copyright ©2011 georgia hospital association mbqip phase 2 focus on hcahps critical access hospital...
TRANSCRIPT
Copyright ©2011 Georgia Hospital Association
MBQIP Phase 2Focus on HCAHPS
Critical Access Hospital PresentationJuly 23 2014
Copyright ©2011 Georgia Hospital Association
Objectives
• Define the 3 phases of the Office of Rural Health MBQIP program
• Describe Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) • Understand the value of engaging in the
HCAHPS process• Identify the benefits and challenges of HCAHPS• Review HCAHPS Vendor Directory
Copyright ©2011 Georgia Hospital Association
Medicare Beneficiary Quality Improvement Project • Began September 2011, voluntary-register on Quality Net 100% participation goal by FY 2014• Nationwide quality improvement plan for rural healthcare
• Improves access for Medicare beneficiaries served, including EMS• Voluntary CAH quality benchmarking & reporting to CMS Hospital Compare• Builds a national data base to demonstrate effect of rural quality improvement
initiatives
• Phase I Process measures for inpatient Pneumonia & HF• Phase II- Outpatient measures 1-7 and HCAHPS• Phase III-Pharmacy CPOE review of orders in 24 hours
& ED transfer communication & report quality improvement data to state
Copyright ©2011 Georgia Hospital Association
MBQIP – Why participate?
• Promotes accountability & public disclosure
• Future of all hospital reimbursement will soon be tied to performance-Get ahead of the curve
• Only statistically significant volumes will be reported (>25 cases)
• Gives benchmark data to analyze and guide performance improvement
• It’s the RIGHT thing to do ! Evidence drives improvement
Copyright ©2011 Georgia Hospital Association
The Patient Experience of Care is Fundamental to Clinical Improvement
Understanding the patient experience of care is not an add-on activity: it should be used as a fundamental element in your other improvement efforts.
For those working on the GHA Partnership for Patients Hospital Engagement Network (HEN) your work will benefit directly from your efforts to improve the patient experience of care.
Patient-centered care is a driver of clinical outcomes
Employee and patient engagement are 2 sides of one coin
HCAHPS assesses key factors in ADEs and readmissions
Copyright ©2011 Georgia Hospital Association
New Care Transition composite will be publicly reported on Hospital Compare, October 2014
Copyright ©2011 Georgia Hospital Association
Vendors GA Rural/CAH hospitalsVENDOR List as of April 2014
AVATAR INTERNATIONAL INC (1)HEALTHSTREAM RESEARCH (8)JL MORGAN AND ASSOCIATES INC (2)NATIONAL RESEARCH CORPORATION ( 5)NO VENDOR (1)PRESS GANEY ASSOCIATES (6)RURAL COMPREHENSIVE CARE NETWORK (4)
Copyright ©2011 Georgia Hospital Association
• Hospital level results reported at http://www.hospitalcompare.hhs.gov
• Additional reports on HCAHPS website (http://hcahpsonline.org)– Top box scores by state– Percentiles– Correlations– Hospital Characteristics
HCAHPS reports
Copyright ©2011 Georgia Hospital Association
Comparative DataJune 30 2012-July 1 2013
Patients who reported that their nurses "Always" communicated well.
Patients who reported that their doctors "Always" communicated well.
Patients who reported that they "Always" received help as soon as they wanted.
Patients who reported that their pain was "Always" well controlled.
Patients who reported that staff "Always" explained about medicines before giving it to them.
Patients who reported that their room and bathroom were "Always" clean.
Patients who reported that the area around their room was "Always" quiet at night.
Patients who reported that YES, they were given information about what to do during their recovery at home.
Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).
Patients who reported YES they would definitely recommend the hospital.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
84%
85%
74%
77%
71%
78%
72%
85%
72%
71%
78%
82%
65%
70%
64%
71%
66%
83%
70%
70%
GA Hospital Average FLEX hospital Average
Copyright ©2011 Georgia Hospital Association
Communication with Nurses
During this hospital stay…how often did nurses treat you with courtesy
and respect? (Q1)how often did nurses listen carefully to you?
(Q2)how often did nurses explain things in a way
you could understand? (Q3)
Copyright ©2011 Georgia Hospital Association
Communication with Nurses
Success Strategies:Hourly RoundingWhite Boards/Care BoardsBedside ReportingAIDETAscertain need for and obtain language
assistance.
Copyright ©2011 Georgia Hospital Association
Communication with Doctors
During this hospital stay…how often did doctors treat you with courtesy
and respect? (Q5)how often did doctors listen carefully to you?
(Q6)how often did doctors explain things in a way
you could understand? (Q7)
Copyright ©2011 Georgia Hospital Association
Communication with Doctors
Success Strategies: Using strategic language – I am washing my hands for your SAFETY.”– “I have TIME to answer your questions.”– “I want you to be INVOLVED in your treatment plan” – “I want to be sure I EXPLAIN everything to you…”– “To protect your PRIVACY, let me close the curtain.”– “For your COMFORT, I ordered pain medicine...”– “I want to keep you INFORMED…”– “I want to make sure we are THOROUGH”– “You are in good hands with the nurses on this floor.”
• STUDER
Copyright ©2011 Georgia Hospital Association
Responsiveness of Hospital Staff
During this hospital stay….
after you pressed the call button, how often did you get help as soon as you wanted it? (Q4)
How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted? (Q11)
Copyright ©2011 Georgia Hospital Association
Responsiveness of Hospital Staff
Success Strategies:“No Pass” ZonesHourly rounding
Copyright ©2011 Georgia Hospital Association
Pain Management
During this hospital stay,
how often was your pain well controlled? (Q13)
how often did the hospital staff do everything they could to help you with your pain? (Q14)
Copyright ©2011 Georgia Hospital Association
Pain ManagementSuccess Strategies:
• Patients’ experience of pain management is not entirely dependent on their level of pain
• Pain management perceptions are affected by many factors, including:– Effective communication with physicians and nurses– Responsiveness – Empathy
• Set Reasonable Expectations– Be candid about the pain to be expected– Keep the patient informed
• e.g., use the white board to keep the pain goal and plan visible, as well as next scheduled medication
• Respect the Patient’s Expertise– Discuss options, tradeoffs, and preferences, including what has worked previously – Develop pain goals and a plan
• Explain the purpose of the pain scale• Ask patients contextual questions
– e.g., at what point on the scale would they take an over the counter medicine for pain
Copyright ©2011 Georgia Hospital Association
Communication of Medications
Before giving you any new medicine,
how often did hospital staff tell you what the medicine was for? (Q16)
how often did hospital staff describe possible side effects in a way you could understand? (Q17)
Copyright ©2011 Georgia Hospital Association
Communication of Medications
Success Strategies:TV Education channel Involving multidisciplinary approach
Dietician Respiratory Clinical Pharmacist
White Boards– List new Medications– Document teaching for cross communication and
reinforcement
Copyright ©2011 Georgia Hospital Association
Discharge InformationDuring this hospital staydid doctors, nurses or other hospital staff talk
with you about whether you would have the help you needed when you left the hospital? (Q19)
did you get information in writing about what symptoms or health problems to look out for after you left the hospital? (Q20)
Copyright ©2011 Georgia Hospital Association
Discharge InformationSuccess Strategies:Identify the correct medicines and a plan for
the patient to obtain and take them.Use “target tool” to educate the patient about
his or her diagnosis and self management
Copyright ©2011 Georgia Hospital Association
Care Transition
During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left.(Q23)
When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. (Q24)
When I left the hospital, I clearly understood the purpose for taking each of my medications. (Q25)
Copyright ©2011 Georgia Hospital Association
Care Transition
Success Strategies:Make appointments for follow-up medical
appointments and post discharge tests/labs. Organize post-discharge outpatient services and
medical equipment.Provide telephone reinforcement of the Discharge
Plan.
Copyright ©2011 Georgia Hospital Association
HCAHPS: Global ItemsOverall rating of the hospital 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? (Q21)
Recommendation of hospital Would you recommend this hospital to your friends
and family? (Q22)
Copyright ©2011 Georgia Hospital Association
Individual Items
Cleanliness of Hospital Environment (Q8)
Quietness of Hospital Environment (Q9)
Copyright ©2011 Georgia Hospital Association
Individual ItemsSuccess Strategies: Staff returns if patient is not in room during
cleaning Gold stickers on toilet paper From: leaving tent cards To: “Get Well” cards Revise job descriptions and related materials
e.g., role is to prevent nosocomial infections
Bring out Quiet signs Inquire regarding quietness on unit during
rounding Ask about and preserve patient sleep rituals
e.g., a cup of tea, reading material, snack
Change EKG batteries & leads at a.m. shift change
Copyright ©2011 Georgia Hospital Association
How will HCAHPS Reinforce Focus on Quality?
• Patient-Centered care is a quality indicator• Quality no longer the domain of just the
clinicians• Gives a voice to the patient perception of safety• Highlights communication issues/barriers• Patient-centered care actively involves patients
in their care• More senior leaders are engaged and interested
in delivering patient-centered care
Copyright ©2011 Georgia Hospital Association
The Patient Experience of Care is Fundamental to Clinical Improvement
• HCAHPS is viewed as a valuable tool to help organizations achieve multiple objectives
• HCAHPS is part of a coordinated, comprehensive approach to partnering with patients and families
• Everyone works together as a team to identify opportunities for improvement, innovate and implement strategies, and celebrate success
Copyright ©2011 Georgia Hospital Association
HCAHPS Challenges
• Cost• Obtaining a meaningful response• Public perception that low volume could be a negative trait for a care provider
Copyright ©2011 Georgia Hospital Association
Foundational Elements of Patient-Centered Care
–Leadership–Patient/Family Partnership–Workforce Engagement–Data Use/Performance Improvement
HCAHPS Success Depends on A Strong Foundation
36
Copyright ©2011 Georgia Hospital Association
View patient experience data as an opportunity for “appreciative inquiry”Reveal hidden innovation within your own organizationExamine improvement (including change in “bottom
box” scores), not just achievement
Put HCAHPS data in context with other qualitative and quantitative information about the patient and staff experiencePreserve relationships by noting what is working well
Mine the Data for Solutions, Not Just Problems
Copyright ©2011 Georgia Hospital Association
Other Important Sources of Information
Patient Experience Post-discharge phone calls
Rounding
Patient and family focus groups
Patient and family advisory council/advisors
Ombudsman/patient advocate programs
Compliments
Staff Experience Employee Engagement Data
Staffing Levels
Patient Safety Culture Survey Data
38
Copyright ©2011 Georgia Hospital Association
Shadowing
A unique opportunity to gain a perspective on the experience through the patient’s eyes
Request patient permission Explain role is to observe and identify opportunities to improve care
that will help others Record observations
Patient/family perspective Your own reactions
39
http://www.pfcc.org/go-shadow/
Copyright ©2011 Georgia Hospital Association
Tools of the trade
Hunches, theories, ideas
Small scale test
Larger scale test of change
Implementation of change
Monitor change
Change that results is SUCCESS
Copyright ©2011 Georgia Hospital Association
Additional Resources
Fundamentals of HCAHPSUsing HCAHPS Data Effectively
Nurse Communication Responsiveness
Medication Communication Discharge Information
Physician Communication and Engagement Pain Management
Clean & Quiet
AHRQ/HRET Patient Safety Learning Network (PSLN) HCAHPS National Teleconference Series
http://www.psl-network.org/
Copyright ©2011 Georgia Hospital Association
Questions?
It is not just about scores, financial indicators, public reporting, % of
always…it is about compassionate care
and saving lives
Copyright ©2011 Georgia Hospital Association
GHA Contact Information
Kathy McGowan, Vice President of Quality & [email protected] 770-249-4519
Joyce Reid, Vice President of Community Health [email protected] 770-249-4545
Lisa Carhuff, Quality Improvement/Patient Safety Specialist Rural and Critical Access [email protected] 770-249-4553