Ohio Association for the Healthcare Environment

1. Ohio Association for the Healthcare Environment October 26, 2011 ConneXion

2. Meeting Agenda • Welcome/Call to Order • Recognition • Educational Presentation – “HAI & HCAPHS” • Association Update • Announcements • Adjournment

3. “HAIs’ and HCAHPS” Rod Pollard Director – Environmental Services UH Case Medical Center Educational Presentation

4. HAI’s & HCAPHS HCAPHS + Quality + HAI’s = Reimbursement

5. Topics of Discussion • Why is the HCAPHS survey necessary? • Press Ganey & HCAPHS: How are they different? • Redefining quality patient room cleaning – patient interviews • Measuring Clean – validation-statistical data • Staffing – Is it appropriate? • Changing the cleaning process – what works? • Important dates – facts • Information

6. Why is the HCAPHS survey necessary? • HCAPHS provides a national standard for collecting and publicly reporting information about patients’ perspectives about hospital care. • It is the only survey that provides “apples to apples” comparison of hospitals. • The Centers for Medicaid and Medicare Services (CMS) intend to use HCAPHS data to determine the level of funds it will reimburse hospitals for services. • Generally, hospitals with higher HCAPHS will receive higher reimbursement

7. How Does HCAPHS Work? • A hospital provides each eligible inpatient with a survey of 27 questions and other items relating to how often the patient perceived something to have occurred. Example: How often a doctor may ask things or was your room cleaning daily? • The survey also asks the patient to rate the facility overall and questioned the willingness to recommend the facility. • After adjusting certain factors, the government bundles patients’ response into 10 categories and calculates certain responses. • How often did nurses communicate to patients. • Did staff communicate about medication prior to giving them to patient. • What we don’t know are the weight/score given to each category.

8. How is HCAPHS different from Press Ganey? • The primary difference is in the rating scale. • Press Ganey measures various aspects of their hospital experience such as admission, tests and facility cleanliness using a rating scale of • Very good • Good • Fair • Poor. • HCAPHS measure how often a patient perceived an aspect of their care was performed using a scale of • Always, • Sometimes • Never.

9. Redefining Patient Room CleaningInterviews 400 Guests of family members surveyed at a hospital system. • Question: What will it take to get your room clean? • 175 or 44% commented that the room should have an orderly neat appearance. • 125 or 31% stated that seeing an EVS staff member was important. • The patient was asked if a visual aide/tent card stating that “I am sorry I missed you”, signed and dated would help? 120 or 98% responded “yes” • 65 or 16% Trash was emptied in room • 35 or 9% stated that is just looked clean.

10. QualityRoom Ready for OccupancyMeasuring Results

11. High Touch Area • Test - Pre-clean • Test - Post-clean • 19+ identified high touch areas • Success rate >95% • Multiple testing methods • Black Light • 3M • Set Expectations – Deliver Results

12. Staffing

13. Staffing • What is being done and when? • How often? • Staffing based on Adjusted patient days or square footage? • Do you account for empty rooms? Must remain picture perfect? • Throughput • When? • Response time? • Clean time? • Team or Unit approach? • Fixed Tasks • Variable Tasks

14. HAIs’ – Environemental Cleaning FactsWhat Works • Significant vectors of HAIs’ are most environmental surfaces (most have been found to be impacted) in hospitals. • Cleaning criteria and goals should be based upon the surface and location to be cleaned. • Reasons for non-compliance: • All surfaces and all areas should not be cleaned in the same way with the same materials. • This is inefficient, costly and will result in both over & under cleaning of areas.

15. HAIs’ – Environemental Cleaning, cont’d • CLEANING STANDARDS – must be designed and based on type of facility, patient occupancy and risk determination. • CONTRIBUTION – from staff involved with environmental cleaning, facilities and patient care. • MATERIALS – know the microbes you need to kill and the category of surface in need of disinfection. Surfaces should be prioritized based on contamination. Porous surfaces should not be used in patient care settings. • PERSONNEL – making permanent assignments and stressing education have been successful as have internal & external audits. Recognition of EVS is critical to making a program successful. • EDUCATION – establish clearly defined protocols, roles & responsibilities and involve patients in the process. Daily Checklists or “Hot” lists have been effective.

16. HAIs’ – Environemental Cleaning, cont’d • Hand Hygiene and Environmental Cleaning are the “lowest common denominators” of most infection control programs. • Things that are the easiest to implement/accomplish may result in the biggest reduction in the infection rate.

17. Important Dates & FactsValued Based Purchasing • A minimum of 300 completed HCAPHS surveys must be turned in to CMS for reporting purposes. • A total of 17 clinical processes will be measured. One of those will be HAIs’ • Eight measures of the HCAPHS survey will also be used. One of those will be the cleanliness of the hospital. • These measures, along with the other clinical processes, will be used to generate FY 2013 payments.

18. Additional Facts • By August 2012, CMS will publicize each hospitals estimated score and value based incentive for FY 2013 • By November 2012, each hospital will learn the exact amount of their adjustment. • Establish baselines, develop goals, track improvements and correct deficiencies so that your program provides legal defensible data while improving the quality of care and reducing the rate of infection. • HAI’s represent the most common complication in health care settings (5-10% of all hospitalized patients). • HAI’s add 16 billion dollars annually to American health care expenditure. • Hospital regulation falls solely under the jurisdiction of the STATES • Twenty four (24) states have adopted laws requiring the reporting of HAI rates and 7 more are considering legislation.

19. Suggestions & Benefits-Improving HCAPHS Scores • Focus your attention to improvement with one survey that matters. This will save time and resources. • Switch to a process that is action oriented and has meaning. Utilize detailed reports to determine opportunity for improvement from the top down. • Create accountability, take action and generate improvement plans based on your survey data. Establish ownership so weaknesses can be addressed. • Leverage online education, orientation and competencies to improve outcomes that are department specific. These should be designed to improve HCAPHS scores.

20. What Happens When You Do…. • Budget Process – Ability to advocate for more staff, or at least no more cuts due to increased credibility. • Joint Commission – Surveyors may ask how you ensure that adequate staff is available to deliver a level of service. • Department Service Levels – Customers can understand the direct relationship between tasks performed and quality. Service levels can be negotiated based upon cost as well as perceived need. • Accountability – Approval for a level of service becomes an administrative decision based on the cost to deliver the service.

21. Where Can I get Information? To view hospital data go to http://www.hospitalcompare.hhs.gov

22. Look for this presentation and others at www.OhioAHE.org

23. Questions?

24. Association Status Update • MEMBERSHIP GOAL for 2011: • 40 Members by December 31! • Current Membership - 36 • NEED MEMBERS! • YOU can help! • Are YOU a member? • Join OAHE and let others know! • Invite someone to our monthly meetings!

25. Membership Drive We are almost to our goal!

26. Membership: • Membership fees are: • Full Member: $100/annually • Associate Member: $125/annually • Subscribing Member: $150/annually • Make checks payable to: OAHE • Checks may be mailed to: OAHE, 5534 Catmere Drive, Medina, OH 44256

27. Announcements • November Meeting – November 30th • Cleveland Clinic • NA1-140 (Lerner Building, 1st floor) • 3:30P – 5:00P • December – There will be NO December ConneXions Meeting! Enjoy your holiday! • “ConneXions” After-Hours • Coming Soon!

28. Conference Review • 21 Exhibitors participated in Trade Show • Six Educational Presentations Given. • Keynote Speaker was David Frank, internationally known speaker in the cleaning and sanitation industry. • 74 Attendees • Conference Survey (via email and online) • CEU Form available at www.ohioahe.org

29. Announcements • 2012 Annual Conference & Market Place • August 8, 2012, Cleveland • Location TBD • Hilton Inn – Beachwood • Airport Marriot • Columbus/Cincinnati Outreach • Establish Contacts with initial introductory luncheon in Mid-November • Goal of 2012 for local Chapter

30. Annual Meeting • Annual Membership Meeting • February 22, 2012 • UH Case Medical Center • Be on the lookout for more information coming soon!

31. Our Needs • Membership Chair • Partnership Chair • New Media Chair • 2012 Conference Chair/Committee • If you are interested in serving in one of these positions, please contact Rod Pollard or Susan Miller.

32. For all the lastest information, visit us on the web at: www.ohioahe.org

33. Thank You For Attending!