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Minitab Insights Conference 2016 September 12-13, 2016
www.SprangerBusinessSolutions.com 1
Improving Patient Satisfaction with Minitab
Christopher Spranger, MBA, ASQ MBB
Preview
• Changing healthcare environment
• Patient satisfaction process
• Defining our opportunity
• Establishing a baseline
• Finding the “right” factors
• Implementing improvements
• Results & impact
Minitab Insights Conference 2016 September 12-13, 2016
www.SprangerBusinessSolutions.com 2
Changing Healthcare Environment: Value Based Purchasing
How the CAHPS System works
• Surveys administered by a 3rd party
• Standardized questions
• Only top box “counts”
• Domains
CAHPS = Consumer Assessment of Healthcare Providers and Systems
Minitab Insights Conference 2016 September 12-13, 2016
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Improving HCAHPS Scores
Project Title: Design a Patient Education Process
Project Goal: Improve HCAHPS Dimension for “discharge information”
Business Case: For Riverview Hospital, scoring below the Value Based Purchasing benchmarks represents a potential $4.5 million revenue loss over the next 5 years…HCAHPS is 30% of VBP!
“If you pour all of your resources toward improving a domain, expect a 2-3% increase in top box scores within a year.”
-3rd party survey administrator
Minitab Insights Conference 2016 September 12-13, 2016
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Baseline Performance: Discharge Domain
“Let’s develop a process to be performed in MSPI on admission that touches all different learning styles and focus on the needs of elderly, people who do not speak English as
a primary language, and people with lower education levels.”
~Chief Nursing OfficerDefine…
Measure…Analyze…Wait a second…
Minitab Insights Conference 2016 September 12-13, 2016
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Drilling in to find “key factors”
Discharge Domain
Symptoms or health problems to
watch out for?Have help you needed after
you left the hospital?
????? ? ? ? ? ?
Let’s test those assumptions…
The biggest opportunity “must” be… Hypothesis
Med/Surg/Peds Inpatients Ho: MSPI scores are no different than the rest of the inpatient unitsHa: MSPI scores are lower than the rest of the inpatient units
Patients with lower education levels Ho: Patients with lower education levels score the same as the rest of the patientsHa: Patients with lower education levels score lower than the rest of the patients
Patients who do not speak English as a primary language
Ho: Non English speaking patients score the same as English speaking patientsHa: Non English speaking patients score lower than the rest of the patients
Elderly patients Ho: Elderly patients score the same as the rest of the age groupsHa: Elderly patients score lower than the rest of the age groups
Minitab Insights Conference 2016 September 12-13, 2016
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What data is available?
Unit
Visit Identification
NumberHCAHPS Survey
Electronic Medical Records
• By using the Visit Identification number, we were able to correlate the survey responses to each patient’s individual experience
• This helped us identify the key factors we needed to work on to improve our overall scores
Differences between Units
• 3 different units
• Medical / Surgical / Pediatric unit
• Birthing unit
• Critical Care unit
• Data from most recent 12 month period
• One-Way ANOVA using Minitab Assistant to detect differences between the 3 different units
Minitab Insights Conference 2016 September 12-13, 2016
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ANOVA Output - Units
Unit Sample Size Mean
CCUI 23 .6957
FBPI 247 .8016
MSPI 859 .8778
MSP a low performer?
Differences in Education Level
• Seven different education levels recorded
• 4 year college graduate
• 4+ years college
• Some college
• High school graduate
• Some high school
• 8th grade
• NULL
• Data from most recent 12 month period
• One-Way ANOVA using Minitab Assistant to detect differences between the different education levels
Minitab Insights Conference 2016 September 12-13, 2016
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ANOVA Output - Education
Differences in Language
• Three different primary languages recorded
• English
• Other
• NULL
• Data from most recent 12 month period
• One-Way ANOVA using Minitab Assistant to detect differences between primary language
Minitab Insights Conference 2016 September 12-13, 2016
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ANOVA Output - Language
Differences in Age
• Patients aged 18 to 98 years
• Data from most recent 12 month period
• One-Way ANOVA using Minitab Assistant to detect differences between age
Minitab Insights Conference 2016 September 12-13, 2016
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Age Group Graphical Analysis:
0
5
10
15
20
25
30
35
40
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96
Age
Patients Given Information About What to do At Home
% Yes Sample Size
Interpretation of Results: Of the 18 age groups that answered “yes” less than 80% of the time, 7 were from age 29 to 37. Ages that answered “yes” less than 80% of the time: 20, 23, 24, 29, 30, 31, 32, 34, 36, 37, 43, 46, 62, 64, 80, 85, 89, and 90.
Age Group Comparison
88-9778-8768-7758-6748-5738-4728-371 8-27
1 00.00%
90.00%
80.00%
70.00%
60.00%
50.00%
Age Range
% Y
es
91.30%
86.93%88.84%88.21%87.32%
83.53%
71.54%
86.72%
Chart of % Yes by Age group
Minitab Insights Conference 2016 September 12-13, 2016
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Age Group Analysis:
Age Group Sample Size Mean
18-27 128 .867
28-37 130 .715
38-47 85 .835
48-57 142 .873
58-67 212 .882
68-77 233 .888
78-87 153 .869
88-100 46 .913% of “yes” responses
Let’s test our assumptions
The biggest opportunity “must” be… Hypothesis
Med/Surg/Peds Inpatients Ho: MSPI scores are no different than the rest of the inpatient unitsHa: MSPI scores are lower than the rest of the inpatient units
Patients with lower education levels Ho: Patients with lower education levels score the same as the rest of the patientsHa: Patients with lower education levels score lower than the rest of the patients
Patients who do not speak English as a primary language
Ho: Non English speaking patients score the same as English speaking patientsHa: Non English speaking patients score lower than the rest of the patients
Elderly patients Ho: Elderly patients score the same as the rest of the age groupsHa: Elderly patients score lower than the rest of the age groups
Minitab Insights Conference 2016 September 12-13, 2016
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What did we learn?Our “Ah Ha” Moment
What our hunches told us… What the data revealed…
MSP Patients Family Birthplace Patients
Patients with lower education levels No differences in responses between education levels
Patients who do not speak English as a primary language
No differences in responses between different languages
Elderly patients Patients aged 28 to 37 years
Does Diagnosis Matter?
DRG: Diagnosis Related Group
Minitab Insights Conference 2016 September 12-13, 2016
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Targeting High Impact Opportunities
Whole hospital average = 85.83% ‘yes’ responses
• Project #1: Atrial Fib in Critical Care Unit and Med-Surg-Peds (66.7% ‘yes’ responses)
• Project #2: Abdominal Hysterectomies in Med-Surg-Peds (78% ‘yes’ responses)
• Project #3: Vaginal delivery patients in Family Birthplace (77.3% ‘yes’ responses)
Analyze
Key Problem How We Know it Contributed to the Y
Timing of Education
• Voice of the Customer – reoccurring themesInvolvement with Family Caregiver
Expected Outcomes not Clear
Review the data analysis
Map the process
Voice of the customer
Take Action!
Minitab Insights Conference 2016 September 12-13, 2016
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Improvement Strategies
Key Problem Changes Implemented
Timing of Education • Redesign of education process into three phases• Collaborate with primary care physician clinics• Electronic checklist prompts nursing involvement every
8 hours
Involvement with Family Caregiver
• Primary family caregiver is identified up front and engaged in the care management throughout the stay
• Question added to admission database• Family caregiver prints to case management census
sheets
Expected Outcomes notClear
• Clarified vague terms for the specific procedure. “Excessive bleeding”, etc.
Remeasure
Minitab Insights Conference 2016 September 12-13, 2016
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Remeasure
Minitab Insights Conference 2016 September 12-13, 2016
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Business ImpactTo: All EmployeesFrom: Director of Business DevelopmentSubject: ARHC Receives High Marks!
We have received some great news, and I wanted to share it with you.
The Centers for Medicare and Medicaid Services (CMS) recently released a report that ranked ARHC in the 90th
percentile for patient satisfaction scores from January to December 2014. This means that ARHC ranked higher than 89% of hospitals nationwide that are subject to Value Based Purchasing (VBP) – a CMS program that rewards hospitals for the quality of care patients receive. One of the VBP metrics used to score hospitals is their results on inpatient satisfaction surveys.
The highest satisfaction scores were received in the following areas:
• Communications about medicines – Patients reported that new medicines and their potential side effects were explained
• Hospital Environment – Patients reported that their rooms and bathrooms were clean, and that the hospital was quiet at night
• Discharge Information – Patients reported that they received and understood their discharge instructions
Although the ARHC ranking is based on information from 2014, which is the most current information available, it is evidence of what can be achieved when we work as a team and put our patients first.
Congratulations and thank you!
Minitab Insights Conference 2016 September 12-13, 2016
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Lessons Learned
• Leveraging lessons learned across DRGs
• Data analysis of other HCAHPS dimensions to form additional improvement teams
• Finding and using the right data will ensure you are spending time and effort improving the “right things”
• Having teams work on smaller scoped portions of a larger problem simplifies the problem solving process and makes implementing change easier.
• Don’t start an improvement event until you have a clearly scoped problem and supporting data!
Minitab Insights Conference 2016 September 12-13, 2016
www.SprangerBusinessSolutions.com 18
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@Chris24Spranger
LinkedIn.com/in/christophermspranger
facebook.com/SprangerBusinessSolutions/
SprangerBusinessSolutions.com
cmspranger@sprangerbusinesssolutions.com
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