Regina Shupe RN, MSN, CEN April 18, 2012

1. Effective Communication Through AIDET®Key Words at Key Times Five Fundamentals for Hospitalists Regina Shupe RN, MSN, CEN April 18, 2012

2. Another word for Pay-for-Performance, this is a program intended to transform healthcare by fostering a joint clinical and financial accountability system. This new payment system will change CMS from a “passive payer” of services into an “active purchaser” of high quality, affordable, safe healthcare. Hospitals will be reimbursed based on their performance, not just reporting of quality metrics, including the patient perception of quality. Overview - Value-Based Purchasing (VBP) What is VBP? Why is it important? How will it be used? • Source: “Report to Congress: Plan to Implement a Medicare Hospital Value-Based Purchasing Program” ,CMS, Nov. 27, 2007

3. HCAHPS – Hospital Consumer Assessment of Healthcare Providers and Systems A standardized survey tool of 27 questions to measure the patient’s perception of quality care provided during their experience while a patient at an acute-care hospital. The patient perception of care will be publicly reported with other quality metrics on the Hospital Compare website. www.hospitalcompare.hhs.gov The information will be used to provide meaningful data for improvement efforts as well as provide comparisons between hospitals to help consumers choose a hospital. What is HCAHPS Why is it important? How will it be used?

4. Value Based Purchasing FY 2013 12 Core Measures (* 70% Weight) Performance attainment and improvement will determine total hospital reimbursement 1% Base operating DRG payments 8 HCAHPS Composites (* 30% Weight) Implementation FY 2013 (October 2012) Source: Value Based Purchasing Program final rule 4.29.11

5. New 2014 update Value Based Purchasing FY 2014 Core Measures(45% Weight) Performance attainment and improvement will determine total hospital reimbursement 1.25% Base operating DRG payments HCAHPS Composites(30% Weight) Outcomes(25% Weight) Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11

6. New 2014 update 2014 VBP Reimbursement Periods • Process of Care and Patient Experience of Care Domains: • Baseline Period: April 1, 2010 through December 31, 2010 (9-months) • Performance Period: April 1, 2012 through December 31, 2012 (9-months) • Outcomes Domain – Mortality Measures (previously adopted by CMS as final): • Baseline Period: July 1, 2009 through June 30, 2010 (12-months) • Performance Period: July 1, 2011 through June 30, 2012 (12-months) Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11

7. 12 Core Quality MeasuresValue Based Purchasing FY 2013 Core Quality Measures Selected • 2 Heart Attack (Fibrinolytic w/i 30 min’s; PCI w/i 90 min’s) • 1 Heart Failure (Dx instruct) • 2 Pneumonia (Culture in ED w/o anti; CAP immuno pt.) • 7 Surgical Care: Infection and Improvement • Proph anti w/i1 hr of incision • Proph anti selection-surg. • Proph anti Dx w/i 24 hrs of surg. • Cardiac pts-6AM post-op serum glucose • Beta blocker prior to arrival if received during period • Recommended Venous Thromboembolism proph ordered • Venous Thromboembolism proph w/i 24 hrs prior and post Source: Value Based Purchasing Program final rule 4.29.11

8. “ALWAYS” HCAHPS Questions

9. Rev 4.8.11 Execution FrameworkEvidence-Based LeadershipSM Breakthrough Foundation STUDER GROUP®: Objective Evaluation System Leader Development Must Haves® Performance Gap Standardization Accelerators Aligned Goals Aligned Behavior Aligned Process Re-recruit high and solid performers Move low performers up or out • Processes that are consistent and standardized • Process Improvement • PDCA • Lean • Six Sigma • Baldrige Framework Implement an organization-wide staff/leadership evaluation system to hardwire objective accountability Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results Agreed upon tactics and behaviors to achieve goals (Must Haves®) Software

10. Evidence-Based LeadershipSMEvidence-Based Care LEADERSHIP(EBL) PDCA, Lean, Six Sigma, Baldrige Framework Goal Alignment and Cascading Must Haves® OUTCOMES Patient and organizational Aligned Goals Aligned Behavior Aligned Process PATIENT CARE (EBC) e.g. Beta blocker for patient and core measures for Value-based purchasing Treatment Plan Prescribed Diagnosis and Prognosis Compliance Aligned Goals Aligned Behavior Aligned Process

11. Creating a Culture of “Always”Evidence-Based LeadershipSM "The greatest danger in times of turbulence is not the turbulence; it is to act with yesterday’s logic.“ -Peter Drucker

12. Studer Group Five FundamentalsAIDETSM A Acknowledge I Introduce D Duration E Explanation T Thank You

13. The Definition AIDET is a framework of communication used patients, their family members and one another. When used consistently, AIDET reduces anxiety, improving the patient care experience. Key Words at Key Times is part of AIDET.

14. Decrease anxiety with increased compliance Advantages of AIDETSM Improved clinical outcomes and increased patient and physician satisfaction Decreased Anxiety + Increased Compliance =

15. Communication and Malpractice Claims • Risk of most malpractice suits is predicted by practitioners’ inability to communicate well with their patients • Specific physician behaviors that significantly increased the likelihood of malpractice suits include: • Lack of respect • Not listening to the patient • Not providing adequate feedback Hickson, GB, et al. NC Med.J 2007: 68:362-364 Levinson W, et al. JAMA 1997; 277: 553 – 559

16. Relationship between Patient Satisfaction, Complaints and Lawsuits • Physicians with lower patient satisfaction results are more likely to have  patient complaints • Each one point decrement in patient satisfaction scores is associated with a – • 6% increase in complaints • 5% increase in risk management episodes • Lower performing physicians were at greater risks for lawsuits • 75% of complaints were related to communication issues Stelfox HT, et al, The American Journal of Medicine 2005; 118: 1126 – 1133

17. Adherence to Care Plan • As shown in a meta analysis of 79 studies in the general literature of the impact of therapeutic relationship on medical outcomes, the impact is moderate but consistent • Key themes that impact adherence are trust, respect and communication The Importance of the patient-clinician relationship in adherence to antiviral medication International Journal of Nursing Practice 2007

18. Empathetic Responses in Clinical Practice • Of 200 empathetic opportunities, the oncologists in the study responded only 22% of the time. Instead they choose to discuss other aspects of medical care • In another study involving patients with lung cancer, oncologists acknowledged or explored only 11% of empathetic opportunities

19. Physician Empathy = Positive Clinical Outcomes • Through a landmark study, a research team from Jefferson Medical College (JMC) of Thomas Jefferson University has been able to quantify a relationship between physicians' empathy and their patients' positive clinical outcomes, suggesting that a physician's empathy is an important factor associated with clinical competence. The study is available in the March 2011 issue of Academic Medicine *Source: Thomas Jefferson University, Physician's Empathy Directly Associated With Positive Clinical Outcomes In Diabetic Patients

20. Physician Empathy = Positive Clinical Outcomes • "Our results show that physicians with high empathy scores had better clinical outcomes than other physicians with lower empathy scores" good control* (A1c<7.0 percent) good control* (LDL<100mg/dL) • Higher Empathy Good Control • Lower Empathy • Poor Control moderate control* (LDL≥ 100 and ≤ 130 mg/dL) moderate control* (A1c≥ 7.0% and A1c≤ 9.0%) Empathy poor control* (A1c>9.0 percent) poor control* (LDL>130 mg/dL) *Source: Thomas Jefferson University, Physician's Empathy Directly Associated With Positive Clinical Outcomes In Diabetic Patients

21. In person, with your body: • (Wash In) • Smile! • Make eye contact • Acknowledge everyone in the room • Use open body language “Good morning Mr. Warner…”

22. “Hello Mr. Warner. I am Dr. Edwards and I am the hospitalist that is caring for you today….” “Hello Mr. Warner. I am Dr. Edwards and I am the hospitalist that is caring for you today. I am one of a team of hospitalists that will be caring for you. Do you know what a hospitalist is? We are a team of doctors that are specially trained to take care of patients in the hospital. We communicate regularly with your own doctor, and one of us is always here if you need us!”

23. Hospitalist Brochure

24. Advantages of Managing up Self, Coworkers and Other Departments

25. “The CT I ordered will take about 20 minutes to perform and then about one hour for the results….” “I am going to check on you this evening and then Dr. Beeson will be here tomorrow morning and will stop by before 10 am. He and I will have reviewed your case. He is an excellent physicians and I am leaving you in great hands” • How long will the test, procedure, appointment or admissions take? • How long will the patient need to wait before they can go home, return to work…? • When should they expect to see you or another hospitalist again?

26. “Let me explain some more about the procedure. First we are going to start an IV….” (Explain why performing the procedure, what will happen and what they should expect, understanding of side effects, and answer any questions.) • Review memo pad with patient • Why are we doing this? • What will happen and what should you expect? • What questions do you have? • USE UNDERSTANDABLE LANGUAGE

27. Patient Memo Pad • Provided by physician to patient on first encounter • Patient is encouraged to capture questions they may have for the hospitalist team • Hospitalist will review memo pad when they visit with patient and family

28. The Reality of Explanation • Excellent communication between the patient and the provider improves adherence to medication regimens • Patients who do not comprehend all aspects of their disease or the importance of the treatment in controlling the disease and preventing adverse outcomes are less likely to be adherent with the treatment plan Harmon G,et al, Curr Opin Cardiology 2006; 21: 310 – 315

29. “Thank you for choosing us ….Thank you for waiting … Thank you for coming in today…What other questions do you have?” • Show appreciation • Provides a positive closing • Thank patients for trusting us with their care • Leave your business card • (Wash out)

30. HCAHPS Doctor Composite Questions and AIDET:

31. AIDET® HCAHPS – Explanation regarding Medications

32. Tips for knowing when and how to use AIDET® • The elements of AIDET® are important in every interaction with a patient and their family • There are times when you will not need to verbalize all of the elements of AIDET® • Elements of AIDET® do not have to be delivered in any specific order • Managing up yourself and your team is often done with an initial introduction • It is useful to repeat introduction of yourself and your team when you sense increased anxiety in your patient • Duration is best communicated in specific time increments • When you cannot commit to a specific time, commit to a specific time interval in which you or another team member will update the patient on progress

33. Tips ~ Physician/Provider AIDET® • Sit down when entering the room (increases the perception of time) • Shake hands with patients and family members (78% of patients prefer a hand shake – sign of courtesy and respect) • Address patients by name (91% of patients want to be addressed by name) • Use a formal opening and closing statement with patient • Manage up – co-workers, hospital, support services (shows coordination of care, decreases complaints, and reduces anxiety of patients)

34. Website Resources at www.studergroup.comPartner Code EMCA - 551 • Improve Your HCAHPS Results With AIDET –New evidence demonstrates how AIDET can help organizations quickly improve their HCAHPS results • Studer Group Webinar Series: • HCAHPS - Part 2: Pay for Performance is Here – Join Quint Studer, Founder and CEO of Studer Group and David Callecod, FACHE, CEO of Lafayette General Medical Center, Lafayette, LA for a 45 minute web-based video learning session, "HCAHPS - Part II: Pay for Performance is Here"

35. “Vision without execution is hallucination.” Thomas Edison Thank You! Regina Shupe MSN, RN, CEN www.studergroup.com