cahps – it's not about patient satisfaction final · cahps – it's not about patient...

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COPYRIGHT © STUDER GROUP Please do not quote or disseminate without Studer Group authorization Slide 1

CAHPS – It's NOT About Patient Satisfaction!

November 17, 2014

Jeff Morris MD, MBA, FACS StuderGroup Physician Coach & Speaker [email protected]


Choosing a doctor or hospital…

• Only 5% have rated a doctor themselves online

•  1/3 paNents who viewed online sites sought out or avoided physicians based on their raNngs

•  Personal reference from family and friends sNll more important to most people (as was whether a physician was accepted by the pa9ent’s health insurance policy)

Public Awareness, Perception & Use of Online Physician Rating Sites JAMA 2014;311(7):734-735

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COPYRIGHT © STUDER GROUP Please do not quote or disseminate without Studer Group authorization Slide 3 COPYRIGHT © STUDER GROUP Please do not quote or disseminate without Studer Group authorization Slide 3

“The future viability of our organizaNon will be dependent on our ability to deliver service excellence.”

Mayo Clinic

“And importantly . . . A commitment to excellence will not manifest without the leadership, support and example set by physicians.”


It is not about …..

Fluff

Flavor of the day

Kissing butt

Satisfying patients

Pandering

Being nice

The Pa'ent Experience is NOT About Pa'ent Sa'sfac'on!

Smile school Soft

The “scores”

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The Pa'ent Experience is NOT About Pa'ent Sa'sfac'on!

•  How the paNent experiences & reports your care (percepNon)

•  Clinical outcomes

It is the ONLY thing that:

•  differenNates YOU from other providers •  gives YOU a COMPETITIVE ADVANTAGE and what

differenNates YOU from other providers?

And this is determined by:


“ Cou l d a g r e a t e r miracle take place than for us to look through each other's eyes …for an instant?” Henry David Thoreau

CAHPS -‐ The Eyes & the Voice of the PaNent

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The Business Case for the PosiNve PaNent Experience

According to a Harris Poll (WSJ – Sept/04)

“People place more importance on doctors’ interpersonal skills than their medical judgment or

experience; and doctors’ failings in these areas are the overwhelming factor that drives pa8ents to switch

doctors.”


Pa9ents’ ra9ngs of quality are more predicted by their ra9ng of our ability to communicate than technical care. * Annals of Internal Medicine

*Chang et al., Ann Intern Med. 2006;144:665-‐672

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The Difference between PercepNon and Reality


Like it or not ….. People are saying things about how they perceive you and the care you provide!

•  Healthgrades.com

•  RateMDs.com

•  Angie’s List

•  Vitals.com

•  Beierdoctor.com

•  Drscore.com

•  RateYourDoc.com

•  Hospitalcompare.gov; PhysicianCompare.gov

•  Facebook, Twiier & other Social Media

•  ……. etc .

Understanding Understanding Understanding Reference: http://www.aamc.org/advocacy/061107update.pdf

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Would a Consumer Choose You?

•  93.8% reported being willing to go out of their way (drive further, reschedule appointments)

•  83% of consumers are very/somewhat concerned about hospital quality

•  64.9% said they would pay more to seek care at a more highly-‐rated hospital

•  60.7% feel the federal government should pay highly-‐performing hospitals more

Source: HealthGrades, Inc. 2010 survey


A Dose of Reality in this CompeNNve Marketplace •  Loyal pa9ents are the most vocal in telling others about posi9ve experience; greatest impact on revenue (repeat visits & referrals)

•  Loyal pa9ents more tolerant of minor problems

•  Loyal pa9ents less likely to sue

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MalpracNce Risk MalpracNce LiNgaNon -‐ Cited Reasons

•  Didn’t listen

•  Didn’t return phone calls

•  Showed liile concern or respect for paNent condiNon •  Rude

•  Didn't spend enough Nme

•  Didn’t answer quesNons adequately

Patient Complaints and Malpractice Risk, JAMA 2002


MalpracNce Risk

•  Significantly correlated with their physicians communicaNon skills (coefficient = 1.73, 95% CI 1.10 – 2.35; p = .00)

• Not correlated with quality of care, as determined by chart reviews that inves9gated whether the standard of care was met (coefficient = 0.03, 95% CI -‐0.12 -‐ -‐0.18;p = .68)

Chang, JT et al, Annals of Internal Medicine 2006; 144: 665 – 672

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Taking You and Your Organization to the Next Level © 2011 Studer Group®

Pay for Performance is

Here

Now*

*Performance Period is July 1, 2011-‐ March 31, 2012


The New Paradigm – Value Based Purchasing

Outcome = Income

Service Quality = Medical Care Quality

Service and Care Quality are inseparable

What does it mean to be a “good doctor?”

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Enhanced CommunicaNon = PosiNve PaNent Experience = Beier Compliance = Improved Quality

There are now over 100 observaNonal and 20+ experimental studies published demonstra9ng the correlaNon of communicaNon (paNent experience) with compliance …….. and

"Compliance with treatment regimens has significant influence on quality measures in chronic disease and outcomes.

Medical Care: August 2009 -‐ Volume 47 -‐ Issue 8 -‐ pp 826


Behaviors that contribute to paNent adherence to care plan "The interacNon between the paNent and his or her physician is the first, and, arguably, the most important interacNon in ensuring adequate medicaNon adherence." Harmon, Lefante & Krousel-‐Wood

(Current Opinion in Cardiology 2006, 21:310–315)

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Physician Empathy

•  "Our results show that physicians with high empathy scores had beier clinical outcomes than other physicians with lower empathy scores"

good control* (A1c<7.0 percent) •  Higher Empathy

Good Control •  Lower Empathy

Poor Control moderate control* (A1c≥ 7.0% and

A1c≤ 9.0%)

poor control* (A1c>9.0 percent)

good control* (LDL<100mg/dL)

moderate control* (LDL≥ 100 and ≤

130 mg/dL)

poor control* (LDL>130 mg/dL)

Em

pathy *Source: Thomas Jefferson University, Physician's Empathy Directly Associated With Posi8ve Clinical Outcomes In Diabe8c Pa8ents Acad Med. 2011;86:359–364.


Physician Empathy

Em

pathy

Conclusions These results suggest that physician empathy is significantly

associated with clinical outcome for paNents with diabetes

mellitus and should be considered an important component

of clinical competence.

Acad Med. 2012;87:1243–1249.

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High PaNent PercepNon of Care equals Lower Preventable Readmissions

Moving inpa8ent percep8on of care correlates to a decrease in readmissions.

Source: The American Journal of Managed Care; Rela8onship Between Pa8ent Sa8sfac8on With Inpa8ent Care and Hospital Readmission Within 30 Days; 2011; Vol. 17(1)

2.3% Pneum-‐onia

3.1% Heart Failure

2.6% Acute MI

New!

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Clear ConnecNon between PaNent-‐Centered Care and Clinical Quality Outcomes Compared Hospital Quality Alliance (HQA) scores for the Quality of Clinical Care to HCAHPS Global Ra9ng for 2,429 hospitals

HCAHPS RaNng AMI CHF PNA Surgery

Lowest quar9le 93.5 82.7 88.5 82.8

Second quar9le 94.5 85.2 90.1 84.3

Third quar9le 94.6 85.9 90.7 85.2

Highest quar9le 95.3 86.0 90.8 85.7

P value for trend <0.001 <0.001 <0.001 <0.001

Source: Jha et al. New England Journal of Medicine 359, no. 18 (2008): 1921-1931.


The Alphabet Soup of CAHPS & PECS

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As Hospital’s ED Percentile Ranking Increases, So Does Its HCAHPS “Overall” Percentile Ranking


ED PECS: ED Patient Experiences with Care Survey

Will ask pa9ents about their experiences with

•  arriving at the ED •  during ED care •  awer being admilng to the hospital or discharged from the ED

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ED PECS: ED Patient Experiences with Care Survey

Currently three dram versions of the survey being tested:

•  one for pa9ents discharged to the community

•  one stand-‐alone version for pa9ents admiied to the hospital

•  another version for pa9ents admined to the hospital that will be administered as a supplement to the exisNng HCAHPS survey


CG CAHPS Core Questions & Composites 15 questions grouped in 5 composites

Getting Timely Appointments, Care, and Information (Access)

•  Getting appointments for urgent care •  Getting appointments for routine care or

check-ups •  Getting an answer to a medical question

during regular office hours •  Getting an answer to a medical question

after regular office hours •  Wait time for appointment to start

Rating of the Provider (Doctor)

•  Overall rating of your Provider

Provider (Doctor) – Patient Communication

•  Provider explanations easy to understand •  Provider listens carefully •  Provider gives easy to understand instructions •  Provider knows important information about

medical history •  Provider shows respect for what you have to

say •  Provider spends enough time with you

Courteous and Helpful Office Staff

•  Clerks and receptionists were helpful •  Clerks and receptionists treat you with

courtesy and respect

Test Results

•  Follow up on Test Results

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Common Sense CommunicaNon Skills

Verbal and Non Verbal


Published in 1936 Studies on career success & financial rewards revealed that: •  15% anributable to "specialized knowledge" in the field

•  85% due to skill in "human engineering" (rela9ng well to people)

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Tools & TacNcs


Albert Mehrebian’s Work on EffecNve CommunicaNon

When discussing maiers of feeling and axtude, effecNve communicaNon is a funcNon of:

Verbal Content: 7% Vocal Expression: 38% Visual Cues: 55%

What is important is "CONGRUENCE"

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AIDET®

Acknowledge

Introduce

Duration

Explanation

Thank you


Key Words at Key Times

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Anesthesiologists and PerioperaNve CommunicaNon Kopp, Vincent J. M.D. Shafer, Audrey M.D.

Anesthesiology:August 2000 -‐ Volume 93 -‐ Issue 2 -‐ pp 548-‐555

• Literal meaning of “profession” = “speaking forth”

• Facility with a variety of communicaNon skills signifies highly developed professionalism.

What Does Professionalism Have to do with CommunicaNon Skills?


Professionalism Requires EffecNve CommunicaNon

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Speaking v.

Communicating


COMMUNICATING

is about listening and getting a message across that we want others to hear and be

receptive to.

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Advantages of AIDET® & Key Words

Decrease anxiety with increased compliance

= Decreased Anxiety

Improved Compliance +

Better clinical outcomes, more positive patient experience and

greater professional

fulfillment


The Difference may be in the PresentaNon

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They may not remember what you said… They may not remember what you did… They always remember how you made them feel.

Maya Angelou

ConnecNng at a "gut level"


Challenges

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Challenge: We are Creatures of Habit We are creatures of habit (omen bad habits)


“There is no need for any individual to have a computer in their home.”

~ Ken Olsen, president of Digital Equipment Corp., 1977

Recognize that “Change” Can Be Uncomfortable

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“Who the hell wants to

hear actors talk.” ~E.A. Warner,

Warner Bros., 1927



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“People wish to be se[led; but only as far as they are unse[led, is there any hope for them.”

Ralph Waldo Emerson


Organiza9onal culture is not one that supports direct communica9on

Challenge: OrganizaNonal Culture

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• When you first start doing anything, you may not do it well.

• Almost never will anyone do something right the first 9me.

• Experts become experts through prac9ce.

Remember . . . The Ark was Built by Amateurs, the Titanic by Professionals.

Challenge: I am not an “expert”


Challenge: Technology

HOW?

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Challenge: Technology


EHRs and CPOE: Best PracNces §  Scribes §  Manage-‐up advantages

–  Real-‐9me –  Remote access (on-‐call and amer-‐hours

retrieval) –  Safety

§  MiNgate impersonal nature (“narrate”) –  “Know that I am hearing all that you say…I

may occasionally record items in the system while we are talking…”

§  Make the paNent an engaged and informed parNcipant of the EHR –  Posi9oning of monitor –  Sharing of PACS/Test Results –  Sharing of consult request –  Sharing of e-‐prescrip9on feature –  Pa9ent viewing of test results remotely

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Embrace technology but …. there is sNll a place for paper


But one more reason to be concerned about the paNent experience ….

…… it negaNvely or posiNvely impacts your personal life and your professional saNsfacNon

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Professional “Burnout”

Arch Intern Med. Published online August 20, 2012. doi:10.1001/archinternmed.2012.3199


Professional “Burnout”

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The Cost of Burnout -‐ Impairment:

•  Threatens paNent safety

•  Reduces consistency of excellence

•  Decreases collaboraNon

•  Increases costs

•  Adversely affects collegiality

•  Reduces empathy -‐ “compassion faNgue”

•  Increases liability risk

•  Drives away high performers

•  Increases recruitment costs

•  Makes healthcare and the organizaNon less airacNve


Burnout Busters -‐ What Can Professionals Do? Reconnect to purpose, worthwhile work and

making a difference.

H E A R T M I N D

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It is not about smile school

It is not about “being nice”

It is not about “fixing the scores”

It is not about “giving them what they want”

The Clinical & Business & Personal & Professional Case For the PosiNve PaNent Experience – connecNng the dots ……


It is about proven evidence based behaviors that are requisites for clinical effecNveness, marketplace

compeNNveness, malpracNce protecNon and the quality of work & personal life.

The Clinical & Business & Personal & Professional Case For the PosiNve PaNent Experience – connecNng the dots ……

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What Determines Our Success?

“Success is neither magical or mysterious. Success is the natural consequence of consistently applying the basic

fundamentals.” Jim Rohn


“It isn’t hard to be good from Nme to Nme; what’s tough is being good every day.”

Willie Mays

It is about Building a Culture of Consistency

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Make a commitment to be personally accountable and hold each other accountable for improving the paNent care experience and communicaNng beier with paNents, staff and each other

It is about Building a Culture of Accountability


It is about Building a Culture of CollaboraNon & Teamwork

•  Physicians •  Nursing •  ExecuNve Leadership •  Access / EVS •  Allied Health Services •  Pastoral Care •  Board of Directors •  NutriNon / Lab / Rad / Pharm

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An “almost home-‐run” ……

…… unNl you touch all the bases


Now that’s a home run!

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“ Cou l d a g r e a t e r miracle take place than for us to look through each other's eyes …for an instant?” Henry David Thoreau

CAHPS -‐ The Eyes & the Voice of the PaNent


The Eyes & the Voice of the PaNent

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It always seems impossible un8l it

is done.”

Nelson Mandela

cahps – it's not about patient satisfaction final · cahps – it's not about patient...

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