© Planetree 2013
Patient-Centered Strategies for HCAHPS Improvement
Presenter: Michael Lepore, PhD, Director, Research , Quality and Evaluation, Planetree May 8, 2013
Overview © Planetree 2013
• HCAHPS Basics • Patient Experience as a Healthcare Priority
• From Improving HCAHPS Scores to Changing the Culture of Care Delivery • Patient-Centered Strategies for HCAHPS Improvement
© Planetree 2013
HCAHPS 101 Hospital Consumer Assessment of Healthcare Providers and Systems
HCAHPS 101 © Planetree 2013
• A tool that asks patients about their hospital experiences • A method for collecting standardized patient experience data • A method for adjusting data for equitable comparisons and benchmarking • A mechanism for publicly reporting results • Incentives for using to improve hospital quality of care
© Planetree 2013
• Dec. 2012 publicly reported scores are based on more than 2.9 million completed surveys from patients at 3,892 hospitals • Every day more than 7,900 patients complete the HCAHPS survey
© Planetree 2013
Improving the patient experience is a priority
HCAHPS and the Quality Connection © Planetree 2013
“HCAHPS performance is more predictive of readmission rates
than the objective clinical performance measures often used to assess the quality of hospital care.” Boulding et al. in American Journal of Managed Care, 2011
“Two overall measures of hospital performance, the overall rating
of the hospital and willingness to recommend the hospital, had strong relationships with better technical performance in processes of care related to pneumonia, CHF, myocardial infarction, and for surgical care.” Isaac et al. in Health Services Research, 2010
Elevating the importance of patient experience measures © Planetree 2013
Value-Based Purchasing: Transition from pay for reporting to pay for performance • Points earned for:
– Achievement – Improvement – Consistency (HCAHPS)
2013 Value Based Purchasing Domains © Planetree 2013
Clinical Process of Care Domain (12 measures)
Patient Experience of Care Domain (8 measures)
• AMI • Heart Failure • Pneumonia • Surgical Care Improvement • Healthcare Associated Infections
• HCAHPS measures • 7 composites & 1 global measure • Does not include Likelihood to Recommend • Quiet at Night and Cleanliness rolled into one composite
70%
30%
Proposed 2014 Value Based Purchasing Domains © Planetree 2013
30% Patient Experience of Care
25% Outcomes
45% Clinical Process of Care
© Planetree 2013
HCAHPS Performance 30% of Total
National Median VBP Score
54
Score Needed to Maximize Medicare Reimbursements Under VBP
70
National Median Score on Clinical Measures
64
Score on Clinical Measures Needed to Maximize Reimbursement
81
National Median HCAHPS Score
21
HCAHPS Score Needed to Maximize Medicare Reimbursements
61
The heart of the matter – relationships and communication. “I find that if the doctors would just talk in my terms instead of these long words, that would help. I am not a doctor; these words don’t mean nothing to me.” -
A Consistent Finding: It’s All About Culture © Planetree 2012
• High performing sites credited their success not to specific practices, but to a well-established culture of patientcentered care
• High performing sites had implemented a comprehensive approach to patient engagement, family involvement and staff engagement
© Planetree 2012
Need list of members
From Improving HCAHPS Scores to Changing Health Care Cultures: Planetree
Who is Planetree? © Planetree 2012
Industry
Advocate
Standard
Individual
Solution Provider
Setter
Team
Advocating for what patients and caregivers need and want © Planetree 2013
Compassionate Human Interactions Access to Meaningful Information Support & Participation of Family, Friends Healing Environment
Support for body, mind & spirit Arts and Entertainment Spirituality Caring Touch Integrative Therapies Healthy Food and Nutrition
Making the Connection © Planetree 2013
Planetree Model Components
HCAHPS Categories
Communication with Nurses Communication with Physicians Responsiveness Compassionate Human Interactions Pain Management Care Transitions Overall Satisfaction and Likelihood to Recommend Communication with Nurses Communication with Physicians Access to Meaningful Information Communication about Medications Care Transitions Discharge Instructions Responsiveness Support and Participation of Family Discharge Instructions Cleanliness Healing Environment Quiet at Night Responsiveness Pain Management Support for Body, Mind and Spirit Quiet at Night Overall Satisfaction and Likelihood to Recommend
Patient-Centered Strategies for HCAHPS Improvement 1) Partner with patients. 2) Create a physical environment that supports your culture. 3) Make data meaningful to staff. 4) Look beyond the hospital setting. 5) Put compassion first.
© Planetree 2013
1. Partner with Patients and Families
Patient Pathways
Shared Medical Records
Impact of Shared Medical Record on Overall Patient Satisfaction with Care
Very satisfied with their overall hospital experience?
Patients who are told they could read their medical chart are more likely to be very satisfied with their overall hospital experience 90%
80%
70% 77.8% 60%
69%
50% Yes
No
Were you told you could read your medical chart? *Note: In a random survey of 4500 adults, 79% patients expressed interest in access (Fowles, Arch Intern Med. 2004)
© Planetree 2013
“Reviewing the chart with someone put me at ease.”
Bedside Shift Report
Bedside shift report drives patient satisfaction Effects of bedside shift change at a Planetree Designated Hospital 96 6 months prior to implementation of bedside report 6 months after implmentation of bedside report
94
92
90
88
86
84
82 Nurses treat you Nurses attitude Attention to Nurses kept you Staff include you Staff worked with toward requests special/personal infromed in decision re: together to care courtesy/respect needs treatment for you
Partnering with Patients…Beyond the Bedside
• Invite patients to serve on hospital committees and HCAHPS improvement task forces • Invite board members to round on patients prior to every board meeting
• Invite a patient to share his or her story (what went well, what didn’t go well) to kick off every board meeting
2. Create a physical environment that supports your culture
“Why is the hospital not as humanely practical in aesthetic effect as it tries to be in physical support?” Frank Lloyd Wright
Poor Patient Experience = Post-Hospital Syndrome © Planetree 2013
CONTRIBUTING FACTORS: •
sleep deprivation
•
disruption of normal circadian rhythms
•
poor nourishment
•
poorly controlled pain and discomfort
•
medications that can alter cognition and physical function
•
deconditioning due to bed rest or inactivity
Krumholz, HM. N Engl J Med 368:100 - 102 | January 10 , 2013
Assess Your Healing Environment/Reduce Stressors © Planetree 2013
EMOTIONAL SUPPORT • Family overnight accommodations
SLEEP SUPPORT • Quiet Environment/Sleep Menus NOURISHMENT • Family Kitchens/Access to Food
CONNECTION TO NATURAL ENVIRONMENT • Healing Gardens and Natural Light
Innovations in the Healing Environment: A Patient-Centered Quiet Campaign © Planetree 2013
More Evidence
The use of call lights by patients decreased by 40% following implementation of decentralized nursing stations & 24-hour visitation (Charmel, 2003)
3. Make data meaningful to staff. But remember, the data are not the point, patient experiences are the point! -
Making Data Meaningful to Staff © Planetree 2013
Engage staff (and patients) in the selection of quality measures Involve staff in performance improvement efforts Give staff time to participate in improvement efforts
Display data so it is easy to read and standardized Make staff aware of the data being measured Discuss in staff meetings Reinforce with postings and displays Meredith EK. Developing Frontline Staff in Performance Improvement. Nurse Leader; 2011.
4. Look beyond the hospital setting © Planetree 2013
New HCAHPS Domain: Care Transitions © Planetree 2013
Mandatory for patients discharged as of Jan. 2013: • Question 1: The hospital staff took my preferences and those of my family or caregiver into account in deciding what my healthcare needs would be when I left the hospital. • Question 2: When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. • Question 3: When I left the hospital, I clearly understood the purpose for taking each of my medications.
Patient-Centered Care Transitions © Planetree 2013
• Same Page Transitions
Physician
Hospital
Office
• Inter-Continuum Collaboratives • Physician appointments made prior to hospital discharge
Patient
• Discharge summary provided to patient and PCP • Personal Health Records • Support for family caregivers
Skilled Home Health Agency
Facility
5. Put compassion first. © Planetree 2013
“I felt like I was interrupting them when I asked a question.”
Compassion in Action
Patient Experience training and education for staff- Middle Management Training VA New Jersey Sleep Menu Good Samaritan Hospital Patient Story Board
Physician communication coaching
“[The doctor] came in, pulled
up a chair and said he wanted to talk…and we talked on my terms.”
A Measureable Framework for PCC Culture Change and HCAHPS Improvement
Criteria can be downloaded at www.planetree.org
© Planetree 2013
Planetree Designated Hospitals and HCAHPS performance:
A marker of Quality: Planetree Designated Hospitals consistently outperform the National Average on HCAHPS since public reporting of scores began.
Patient's Room and Bathroom Always Kept Clean 76 75 74 73 72 71 70
69 Mar-09
Jun-09
Sep-09
Dec-09
Mar-10
Jun-10
Sep-10
Dec-10
Mar-11
Jun-11
CMS Reporting Period
Designated Hospital Average
National Average
Sep-11
Dec-11
Mar-12
Responsiveness 68
67
66
65
64
63
62 Mar-09
Jun-09
Sep-09
Dec-09
Mar-10
Jun-10
Sep-10
Dec-10
Mar-11
Jun-11
CMS Reporting Period
Designated Hospital Average
National Average
Sep-11
Dec-11
Mar-12
Patients Given Information About Recovery At Home 88 87 86 85 84 83 82 81
80 Mar-09
Jun-09
Sep-09
Dec-09
Mar-10
Jun-10
Sep-10
Dec-10
Mar-11
Jun-11
CMS Reporting Period
Designated Hospital Average
National Average
Note: The difference is statistically significant (p