Transcript HCAHPS & Patient Satisfaction - Texas Center for Quality

Patient Centeredness:
“A Journey from Theory to Application”
L.I.F.E. Concepts
Veronica Cochran RN, MS
Learning Objectives
• Discuss patient-centric care delivery in the
hospital setting
–
–
–
–
Patient Centeredness
Best practices for health care delivery
Customer satisfaction
Organizational Success
• Describe HCAHPS as a means of measuring
perception of care
– Measuring patient perception
– Managing measurements
– Measuring with more meaning
Opening Video
What is Patient Centeredness?
What is Patient Centeredness?
It must FIRST be
well defined
Patient Centeredness… as a Value
•
•
•
•
Beliefs and ideals shared
by members of a culture
about what is desirable or
undesirable
Influence attitude and
behavior
Serve as broad guidelines
for situations
Predict behavior
Must be Defined to be Aligned
Patient Centered – Defined
“Providing care that is respectful of and responsive to
individual patient preferences, needs, and values
and ensuring that patient values guide all clinical
decisions.”
IOM Committee authors included patient centeredness as
an essential component of quality care.
Values
Behaviors
Goals
Processes
Experience
Driving Alignment…
•
•
•
•
•
•
Job descriptions
Behavioral interviewing
30, 60 and 90 day evaluations
New hire orientation
Annual service training
Annual performance evaluations
“Until new behaviors are rooted in social norms and shared values, they are
always subject to degradation as soon as the pressures associated with the
change effort are removed.”
- John Kotter, Leading Change
What is Patient Centeredness?
The Why of Patient Centered Practice?
Shared Stewardship of Healthcare
Informing and
Engaging
Patients/families
Knowledge
Understanding
and Compliance
Improved
quality, safety
and perception
Self Management and Population Health
The Real Dollars and Sense…
Earning
back our
dollars
Return On Investment…
•
•
•
•
•
•
•
•
•
•
impacts patient loyalty
impacts growth and market share
impacts organizational brand
impacts patient decision making and stewardship
of health and healthcare resources
impacts compliance
impacts quality and safety
impacts patient outcomes
impacts employee morale and satisfaction
impacts employee retention
impacts VBP and financial reimbursement
To Be or Not To Be?
Patient Centered…
Communication
Compassion
Consistency
Collaboration
“Two words…
information and
communication
are often used
interchangeably
but they signify
quite different
things,
information is
giving out;
communication is
getting through
~Sidney Harris
Communication
• Explain things in a way you could understand
(Q3&7)
• Listen carefully to you (Q2&6)
• Staff told you what medicine was for (Q16)
• Staff described possible side effects in a way
you could understand (Q17)
Collaboration
• Did they listen carefully to you (Q2&6)
• Treat you with courtesy and respect (Q1&5)
• Did staff talk with you about help you needed
when you left the hospital (Q19)
• Did you get information in writing about what
symptoms to look out for when you left hospital
(Q20)
• New question: where your preferences taken
into consideration
Consistency of Care
• Responsiveness to call light… (Q4)
• Help to BR as soon as you wanted…(Q11)
• Staff did everything they could to help you
with you pain (Q14)
• How often was your pain well controlled (Q13)
• How often were you room and bathroom kept
clean (Q8)
• How often was the area around your room
quiet at night (Q9)
Compassion and Empathy
• Listened carefully to you” (Q2&6)
• Treat you with courtesy and respect” (Q1&5)
• Staff did everything to help with pain (Q14)
The Cost of Distrust…




Avoidance of discretionary healthcare
Higher rates of non-compliance
With-holding medically relevant information
Less than favorable quality outcomes
Real-Time…Validation
• Call lights, number of falls, and complaints can be
used to validate rounding
• Asking patients knowledge based questions can
be used to validate rounding and BSSR
• Assign all domains or questions to specific owner
e.g. council, unit or department; develop daily
PCP’s that can be tracked and measured
• Review every service failure for process
improvement opportunities
What is Patient Centeredness?
What Is H-CAHPS?
Hospital
Consumer
Assessment of
Healthcare
Providers and
Systems
‘Measures adult inpatient perception of quality of care
they received at a given hospital’
Measuring Perception
Perception is Reality
HCAHPS Domain Scoring: Micro + Macro = Total
Component
Description
Maximum Points
Micro Dimensions
Micro:
Achievement*
and
Improvement
Macro:
Consistency
Total
Evaluates each dimension
based on achievement
and improvement scores,
similar to scoring
methodology for clinical
process measures.
Nurse communication
10
Doctor communication
10
Clean, quiet
10
Responsiveness
10
Pain management
10
Comm. about meds
10
Discharge info
10
Overall rating
10
80
Evaluates consistency across dimensions
20
Combines micro and macro components to
provide an overall HCAHPS score
100
*HCAHPS micro dimension scoring is similar to scoring for process measures. Achievement points are
awarded on a 10-point scale, and improvement points are awarded on a 9-point scale. The 10-point
maximum depicted in the figure indicates maximum achievement points.
HCAHPS Measures Frequency
HCAHPS FREQUENCY SCALE:
“Always”
“Usually”
“Sometimes”
“Never”
Top Box Score – “Always”
TOP BOX FOR OVERALL QUESTIONS:
Overall Hospital Rating (9 or 10)
Likelihood to Recommend (Yes –Definitely)
HCAHPS…Reimbursement
Hospital Performance Exceeds Benchmark
Threshold
Full Achievement
Points (10-point scale);
Improvement Points
N/A
Benchmark
Hospital Performance Between Threshold & Benchmark
Partial Achievement
OR
Improvement Points
Threshold
Benchmark
Hospital Performance Below Threshold
No Achievement Points;
Possible Improvement
Points (9-point scale)
Threshold
Benchmark
HCAHPS Myth?
AS
EVS
RT
RAD
Lab
ED
HCAHPS
Public Transparency
Public Transparency & Social Media
The Clock is Ticking…
Patient Centered…
Real time
measures
Real time
feedback
Service
Recovery
Compliment or
Coach
Real-Time…Validation
• Call lights, number of falls, and complaints can be
used to validate rounding
• Asking patients knowledge based questions can
be used to validate rounding and BSSR
• Assign all domains or questions to specific owner
e.g. council, unit or department; develop daily
PCP’s that can be tracked and measured
• Review every service failure for process
improvement opportunities
Things to Consider…
Communicate with
Courtesy
Compliance and Self
Management
Things to Consider…
Improved Listening
Improved patient
understanding and
stewardship of health and
healthcare resources
Patient Centeredness… an Outcome
Care Transition Questions
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.
Strongly Disagree
 Disagree
 Agree
 Strongly agree
When I left the hospital, I had a good
understanding of the things I was
responsible for in managing my health.
Strongly Disagree
 Disagree
 Agree
 Strongly agree
January 1, 2013
When I left the hospital, I clearly
understood the purpose for taking each of
my medications.
Strongly disagree
Disagree
Agree
Strongly Agree
I was not given any medication when I
left the hospital
Looking at Measures in Complement
What is Patient Centeredness?
Patient Centeredness…an Expectation
Value
Practice
Outcome
Patient Centeredness… A Key…
Loyalty
Health Literacy
Experience
Self Management
Satisfaction
Compliance
Loyalty is the result of CARE
C
Communication
A
Always
Consistency
R
Relational
Collaboration
E
Empathy
Compassion
Resources
• Marketing Your Hospital, Traditional and Social Marketing
Ideas for Hospitals: Hospital Marketing; It’s all about the
Patient. March 6 2010 Jimmy Warren
• HCAHPS: Patient Experience & Impact of Value -Based
Purchasing, HealthStream Research
• Quint Studer: Using HCAHPS to Drive Patient Satisfaction
Lindsey Dunn (Becker’s Hospital Review 03-30-2010)
• HealthStream: Transitional Care Questions: Why Do They
Matter to HCAHPS? (Pt. I) posted by Stephen McClure 10-25-12
• StuderGroup