CREATING AN EPIDEMIC OF EMPATHY
Chrissy Daniels, MSPartner, Strategic Consulting
© 2017 Press Ganey Associates, Inc.
CEO: I want it to feel better. We need to change the culture. Put together a plan
Me: Sure???
University of Utah Provider Rankings All Facility National benchmark
0%
10%
20%
30%
40%
50%
2009n=114
2010n=173
2011n=319
2012n=286
2013n=431
2014n=442
2015 n=481
2016 n=554
4%
1% 3%
9%
22%
13%
27%
17%
46%
25%
50%
26%24%
44%
41% OF PROVIDERSARE IN THE TOP 10%
27% OF PROVIDERS ARE IN THE
TOP 1%
© 2017 Press Ganey Associates, Inc.
Outline
§ History & present state of US patient experience measurement
§ Statistical drivers that influence patients§ Strategies to influence practice
§ Shared purpose§ Intrinsic motivation§ Purposeful practice
© 2017 Press Ganey Associates, Inc.
History and Current State of Patient Experience Measurement
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Evolution of US Patient Experience Measurement
§ Patient Advocacy emerges§ Joint Commission Requirement to Measure Patient Satisfaction§ Standardized Instrument (voluntary) by CMS§ NQF Defines Patient Experience Measure as PROMs§ Requirement for Participation § Value Based Payment
6
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Idea to Implementation
Survey Development
•Literature Review•Request for Information
•Draft Survey•Field Test AHRQ Review
•CAHPS Consortium Review
•Posting to Website
NQF Review•Measure Endorsement
•MAP Recommendations
Pay for Reporting•Program Guidelines & Requirements
•Dry Run•National Implementation Pay for
Performance•Benchmarks Established
•Performance Period
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Sample CAHPS Questions
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Proposed 2018 Weighting
Clinical25%
Efficiency25%
HCAHPS25%
Safety25%
FY 20182%atrisk
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Expansion of CAHPS Requirements
Medical Practices 2+ EPs
Emergency Departments Anticipated ED CAHPS ImplementationED CAHPS Survey Development
Hospital Outpatient Departments, Ambulatory Surgery Centers Anticipated OS CAHPS ImplementationOutpatient Surgery CAHPS
Survey Development
Pediatric Inpatient Hospitals Child HCAHPS Implementation (Voluntary)
2%
Inpatient Hospitals HCAHPS used within VBP
Inpatient Psychiatric Facilities
Inpatient Psychiatric CAHPS Survey Development Anticipated PY CAHPS Implementation
Dialysis Centers ICH CAHPS continue used within QIP
Hospice Providers Hospice CAHPS Implementation (pay for reporting tied to APU)
Accountable Care Organizations ACO CAHPS used within Pioneer & Shared Savings programs
Medical Practices 100+ EPs
25% of quality score
Home Health Agencies HHCAHPS Continues (tied to APU)
PQRS CAHPS used within VBPMPQRS CAHPS
Medical Practices 25+ EPs PQRS CAHPS within VBPMPQRS CAHPS
PQRS CAHPS
2017 2018 2019
© 2017 Press Ganey Associates, Inc.
Statistical Drivers that Influence Patient Loyalty
12© 2015 Press Ganey Associates, Inc.
What Do Patients Really Value?
High: Confidence in Provider
1.9% Fail to Recommend
High: Worked Together28% Fail to Recommend
Low: Worked Together90% Fail to Recommend
Low: Confidence in Provider
74.6% Fail to Recommend
High: Concern
for Worries
0.6% Fail
Low: Concern
for Worries
5.6% Fail
High: Concern
for Worries
6.3% Fail
Low: Concern
for Worries22.3%
Fail
High: Listens
Carefully24.7%
Fail
Low: Listens
Carefully45.7%
Fail
High: Courtesy78.2%
Fail
Low: Courtesy92.8%
Fail
3% of patients 68.4% of patients
2.4% of patients 5.9% of patients0.8% of patients 3.4% of patients11.4% of patients
2.5% of patients
High: Worked Together1% Fail to Recommend
Low: Worked Together11% Fail to Recommend
8% of patients 72% of patients14% of patients 5% of patients
81% of patients19% of patients
All Patients15.7%
Recommendation Failure Rate
Low Risk
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HCAHPS Rating 0-10 (% 9-10)
© 2014 Institute for Innovation
High: RN Listen
93.3% 9-10
Low: RN Listen
75.4% 9-10
High: RN Listen
78.1% 9-10
Low: RN Listen
59.5% 9-10
High: RN Listen
55.0% 9-10
Low: RN Listen
36.1% 9-10
High: RN Disch Pref38.0% 9-
10
Low: Disch Pref15.1% 9-
10
4.0% of patients 75.4% of patients
3.2% of patients 14.7% of patients
6.1% of patients 11.6% of patients
9.3% of patients 0.3% of patients
Low: RN Courtesy16.8% Top Box 9-10
High: Staff worked together
87.1% Top Box 9-10
High: RN Courtesy48.5% Top Box 9-10
Low: Staff worked together36.7% Top Box 9-10
High: Room Clean91.8% Top Box 9-10
Low: Room Clean74.8% Top Box 9-10
17.9% of patients
48.1% of patients
10.4% of patients
17.8% of patients
69.5% of patients
28.4% of patients
All Patients72.1%
Top Box 9-10 (Very Good)
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Emergency Driver of Patient Loyalty
High: Info re delays97.0%
LTR
Low: Info re delays82.6%
LTR
High: Info care at home77.5%
LTR
Low: Info care at home56.0%
LTR
High: RN attn to needs58.1%
LTR
Low: RN attn to needs 33.3%
LTR
High: Info care at home38.4%
LTR
Low: Info care at home10.3%
LTR
8.5% of patients 37.3% of patients2.6% of patients 3.7% of patients6.5% of patients 6.2% of patients20.4% of patients 2.1% of patients
Low: Dr Courtesy12.9% Top Box LTR
High: Staff cared about you91.4% Top Box LTR
High: Dr Courtesy45.4% Top Box LTR
Low: Staff cared about you24.1% Top Box LTR
High: Dr kept you informed94.5% Top Box LTR
Low: Dr kept you informed68.6% Top Box LTR
6.6% of patients 51.2% of patients23.6% of patients 12.9% of patients
59.0% of patients37.4% of patients
All Patients65.0%
Top Box LTR (% Very Good)
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What is Correlated with Likelihood to Recommend
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Strategies that Influence Practice
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3 Strategies to Influence Practice
§ Shared purpose through stories§ Activating intrinsic motivation§ Importance of purposeful practice –
embracing ritual
© 2017 Press Ganey Associates, Inc.
The creation of a shared purpose begins with stories, not data; the stories that crystallize how caregivers want to see themselves.
Thomas Lee, MD
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Focus on Delight
CARING TEAMWORK EFFICIENCYLISTENING EXPLAINING
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5 Elements of Patient Experience
CARING
LISTENING
EFFICIENCY
KNOW me
HEAR me
MAKE IT EASY for me
EXPLAINING
TEAMWORK
TEACH me
COORDINATE for me
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Tell the Story: Comments of the Week
#1 Wow! Completely blown away by Dr. Greis and his staff! What a wonderful experience I was provided. Dr. Greis is so caring, intelligent and even has a sense of humor (which is rare for a surgeon), lol! I had a complete ACL tear and meniscus tear. He replaced my ACL with a donors so I wouldn’t have to take as long to heal! Which is extremely important to me but even more so as i am a wife and mother of 4, one of my children is a newborn. I noticed your office does a lot of famous sports peoples surgery and I have a feeling Dr. Greis is a major surgeon for these people. He's so awesome and was so good to me I feel he treated me just as good as those famous people. Thank you Dr. Greis for being refreshingly caring and friendly--a rarity in the medical field these days! I would recommend him to ANYONE!!! –Orthopaedic Center, Patrick Greis, MD
© 2017 Press Ganey Associates, Inc.
I can’t wait to hear what the patient experience people can teach me.
said no clinician, ever.
How You Want Patients to
Describe You
ACCOMODATING ATTENTIVE APPROACHABLE CALM CARINGCOLLABORATIVE COMFORTING COMMITTED COMPASSIONATE COMPETENTCONNECTED CONSCIENTIOUS DELIBERATE ENGAGED EXPERT FRIENDLYHOPEFUL INTELLIGENT INSTRUCTIVE KNOWLEDGEABLE PASSIONATEPERCEPTIVE PERSONAL PRESENT PROBLEM SOLVER PROFESSIONALPROACTIVE RELIABLE REFLECTIVE RESPONSIVE REPSONSIBLE SAFESTABLE THOUGHTFUL THOROUGH TRUSTWORTHY WARM WELCOMING
ACCOMODATING ATTENTIVE APPROACHABLE CALM CARINGCOLLABORATIVE COMFORTING COMMITTED COMPASSIONATE COMPETENTCONNECTED CONSCIENTIOUS DELIBERATE ENGAGED EXPERT FRIENDLYHOPEFUL INTELLIGENT INSTRUCTIVE KNOWLEDGEABLE PASSIONATEPERCEPTIVE PERSONAL PRESENT PROBLEM SOLVER PROFESSIONALPROACTIVE RELIABLE REFLECTIVE RESPONSIVE REPSONSIBLE SAFESTABLE THOUGHTFUL THOROUGH TRUSTWORTHY WARM WELCOMING
3WORDS
© 2017 Press Ganey Associates, Inc.
When I figured out my vision and how to share it with my team and my patients everything got so much easier.
Stephanie Klein, MD
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Move from Idea to Excellence
Lessons from Grit by Angela Duckworth
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Deliberate PracticePurposePassion
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Embracing Ritual through Deliberate Practice
Transforming Patient Experience Through Power of Ritual – D. Glenn, MD Hawaii Pacific Health https://catalyst.nejm.org/patient-experience-power-ritual-physician-checklist/
A ritual is in fact a primitive checklist . . . a series of steps that, when repeated consistently, foster feelings of safety and trust between client and caregiver.• sitting down• making eye contact• being cognizant of nonverbal cues • reflective listening, • proper computer etiquette• use of a patient agenda
Caregivers asked to identify those they already do + 2 more
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Further Reading
§ Epidemic of Empathy, Thomas Lee, MD§ Antidote to Suffering, Christina Dempsey, RN§ Team of Teams, General Stanley Chrystal§ What Patients Say, What Doctors Hear, Allison Ofri, MD§ Teaming, How Organizations Learn, Innovate and Compete, Amy
Edmundson
28© 2015 Press Ganey Associates, Inc.
Conclusions
§ Patient experience measurement is a foundational component of value based care
§ Patients value skill, teamwork and empathy. § Activating and directing intrinsic motivation is
key.
Chrissy Daniels, MS Partner, Strategic [email protected]