The Patient Experience: The Good, the Bad, the Ugly

1. The Patient Experience: The Good, the Bad, the Ugly Jeffrey Beers RN, BSN, MA Manager, Clinical Risk Management and Patient Safety UHCMC Hiloni Bhavsar, MD Internal Medicine Chief Resident UHCMC Henry Koon, MD Director, Medical Oncology Cutaneous Malignancy Program Seidman Cancer Center UHCMC Lynda Reilly, BS Ed, RN, BSN Sr. Clinical Content Analyst UH Electronic Medical Records Physician Design Team University Hospitals Jane Dus, ND, RN, NE-BC Vice President, Medical Surgical Services UHCMC Maureen Broscoe, RD, PMP Manager Core Team Electronic Medical Record University Hospitals Marcie Manson, Esq. Associate General Counsel University Hospitals

2. Objectives • Understand changes that have taken place to improve patient satisfaction across the system • Understand patient perception/perspective • Identify specific action items for implementation in practice University Hospitals

3. HCAHPS… Hospital Consumer Assessment of Healthcare Providers and Systems University Hospitals Case Medical Center University Hospitals 4

4. HCAHPS… CMS partnered with Agency for Healthcare Research and Quality (AHRQ) to develop it 2. The first national, standardized, publicly reported survey of patients’ experience of care 3. Three items used to adjust for the mix of patients across hospitals University Hospitals Case Medical Center University Hospitals 5

5. HCAHPS… 4. Two items relate to race and ethnicity 5. AHRQ carried out a rigorous and scientific process to develop this 6. In 2005, the HCAHPS survey was endorsed by the National Quality Foundation (NQF) University Hospitals Case Medical Center University Hospitals 6

6. Eligible Patients Adult Medical, surgical or maternity care Overnight stay or longer Alive at discharge University Hospitals Case Medical Center University Hospitals 7

7. Eligible Patients Excludes hospice discharges, prisoners, foreign addresses & patients discharged to nursing homes or skilled nursing facilities Excludes Pediatric, Psychiatric & Specialty Hospitals Encompasses 85% of patients University Hospitals Case Medical Center University Hospitals 8

8. HCAHPS Administration Random sample of adult patients UH does 100% sampling Between 48 hrs and 6 weeks after discharge Not restricted to Medicare Hospitals may use vendor or collect their own data University Hospitals Case Medical Center University Hospitals 9

9. HCAHPS Administration May use email, telephone, mail with telephone follow up or interactive voice recognition Hospitals can use HCAHPS alone or include questions after the core items Must survey throughout all months Available in several languages University Hospitals Case Medical Center University Hospitals 10

10. Prohibited Actions Attempt to influence answers Indicate the hospital will be rewarded Offer incentive Indicate hospital’s goal of high rating University Hospitals Case Medical Center University Hospitals 11

11. HCAHPS Content: 27 questions 18 core - critical aspects of patient experience 4 direct patients to relevant questions Answer choices: ○ Never ○ Yes ○ Sometimes OR ○ No ○ Usually ● Always University Hospitals Case Medical Center University Hospitals 12

12. Final HCAHPS Measures for VBP FY 2013 Communication with Nurses Communication with Doctors Responsiveness of Hospital Staff Pain Management Communication about Medicines Cleanliness and Quietness of Hospital Environment Discharge Instructions Overall Rating of Hospital University Hospitals Case Medical Center 13

13. Medicine Quality SummitHCAHPS Questions COMMUNICATION WITH DOCTORS • During this hospital stay, how often did Doctors treat you with courtesy and respect? • During this hospital stay, how often did doctors listen carefully to you? • During this hospital stay, how often did doctors explain things in a way you could understand? University Hospitals Case Medical Center

14. UH Wholly Owned HospitalsValue Based Purchasing Patient Satisfaction

15. University Hospitals

16. Physician Satisfaction (Geneva) • Monthly CMO report to all physicians with tips on patient satisfaction. (Press Ganey & HCAHPS primer /UHC Webcast) • Physician Satisfaction discussed at each MEC meeting with hard data sharing. • Quarterly individual scores with each patient answer shared with each physician (ED included) • Data is extracted from the PG website • Follow up with poor performers (< 50th percentile) • Expectations made clear (ED- reimbursement tied to scores)

17. UH Richmond Physicians Plan Attending Physicians Share personal data Post data publicly Encourage compliance Hospitalists Monthly reporting and discussion of scores Direct Observation initiative Simulation training HCAHPS training videos (CWRU psych dept) Payment incentives Resident Staff Direct Observation plus training videos Continued education HCAHPS Professionalism

18. UHCMC In-patient 2012 PlanPatient Satisfaction Bundle Processes Interventions/Processes * Introduce/shake hands * Use names * Make eye contact/sit * White board Aim To consistently achieve excellence in patient experience as measured by top quartile outcomes on HCHAPS and Press Ganey surveys Drivers • Connect with me • Communicate and involve me in my care • Check on me • Teach me • Follow-up with me * Daily rounds * Don’t interrupt/watch tone * Show empathy * Speak with families * Daily rounds * Stay up to date on tests * Explain meds in a complete way * Explain diagnosis * Teach back methods * Recommendations for treatment * Explain the clinical course * Clear follow up appts * Explain how to get advice/help * Follow up phone call

19. UHCMC Resident Pilot Data: 199 patients and 58 physicians comparative study

20. How much time do you want your physician to spend with you daily? 5-10 minutes 10-15 minutes 15-20 minutes 20-30 minutes Greater than 30 minutes

21. What percentage of patients could name their physician? 5% 10% 20% 30% 50% 70% 100%

23. UHCMC Resident Pilot Data: 199 patients and 58 physicians comparative study University Hospitals

24. UHCMC Resident Pilot Data: 199 patients and 58 physicians comparative study October 27, 2012 University Hospitals 25

25. UHCMC Resident Pilot Data: 199 patients and 58 physicians comparative study University Hospitals

26. Patient Advocate Data 2012 Jan - Sept Total # of Patient Advocate Entries:  2996 Complaint:  2063 Compliment:  79 Grievance:  293 Request Info:  145 Non-patient issues/visitor:  416

27. Patient Advocate Data Communication Issues play a part in 1947 complaints Of those, the top 5 breakdown issues under communication General Communication Issue:  947 Rude Behavior:  399 No Clinical Feedback:  165 Lack of information:  95 Miscommunication:  65

28. Advocate Office Complaint: Lack of information regarding treatment Poor pain control Don’t know name of attending MD response to Advocate I round everyday Complaints ridiculous

29. Advocate Office Complaint: MD asked about patient’s HIV meds with visitors in room Visitors unaware of patient’s HIV status Compliance Office: Office of Civil Rights follow up in similar case

30. Patient Advocate Complaint: Called office nurse and MD lines 3-4 times without call back Went to ED for treatment After ED visit called office without return call Did get MD office appointment At visit MD states unaware patient ever called office

31. Patient Advocate Complaint: MD not listening to pain issues Request another physician Now with planned surgery patient concerned regarding surgical pain and chronic pain

32. Thank You. University Hospitals