Connecting Care and Quality in Nursing

1. Connecting Care and Quality in Nursing Lyn Ketelsen, RN, MBA June 7, 2013

2. Value-Based Purchasing Roadmap CMS quality-based payment initiatives will put more than 11% of payment at risk REPORTING HOSPITAL QUALITY DATA FOR ANNUAL PAYMENT UPDATE 2% of APU 2% VALUE-BASED PURCHASING READMISSIONS 3% HOSPITAL-ACQUIRED CONDITIONS 1% 5% MEANINGFUL USE

3. Never Events: Financial Impact Source: CMS Fact Sheet, “CMS PROPOSES ADDITIONS TO LIST OF HOSPITAL-ACQUIRED CONDITIONS FOR FISCAL YEAR 2009”

4. Patients’ Perception of Care = QualityPressure Ulcer Stages III and IV

5. Patients’ Perception of Care = QualityVascular Catheter-Association Infection

6. Patients’ Perception of Care = QualityManifestations of Poor Glycemic Control

7. High Patient Perception of Care Equals Lower Preventable Readmissions 1/5 of Medicare Beneficiaries are readmitted within 30 days with an annual cost of $17.4 Billion 2.6% Acute MI 3.1% Heart Failure 2.3% Pneum-onia Source: The American Journal of Managed Care; Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission Within 30 Days; 2011; Vol. 17(1)

8. Figure 11 Percent of AMI Patients Surviving To One Year Post Discharge Stratified by Level of Patient-Centered Care (PCC) 0.997 1 0.989 0.987 0.981 0.997 0.992 0.98 0.970 0.962 0.978 0.960 0.954 0.951 0.96 0.949 0.946 0.957 0.938 0.94 0.944 0.930 0.92 Percent of Patients Surviving 0.9 0.906 0.903 Low PCC (n=372) High PCC (n=371) 0.895 0.890 0.88 0.879 0.871 0.86 0.84 Level of PCC was defined using the composite average of Picker dimension scale scores (see Fig. 8.1). Low PCC = bottom fifth of the distribution (scores <=56.85); high PCC = top fifth of the distribution (scores >=97.14). 0.82 0.8 1 2 3 4 5 6 7 8 9 10 11 12 Months After Discharge Patient-Centered Care and Mortality A different source: Glickman SW et al, Patient Satisfaction and Its Relationship with Clinical Quality and Inpatient Mortality in Acute Myocardial Infarction, Circa Cardiovasc Qual Outcomes 2010;3:188-195.

9. Rounding for Outcomes Leader Rounding on Patients Objective Evaluation System Must Haves® Leader Development Performance Management Standardization Accelerators Aligned Behavior Aligned Goals Aligned Process

10. Driving Performance

11. Rounding on PatientsWhy? • Foundational tactic that drives results • Reconnects leaders to patient care • Provides best opportunity for “eyes on the field” “boots on the ground” leadership • Builds leadership assessment skills just like we built nursing assessment skills

12. Leader Rounding on Patients“Did a Nurse Manager Visit You During Your Stay?” n= 561 n= 604 n= 601 n= 608 • Tactic and Tool Implemented: • Leader Rounding on Patient n= 104 n= 105 n= 106 n= 96 Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010

13. Four Goals • Create Empathetic Connection with Patients • Service Recovery (if needed) • Harvest Compliments and Manage Up • Assess Quality of Care

14. Rounding with Patients and Families

15. Two Key Questions • What have you learned about care being delivered? • What MUST you do with that information?

16. Verification: Patient Rounding Log • Priorities • Staff and Physicians to Recognize • Issues for follow-up • Notes and comments

17. This is a test The ability of nurse leaders to hardwire nurse leader rounding on patients directly correlates with their ability to lead the hardwiring of practices they will be asking of their staff…

18. A robust system of validation must be in place to ensure frequency, quality and outcomes are achieved Validation

19. If you are not getting value or results • Are you asking the right questions during rounds? • Are you using what you learned from rounding to make improvements? • Are you doing enough of it? • Round on one nurses assignments and then give him/her feedback, then repeat. The learning based on this ability to compare will be very beneficial Every Patient, Every day…Always

20. Hourly Rounding® Lyn Ketelsen, RN, MBA Studer Group Coach

21. Hardwire the full scope of the Patient Care Model Hourly Rounding® Use opening Key words: Round Perform scheduled tasks Perform 3P’s Additional Comfort measures Environmental assessment of room Closing Key words Tell when you will return Log the round Bedside Shift Report AIDET® introduction Communication of current state and plan of care Teach back reinforcement of important patient care information such as drug side effects Nursing and Patient Care Excellence Individualized Patient Care Ask what 2-3 things will ensure excellent care Write on board Used by all members of the care team Ask each shift to reinforce listening Post visit calls 1. Questions designed to assess patients progress at home 2. Listening with more than your ears Reference: Studer Group Patient Care Model

22. Hourly Rounding℠

23. The Why Hourly Rounding on patients is one of ten (10) new ways hospitals can ‘see’ differently. “Hourly Rounding, developed by Studer Group, the largest study ever focused on the impact of rounding. Hourly Rounding ‘restores sanity and joy to our workforce.’” • Maureen Bisognano, COO of IHI, 2007

24. 8 Behaviors of Hourly Rounds: The P’s Aren’t Enough

25. Ancillary and Support Departments • Everyone can be trained to do the environmental assessment of the room

26. THE LOGS…The Promise

27. Use of Communication Boards…the promise

28. Cost Avoidances – Falls Estimated Cost Avoidance = $367,064 Source: Tennessee Organization, Admissions: 15,598, Bed size: 304, >1400 employees, Employees=1441

29. Cost Avoidances – Decubitus Estimated Cost Avoidance = $330,658 Source: Tennessee Organization, Admissions: 15,598, Bed size: 304, >1400 employees, Employees=1441

30. Tips • Must have a buddy system formalized • Can’t be delegated outside of the staff within the matrix but needs to include all staff in the matrix. • Let’s talk about pain, communication, medication, clean and quiet. • Behaviors matter • Active Listening • Eye contact • Tone of voice • Appropriate speed of speech • Appropriate use of touch • Not multi-tasking • Appropriate use of humor/emotion • Physical positioning – sitting, kneeling, etc. • Energy mirrors the needs of the patient

31. Robots?!? Being Robotic is a function of the messenger – Not the message!

32. Jazzercise vs. Rockettes

33. Phases of Competency and Change Even with positive change, there is resistance . . .

34. Rounding Queen • This is hard • Takes longer than you think • Try to make it fun • http://www.youtube.com/watch?v=ovNWV1D4X0c

35. Thank You! Lyn Ketelsen RN, MBA Lyn.ketelsen@studergroup.com www.studergroup.com