Permanente

Objectives  Who is Kaiser Permanente?  Understand Kaiser Permanente’s approach to the new era of consumerism

 Learn key strategies for improving and sustaining “Always” behaviors  Experience Kaiser Permanente’s innovative Coaching for Excellence model to improve reliability and performance

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Kaiser Permanente Markets and Membership (as of 06/30/2014)

Mid-Atlantic States 516,099 members

Northwest 618,802 members

California 7,341,780 members

Hawaii 229,746 members

Georgia 259,450 members Colorado 618,802 members

Change in Top Box Since Q1 2009 – Kaiser vs. National Average

Change in Top Box Since 2009 Kaiser vs National Average

Source: CMS Hospital Compare

Health Care Marketplace STRONG MARKET FORCES

 Consumerism & Retail Markets  Opening of Exchanges  Increased Cost-Sharing  Social Media & KP Reputation  Increased Competition/ACOs

ARE CREATING MORE URGENCY FOR: MEMBER EXPERIENCE

MEMBER LOYALTY/ADVOCACY

MEMBER GROWTH

“More than a third [of U.S. consumers] said they would switch providers or health insurers if they were offered their ideal experience. The ideal experience is increasingly being defined by non-clinical elements, such as convenience, amenities, and customer service. ” — PricewaterhouseCoopers Health Research Institute Report (2012) 5

“Designed” to make lives better Delivering this…

Requires this…

And people who…

Core Values Engagement • Unit Based Teams • Evidence-based practices (e.g. rounding) • Accountability systems • Professional standards • Communication models

Systems built through our members’ lens:

Personalized Empowering Seamless 6

• Access • Phone Service • Digital/Mobile

• Have clarity around our shared purpose • Are engaged and inspired • Are supported with training, systems, processes and technology • Are empowered to do the right thing for members and each other

Tactics

Sequence

Driving Consistency Through a Culture of Excellence

Aligned Leadership (launching)

Aligned Culture (engaging)

Aligned Behaviors (standardizing)

Aligned Processes (sustaining)

Leadership Alignment

Rounding for Outcomes

Communication Skills

Validation

Goal Cascading

Recognition

Patient Rounding

Ongoing Reinforcement

Accountability

Experience Standards

Pre & Post Calls

Performance Coaching

Excellence Teams

Coaching for Excellence

Reception Area Rounding

Technology Enablers

Leadership Dev’t

Hiring & On boarding

(Patient & Family Centered Care and Cultural Relevance)

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Experience Design

HCAHPS Performance All Domains Compared to National Benchmarks Q4 ‘06

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HCAHPS Performance All Domains Compared to National Benchmarks Q1 ‘07

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HCAHPS Performance All Domains Compared to National Benchmarks Q3 ‘07

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HCAHPS Performance All Domains Compared to National Benchmarks Q1 ‘08

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HCAHPS Performance All Domains Compared to National Benchmarks Q3 ‘08

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HCAHPS Performance All Domains Compared to National Benchmarks Q1 ‘09

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HCAHPS Performance All Domains Compared to National Benchmarks Q3 ‘09

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HCAHPS Performance All Domains Compared to National Benchmarks Q1 ‘10

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HCAHPS Performance All Domains Compared to National Benchmarks Q3 ‘10

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HCAHPS Performance All Domains Compared to National Benchmarks Q1 ‘11

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HCAHPS Performance All Domains Compared to National Benchmarks Q3 ‘11

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HCAHPS Performance All Domains Compared to National Benchmarks Q1 ‘12

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HCAHPS Performance All Domains Compared to National Benchmarks Q3 ‘12

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HCAHPS Performance All Domains Compared to National Benchmarks Q1 ‘13

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HCAHPS Performance All Domains Compared to National Benchmarks Q3 ‘14

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HCAHPS Performance All Domains Compared to National Benchmarks Q1 ‘14

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HCAHPS Performance All Domains Compared to National Benchmarks Q3 ‘14

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HCAHPS Improvement Over Time

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Key Strategies for improving and sustaining “Always”  

 

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People Engagement Data and Analytics Communication and Coaching for Excellence Experience Standards

Key Strategy: People Engagement All employees in the Northwest Region, as well as four medical centers in Southern California received one question about direct report rounding: Does your immediate supervisor do “direct report rounding” with you at least quarterly? 100% 95%

90% 86%

80% Round: No [N=2,422]* Round: Yes [N=11,160]*

86%

84%

80%

70% 60% 59%

50% 40%

52% 48%

30% Work Unit Index

Workplace Safety Index

Workforce Effectiveness

Engagement

Respondents who perceive their immediate supervisors use “direct report rounding” have greater favorability across the four indices 27

* 2013 People Pulse – This analysis includes respondents who were asked the “rounding” item (SCAL Medical Centers [Downey, Orange County, San Diego, West Los Angeles])

Key Strategy: Data and Analytics Data Reporting by Unit/Department:  HCAHPS unit level data

Internal evidence to support and monitor key practices:  Nurse Knowledge Exchange (bedside shift report)  Hourly Rounding

 Nurse Leader/Charge Nurse Rounding on Patients

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Nurse Knowledge Exchange = Patient and Family Engagement Key Indicators  Shift change at bedside with introduction of oncoming nurse  Regular updating of the Care Board  Reviewed daily plan of care with patient input  Validating patient’s understanding of their plan of care

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Nurse Knowledge Exchange Impact

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Hourly Rounding Drives Perception of Care and Nurse Communication

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Nurse Manager Rounding = Consistency Key Indicator: A nurse manager or leader visited me daily about my care.

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Key Strategy: Skills Labs

“Yeah, we’re doing that…” “Now, what does right really look like again?”  Demonstration of “right”  Real environment  Real scenarios  Validate in real time  Video tape

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Key Strategy: Communication and Coaching

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Coaching for Excellence: Investment Coaching Model How can I help you be successful? “Hi…could I have a minute of your time?” “Remember the expectation / team agreement / standard that…” “I heard / read / noticed that you …” “The impact for…when you…is…” “I wanted to thank you so much for your attention to … “ OR “How can I help you be successful?” “Thank you for taking the time to talk with me about this.”

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Key Strategy: Experience Standards

One KP Experience Standards Revised to reflect the voice of the member, patient, and customer.

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Tips / Lessons Learned  Maximizing Use of Data • Transparent and comparative KP data • Actionable data at unit level • Actively used for coaching opportunities

 Validating Through Skills Labs • Closes the knowing/doing gap • Reduces variation

 Standardizing a Model for Leader Coaching • Clarify and lead with expectations • Enhances coaching in the moment and the “why” • Recognition too!

 Branded Experience • Standards 37

Thank you Kaiser Foundation Health Plan National Service Quality 1 Kaiser Plaza 18B Oakland, CA 94612 Deborah Romer Vice President, National Service Quality [email protected] Michelle D. Munn Senior Director, National Service Quality [email protected] 38