Transcript Low to High State Average Results in the “Percent

Creating A Culture of Always
Karen Cook, RN, BSN
Kansas Organization of Nurse Leaders
November 14, 2014
Slide 1
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Low to High State Average Results in
the “Percent of Patients that Rate the Hospital a 9 or 10”
Rating Category 1 Average Top
Box 55%-67%
VI
DC
NY
NJ
MD
NM
WV
NV
FL
DE
AK
Rating Category 2 Average Top
Box 68%-70%
WY
CT
CA
MT
VA
PA
MA
HI
GA
RI
AZ
ND
WA
TN
Rating Category 3 Average Top
Box 70%-72%
AR
OR
IL
NH
MS
NC
AL
VT
MO
MI
OK
KY
SC
OH
Rating Category 4 Average Top
Box 73%-78%
TX
ID
IN
WI
MN
ME
UT
LA
CO
IA
KS
SD
NE
Source: Hospital Compare August 2014, Patients discharged between 4Q12-3Q13
Slide 2
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Learning Objectives
1. Define a “Culture of Always” from an
operational and service perspective (HCAHPS)
2. Describe seven skills great leaders use for high
engagement
3. Ten questions to ask if you are not getting
results
Slide 3
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CEO’s Top Ten Issues - 2013
RANK
1
2
3
3
5
6
7
8
9
10
11
ISSUE
Financial challenges
Healthcare reform implementation
Governmental mandates
Patient safety and quality
Care for the uninsured
Patient satisfaction
Physician-hospital relations
Population health management
Technology
Personnel shortages
Creating an accountable care organization
Ranked #1 concern
for the last 10 years
Note: January 13, 2014; American College of Healthcare Executives;
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Slide Issues
4
Top
Confronting Hospitals: 2013;
388
CEOs
Please
do not hospital
quote or disseminate
without Studer Group authorization
The Journey to Excellence
“A culture of high performance
means an organization consistently
performs certain behaviors using
various tools and techniques that
create measurable, evidence-based
quality outcomes at lower cost.
Creating a consistent highly reliable
culture is the hardest thing anybody
can do.”
Quint Studer
Slide 5
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The Culture Is Reflected In Leadership
“It is implicit in our mission that our
work, our care, and our decisions be
guided by the needs of our patients.
But to truly be guided by the needs of
our patients, we must first LISTEN to
them."
Jeannette Ives Erickson,
Senior Vice President for Patient Care and Chief Nurse,
Massachusetts General Hospital
Slide 6
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Thirty Second Elevator Speech – CAHPS
Consumer Assessment of Healthcare Providers and Systems
The CAHPS Surveys are standardized surveys to measure the
patient perception of quality care. Only the most positive of
responses to areas that are important to patients are publicly
reported on the government quality website.
They were created to:
 Increase the transparency of the quality of care provided by hospitals,
providers, outpatient and home health agencies
 Provide incentives for providers to improve the quality of care that they
provide
 Provide an avenue for the public to create objective and meaningful
comparisons about the quality of care provided
Slide 7
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http://www.medicare.gov/hospitalcompare
 Emergency Room
 Hospital Outpatient
Surgery Department
 Ambulatory Surgery Center
 Hospice
 ACO/Physician Practice
 Health Insurance
Exchange
 National Implementation in
2014-Inpatient Center
Hemodialysis CAHPS
 AND there’s an APP
Slide 8
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Communication with Nurses is The Key Driver of Hospital-Patient Relationships
Nurse Communication has highest correlation with Willingness to Recommend
As Patients’ Perception of Care Increases, Their Willingness to Recommend Increases
Patient-level Pearson correlations with Definitely Recommend the Hospital
for patients discharged between April 2012 and March 2013
3.1 million completed surveys
0.7
0.58
0.6
Pearson Correlation
0.5
0.42
0.4
0.3
0.45
0.48
0.45
0.36
0.27
0.29
0.2
0.1
0
Discharge
Information
Quietness of
Hospital Env.
Cleanliness of
Hospital Env.
Comm. About
Medicines
Communication Responsiveness
with Doctors
of Hosp. Staff
Pain
Management
Communication
with Nurses
HCAHPS Composite
HCAHPS Patient Level Correlations. www.hcahpsonline.org. Centers for Medicare & Medicaid Services, Baltimore, MD. Originally posted January 16, 2014.
Slide 9
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Kansas Hospitals National Rank:
7th in Responsiveness; 10th in Nurse Communication; 13th in
Communication about Meds; 20th in Pain Management
Kansas Acute Care vs Critical Access Hospitals
Patient Experience of Care - National Percentile Ranking
Acute Care Hospitals
90%
84%
80%
Average National Percentile Rank
Critical Access Hospitals
77%
74%
77%
73%
73%
72%
70%
60%60%
60%
59%
55%
61%
57%
51%
50%
57%
51%
47%
51%
56%
50%
40%
30%
20%
10%
0%
Patient Experience Composite
Slide 10
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HCAHPS Measures Receiving HCAHPS Stars
 HCAHPS Composite Measures
1. Communication with Nurses (Q1, Q2, Q3)
2. Communication with Doctors (Q5, Q6, Q7)
3. Responsiveness of Hospital Staff (Q4, Q11)
4. Pain Management (Q13, Q14)
5. Communication about Medicines (Q16, Q17)
6. Discharge Information (Q19, Q20)
7. Care Transition (Q23, Q24, Q25)
 HCAHPS Individual Items
8. Cleanliness of Hospital Environment (Q8)
9. Quietness of Hospital Environment (Q9)
 HCAHPS Global Items
10. Overall Hospital Rating (Q21)
11. Recommend the Hospital (Q22)
 Summary Star Rating
 (Moving Up FY 2015 to FY 2016)
Slide 11
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Score and Star Rating
 Each HCAHPS measure response is combined and converted
to a 0-100 linear-scaled score “Linear Score” (Not just top box)
 Closely related to “Top Box”, “Middle Box”, and Bottom Box”
scores publicly reported on Hospital Compare website
 The HCAHPS Summary Star Rating combines the star rating
of all the HCAHPS measures
 7 Star Ratings from the HCAHPS Composites
 Average of cleanliness and quietness
 Average of Overall and Recommend
Slide 12
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Provider
Call
10-8-14
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Example Calculation of HCAHPS Summary
Star Ratings
Excerpt slide from CMS National Provider Call 10-8-14
Slide 13
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Distribution of HCAHPS
Summary Star Rating in the Dry Run
Slide 14
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10-8-14
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Nurse Communication Drives Global Ratings in
Kansas Hospitals
Rate Hospital 9 or 10 by Hospital
Ranking in Nurse Communication
Definitely Recommend by Hospital
Ranking in Nurse Communication
100%
90%
80%
86%
90%
80%
Avg. Percentile for Recommend
Avg Percentile for Rate 9 or 10
80%
67%
70%
55%
60%
50%
40%
30%
30%
20%
70%
60%
60%
51%
50%
40%
35%
30%
20%
10%
10%
0%
0%
0-24th
Percentile
25-49th
Percentile
50-74th
Percentile
75-99th
Percentile
Nurse Communication Ranking
0-24th
Percentile
25-49th
Percentile
50-74th
Percentile
75-99th
Percentile
Nurse Communication Ranking
Slide 15
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Emergency Department Patient Experience With
Care Survey (EDPEC Pilot Completed)
 Communication by Provider Type








Doctors Listening to Your Concerns
Doctors Using Words and Terms You Could Understand
Doctors Involving You in Decisions about Your Care
Doctor's Understanding and Caring
Doctor's Instructions/Explanations of Treatment/Tests
Nurses' Responsiveness to Your Needs and Requests
Nurses' Understanding and Caring
Nurses' Instructions/Explanations of Treatments/Tests
 Instructions for Care at Home
 Hospital Staff's Courtesy and Friendliness to You
 Timeliness/Throughput
 Transitions of care
 Pain Management
Slide 16
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ED Wait Times and LWBS
Kansas Acute Care vs Critical
Access Hospitals
Median Door to Doc Times in Minutes
Critical Access Hospitals
19.08
Kansas Acute Care vs Critical
Access Hospitals Percent ED
Patients LWBS
2.00
Critical Access Hospitals
1.40
Acute Care Hospitals
Acute Care Hospitals
22.35
.00
17.00 18.00 19.00 20.00 21.00 22.00 23.00
Slide 17
.50
Acute Care Hospitals
1.00
1.50
2.00
2.50
Critical Access Hospitals
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Outpatient/Ambulatory Surgery Patient
Experience of Care Survey (O/ASPECS)
 CMS is developing this survey and plans field test in 2014
 Preparation for the surgery or procedure
 Check-in and pre-operative processes
 Cleanliness and privacy of the surgery facility
 Surgery facility staff
 Discharge from the facility
 Preparation for recovering at home
 Patient-reported health outcomes as a result of the surgery
or procedure
Note: There is a Surgical Survey created by American College of Surgeons , but it focuses on the surgeon, not the facility
Slide 18
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We Are In FY2016 Performance Period
Slide 19
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Measure in the New Efficiency Domain
 MSPB-1 Medicare Spending per
beneficiary
 A claims-based measure that include
risk-adjusted and price-standardized
payments for all Part A and Part B
services provided from 3 days prior to
a hospital admission (index admission)
through 30 days after the hospital
discharge
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Downloads/NPC-MSPB-09Feb12-Final508.pdf
Slide 20
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Measure in the Outcomes Measures for 2015
AHRQ PSI-90
Slide 21
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Patient Safety
Kansas vs. Rest of Nation
PSI-90 SAFETY RATE Complication/patient safety for selected indicators
(composite)
0.700
0.660
0.601
0.580
0.600
0.510
0.500
PSI 90 Rate
0.410
0.400
0.300
0.200
0.100
0.000
Kansas Hospitals
Nation 95th Percentile
Nation 75th Percentile
Slide 22
Nation 50th Percentile
Nation 25th Percentile
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Room Cleanliness Drives Procedural Outcomes
As Patients’ Perception of Care Increases, Healthcare Associated Infections Decrease
Clostridium difficile (or C.diff.)
Infections by Hospital Rating for Room
Cleanliness
0.900
Standardized Infection Rate
0.800
0.700
0.600
0.889 0.868
1.200
0.786
1.000
0.589
0.500
0.400
0.300
0.200
Standardized Infection Rate
1.000
Staphylococcus aureus (or MRSA)
Blood Infections (Antibiotic-resistant
blood infections) by Hospital Rating for
Cleanliness
1.135
0.954 0.910
0.876
0.800
0.600
0.400
0.200
0.100
0.000
0.000
0-24th
25-49th
50-74th
75-99th
Percentile Percentile Percentile Percentile
0-24th
25-49th
50-74th
75-99th
Percentile Percentile Percentile Percentile
Hospital Rating for Room Cleanliness
Hospital Rating for Room Cleanliness
Slide 23
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Overview – Hospital Acquired Condition Program
What is HAC
Program
How will it be
used?
Beginning in October 2014, the Hospital-Acquired
Condition Reduction Program, mandated by the
Affordable Care Act, requires the Centers for
Medicare & Medicaid Services (CMS) to reduce
hospital payments by 1% for hospitals that rank
among the lowest-performing 25 percent with regard
to HACs. This is in addition to the maximum 1.5%
Value Based Purchasing and 3% Excess
Readmission Penalties for FY2015.
Later this year, Medicare will release the final scores in this HospitalAcquired Condition Reduction Program. Hospitals getting the penalty
will lose 1 percent of each Medicare payment from Oct. 1 through
Sept. 30, 2015.
Slide 24
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Healthcare Associated Infections
Kansas Hospitals Healthcare Associated Infections
Kansas Hospitals
Nation 75th Percentile
Nation 50th Percentile
Nation 25th Percentile
1.600
1.480
1.400
1.153
1.200
Standardized Infection Ratio
1.331
1.293
1.269
1.113
0.965
1.000
0.845
0.784
0.800
0.799
0.751
0.698
0.765
0.734
0.657
0.600
0.457
0.400
0.200
0.350
0.350
0.398
0.313
0.427
0.290
0.159
0.000
0.000
Catheter-associated
urinary tract
infection (CAUTI)
Central-line
associated
bloodstream
infection (CLABSI)
Clostridium difficile
(or C.diff.) Infections
Slide 25
Staphylococcus
Surgical site
Surgical site
aureus (or MRSA)
infections from infections from colon
Blood Infections
abdominal
surgery (SSI: Colon)
(Antibiotic-resistant hysterectomy (SSI:
blood infections)
Hysterectomy)
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Learning Objectives
1. Define a “Culture of Always” from an operational and
service perspective
2. Describe seven skills great leaders use for high engagement
3. Ten questions to ask if you are not getting results
Slide 26
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Seven Skills For High Engagement
1. Being Authentic – connect to the WHY
Slide 27
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Seven Skills For High Engagement
1. Being Authentic – connect to the WHY
2. Having Empathy – this is hard work
Slide 28
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Nonverbal Communication and Empathy
 Eye contact most highly linked to empathy
 TWO Social touches (not associated with tasks such as
handshake, healing touch, pat on arm, etc.)
 Sit versus stand
Slide 29
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Seven Skills For High Engagement
1. Being Authentic – connect to the WHY
2. Having Empathy – this is HARD work
3. Knowing when to push… and when to hold back
Slide 30
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Seven Skills For High Engagement
1. Being Authentic – connect to the WHY
2. Having Empathy – this is HARD work
3. Knowing when to push… and when to hold back
4. Move conversation back to point – mission driven
Slide 31
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Seven Skills For High Engagement
1. Being Authentic – connect to the WHY
2. Having Empathy – this is HARD work
3. Knowing when to push… and when to hold back
4. Move conversation back to point – mission driven
5. Breaking actions into understandable steps – aligned
with the goals
Slide 32
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Move Conversation Back to Point - WHY
WHY: We help to keep 492
patients from having to come
back into the hospital.
What: “Your goal is achieve a
readmission index of <1.0%”
Target: Reduce readmissions
of CHF patients (FY 1.07%)
Metric: Improving “HCAHPS
Medication Composite –
(Explain Side Effects of
Medications)
Weight: 30%
Slide 33
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High Patient Perception of Care Equals Lower
Preventable Readmissions
1/5 of Medicare Beneficiaries are
readmitted within 30 days with an
annual cost of $17.4 Billion
2.6%
Acute
MI
3.1%
Heart
Failure
2.3%
Pneumonia
Source: The American Journal of Managed Care; Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission
Within 30 Days; 2011; Vol. 17(1)
Slide 34
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Readmissions
Kansas Acute Care vs Critical Access Hospitals
30-day hospital-wide all- cause unplanned readmission
17.0
16.5
16.5
15.9
16.0
Percent
15.5
15.4
15.4
Kansas Acute
Care Hospitals
Nation 75th
Percentile
16.0
15.0
14.5
14.4
14.0
13.5
13.0
Nation 95th
Percentile
Nation 50th
Percentile
Kansas Critical
Access
Hospitals
Nation 25th
Percentile
Comparison Groups
Slide 35
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Relationship Between Percent of Patients that Rate Hospital a 9 or 10
and FY2015 Excess Readmission Penalties
Hospitals with Higher HCAHPS Patient Experience of Care Results
for Percent of Patients that Rate Hospital a 9 or 10
Have Lower FY 2015 Readmission Penalties
0.70%
0.61%
Average Excess Readmission Penalty
0.60%
0.53%
0.46%
0.50%
0.40%
0.35%
0.30%
0.20%
0.10%
0.00%
0-24th Percentile
25-49th Percentile
50-74th Percentile
75-99th Percentile
Hospital Ranking for HCAHPS Patients that Rate Hospital a 9 or 10
There is a statistically significant difference between hospital groups as determined by one-way ANOVA (F (3,3235) = 24.5, p = .000). A Tukey post-hoc test
revealed that Readmission Penalties are statistically significantly lower for hospital groups that patients rate highly for Rate 9 or 10 (p=.000).
Slide 36
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CMS Patient Family Engagement Metrics
Best Practice Category
PFE Metric
Instruction: For each of the following items, indicate if the hospital does this or does not do
this. If you do not know, indicate so.

Does=1

Does not=0

Unknown=u
Point of Care
1.
Prior to admission, hospital staff provides and discusses a discharge planning
check list with every patient that has a scheduled admission, allowing questions or
comments from the patient or family (e.g., the planning checklist may be similar to
the CMS Discharge Planning Checklist).
2.
Hospitals conduct both shift change huddles for staff and do bedside reporting with
patients and family members in all feasible cases.
3.
Hospital has a dedicated person or functional area that is proactively responsible
for Patient and Family Engagement and systematically evaluates Patient and Family
Engagement activities.
4.
Hospital has an active Patient and Family Engagement Committee (PFEC) OR at
least one former patient that serves on a patient safety or quality improvement
committee or team.
5.
Hospital has one or more patient(s) who serve on a Governing and/or Leadership
Board and serves as a patient representative.
Policy & Protocol
Governance
Slide 37
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Relationship Between Percent of Patients
that Receive Discharge Instructions
and FY2015 Excess Readmission Penalties
Hospitals with Higher HCAHPS Patient Experience of Care Results
for Percent of Patients that Received Discharge Instructions
Have Lower FY 2015 Readmission Penalties
Average Excess Readmission Penalty
0.70%
0.60%
0.57%
0.51%
0.50%
0.48%
0.40%
0.40%
0.30%
0.20%
0.10%
0.00%
0-24th Percentile
25-49th Percentile
50-74th Percentile
75-99th Percentile
Hospital Ranking for HCAHPS Patients Received Discharge Instructions
There is a statistically significant difference between hospital groups as determined by one-way ANOVA (F (3,3233) = 10.3, p = .000). A Tukey post-hoc
test revealed that excess readmission penalties are statistically significantly lower for hospital groups that patients rate highly for providing Discharge
Instructions (p=.000).
Slide 38
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(http://www.nextstepincare.org)
Free Toolkit To Engage Family in Planning Transitions
Slide 39
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Tour of the online training tool
https://ccnm.thinkculturalhealth.hhs.gov/default.asp
Slide 40
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Seven Skills For High Engagement
1. Being Authentic – connect to the WHY
2. Having Empathy – this is HARD work
3. Knowing when to push… and when to hold back
4. Move conversation back to point – mission driven
5. Breaking actions into understandable steps – aligned
with the goals
6. Limiting and sequencing change – keep informed
Slide 41
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Sequence Priority Initiatives
1. Leadership Evaluations Aligned
to Goals
2. Peer Interviewing/Selection
3. Round for Outcomes
1. Round on staff
2. Nurse leader rounding on
patients
4. Key words at key times (AIDET
and Individualized Patient Care)
5. Hourly Rounding℠
6. Bedside Report (Handover)
7. Post-visit phone calls
Slide 42
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Managing Complex Change
Vision
Skills
Incentives
Resources
Action
Plan
Change
Vision
Skills
Incentives
Resources
Action
Plan
Confusion
Vision
Skills
Incentives
Resources
Action
Plan
Anxiety
Vision
Skills
Incentives
Resources
Action
Plan
Gradual
Change
Vision
Skills
Incentives
Resources
Action
Plan
Frustration
Vision
Skills
Incentives
Resources
Action
Plan
False
Starts
Ambrose, 1987, Managing Complex Change
Slide 43
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Seven Skills For High Engagement
1. Being Authentic – connect to the WHY
2. Having Empathy – this is HARD work
3. Knowing when to push… and when to hold back
4. Move conversation back to point – mission driven
5. Breaking actions into understandable steps – aligned
with the goals
6. Limiting and sequencing change – keep informed
7. Connect the dots to the POSITIVE!
Slide 44
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“Rate honesty and ethical standards of
people in these fields”
Gallup Poll: http://www.gallup.com/poll/159035/congress-retains-low-honesty-rating.aspx
Slide 45
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Most trusted but are we happy?
 Nursing rated #2 LEAST happy profession
 Compensation
 Growth opportunities
 Workplace culture
“Nurses have more issues with
the culture of their workplaces,
the people they work with, and
the person they work for”
CareerBliss.com released list based on analysis of 100,400+ Associates, 2011-2012
Slide 46
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Most trusted, but are we engaged?
 Engaged – work with passion and
feel a profound connection to their
company, drive innovation and move
the company forward
 Not-engaged – essentially
“checked-out” or sleep-walking
through their day, putting time in but
not energy or passion in their work
 Actively dis-engaged- not only
unhappy at work but actively acting
out their unhappiness. Every day
these workers undermine what
their engaged co-workers
accomplish.
-Gallup

Slide 47
Nurse Engagement
Survey
9%
22%
26%
43%
Engaged
Ambivalent
Content
Disengaged
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Business Case For Engagement
Median differences between top-quartile and
bottom-quartile units in Associate engagement
were:
 -12% in customer ratings
 -18% in productivity
 -49% in safety incidents
 -37% in absenteeism
 -41% in patient safety incidents
Source: Q12® Meta-Analysis: The Relationship Between Engagement at Work and Organizational Outcomes,
Gallup 8
Slide 48
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#1 Strategy: Rounding for Outcomes on Associates
“Rounding on Associates allows us to truly connect with our mostvalued “asset” and gather feedback every day on our efforts to create
a great place to work. But more important, it allows us to build
relationships with and recognize each of our primary nurses for the
meaningful work they do everyday.”
Pennie Peralta, Chief Nursing Officer
Bon Secours, Roper St. Francis,
Charleston, SC
Named one of Becker’s Hospital Review
Top 100
Slide 49
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Rounding on Staff: Leader WIIFM
Rounding questions
Foster team development, take a pulse of the
Department & provide insight into
staff skills & behaviors
1.
2.
3.
4.
5.
6.
7.
8.
9.
Personal Connection
What is working well?
Anyone I can recognize? Why?
What systems or processes are not working well?
What can we do to improve them?
Do you have the tools you need to do your job?
What’s one way we can improve…
Is there anything you need from me?
Thank you for making a difference!
Slide 50
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Rounding – WHY?
 Create strong personal relationships (caring)
#1 way to show you care about them FIRST – as a
person
 And SECOND – as their leader

 Develops a culture of recognition with focus on
positives (appreciative)
 Creates better operational performance (efficiency)
 Communicates 1:1 on key issues (responsible)
 Promotes transparency (trustworthy)
Improved Employee Engagement
Slide 51
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Rounding on Staff Aligns With
Creating Joy, Meaning and Workforce Safety
1. Am I treated with dignity and
respect by everyone, every day, in
each encounter?
2. Do I have what I need: education,
training, tools, financial support,
encouragement, so I can make a
contribution to this organization that
gives meaning to my life?
3. Am I recognized and thanked for
what I do?
Download at Lucian Leape Foundation www.npsf.org/lli
Slide 52
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Communication Tools For Employees
 Employee Forums
 Communication Boards
 Stoplight Reports
 Rounding
 Huddles
 Department Meetings
 Newsletters
 Supervisory Meeting Model
Slide 53
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High Impact Suggestion for Improvement
# 1 – Elevate Accountability at ALL Levels
WHY? We must engage the hearts and minds of all staff to
promote effective communication and coordination of care.
With a scale of Always, every interaction impacts the
patient perception of quality care.
 Accountability for Leaders
 Align evaluations to measureable outcomes
 Accountability for Staff
 Rejuvenate the behavior standards and be aggressive about
managing people who do not uphold the values
 Expand HCAHPS education to all staff and their role
 Round on staff to promote engagement
Slide 54
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High Impact Suggestion for Improvement
# 2 – Use Key Words at Key Times
WHY? Key words reflect a communication style that
improves the quality of information provided by every
person in every interaction. This makes care safer,
patients less anxious and informed about their care.
 Identify key times (defining moments that occur during
times of vulnerability that create memorable
experiences (positive or negative)
 Train and validate all employees on the concept of
communicating with empathy and compassion,
“managing up”, AIDET and Narrating Your Care
Slide 55
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High Impact Suggestion for Improvement
# 3 – Nurse Leader Rounding on Patients
WHY? Rounding is the best way to PROACTIVELY connect
with patients to ensure the delivery of quality care, validate
staff behaviors, and recognize employees living the values.
 Every patient – every day with documentation of themes
 Reduces variance in frequency of behaviors and ensures they
are hardwired (real-time recognition or coaching)
 Links to actionable information to drive results
 Hourly rounding
 Bedside handover
 White/care boards complete
Slide 56
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Patient Care Model
Hourly
Rounding
Bedside Shift
Report
Nursing and
Patient Care
Excellence
Individualized
Patient Care
Slide 57
Discharge
Phone Calls
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Learning Objectives
1. Define a “Culture of Always” from an operational and
service perspective
2. Describe seven skills great leaders use for high
engagement
3. Ten questions to ask if you are not getting results
Slide 58
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Ten Questions To Ask If Not Getting Results
1. Was education provided to all involved regarding the expected
behaviors?
2. Was the WHY over-communicated about the expected behavior?
3. How do you measure and communicate impact to goals?
4. Has leadership made it clear it is mandatory, not optional?
5. Is leadership role-modeling the behavior?
6. Has the behavior been taught using role-play/skill lab?
7. Are you measuring and validating competency?
8. Are leaders noticing and giving positive feedback?
9. Are leaders managing gaps in performance on the spot?
10. Is it clear there are consequences for non-compliance, including
termination?
Do you have a culture of ALWAYS?
Slide 59
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References and Resources
www.hcahpsonline.org
www.cms.gov
Kotter, J.P. (2002). The heart of change. Boston: Harvard Business Press.
Mackoff, Barbara and Pamela Kaluer Triolo. Ten Signature Behaviors of
Great Nurse Managers
Ritter, J. (2012). Resistance to change and change management. In N.
Borkowski (Ed.), Organizational behavior in health care (pp. 373397). Boston: Jones & Bartlett.
Studer, Quint. A Culture of High Performance. Firestarter Publishing.
2013
Slide 60
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Kansas Hospitals National Rank for Improvement in One Year:
30th in Responsiveness; 33th in Nurse Communication; 26th in
Communication about Meds; 44th in Pain Management
Kansas Acute Care vs Critical Access Hospitals
Patient Experience of Care Improvement in One Year in Top
Box
Acute Care Hospitals
Critical Access Hospitals
2.50
2.07
2.00
2.00
1.50
1.50
1.43
1.29
Change in One Year
1.14
1.14
1.13
1.00
.71
.50
.64
.27
.08
.04
.00
-.06
-.04
-.29
-.50
-1.00
-.19
-.31
-.85
-1.00
-1.50
Axis Title
Slide 61
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Medicare Spending Per Beneficiary
Kansas vs National Avg.
Medicare Spending Per Beneficiary
Kansas Average
Kansas Hospitals vs National Average
MSPB Efficiency Domain Score
0.99
National Average
0.98
0.98
$255
1 to 3 days Prior to Index Hospital
Admission
$256
0.97
$10,865
During Index Hospital Admission
0.96
$10,399
0.95
0.94
$7,603
1 through 30 days After
Discharge from Index Hospital
$8,049
0.94
$18,724
The Complete Episode of Care
0.93
$18,704
0.92
$0
$5,000 $10,000 $15,000 $20,000
Slide 62
Kansas Hospitals
National Avg.
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Nurse Communication Drives VBP Results
Both Clinical Process of Care and Patient Experience of Care VBP Scores Are
Influenced by the Quality of Nurse Communication
Average VBP Clinical Process of Care
Domain Score
by Hospital Ranking in Nurse
Communication
80
64.2
65.0
64.0
63.0
62.0
60.6
61.0
60.0
59.0
61.2
59.0
58.0
73
70
Patient Experience Domain Score
Clinical Process of Care Domain Score
Average VBP Patient Experience of Care
Domain Score by Hospital Ranking in
Nurse Communication
60
50
50
40
40
30
26
20
10
57.0
56.0
0
0-24th
25-49th 50-74th 75-99th
Percentile Percentile Percentile Percentile
0-24th
25-49th 50-74th 75-99th
Percentile Percentile Percentile Percentile
Hospital Ranking in Nurse Communication
Hospital Ranking in Nurse Communication
Slide 63
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Nurse Communication Drives Financial Reimbursements or Penalties
Both VBP and Excess Readmission Penalties Are Influenced by the Quality of
Nurse Communication
2014 Average Value Based
Purchasing Bonus or Penalty
by Hospital Ranking in Nurse
Communication
0.25%
2014 Average Excess Readmissions
Penalty by Hospital Ranking in
Nurse Communication
0.00%
0-24th
25-49th
50-74th
75-99th
Percentile Percentile Percentile Percentile
0.22%
-0.05%
Percent Bonus or Penalty
0.15%
0.08%
0.10%
0.05%
0.00%
-0.05%
0-24th
25-49th
50-74th
75-99th
Percentile Percentile Percentile Percentile
-0.03%
-0.10%
Excess Readmission Penalties
0.20%
-0.10%
-0.15%
-0.20%
-0.25%
-0.26%
-0.30%
-0.15%
-0.20%
-0.19%
-0.16%
Hospital Ranking in Nurse Communication
Slide 64
-0.35%
-0.24%
-0.29%
Hospital Ranking in Nurse Communication
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Barriers to Communication
Hospital Staff Responses to the 2012 Hospital Survey on Patient Safety Culture
Agency for Healthcare Research and Quality (AHRQ)
 Staff feel free to question the decisions of those with more authority - 47%
 Staff feel like their mistakes are held against them - 50%
 Important patient care information is often lost during shift changes - 51%
 We have enough staff to handle the workload - 56%
 It is often unpleasant to work with staff from other hospital units - 59%
 Staff are afraid to ask questions when something does not seem right 63%
 My supervisor/manager overlooks patient safety problems that happen
over and over - 76%
Slide 65
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