Setting the Stage for HCAHPS Success

1. Setting the Stage for HCAHPS Success December 7, 2012 Carrie Brady, JD, MA cbradyconsulting@gmail.com

2. Overview of Today’s Web Conference Introduction to Year Two of the AHRQ-HRET HCAHPS Patient Safety Learning Network HCAHPS and Why It Matters Opportunities and Challenges of HCAHPS The Unique Nature of HCAHPS HRET Curriculum Overview

3. AHRQ/HRET Patient Safety Learning Network (PSLN) Project • This program is supported by the U.S. Agency for Healthcare Research and Quality (AHRQ) through a contract with the Health Research and Educational Trust (HRET). • HRET is a charitable and educational organization affiliated with the American Hospital Association, whose mission is to transform health care through research and education. • AHRQ is a federal agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.

4. The Patient Experience of Care is Fundamental to Clinical Improvement • Understanding the patient experience of care is not an add-on activity: it should be used as a fundamental element in your other improvement efforts. • For those working on the HRET Partnership for Patients Hospital Engagement Network (HEN) or another HEN, your work will benefit directly from your efforts to improve the patient experience of care (e.g., readmissions, ADEs). • Lessons you learn in this HCAHPS Learning Network will help you succeed in the HEN project because— • Patient-centered care is a driver of clinical outcomes • Employee and patient engagement are 2 sides of one coin • HCAHPS assesses key factors in ADEs and readmissions

5. HCAHPS Curriculum 2012-13All Web conferences are scheduled for 12-1pm Eastern • December 7, 2012: Fundamentals of HCAHPS • December 18, 2012: Using HCAHPS Data Effectively • December 19, 2012: Using HCAHPS Data Effectively (this date for workshop PSLN participants only) • January 16, 2013: Nurse Communication • February 13, 2013: Responsiveness • March 13, 2013: Medication Communication • April 24, 2013: Discharge Information • May 15, 2013: Physician Communication and Engagement • June 5, 2013: Pain Management • July 17, 2013: Clean • August 14, 2013: Quiet

6. HCAHPS Technical Assistance Faculty • Carrie Brady, MA, JD • HRET’s primary HCAHPS faculty • Former senior Connecticut Hospital Association staffer • Previously a vice president at Planetree • Experienced hospital peers • To be identified using performance data and PSLN partner recommendation • Will provide case studies

7. HCAHPS At A Glance • Standardized national survey of hospital inpatients • Administered after discharge • 27 questions • 18 substantive questions • 4 screening questions • 5 demographic questions • 5 questions to be added January 1, 2013

8. HCAHPS Topics • CMS reports individual scores for: • Cleanliness • Quiet at night • Overall rating • Willingness to recommend • CMS reports composite scores for 6 topics: • Nurse Communication • Doctor Communication • Medication Communication • Responsiveness • Pain Management • Discharge Information

9. New HCAHPS Questions: Care Transitions Scale: Strongly Disagree, Disagree, Agree, Strongly Agree During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left. When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. When I left the hospital, I clearly understood the purpose for taking each of my medications.

10. New HCAHPS Questions: Patient Information • During this hospital stay, were you admitted to this hospital through the Emergency Room? (Yes, No) • In general, how would you rate your overall mental or emotional health? (Excellent, Very Good, Good, Fair, Poor)

11. Why HCAHPS Matters:CMS Value-Based Purchasing 11 Your performance today affects your value-based purchasing payments

12. CMS Value-Based Purchasing 30% HCAHPS 12

13. Increasing Relative Importance of Patient Experience for Value-Based Purchasing

14. The Evidence Is Mounting HCAHPS Matters Clinically

15. Source: Boulding W et al. Relationship between Patient Satisfaction with Inpatient Care and Hospital Readmissions Within 30 Days, Am J Manag Care. 2011; 17(1): 41-48. HCAHPS and Readmissions For the core clinical areas (HF, PN), HCAHPS performance was more predictive of readmission rates “than the objective clinical performance measures often used to assess the quality of hospital care.”

16. Source: Isaac T et al., The Relationship between Patients’ Perception of Care and Measures of Hospital Quality and Safety, Health Services Research 45:4 (August 2010) HCAHPS and Quality/Safety “[T]here were consistent relationships between patient experiences and technical quality as measured by the measures used in the HQA program, and complication rates as measured by the AHRQ PSIs.”

17. Source: Glickman SW et al, Patient Satisfaction and Its Relationship with Clinical Quality and Inpatient Mortality in Acute Myocardial Infarction, Circ Cardiovasc Qual Outcomes 2010;3:188-195. Patient Experience and Clinical Outcomes “[W]hen we controlled for a hospital’s clinical performance, higher hospital-level patient satisfaction scores were independently associated with lower hospital inpatient mortality rates.”

18. Is HCAHPS a tool to develop a shared understanding of patient and staff needs? OR Is HCAHPS driving a wedge between patients and staff? How Are You Using HCAHPS?

19. The Opportunities and Challenges of HCAHPS Challenges If used incorrectly, HCAHPS data can: • Drive a wedge between patients and staff • Create frustration and distrust between administration and staff • Be perceived as invalid or simply irrelevant • Become an excuse not to listen Opportunities If used correctly, HCAHPS data is a valuable tool to: • Understand the patient experience • Gain useful information not available from other sources • Highlight important ways to improve clinical outcomes and safety • Monitor and deepen relationships with patients

20. Ideal Scenario HCAHPS is viewed as a valuable tool to help organizations achieve multiple objectives HCAHPS is part of a coordinated, comprehensive approach to partnering with patients and families Everyone works together as a team to identify opportunities for improvement, innovate and implement strategies, and celebrate success

21. More Common Scenarios HCAHPS is used as a weapon by managers who: • Feel pressured to improve scores but don’t know how • Have run out of improvement strategies/need fresh ideas Response of staff members: • Ignore data completely • Become angry with patients • Try to improve, but are overwhelmed by tasks that are not well aligned or prioritized

22. The Nature of HCAHPS HCAHPS is a quantitative tool designed to evaluate the qualitative relationship between patients and staff.

23. HCAHPS is Different and the Difference is Important • Clinical process measures have objective answers that are capable of independent validation. • e.g., Did you give the patient aspirin? • HCAHPS tells us how we are meeting our patients’ unique needs. • HCAHPS asks for reports of experience rather than ratings, because reports are more objective. • The patient’s perception is reality for that patient and we need to understand that reality to provide effective clinical care.

24. Patients See Things Differently Than Providers Source: Weingart SN et al. “Patient-Reported Safety and Quality of Care in Outpatient Oncology” Joint Commission Journal on Quality and Patient Safety; 33:2, 2007 • 22% of 193 patients reported a “recent unsafe episode” • More than 80% of the reported experiences were classified by reviewers as “service quality incidents” • 33% related to waits and delays • 21% related to poor communication and information for patients • 13% related to poor coordination of care among staff

25. Patients’ Perspectives are Invaluable CONCLUSIONS: “Patient-reported service quality deficiencies were associated with adverse events and medical errors. Patients who report service quality incidents may help to identify patient safety hazards.” (emphasis added) Taylor BB et al. Medical Care 2008 Feb;46(2):224-228

26. We Also Need to Know What Patients Don’t Know Source: Olson DP and Windish DM, “Communication Discrepancies Between Physicians and Hospitalized Patients” Arch Intern Med 2010; 170 (15): 1302-1307.

27. Hospital Consumer Assessment of Healthcare Providers and Systems HRET Curriculum: A New Way of Thinking about HCAHPS

28. What HCAHPS Can Also Mean How Can you Always Help Patients/ Providers Succeed?

29. HCAHPS Success Depends on A Strong Foundation Foundational Elements of Patient-Centered Care • Leadership • Patient/Family Partnership • Workforce Engagement • Data Use/Performance Improvement

30. Curriculum Objective To support hospital teams in effectively using HCAHPS as a tool for improving quality, safety, and the patient experience.

31. HCAHPS Team Members • Patients/families • Frontline staff • Organizational leaders • Clinical and non-clinical departments Don’t forget: • Quality Improvement • Pharmacy • Environmental Services • Physicians

32. Strategies to Achieve the Objectives • Provide expertise, research, and practical tools • Harness participants’ institutional wisdom • Build internal teams and external communities for ongoing improvement work

33. Our Secret Ingredient You! Your experience and enthusiasm is an essential component of the curriculum

34. To Make the Most of HCAHPS: “The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.” Marcel Proust

35. What’s Next for HCAHPS PSLN Participants? 1) Resource list and compilation of successful strategies 2) Series of Webinars at noon Eastern • December 18, 2012 Web conference: Using HCAHPS Data Effectively • December 19, 2012 Web conference: Using HCAHPS Data Effectively • Dec 19th Webinar is for workshop PSLN participants only • January 16, 2013: Nurse Communication will be the first in a series of 8 monthly HCAHPS domain-specific Web conferences, also at noon Eastern time

36. PSLN Extranet – www.psl-network.org

37. Creating an account will give you access to… • Archived webinars • Medication Reconciliation • HCAHPS and Value Based Purchasing • Project RED • Discussion Forum (coming soon) • Registration links for upcoming events (coming soon)

38. Questions?