Patient Satisfaction: The New Performance Priority

1. Patient Satisfaction: The New Performance Priority 7thmidwestern Hospital Medicine Conference September 23, 2011 Julia wright, MD, FACP, SFHM Regional CMO, Cogent-HMG

2. Objectives Understand patient satisfaction as a component of health care quality reform Engage hospitalists in leading new directions of quality, aligning with hospital administrations Develop an approach to address and improve the patient experience at your facility Understand HCAHPS and its utility as the metric to evaluate performance

3. Frequently Asked Questions How did we get to this point? Why should you care about it? Where is your patient satisfaction? How can you improve it?

4. “Improving the Quality and Efficiency of Health Care”

5. Hospital Operations Public reporting and direct financial accountability are driving changes in hospital performance Public Reporting: market Value-Based Purchasing: money

6. FY 2013 1% With-hold 70% Process of Care 12 CORE MEASURES 30% Patient Experience HCAHPS: 8 composites Attainment or Improvement 2009 2010 2011 2012 2013 [baseline] [perform] [pay]

7. Hospital Consumer Assessment of Healthcare Providers andServices

9. HCAHPS: Reporting and Payment Evaluation of Care Environment Global items Communication with nurses (3) Communication with doctors (3) Responsiveness of hospital staff (2) Pain management (2) Communication about medicines (2) Discharge information (2) Cleanliness of hospital environment Quietness of hospital environment Overall rating of hospital (0-10) Willingness to recommend hospital (y/n)

11. Where is your patient satisfaction?

12. HCAHPS and Hospitalists Composite measures Individual items Global items Communication with nurses (3) Communication with doctors (3) Responsiveness of hospital staff (2) Pain management (2) Communication about medicines (2) Discharge information (2) Cleanliness of hospital environment Quietness of hospital environment Overall rating of hospital Willingness to recommend hospital

13. Impact of Survey Performance On Hospital Bottom Line: Value-Based Purchasing Referral Volume By Hospitalists: Medico-legal Customer retention Readmission rate Cost of care

14. Impact on Hospitalists(Why should you care?) Smoother patient care: cost/testing lower compliance higher fewer complaints and litigation Your own satisfaction: reputation, retention, altruism Your group’s success Your compensation!

15. Bonus and Incentives: Surveys Say… Today’s Hospitalist: $50,000 of total compensation 72% productivity 63% quality 26% citizenship SHM-MGMA: majority of programs 78 % quality indicators 67% patient satisfaction Today’s Hospitalist 2010 Compensation and Career Survey SHM /MGMA Survey 2010

16. Sample

17. How Can We Improve?

18. Survey Key Points HCAHPS measures quality of care. Patients respond based on their perceptions and impressions of the experience. The overarching goal is to give effective clinical care and a great patient experience, exceeding expectations.

19. What Influences Patient Responses First and Last Encounters: ED and Discharge In Between: attention/communication/physical needs Nursing Communication Pain Management Physician Interaction

20. Plan for Success: The Hospital Partner with Hospital leads to create a specific plan with consistent changes. Focus on key areas: ED, staff (RN/MD), discharge process. Use available baseline information: survey data, complaints, physician satisfaction, and focus groups.

21. Hospitalist Group Plan Team Commitment: champion, recruiting Review data, and incent: Bonus and Scorecard Provide support and set up for success: handoff, MDR, physician satisfaction, schedule Train hospitalists

22. What IS the patient’s experience? FEAR LOSS OF CONTROL Poor sleep Pain Disparate communication Waiting Lack of information

23. It’s not rocket science!! Patients want… to know who you are and what you do informationon treatment and diagnosis influenceand control- comfort/responsiveness to feel respected and valued

24. [pre]SPIKES PRE S PI K E S preparation break patterns setting use your Cogent HMG collateral perception gain patient’s perspective immediacy respond to immediate concerns knowledge convey information empathy illustrate human understanding support provide continuing care CREATED by for

25. The Purposeful Visit: Knock Before Entering Consistent Communication Get and share information: handoff/EMR/RN Check Your Pulse: EI Convey EMPATHY and available time

26. The <8 Minute Purposeful Visit Introduce, explain hospitalist care role Address the main concern Listen reflectively Information with joint decisions Open for questions

28. Tools and Techniques Tools: FAQs, Business Cards and the White Board Second Contact Discharge Experience Follow-up Calls

29. Service Plan Responsiveness Point of service/ Service recovery Complaints are the tip of the iceberg!

30. Assessing Performance Ask Patients - “How are we doing?” Review survey and complaint data with group Observe hospitalists and provide individual feedback Include the hospital Provide recognition/accountability

32. Conclusions It’s about great patient care, not a survey. Hospitalists are ideally suited to lead quality- and hospitals expect it.

33. Summary: Hospitalists and Quality Hospitalists are change leaders and an operational arm of the hospital. We directly impact Quality and Patient Satisfaction and can help lead hospitals to success in this arena. Key elements for success: -Collaboration: work together, understand the importance and develop a strategy -A well-coordinated, supported hospitalist team

34. Your Mission Develop a personalized patient interaction, focusing on communication and empathy. Use tools (FAQs, brochures, white board) Communicate consistently. Respond quickly to concerns. Make 2-3 consistent changes, adjust, and gain satisfaction!

35. Web References www.pressganey.com www.thefrontierproject.com www.hhs.gov www.qualitynet.org www.hcahpsonline.org www.hospitalcompare.hhs.gov www.studergroup.com Email: Julia Wright jwright@hmgdoc.com

36. Literature References Lee AV. What can we learn from patient dissatisfaction? JHospitalMed 2010; 5(9) 514-517 Ferranti DE. Assessing patient perceptions of hospital communication skills using the Communication Assessment Tool. JHospitalMed 2010; 5(9) 522-526 Bertakis. Patient centered care is associated with decreased health care utilization. JABFM 2011; 229-239 Zolnierik KB. Physician communication and patient adherence to treatment. Med Care 2009; 47(8) Transforming Hospitals: Designing for Safety and Quality. www.AHRQ.gov/quality/transform Studer, Robinson. The HCAHPS Handbook. Chang. Annals of Internal Medicine 144, 9, 665-672 (2006) Arora. Ability of hospitalized patients to identify their in-hospital physician. Arch Int Med 2009; 169(2) OLeary KB. Patients understanding of their plan of care, Mayo Clinic Proceedings2010; 85(1) 47-52 AmJManagedCare 2011 (17)1 2011 CMS VBP Rules. Federal Register 76(9)