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Session #4:
“Voice of the Patient”
Using Data to Transform the Patient Experience
James Merlino, MD
Chief Experience Officer, Cleveland Clinic
“Patients First….”
Main Campus
Nurse Communication
%ile
Source: CMS and Dashboard 1.31.14
Nurse Communication
Data Time Frame: Discharges between Q2 2012 – Q1 2013
Main Campus
Doctor Communication
%ile
Source: CMS and Press Ganey 5.1.14
Largest Hospitals in US
Doctor Communication
Poll Question #1
Healthcare providers
understand what their
“customer” – the
patients, want?
1) True
2) False
Leaders Survey
Top priorities
•
•
•
•
•
•
New facilities
Quiet-time to ensure rest
Private rooms
Food on demand
Interactive bedside computers
Eliminate visiting hour restrictions
Patient Desires
Respect
Communication between staff
Happy people
Patient Emotions
•
•
•
•
•
Stressful
Anxiety
Fear – Terror !
Uncertainty
Confusion
…And the Family
Scale of Importance on Satisfaction
Most important
Staff Cared
Global Sat.,
Doctor concern for
Concern, Empathy
Comfort
Doctor Explained
Nursing / ED
Info to care for self at
Staff, Wait
home
Times
Doc kept pt Informed
Nurse kept pt Informed Communication
Info about Delays
& Information
Family & friends kept
Informed
Nurses attn to Needs
Ancillary Care,
Doctor Listened
Comfort,
Pain Control
Administrative
Doctor Courtesy
Respect for Privacy
Staff Behavior
Nurses Listened
and Pain
Courtesy to family &
friends
Less important
Wait time before Doctor
Nurse Courtesy
Nurse concern for Privacy
Staff permitted family &
friends to be w/patient
Cleanliness
Helpfulness of person
first asking about
condition
Wait time for Radiology
Comfort during blood draw
Wait time before treatment
area
Comfort during Rad
Personal Ins Privacy
Rad Staff Courtesy
Waiting Area Comfort
Ease to provide insurance
Courtesy taking ins.
Wait time of staff notice
Poll Question #2
What is the most important
factor driving improvement
in healthcare delivery?
a)
b)
c)
d)
e)
Data transparency
Financial incentives for performance
Improved leadership / management skills
Both 1 and 2
Both 2 and 3
Increasing Accountability
Compared like
Washing
Machines
Quality – Based Payment
Reform Initiatives
2010
2011
2012
2013
2014
2015
2016
Inpatient Quality Reporting Requirement (IQR)
VBP
VBP
2017
2018
2% of APU
Value Based Purchasing
Readmissions
Hospital Acquired Conditions (DRG Demotions)
2%
3%
Hospital Acquired Conditions
1%
Meaningful Use
1%
Poll Question #3
Every caregiver in an
organization must be held
accountable to
organizational metrics?
1) True
2) False
The “360”
Before
After
The Episode
Manage the 360 Continuum
Inpatient Journey
Admission
Ambulatory
Discharge
Activities
Follow up
care
Ongoing relationship
management
Hospital Stay
Events / Procedures
Billing
Visits
Pre-admission
activity
Calls
Access
Inpatient flow
Caregiver Perspective
data along the Continuum
data down the vertical
Enterprise
Business Unit
Floor / Unit
Hospital
Institute
Department
Center
Strategic
Tactical
data along the Continuum
Leader
Manager
Individual
Operational
Enterprise view
Institute view
Center view – Physician specific metrics
Unit view – Nurse and team specific metrics
Trending
Score - Scorecard
DDI Physicians
Doctor communication vs. Hospital rating
DDI Physicians - HCAHPS Dr. Communication & Rating
2009 Discharges with Surv ey s Returned >= 5
Natl Avg = 64%
90
28
Good doctor
Bad hospital rating
21
48
80
50
33
41
14
18
30
DOC COMM
45
70
42
40
15
24
27
20
5
2
9
17 6
7
25 12
23
4
1
29
53
22
31
8
1026
1611
36
51
49
37
60
3
13
39
52
19
Natl Avg = 80%
47
46
34
32
56
54
44
50
Low
Communication
Low
Rating
Low Reputation
40
20
30
43
55
35
38
40
50
60
Rating
'n' of DDI P hysicians with > 5 '0 9 sur veys r etur ned = 5 6
Poor Doctor
Communication
High Hospital Rating
70
80
90
Poll Question #4
Patient comments –
anecdotes and verbatims
– alone, can drive
improvement!
1) True
2) False
Verbatims
• “Never sure who my doctor was..”
• “Surgeon never saw me – until I was very
critical”
• “Never saw my surgeon – only the fellow”
• “Doctor had attitude”
• “Doctor was rushed”
• “Too many doctors – I never new who was
in charge.”
• “ ----- group was backing out of the door
as my wife was asking questions – very
rude.”
Physician Patient Comments
Positive
43%
Negative
49%
N = 540
Mixed
8%
Opportunities for Improvement
Doctor Communication Verbatims
Listening
10%
Dr Time Others
3%
1%
Coordination
25%
Attitude /
Compassion
17%
Explain
20%
Staff Dr Access
24%
72% Communication
Patients First….
•
•
•
•
Purpose is transformational
Understand your customer
Transparency
Collect data across the continuum
and drive it down the organization
• The “soft” stuff counts!
Analytic
Insights
Questions &
Answers
A
Session Feedback Survey
1. On a scale of 1-5, how satisfied were you overall with the Glenn
Steele / Geisinger session?
2. What feedback or suggestions do you have for the Glenn Steele /
Geisinger session?
3. On a scale of 1-5, how satisfied were you overall with the Jim Merlino
/ Cleveland Clinic session?
4. What feedback or suggestions do you have for the Jim Merlino /
Cleveland Clinic session?
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