Your Impact on HCAHPS

Sarah D. PonderImprovement Manager

Press Ganey Associates

HCAHPS 101

3

Consumer Assessment of Healthcare Providers and Systems

Produces comparable data for public reportingCreates incentive for organizations to improveEnhances public accountability and transparency

Hospital CAHPSHome Health Care CAHPSClinician and Group CAHPS… more to come!

CAHPS provides an apples to apples metric for publicreporting—additional measurement may be needed for ongoingquality improvement activities and monitoring.

What is CAHPS?

4

Consumers have access to the data

Consumers relate more easily to CAHPS ® data than to clinical data

Some use CAHPS ®

data to choose hospitals

CAHPS ® is in the public eye

Media coverage

Promotion by hospitals themselves

Participation linked to reimbursement

Will have volume, revenue, and reputation implications down the road

Why is CAHPS ® Important?

5

HCAHPS Survey

6

HCAHPS Survey Format

Evaluative Questions

Global Rating Questions Screening Questions

About You Questions

7

Hospital EnvironmentDuring this hospital stay, how often were your room & bathroom kept clean?

Never, sometimes, usually, always

During this hospital stay, how often was the area around your room quiet at night?

Never, sometimes, usually, always Overall RatingUsing any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?

0-worst—10-best possible hospital

Would you recommend this hospital to your friends & family? Definitely no, probably no, probably yes, definitely yes

Questions you Impact

8

Patient Eligibility

All payer types

18 years or older

At least one overnight stay in the hospital (admit date & discharge date cannot be the same)

All MS-DRGs except: Primary psychiatric diagnosis, discharged from rehab or from

skilled nursing

Alive at the time of discharge

Not sent to patients with an international address

Not sent to patients discharged to hospice or correctional facilities

New: Not sent to patients discharged to nursing home or skilled nursing

General Survey Guidelines

9

Hospitals SHOULD

Encourage response to the survey

“It is permissible to notify the patient while in the hospital or at discharge that they may receive a survey after discharge.”

Improve the patient experience

Distribute the communication guidelines

Hospitals SHOULD NOT

Ask patients for a certain score

Indicate that their goal is to receive a certain score

New: Show the HCAHPS survey or cover letter to the patient prior to survey administration

New: Mail pre-notification letter or postcards

Communication Guidelines

Public Reporting

11

DomainsCommunication with DoctorsCommunication with NursesResponsiveness of Hospital StaffPain ControlCommunication about MedicinesDischarge Information

QuestionsCleanliness of Physical EnvironmentQuiet of Physical EnvironmentOverall Rating of CareLikelihood to Recommend

HCAHPS Public Reporting

12

Data are adjusted based on the following: Patient Characteristics (“patient mix adjustment”)–Examples

– Type of Service (Medical, Surgical, OB)

– Self Reported Health

– Age

– Education

– Language

– Emergency room admission

Mode of survey distribution (“mode adjustment”) Phone Mail Mixed mode- mail & phone Active Interactive Voice Response

General Guidelines: Adjustments

13

Updated Public Reporting Schedule

April 2011: Discharges from July 2009 – June 2010

July 2011: Discharges from October 2009 – September 2010

October 2011: Discharges from January 2010 – December 2010

January 2012: Discharges from April 2010 – March 2011

14

Tables- Distribution of Responses

15

The yellow bars indicate the National & State averages.

The blue bars indicate the averages for facilities selected.

Graphs - Percentage of “Always” Responses

16

Additional reporting programs through the states of California, Rhode Island, Minnesota, Ohio, Maryland, Maine

State Reporting Programs

Value Based Purchasing

18

Common Terminology: Pay for performance or Pay for quality

Health Reform UpdatesValue Based Purchasing will start in fiscal 2013Current hospital VBP program will transition from “Pay-for-Reporting” to “Pay-for Performance”

Up to 2% of your Medicare reimbursement will be at stake Hospitals will lose reimbursement unless their performance is at benchmark

levels Includes HCAHPS performance and Core Measures Will start at 1% and this will be ramped up to 2% by 2017

Who will be reimbursed for HCAHPS performance? Top performing healthcare providers Greatest improving healthcare providers

Value-Based Purchasing

19

Future Measures

AHRQ patient safety indicators, inpatient quality indicators and composite measures

Nursing sensitive care

AMI, heart failure and pneumonia mortality rates

Hospital Value Based Purchasing - Measures

20

Nurse Communication Doctor Communication Cleanliness and quietness Responsiveness of hospital staff Pain management Communication about medications Discharge information Overall hospital rating

HCAHPS Measures Used In Value Based Purchasing

Copyright © 2011 Press Ganey Associates

21

Hospitals will be awarded points toward their earn back of withheld DRG payments.

Earn Achievement Points based on your performance on HCAHPS publicly reported measures. The spread between the threshold to benchmark

Earn Improvement Points based on improvement from the baseline period. Baseline to 95th

HCAHPS 8 Measures – 80 Possible Points

1 Consistency Score- 20 Possible Points

Value Based Purchasing Model

22© MHA 2009

Up to 20 Points Based on Lowest Ranking HCAHPS Measure

HCAHPS “Consistency” Points

Copyright © 2011 Press Ganey Associates

10

10 20 30 40 50 60 70 80 90 99

Percentile Rank •

20

23

Proposed Timeline

Key Timeframes for VBP

The “Baseline Period” discharges July 1, 2009 – March 31, 2010. The “Performance Period” discharges July 1, 2011 – March 31, 2012.

Copyright © 2011 Press Ganey Associates

Moving from Measurement to Action: Improvement Strategies

So where do we do focus?

Patient Priorities

Lowest Ranking Question

Most Opportunity to Earn Money Back

Create Performance Improvement Teams Around Each Publicly Reported Measure

26

National HCAHPS data by Service Line

27

28

Step 1: Identify a Goal

[S] Specific. Exactly what is it you wish to accomplish?

[M] Measurable. Identify the means by which you will achieve each goal. How will you know when you have reached it? Keep in mind that you will always have more control over performance than you will over outcome so set performance goals whenever possible.

[A] Action-oriented. Describe your goals using action verbs. What will you do (step by step) to reach your goal?

[R] Realistic. Choose goals that are possible and achievable. Goals set too high will discourage while goals set too low will not challenge and motivate.

[T] Timed. Determine deadlines for each of your goals. Deadlines can be flexible & adjusted as needed but deadlines help keep you focused and moving. 

29

Look at patient comments for trends or patterns Conduct patient & employee focus groups Fishbone Diagram at a high level

“5 Why’s” What is causing area of poor performance? Root cause analysis Flowcharting What are the CTQs?

Step 2: Identify the Cause

Patient Expectations

30

Thinking backwards from the score itself

What is the perception of patients? What do they experience? (long wait, conflicting information, being

alone, in pain, etc.) How does it make them feel? (unvalued, confused, lack of trust, lonely,

afraid, stressed, etc.)

Causes don’t create a score, they create an environment in which a patient feels a certain way- that is what shapes how they evaluate care

Determining cause is extremely important- it ensures you are efficient in your choice of strategy for improvement

Cause- Solution Relationship

31

Make two columns: one with patient experiences & one with patient feelings

Then make chart (below)- with your own ideas

Then take this back to staff & get their input

Cause Solution Activity

32

Selecting a Course of Action:

We have identified that we can impact the following causes:

Because we can either: Modify the cause itself Modify how patients feel

We are selecting the following viable practice to match the causes of the patients’ current experience:

It should address the experience of patient (i.e. reduce wait time) or change the way a patient currently feels (i.e. reduce anxiety):

Cause Solution Activity (cont.)

33

Which causes are you trying to address? Which causes do you have control over? Will you modify a cause or shape perception?

Does the selected solution address the causes or perceptions you have control over?

Will the selected solution be visible to patients? Will it be big enough to change? Will it impact all patients?

Is there anything you need to fix first, before you can implement this solution?

Step 3: Recommend a Solution

34

“During this hospital stay, how often were your room & bathroom kept clean?

Ask patients when leaving the room if the room meets their cleanliness standards & if they would like anything else cleaned.

Increase frequency of non-daily cleanings (i.e. washing walls, waxing the floor, etc.)

Reinforce cleanliness by emptying waste baskets multiple times a day, offering to change sheets, etc.

Make all staff accountable for the appearance, not just environmental services

Include environmental services on unit cross functional teams

Room & Bathroom Kept Clean

35

“During this hospital stay how often was the area around your room quiet at night?”

Modify equipment: Foam on trash cans, squeaky wheels on carts fixed, oil on doors, no

overhead announcements, dim lights, phone ringers turned down Use a dosimeter to measure noise levels on unit & track for a

period of time Work cross functionally with other departments to get

feedback regarding building or equipment noise Provide patients with a welcome kit that talks about “Quiet

hospitals help healing” that contains ear plugs, eye covers, & note that says: “one who has a good night’s rest awakes to a glorious morning”

Quiet at Night

36

“Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?”

“Would you recommend this hospital to your friends & family?”

Empower all staff with power to “make it right” with patients Hire for attitude over aptitude, it is easier to teach skills than

service Share data openly with all levels of the organization Focus on employee satisfaction, happy employees make for

happy patients Use multiple outlets for patient feedback, especially creating a

patient advisory council

Rate & Recommend this Hospital

Universal Viable Practices

38

“Maintenance” Rounds Conducted a minimum of once per shift, environmental services staff

visit each patient on the floor to make sure the cleanliness of the room meets their standards

Introduction Rounds Each morning environmental services staff brings the morning paper to

the patient with a sticker on it that says the staff member’s name & a contact number if at any point the room needs attention

Appearance Rounds Once a day the building services director rounds on specific units &

areas to get feedback from unit directors & managers on their current needs (i.e. light is out in room 203 or heater is not operational in conf room)

Cross Functional Team Rounds A member of both the environmental services team & the building

services team should sit on the patient satisfaction committees throughout the organization to help address related patient needs

Rounding

39

Key messages should be used when there is an important message all patients should receive

Make sure a key message is: Staff that are going to use the key messages help to develop them Clear, short, and easy to understand Sounds natural and can be customized by staff

Limit 4-5 key messages per staff member

Examples: Greeting patients and families Entering and leaving patient rooms Communicating about actions that protect privacy/safety Informing patients of hospital services Patient rounds

Key Messages

40

Service Moments of Truth

41

Keep it simple & easy for everyone to remember

Have one toolkit for every department

A no questions asked policy should be enforced for toolkit usage

Have tracking spreadsheet to look for service patterns

Not all complaints warrant toolkit usage, most issues just require a sincere apology

Employ a Service Recovery Strategy

“H.E.A.T.” Philosophy Hear Empathize Apologize Take responsibility

“H.E.A.R.T.” Philosophy Hear the patient Empathize with the patient Apologize to the patient Respond to the patient Thank the patient

“Relate” Philosophy Recognize concern Empathize Listen Apologize Take responsibility Explain what you are going to do

“6 A’s” Awareness Acknowledgement Apology Active Listening Action, Amendment Avoiding

42

Read patient comments to see if your staff members are mentioned by name

Have a recognition program that allows staff members to nominate each other for going above & beyond

Have a service hero of the month in your department Customize your recognition to the individual staff member

In your one on one meetings with them ask them what their favorite food, restaurant, pasttime, etc.

Celebrate birthdays & recognize anniversaries Celebrate your improvement with banners or trophies Schedule team outings or treats (i.e. pizza parties or ice cream

socials) Hand written notes sent to their home

Reward & Recognition

43

Have a bulletin board outside your department that contains: Patient satisfaction scores Patient comments that mention your department or staff Priority for the quarter or six month period Letters from patients Customer hero of the month Employee to employee recognition

Educate new staff members on the survey process & your goals

Create monthly electronic/printed dept. newsletters & dedicate a section to patient satisfaction data

Data Sharing

44

“Director of First Impressions” Security, front desk staff, volunteers, etc.

“Fresh as a Daisy”

Color choices in patient rooms & hallways

No flyers/posters taped to the walls or elevators

Way-finding/signage

Employee satisfaction focus

Anticipate patient needs

Separate areas on the units for physician/family consults

Other General Practices

45

Two main phases: 1. Preparation

a) Project team & roles

b) Communication

c) Development of training

d) Preparing measurement

e) Preparing accountability

f) Prepare logistics

2. Execution

a) Educate

b) Roll-out: follow through on your plan

Step 4: Implement a Solution

46

Monitor: Measure Behavior Tracking Observation Self-Reporting Auditing Feedback

Review: Did you meet your Goal?

Yes Celebrate Increase Goal or Sustain

No Why Not?

Steps 5 & 6: Monitor & Review

47

Thank you for attending!