the patient experience: the good, the bad, the ugly

The Patient Experience: The Good, the Bad, the Ugly

Hiloni Bhavsar, MDInternal Medicine Chief ResidentUHCMC

Henry Koon, MDDirector, Medical Oncology Cutaneous Malignancy ProgramSeidman Cancer CenterUHCMC

Jane Dus, ND, RN, NE-BCVice President, Medical Surgical ServicesUHCMC

Jeffrey Beers RN, BSN, MA Manager, Clinical Risk Managementand Patient SafetyUHCMC

Lynda Reilly, BS Ed, RN, BSNSr. Clinical Content AnalystUH Electronic Medical Records Physician Design TeamUniversity Hospitals

Maureen Broscoe, RD, PMPManager Core Team Electronic Medical RecordUniversity Hospitals

Marcie Manson, Esq. Associate General CounselUniversity Hospitals

October 27, 2012 University Hospitals 2

Objectives

• Understand changes that have taken place to improve patient satisfaction across the system

• Understand patient perception/perspective • Identify specific action items for

implementation in practice

10/29/2011 University Hospitals Case Medical CenterUniversity Hospitals 4

HCAHPS…

Hospital Consumer Assessment of Healthcare Providers and Systems


HCAHPS…

1. CMS partnered with Agency for Healthcare Research and Quality (AHRQ) to develop it

2. The first national, standardized, publicly reported survey of patients’ experience of care

3. Three items used to adjust for the mix of patients across hospitals

University Hospitals Case Medical CenterUniversity Hospitals 6

HCAHPS…

4. Two items relate to race and ethnicity

5. AHRQ carried out a rigorous and scientific process to develop this

6. In 2005, the HCAHPS survey was endorsed by the National Quality Foundation (NQF)


Eligible Patients

• Adult• Medical, surgical or maternity care• Overnight stay or longer• Alive at discharge


Eligible Patients

• Excludes hospice discharges, prisoners, foreign addresses & patients discharged to nursing homes or skilled nursing facilities

• Excludes Pediatric, Psychiatric & Specialty Hospitals

• Encompasses 85% of patients


HCAHPS Administration

• Random sample of adult patients• UH does 100% sampling

• Between 48 hrs and 6 weeks after discharge

• Not restricted to Medicare

• Hospitals may use vendor or collect their own data


HCAHPS Administration

• May use email, telephone, mail with telephone follow up or interactive voice recognition

• Hospitals can use HCAHPS alone or include questions after the core items

• Must survey throughout all months

• Available in several languages


Prohibited Actions

• Attempt to influence answers

• Indicate the hospital will be rewarded

• Offer incentive

• Indicate hospital’s goal of high rating


HCAHPS Content:

• 27 questions

• 18 core - critical aspects of patient experience

• 4 direct patients to relevant questions

• Answer choices:

○ Never ○ Yes○ Sometimes OR ○ No○ Usually● Always

10/29/2011 University Hospitals Case Medical Center 13

Final HCAHPS Measures for VBP FY 2013

• Communication with Nurses

• Communication with Doctors

• Responsiveness of Hospital Staff

• Pain Management

• Communication about Medicines

• Cleanliness and Quietness of Hospital Environment

• Discharge Instructions

• Overall Rating of Hospital

10/29/2011 University Hospitals Case Medical Center 14

Medicine Quality SummitMedicine Quality SummitHCAHPS QuestionsHCAHPS Questions

COMMUNICATION WITH DOCTORS

1. During this hospital stay, how often did Doctors treat you with courtesy and respect?

2. During this hospital stay, how often did doctors listen carefully to you?

3. During this hospital stay, how often did doctors explain things in a way you could understand?

UH Wholly Owned HospitalsValue Based Purchasing Patient Satisfaction

HCAHPS Patient Satisfaction Target 55%Ahuja Bedford Conneaut Geauga Geneva Richmond St. John UH CMCNurse Communication 78% 77% 77% 82% 83% 89% 79% 75% 80%Doctor Communication 81% 77% 76% 83% 71% 86% 78% 74% 76%Hospital Staff Responsiveness 64% 54% 59% 86% 81% 78% 72% 65% 46%Pain Management 71% 70% 66% 76% 75% 82% 68% 67% 62%Communi8cation about Medicines 62% 57% 57% 78% 67% 72% 66% 57% 64%Hospital Cleanliness and Quietness 65% 62% 54% 77% 63% 70% 63% 57% 63%Discharge Information 83% 82% 79% 91% 88% 91% 86% 83% 83%Overall Hospital Rating 69% 75% 60% 82% 73% 84% 70% 70% 65%

YTD % Top Box Responses as of August 18, 2012

Physician Satisfaction (Geneva)

• Monthly CMO report to all physicians with tips on patient satisfaction. (Press Ganey & HCAHPS primer /UHC Webcast)

• Physician Satisfaction discussed at each MEC meeting with hard data sharing.

• Quarterly individual scores with each patient answer shared with each physician (ED included)

• Data is extracted from the PG website

• Follow up with poor performers (< 50th percentile)

• Expectations made clear (ED- reimbursement tied to scores)

UH Richmond Physicians Plan

• Attending Physicians– Share personal data– Post data publicly– Encourage compliance

• Hospitalists– Monthly reporting and discussion of scores– Direct Observation initiative

• Simulation training

– HCAHPS training videos (CWRU psych dept)– Payment incentives

• Resident Staff– Direct Observation plus training videos– Continued education

• HCAHPS• Professionalism

UHCMC In-patient 2012 PlanPatient Satisfaction Bundle Processes

* Introduce/shake hands

* Use names

* Make eye contact/sit

* White board

* Daily rounds

* Don’t interrupt/watch tone

* Show empathy

* Speak with families

* Daily rounds

* Stay up to date on tests

* Explain meds in a complete way

* Explain diagnosis

* Teach back methods

* Recommendations for treatment

* Explain the clinical course

* Clear follow up appts

* Explain how to get advice/help

* Follow up phone call

Aim

To consistently

achieve excellence

in patient

experience as

measured by top

quartile outcomes

on HCHAPS and

Press Ganey

surveys

Drivers

• Connect with me

• Communicate and involve me in my care

• Check on me

• Teach me

• Follow-up with me

Interventions/Processes

UHCMC Resident Pilot Data: 199 patients and 58 physicians comparative study

How much time do you want your physician to spend with you daily?

A. B. C. D. E.

0% 0% 0%0%0%

A. 5-10 minutes

B. 10-15 minutes

C. 15-20 minutes

D. 20-30 minutes

E. Greater than 30 minutes

What percentage of patients could name their physician?

A. B. C. D. E. F. G.

0% 0% 0% 0%0%0%0%

A. 5%

B. 10%

C. 20%

D. 30%

E. 50%

F. 70%

G. 100%



0%10%20%30%40%50%60%70%80%90%

100%

KnowPhysician

NamePhysician

DescribePhysician

Updatedon Plan

Physician

Patient



02468

1012141618

How MuchTime

How ManyTimes

Physician

Patient



0%

10%

20%

30%

40%

50%

60%

70%

Physician Communication Time Spent with Physician

Patient Excellentor AboveAverage

Patient Averageor Poor

PhysicianExcellent orAbove Average

PhysicianAverage or Poor

Patient Advocate Data

• 2012 Jan - Sept • Total # of Patient Advocate Entries: 2996

– Complaint: 2063– Compliment: 79– Grievance: 293– Request Info: 145– Non-patient issues/visitor: 416

Patient Advocate Data

• Communication Issues play a part in 1947 complaints

• Of those, the top 5 breakdown issues under communication– General Communication Issue: 947– Rude Behavior: 399– No Clinical Feedback: 165– Lack of information: 95– Miscommunication: 65

Advocate Office

• Complaint: – Lack of information regarding treatment

– Poor pain control

– Don’t know name of attending

• MD response to Advocate – I round everyday

– Complaints ridiculous

Advocate Office

• Complaint:– MD asked about patient’s HIV meds with visitors in room

– Visitors unaware of patient’s HIV status

• Compliance Office: – Office of Civil Rights follow up in similar case

Patient Advocate

• Complaint:– Called office nurse and MD lines 3-4 times without call back

– Went to ED for treatment

– After ED visit called office without return call

– Did get MD office appointment

– At visit MD states unaware patient ever called office

Patient Advocate

• Complaint:– MD not listening to pain issues

– Request another physician

– Now with planned surgery patient concerned regarding surgical pain and chronic pain


Thank You.

the patient experience: the good, the bad, the ugly

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