Working to Improve the

Patient Experience

June 27, 2013 10:00-11:30a.m.

Arizona Critical Access Hospital Quality Network

Arizona Rural Hospital Flexibility Program

AZ-CAH Quality Network

CAH Participants

Benson Hospital Teresa Vincifora Ora Goodman Amanda Osuna

Carondelet Holy Cross Hospital Lloyd Brown Debra Knapheide

Cobre Valley Community Hospital Kara Holcomb

Copper Queen Community Hospital Claudia Romo Sadie Maestas

Hopi Health Care Center LeeAnn Beach

Hu Hu Kam Memorial Hospital Sarah Wolterman

Little Colorado Medical Center Sonia Ybarra Leslie Fusaro

Northern Cochise Community Hospital Susan Cazaux

Page Hospital

Parker Indian Health Center Sherry Killingsworth Lily Shimahara

Sage Memorial Hospital Christi El-Meligi

Southeast Arizona Medical Center Annie Benson Robi Berry

White Mountain Regional Medical Center Cherie Passalacqua

Wickenburg Community Hospital Linda Brockwell Judy Carroll

Purpose of Today’s Webinar

• Strengthen the AZ-CAH Quality Network

• Support hospitals in selecting QI project to improve patient satisfaction

• Discuss process for sharing HCAHPS Scores

• Identify next steps

I. Welcome and Introductions

II. Updates and discussion of current AZ-CAH use of HCAHPS

• AZ-CAHs HCAHPS Scores

• Experience with vendors

– Aims Statements

– Data Exchange

• Plans to improve the patient experience

III. Pt. Satisfaction QI Projects

a. Benson Hospital– Pain Management

b. Discussion of projects

IV. AZ CAH Awards and recognitions

V. Introduction to Wendy Perrell

VI. Next Steps - August 1st Workshop

VII. Summary & Evaluation

Agenda

HCAHPS Reported by Hospitals

Established New to HCAHPS Not currently

Carondelet Holy Cross Benson Hospital Hopi Health Care Center

Cobre Valley Reg. Medical Ctr. Hu Hu Kam Memorial Hospital Little Colorado Medical Center

Copper Queen Comm. Hospital Northern Cochise Comm. Hospital Parker Indian Health Center

Page Hospital White Mountain Reg. Med. Ctr. Sage Memorial Hospital

Wickenburg Comm. Hospital Southeast Arizona Medical Ctr.

• How are you receiving HCAHPS data? – What frequency? – What format? – What kinds of reports?

• How are you using HCAHPS information? – Who receives reports? – What hospital areas

• Are you satisfied? – Examples of use – Suggestions for improvement?

• What questions do you have?

Discussion

HCAHPS Survey: Nurse Communication

Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor Data

0 10 20 30 40 50 60 70 80 90 100

H

A

D

J

B

Arizona

I

K

Nurses Communication

%

HCAHPS Survey: Doctor Communication

Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data

65 70 75 80 85 90 95

H

B

D

J

A

I

Arizona

K

Doctors Communication

%

HCAHPS Survey: Cleanliness of Room/bathroom

Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data

0 10 20 30 40 50 60 70 80 90 100

J

H

A

D

I

B

Arizona

K

Cleanliness of Room/bath room

%

HCAHPS Survey: Quietness at night

Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data

0 10 20 30 40 50 60 70 80

D

J

B

H

K

A

I

Arizona

Quietness at night

%

HCAHPS Survey: Responsiveness from Hospital Staff

Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data

0 10 20 30 40 50 60 70 80 90

D

H

I

J

B

Arizona

A

K

Responsiveness from Hospital Staff

%

HCAHPS Survey: Pain Management

Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data

0 10 20 30 40 50 60 70 80 90

H

D

A

Arizona

I

J

B

K

Pain Management

%

HCAHPS Survey: Communications about Medications

Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data

0 10 20 30 40 50 60 70 80 90

B

H

J

D

Arizona

K

I

A

Communications about Medications

%

HCAHPS Survey: Discharge Information

Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data

%

0 10 20 30 40 50 60 70 80 90 100

J

K

D

Arizona

B

I

A

H

Discharge Information

HCAHPS Survey: Willingness to Recommend Hospital

Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data

0 10 20 30 40 50 60 70 80 90 100

B

K

A

H

J

Arizona

D

I

Willingness to Recommend Hospital

%

HCAHPS Survey: Overall Rating of Hospital

Abstracted from Hospital Compare (December 2012, Bullock) and Hospital Vendor data

0 10 20 30 40 50 60 70 80 90

B

H

Arizona

A

K

D

J

I

Overall Rating of Hospital

%

Answer the question, “What are we trying to accomplish”?

Communicate expectations

Are time specific

Are measureable

Define the specific population or populations affected

Are clear and unambiguous

Can be used in your elevator speech

They aim BIG

Source: Dr. Andrea Silvey, HSAG, adopted from Institute for Healthcare Innovation

Effective Aim Statements

• How did you select the project?

• What data did you use?

• Who was / is involved?

• How will QI project information be monitored?

• How does it fit into existing hospital QI projects

• Is there an Aim Statement?

QI Projects Presentations

Benson Hospital

HCAHPS Improvement Project: Pain Management

AZ-CAH Example

• Inpatient Discharge Surveys 4th Quarter 2012

• HCAHPS Scores 4th Quarter 2012

Sometimes Usually Always N/A

How often was pain well controlled? 2% 26% 66% 6%

Adjusted N (Statbase)

Top Box

HSTM DB Top

Box

How often was pain well controlled? 7 43% 67%

How often did staff do everything to help with pain? 7 86% 80%

Identifying the Project

Benson Hospital

AIM Statement:

By December 2013, 85% of Benson Hospital inpatients will report that their pain was always well controlled throughout their hospital stays.

Performance Improvement Team Created

Chief Clinical Officer, Nursing Supervisor, Clinical Nurse Educator, Case Manager

Benson Hospital

Moving Forward

• Thorough pain history/assessment on admission • Establishing a pain goal with each patient • Use of white boards for communication • Hourly rounding • Patient education • Follow up

Plan

Benson Hospital

Room # Date

PAIN GOAL: MEDICATION: ________ LAST DOSE GIVEN NEXT DOSE AVAILABLE _______ RN: CNA:

White Board Information

Benson Hospital

• One full week of hourly rounding has been completed by staff

• All admission assessments since implementation have an established pain goal, and all shift assessments compare the current pain level to the pain goal

• Progress is being communicated to CEO and others at the monthly PI/CAH meeting

Monitoring

Benson Hospital

kk Best Practices: Pain Management

Patients who reported that their pain was "Always" well controlled

Tactics that make “Always” responses more likely 1. Use Individualized Patient Care to Manage

Patient Perception of Pain 2. Conduct Hourly Rounding to Consistently

Address Pain 3. Pain Poster

Source: The HCAHPS Handbook, Studor (2010)

Hospital Recognition

Rural Route, June 2013 CAH Recognition Certificate Recipient for June: Page Hospital, Page, Arizona Congratulations to Page Hospital in Page, Arizona recipient of the Critical Access Hospital (CAH) Recognition Certificate for quality from the National Rural Health Resource Center (The Center). Page Hospital was nominated by Arizona Flex Coordinator Kevin Driesen who pointed out the following ways Page Hospital is deserving of recognition.

"I am pleased to nominate Page Hospital to receive public recognition for having demonstrated excellence and innovation in the area of quality," said Driesen. Page Hospital has demonstrated its leadership and innovation among Arizona's rural hospitals. It is well-managed, provides high quality patient-centered care, and operates in a unique rural environment.

Publicly reporting to Hospital Compare and participating in MBQIP including HCAHPS Leadership has remained stable, and the Hospital employs a strong management team. The Hospital signed a Medicare Beneficiary Quality Improvement Project (MBQIP) Agreement with the AZ-Flex program in 2011 and regularly submits Hospital Compare quality data for pneumonia, heart failure, surgical care, outpatient, and patient satisfaction metrics.

Demonstrated excellence in quality initiatives with documented outcomes The Hospital maintains accreditation through The Joint Commission and its quality outcomes and operational performance rates high relative to peers. In celebration of the 2012 NOSORH National Rural Health Day, iVantage Health Analytics completed an assessment using national health datasets to identify high performing hospitals, those in the top quartile of its iVantage Hospital Strength Index. For this assessment, Page Hospital was Arizona's highest performing hospital, receiving recognition in three-of-four quality-of-care categories: (i) Excellence in Quality (for HF, PN, SCIP, and OP); (ii) Excellence in patient satisfaction (HCAHPS "Willingness to Recommend" and "Overall Quality"); and (iii) Excellence in Efficiency (Cost-to-Charge index). Not surprisingly given Page Hospital's high quality rankings, the Hospital also performs well on financial and operational performance metrics as documented by the Flex Monitoring Team. Specifically, Page Hospital's profitability, cost, and capital structure metrics compare well with peers.

Demonstrated Innovation Page Hospital demonstrates innovation through participation in different initiatives. For example, Page Hospital participates in the Centers for Medicare and Medicaid (CMS) Partnership-for-Patients initiative through the Premier Hospital Engagement Network (HEN). Recently, the Hospital opened an Intensive Care Unit, using eICU Technoloy, a remote monitoring system that uses a two-way, audiovisual communication system to allow staff to see and speak directly with the patient in a room while the patient can see and hear a nurse on a monitor located across from their beds. Page Hospital staff has participated in various AZ-Flex quality initiatives including a collaborative to improve medication reconciliation and efforts to achieve designation as a Level IV Trauma Center.

Copper Queen Community Hospital HCAPHS Strategies • Use of Press Ganey as our patient satisfaction consultant and implementing

recommended tactics to improve performance in low scoring areas • Manager evaluations were developed which incorporated patient satisfaction into

the performance review process • Tracking and reporting patient satisfaction scores monthly through our quality

assurance process improvement committee • Incorporation of patient satisfaction into the strategic planning of the hospital and

holding all parties accountable • Making patient satisfaction one of the 3 key pillars of focus which is discussed at

numerous meetings, from the departmental level up to the Board of Directors • Press Ganey is able to provide how we score on the Value Based Purchasing scale

so we are also using those indicators to focus our improvement efforts. • These strategies have helped us begin to change the corporate viewpoint and

culture of the organization.

Copper Queen Community Hospital recognized for Quality

Hospital Recognition

Hospital Recognition

Next Steps

• Communication – develop project ideas - Flex staff and AZ-CAH Quality Network peers

- Situational analyses with your hospital teams

• Identify QI projects - Aim Statements

• Introduce Wendy Perrell

• Attend AZ-CAH workshop August 1

• Technical Assistance available

• Share HCAHPS data

Working to Improve “The Patient Experience” Workshop Learning Objectives: This workshop will provide a “hands-on” opportunity with an expert, working to get the most from your HCAHPS data.

Logistics:

Date: August 1, 2013

Time: 9-3:30 pm

Location: T-Health Institute · 550 E Van Buren, Phoenix, AZ (3rd floor)

Moderator: Wendy Perrell · SyncroDestiny Coaching

Preparation: Please bring vendor log in & password

Hotel Information: A block of rooms have been reserved at the Marriot Springhill Suites. 802 E. Van Buren. Phoenix AZ 85006, 602-307-9929 for July 31. Please use code AZ-CAH Quality Network. Parking is free at the hotel and is in walking distance to workshop. Travel reimbursement available upon request

Tele-conference connection: Available for those who can’t attend in person. Please contact Jill Bullock by July 15, 2013 for system testing

RSVP: Jill Bullock · 520-626-3722 · bullock1@email.arizona.edu

Upcoming Events

• Please send HCAHPS scores / reports • Develop your QI projects • Communicate TA service needs • AZ-CAH Workshop (August 1, 2013 T-Health

Institute) – Preparation: Please bring vendor log in & password – Send Aims Statement to Jill Bullock – Show/share vendor quality reports workshop

presentations – Discuss strategies to improve pt. satisfaction – Discuss strategies to analyze data

Homework

Medicare Beneficiary Quality Improvement Program (MBQIP)

• Participation Agreements signed – 11 AZ-CAHs – 1,139 National CAHs

• Encourage participation in Hospital Compare / HCAHPS – Phase 01 Measures (Pneumonia / HF) – Phase 02 Measures (HCAHPS, Outpatient) – Phase 03 Measures (ED & Pharmacy, Sept 2013)

• AZ-Flex working in collaboration with HSAG • Second MBQIP report release (June 2013)

– Data Aggregated for four quarters to increase #s

• Summary quality reports will be distributed at August 1st Quality Network

Thank You!

Arizona Rural Hospital Flexibility Program This webinar is made possible through funding provided by the Health Resources and Service

Administration, Office of Rural Health Policy, Medicare Rural Hospital Flexibility Program

Please call us / your peers with any

related thoughts / feedback