challenges and opportunities...• best practices. cchs ed admission rates 2013 ... adapted from emp...
TRANSCRIPT
Patient Experience in the ED:Challenges and OpportunitiesPatient Experience in the ED:Challenges and Opportunities
Stephen Meldon MDDirector, Main Campus ED and
Vice Chair ESI, CCHS
OverviewOverview
• ED Opportunities• ED Challenges
- Patient experience (PG) metrics: EP perception and bias
- What does the data show?• Best practices
CCHS ED Admission Rates 2013CCHS ED Admission Rates 2013
Location % of All AdmitsCC Main Campus 26.1%Euclid 49.5%Fairview 45.9%Hillcrest 44.6%Lakewood 44.8%Lutheran 45.1%Marymount 59.5%South Pointe 74.1%Weston 57.8%
ED OpportunitiesED Opportunities
• Front door to the hospital• Patient experience metrics
- HCAHPS- ED version coming soon- $ at risk
• Engagement• It’s the RIGHT thing to do!
ED “Challenges”ED “Challenges”
• System-based- Census, wait time, physical plant
• Patient-based- Consumer mentality, unrealistic
expectations• Physician-based
- Fast v nice, over Rx, personality• Survey-based
- Sample size, selection and response bias
Adapted from EMP Patient Satisfaction Academy
Drivers ofED Patient Satisfaction:
The Data
Drivers ofED Patient Satisfaction:
The Data
0
2000
4000
6000
8000
10000
12000
Total SurveysCompleted
Pts w/NegativeComment (ED)
Pts w/PositiveComment (ED)
10258
12512491
June 2012 – May 2013
Survey Volume and Negative Comment
Survey Volume and Negative Comment
Source: Press Ganey Surveys June 2012-May 2013
221 229167
224172
104 81 53
481396
449390
230
223
175147
0100200300400500600700800
Arrival Doctors Nurses Overall PersonalIssues
Tests Personal/Ins Info
Family orFriends
PositiveNegative
# of Comments
Comments by Survey Section
All Comments
ED Comments - Sentimentby Survey Section
ED Comments - Sentimentby Survey Section
Source: Press Ganey Surveys June 2012-May 2013
Press Ganey Correlations to Overall Rating of ED Care
Press Ganey Correlations to Overall Rating of ED Care
0.896
0.508
0.2 0.4 0.6 0.8 1.0Rcmnd ED
Staff caredPain controlled
Doctor's concern for comfortNurse kept informed
Info RE delaysFamily or friends informed
Nurse attn to needDoc kept informed
Care for self at home infoCourtesy to family or friends
Doc listenNurse listen
Doc courtesyNurse courtesy
Wait time before doctorNurses' concern for privacy
Let family/friend in while were being treatedHelpfulness of person asked about condition
Wait before treatment areaWaiting area comfort
Person taking blood courtesyConcern for comfort during blood draw
Wait for radEase to provide ins. Info
Privacy of persnl/finance infoCourtesy of person taking prsnl/finance info
Wait before staff acknwld arrivalConcern for comfort during test
Rad staff courtesy
All PG Clients
Source: Press Ganey Database, 1.5M completed surveys from 2011
0.895
0.2 0.4 0.6 0.8 1Rcmnd ED
Staff caredDoctor's concern for comfort
Doc kept informedNurse attn to need
Pain ControlledNurse kept informed
Care for self at home infoDr Explained
Info RE delaysDoc listen
Family or friends informedNurse listen
Doc courtesyCourtesy to family or friends
Nurse courtesyWait before treatment area
Nurses' concern for privacyLet family/friend in while were being treated
CleanlinessHelpfulness of person asked about condition
Concern for comfort during blood drawWait time before doctor
Privacy during proceduresWaiting area comfort
Wait for radCourtesy of person taking prsnl/finance info
Privacy of persnl/finance infoWait before staff acknwld arrivalConcern for comfort during test
Rad staff courtesy
CCHS: Correlations to Overall Rating of ED Care
CCHS: Correlations to Overall Rating of ED Care
Cleveland Community ResultsSurvey measure correlation coefficients to ‘Rate Overall Care’
Based on 10,258 completed Cleveland Clinic Regional Hospitals surveys in 2012
What’s Important to Overall Rating of ED Care?
What’s Important to Overall Rating of ED Care?
Regional Hospitals top 10
1. Recommend ED2. Staff Cared3. Dr Concern for Comfort4. Dr kept pt informed5. Nurse attention to pt needs6. Pain Controlled7. Nurse kept pt informed8. Home going instructions9. Dr Explained10. Info about Delays
All Press Ganey top 101. Recommend ED2. Staff Cared3. Pain Controlled4. Doctors concern for comfort5. Nurse kept pt informed6. Info about Delays7. Family / friends kept informed8. Nurse attention to pt needs9. Doctor kept pt informed10.Home going instructions
Scale of Importance on SatisfactionScale of Importance on Satisfaction
Recommend EDStaff CaredDr concern for Comfort
Dr kept pt InformedNurse attn to needPain ControlledNurse kept pt InformedCare for self at homeDr ExplainedInfo about DelaysDr ListenedFamily & friends keptInformed
Nurse ListenedDr CourtesyCourtesy to family & friendsNurse Courtesy
Most important
Communication, Information & Pain
Global Satisfaction, Concern, Empathy
Wait before treatment areaNurse concern for PrivacyStaff permitted family & friends to be w/patient
CleanlinessHelpfulness of person first asking about condition
Comfort during blood drawWait time before DoctorPrivacy during ProcedureWaiting area ComfortWait time for Radiology Courtesy taking ins.Privacy of persnl/financeinfo
Wait time of staff noticearrival
Comfort during testRad staff Courtesy
Less important
Privacy, Fam/Friends
Ancillary Care & Comfort, Waiting & Administrative
Staff Behavior
Drivers of ED SatisfactionDrivers of ED Satisfaction• ED care ratings influenced most byStaff Concern and Empathy to pt & familyCommunication re condition / treatment /
waitFrequency of Communication (kept informed)Managed Wait Time
• Waiting Times, although important, are not primary drivers of satisfaction
• Ancillary & administrative aspects show lowest correlation
Drivers of ED SatisfactionDrivers of ED Satisfaction
• ED satisfaction is a product of the qualityand frequency of staff interactions and communications with patients.
Patient CommentsPatient Comments• Nurses were cold and unconcerned…my being there was a bother.• Nobody cared.
• Doctor didn't listen, was not attentive - neither doctor or nurse identified themselves
• I had NO knowledge of WHAT was the matter w/me!
• YOU DID NOT GIVE ME RESPECT• I am only the patient your doctors think they are better &
demeaning, non-compassion.
• Extremely long wait with NO explanation.• No one came in over a 5 - 6 hr period & told me what my test
results were or what was going on.
*Most often, despite the actual waiting time, patients are more dissatisfied not knowing what to expect, not being adequately informed of delays, all pointing to poor communication.
CCHS ED Focused OpportunitiesCCHS ED Focused Opportunities
Identified Opportunities fromCC/Press-Ganey Comments
Staff Concern & Empathy to Patient & Family
Communication re: Condition/Treatment
Frequency of Communication (being kept informed)
Actions To Influence Emergency Department
Patient Satisfaction
Actions To Influence Emergency Department
Patient Satisfaction
Caregiver Education
Educate all ED Caregivers to the survey process and
questions
Service Excellence Improving
communication and customer service
Best Practice Recommendations
Best Practice Recommendations
CommunicationImproving the waiting experience for ED
patients and families
Physician CommunicationImproving provider communication
Caregiver EducationCaregiver Education
Educate all ED Caregivers to the survey process and questions
Press-Ganey Doctor SectionPress-Ganey Doctor Section
Service ExcellenceService Excellence
Improve Communication & Customer Service Skills utilizing Communicate with H.E.A.R.T.sm training geared to ED Caregivers to:
• Anticipate common patient desires & needs in the ED fromthe time the patient arrives
• Demonstrate a culture of caring & compassion through deliberate actions, as if it were “your own family”
• Inform patients clearly about their care treatment decisions
S.T.A.R.T with HEARTS.T.A.R.T with HEART
S Smile and greet warmlyT Tell your name, role and what to
expectA Active listening and assistR Rapport and relationship buildingT Thank the person
Set an example for all!Addresses expectations from the initial encounter
Adapted from CCF Office of Patient Experience Handout
Service RecoveryService
Recovery
23
Communication - Improving the Waiting Experience for Pt. & Family
Communication - Improving the Waiting Experience for Pt. & Family
“What” we want to achieve:
• ED Caregivers consistently communicating with patient and family
• Family/support person is welcomed & encouraged
• ED patients receive timely pain medication and avoid delays
Examples of “How” to achieve:Consistent use of• Hourly Rounding• Bedside Handoffs• Plan of Care form• Discharge Callbacks
Physician CommunicationPhysician Communication
How well the Medical Provider communicates is key
Physician communication stronglycorrelates to the patient’s overall satisfaction.
Foundations of Healthcare Communication course
EmpathyEmpathy
• What is empathy?• How can you convey empathy?
- Body language- Listening face- Eye contact- Name the feeling
Adapted from EMP Patient Satisfaction Academy
CommunicationCommunication
• Sit down. Patient perception:- 40% more time- ED patients: 22% (+) variance in time
perception, sitting v standing• Role of language
- Words 7%- Vocal quality 38%- Non-verbal 55%
Adapted from EMP Patient Satisfaction Academy
Press-Ganey Doctor SectionPress-Ganey Doctor Section
CLICCLIC• Courtesy
- Introduce yourself- to everyone in room• Listen
- At least 90 seconds uninterrupted - Sit down
• Inform- Both the patient and family of the plan- (And the assigned RN)
• Comfort- Blankets, water (if appropriate), etc.- Address PAIN
Adapted from EMP Patient Satisfaction Academy
Winning BehaviorsWinning Behaviors
• Focused, mindful: every time• Blameless apology• Introductions• Sit!• Listen- active listening, 90 seconds• Empathize• Sign posting• Disposition visit
Adapted from EMP Patient Satisfaction Academy
0
20
40
60
80
100
ESI Patient SatisfactionESI Patient Satisfaction
20132012
■Overall■Doctors■Nurses
Target = 90th percentile
2011
Data Source: Press GaneyAvon, Main, Twinsburg
Data through March 2014
Perc
entil
e
2014
