hmc patient experience 2017 · co –founder of hamad healthcare quality institute key role in...

HMC Patient Experience 2017

Center for Patient Experience and Staff Engagement


HMC Patient Experience 2017

PresentersNasser Al Naimi

Deputy Chief Quality Officer, Patient Experience Co-Director for Hamad Healthcare Quality Institute Hamad Medical Corporation

Ben Panton

Acting Assistant Executive Director Center for Patient Experience and Staff Engagement Hamad Medical Corporation

Ben Smith

Project Director Center for Patient Experience and Staff Engagement Hamad Medical Corporation

Adil Ahmed

Assistant Executive DirectorCustomer ServicesHamad Medical Corporation

HMC and CPESE overview

Interactive Patient Experience Quiz

Defining Patient Experience

Patient Experience Strategic Framework — IHI Context

Patient Experience Measurement

Patient Journey

Service Improvement

Practical Tools

Biggest Barriers

Presentation Overview

Over 24 years Healthcare experience

Co – Founder of Hamad Healthcare Quality Institute

Key role in shaping quality across Hamad Medical Corporation

Leads HMC’s patient experience strategy

Responsible for over 250 customer service staff

Nasser Al Naimi – MBADeputy Chief Quality Officer, Patient Experience and Co-Director for Hamad Healthcare Quality Institute Hamad Medical Corporation


The Center for Patient Experience and Staff Engagement (CPESE) is the driving force for

engaging with patients and improving the patient experience at Hamad Medical

Corporation (HMC) services and hospitals.

HMC is the main provider of secondary and tertiary healthcare in the State of Qatar, and

one of the leading hospital providers in the Middle East.

The aim is to develop a complete and in depth understanding of our patients, and to

build collaborative partnerships focused on delivering patient and family-centered care.

HMC/CPESE Patient Experience Strategy & Framework Development

HMC aims to deliver the safest, most effective and most compassionate care

HMC strategy underpinned by key elements of the IHI Triple Aim

Better Care – safe, effective, timely, patient centered

Patient Experience strategy – a primary driver for transformation and improvement


Patient Experience Strategy developed around 4 foundation pillars:

1. Patient Experience – HMC patients receive world class treatment in a welcoming, comfortable, caring and safe environment

2. Patient Engagement – HMC patients and their families are fully engaged in their care and our efforts to provide safe, high-quality care for every patient.

3. Patient Education – HMC patients are educated and listened to as an equal partner in their care and provided with readily available information allowing them to make informed decisions about their treatment.

4. Staff Engagement – HMC staff are supported, equipped and empowered to support the experience, engagement and education of patients and their families.


CPESE is the organizational department which supports development and delivery of the strategy:

Interconnects with the Ministry and national patient experience requirements

Supports hospitals with PE program delivery

Listen to and understand our patients – capturing feedback

Listen to and support HMC staff

Identify areas for development

Support quality initiatives

CPESE Areas of Focus

Corporate Initiatives

Nesma’ak Customer Service

Staff Engagement Simulation

Corporate Initiatives

Overseas Treatment Returning Patients

Patient Experience Survey Patience Experience Mobile Application

Nesma’ak provides the patient with assistance at every step of their healthcare journey, and also checks on how patients feel about their experience by the undertaking of patient surveys and analysis of customer feedback.

Using specially designed electronic tracking systems - Nesma’ak is able to capture feedback from multiple sources including: comment cards, in person and over the phone feedback, via the HMC website and through ongoing monitoring of traditional and social media.

Nesma’ak Customer Service

The main work stream around staff engagement is the Stars of Excellence rewards and recognition program, which is led by CPESE. Stars of Excellence aims to reward staff whilst recognizing their efforts and celebrating the success of team-based improvement programs.

The program objectives have been designed in collaboration with Her Excellency Dr. Hanan Mohamad Al Kuwari, Minister of Public Health in Qatar and Managing Director for HMC, and have been consistent since the program began in 2010.

Staff Engagement

Simulation gives quick and easy access to data in a controlled environment. Testing solutions without impacting upon services and getting accurate data has proved invaluable in planning for many services.

Customized dashboards, flowcharts and visual models allow for complex data to be easily seen and understood and gives vital information to those that need it.

Simulation

CPESE Next Steps and Future Developments

Support and build initiatives around the 4 Patient Experience strategy pillars.

Support expansion of HMC – new hospital openings

Regional and international collaboration –sharing of best practice

Patient Stories – learning from our patients

Patient App – listening to our patients

HMC Patient Experience

Strategy

Overseas Patient System Development(Experience)

Family Advisory Councils

(Engagement)

Patient Experience

Conference/Forum

(Education)

Patient Stories(Experience)

Electronic App Enhancement(Experience)

Research Collaboration/

Partnership

Staff Surveys/Wellbeing Programs(Employee Support)

What does Patient Experience mean to me?

What does Patient Experience mean to me?

Quality is everyone's responsibility.

I believe that patient experience is an integral part of quality.

Patient experience is about placing the patient at

the heart of our healthcare system.

Patients are welcomed, guided, supported, educated, reassured

and ultimately shown compassion.

Through hard work, continuous improvement and teamwork, we

can make a positive difference to our patients

Together we can support our patients on their

journey to better health.

Empathy — Put yourself in their shoes

Put yourself in their shoes

Lean Six Sigma: DMAIC

Patient Experience

The Quiz

Quiz

Question 1

Answer

The IHI PDSA improvement methodology is well known: What does PDSA stand for?

0%

0%

0%

0% A — Propose, Design, Sustain, Assess

B — Plan, Do, Study, Act

C — Partner, Develop, Solution, Achieve

D — Present, Determine, Simulate, Allocate

Quiz

Question 2

AnswerAccording to the Beryl Institute, patient experience is defined as:

0%

0%

0%

0%A — “the sum of all interactions, shaped by patient perceptions, that influence an organization’s culture across the continuum of care”

B — “the sum of all patient and staff interactions, that influence the continuum of care across an organization’s culture”

C — “the sum of all interactions, shaped by an organization’s culture, that influences patient perceptions across the continuum of care”

D — “the sum of all interactions, that influence an organization’s culture across the continuum of care”

Quiz

Question 3

Answer

According to the Centre for Geographic Information Systems, Doha (Ad Dawha), the capital city of Qatar, means:

0%

0%

0%

0% A — round bay

B — pearl

C — royal

D — sun

Quiz

Question 4

Answer

What are the 3 aims of the IHI Triple Aim?

0%0%

0%0% A — better care, better health, better value

B — better quality, better safety, better efficiency

C — better access, better effectiveness, better safety

D — better cleanliness, better food, better waits

Quiz

Question 5

Answer

The Warwick Patient Experiences Framework (WaPEF) identifies seven generic themes that are important to a high-quality patient experience: - (1) patient as active participant, (2) responsiveness of services, (3) an individualized approach, (4) lived experience

0%

0%

0%

0% A — (5) care support, (6) empathy, (7) education

B — (5) humane treatment, (6) communication, (7) information and education

C — (5) continuity of care and relationships, (6) communication, (7) information and support

D — (5) continuity of care and relationships, (6) evidence based care, (7) information and support

Defining Patient ExperienceThe Strategic Framework

Patient Experience — Framework

Patient experience is one of the 3 essential dimensions of the IHI triple Aim

(A framework for optimizing health system performance)

Improving the health of the population

Reducing per capita cost of healthcare

Improving patient care and experience

Defining Patient Experience

A universally agreed definition of patient experience doesn’t exist

but…

Parameters of Patient Centered CareWhat do Patients Want/Need?

1. Fast access to reliable healthcare advice

2. Effective treatment delivered by trusted professionals

3. Continuity of care and smooth transitions

4. Involvement of, and support for, family and carers

5. Clear, comprehensible information and support for self-care

6. Involvement in decisions and respect for patient's preferences

7. Emotional support, empathy and respect

Source: Picker Institute


1. Compassion, empathy and responsiveness to needs, values and expressed needs/preferences

2. Coordination and integration of care

3. Information, communication and education

4. Physical comfort

5. Emotional support, relieving fear and anxiety

6. Involvement of family and friends

Source: Institute of Medicine, USA


HMC Patient Experience Aspiration

HMC patients should receive world class treatment in a welcoming,comfortable, caring and safe environment.

Our patients will be treated in a dignified and respectful manner, reassured, educated and listened to as an equal partner in their care and provided with readily available information allowing them to make informed decisions about their treatment.

Improving

Patient

Experience

EDUCATION, CONSULTING &

IMPLEMENTATION

Integrity

Accountability

Admissions

Discharge

Noise at

Night

OP

Appointment

& Registration

Lab &

X-Ray

Pharmacy

Care

Transition

Hospital

Environment

Staff

Responsiveness

Pain

Management

Medicine &

After Care

Communication

Nurse

Communication

Doctor

Communication

Patient

Journey &

Systems

Key

Performance

Indicators

HMC Patient Experience Framework

Patient Experience Framework

Transformation foundations:

1. Leadership at CEO/Board Level

2. Strategic vision

3. Involvement of patients and families

4. Supportive work environment for staff

5. Systematic measurement and feedback

6. Quality of the built environment

7. Supportive technology

Question — which of the below does your organization most demonstrate in supporting change?


0%0%0%0%0%0%0% 1. Leadership at CEO/Board Level

2. Strategic vision






Question — which of the below does your organization least demonstrate in supporting change?


0%0%0%0%0%0%0% 1. Leadership at CEO/Board Level

2. Strategic vision






Supportive work environment for staff

When organizational transformations succeed,

managers typically pay attention to “people issues,”

especially fostering collaboration among leaders and

employees and building capabilities

McKinsey Global Survey

Define — Patient Experience

Set bespoke definition/objective (based on what your patients tell you – what are their expectations?)

Framework build and communication

Recognize that experience delivered at a series of interactions and touch points

Measurement

Measuring Patient Experience

Measuring Patient Experience

From a Patient’s Perspective, what are the top 3 issues that matter most to patients?

0%

0%0%

0%0%

0%0%

0%0% 1. Access to service

2. Comfort

3. Communication

4. Facility

5. Nursing service

6. Other staff attitude and knowledge

7. Physician services

8. Quality of services

9. Privacy

The Fundamentals

The Center for Patient Experience and Staff Engagement (CPESE) introduced Nesma’ak as a key department to support patient experience at HMC:

Enabling an environment for collecting patient feedback

Introducing standardized processes to handle patient feedback

Introduction of Supportive Technology

Analysis & sharing of patient experience data

Key is getting the right balance – activity across the organization

Appropriately informing different decisions

Capturing views at the right point in the patient journey

Capturing Patient Feedback

Hand-held technology Online

surveys

Patient

stories

Feedback

websites Kiosks

Comment

cards

Mobile App

Compliments

Focus groups

Telephone

surveys

On-line

communities

Walking the floor

Complaints

Qualitative

Quantitative

Public

meetings

Face-to-face

surveys

Mystery shoppers

Performance

Benchmarking

Service

improvement New service

development

Local

Accountability

Commissioning

Patient feedback at HMC

With a new Customer Service Program Nesma’ak, came new services:

A new Feedback Call Center (16060) launched 7 days a week, covering 15 hours a day.

Dedicated Comment Cards & Surveys for Inpatient, Outpatient, Emergency Department, Pharmacy, Laboratory, Imaging and Rehabilitation Therapy

SMS acknowledgement of patient feedback

Electronic system to capture all patient feedback

Timely response to all patient feedback received through media

Over 275 patient experience staff working across HMC facilities

Standardized Processes

Process Maps

HMC e-feedback Management System

Sharing of Information with Stakeholders

Monthly, quarterly and yearly dashboards for all HMC Facilities:

Patient Surveys

Comments & Compliments

Complaints

Nesma’ak Operational Performance

Patient Experience Score – to be introduced in Q3 2017

Direct Interaction:

Monthly Quality Meetings at facility level

Executive Management Committee & Patient Experience Committee

Real Time access to feedback data

Face to face meetings with patients

Patient Survey — HMC InpatientPATIENT SATISFACTION SURVEY — Inpatient Department

HAMAD MEDICAL CORPORATION

Patient Survey — HMC OutpatientPATIENT SATISFACTION SURVEY — Outpatient Department


HMC Dashboard

HMC CORPORATE COMPLAINTS

MONTHLY DASHBOARD

Comments / Compliments Dashboard

COMMENTS/COMPLIMENTS MONTHLY DASHBOARD


How we do determine the areas that need improvement?__

0 50 100 150 200 250 300 350 400 450 500

Physician service

Nursing service

Staff attitude/knowledge

Communication

Quality of service

Access to service

Facility

Privacy/ComfortOct

Nov

Dec

Complaints by themes YTD/ Monthly breakdown: Q3 2016

0 50 100 150 200 250 300 350 400 450

Physician service

Nursing service

Staff attitude/knowledge

Communication

Quality of service

Access to service

Facility

Privacy/Comfort

Jan

Feb

Mar

Complaints by themes YTD/ Monthly breakdown: Q1 2017

How we do determine the areas that need improvement?__

Monitoring the Improvement

52%

48%

CLOSED COMPLAINTS: JUNE 2016

Complaints closed withinSLA timeframe

Closed complaints thatdid not meet SLAtimeframe 76%

24% Complaints closed withinSLA timeframe

Closed complaints that didnot meet SLA timeframe

CLOSED COMPLAINTS: MARCH 2017

Monitoring Improvement

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t/N

ore

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L3 L2

Reason for overdue vs. levels – JULY 2016

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L3 L2

Reason for overdue vs. levels – OCTOBER 2016

After setting a new processes of communication, a sufficient improvement noticed in reducing the overdue cases

Indicator NotesQ3

2016

Q4

2016

Q1

2017Reason

1Patient Satisfaction

Level83% 83% 86%

Overall services improvements,

positively affect he satisfaction

level.

2 Complaints ReceivedDelivered by

phone, e-mail,

letter, in person,

etc.

717 913 809

Action taken by stakeholders

on most recurrent issues, lead

to decreasing in the complaints.

3 Thanks Received 337 420 944

Sufficient increment in the

compliment received for

improved services.

Monitoring Improvement

Turning Patient Feedback to “Meaningful Resource for Care Delivery”

Gather feedback from your patients regularly and systematically

Understand your findings

Share results widely throughout your organization

Get stakeholders involved

Action plan with service users and staff

Maintain progress

Continuous innovation to improve customer services

Checklist___

Patient Journey

Patient Journey: Why is it important?

Each patient has a different journey through the system

Every patient journey matters

Every patient wants to have a good experience

Every patient has a different perspective on their experience

“ 80% of the of the problem is in the system, not the people”

- Dr. W. Deming

Patient Journey

Patient Journey: No one way

Build comprehensive understandings of entire patient journeys from the patient perspective

Co-created (with patients & healthcare stakeholders) strategies and tactics to address journey gaps

See what they see and what you can do to improve

Patient Journey: Not just the care

Post HospitalizationHospitalizationPre Hospitalization

All-round Experience

Many providers ignore the ‘non visual’ aspects of a patients experience

Website

Patient Portals

Call Centers

Social Media

Word of Mouth

Non clinical experiences

Parking

Food

Location

Signage

Customer services

Scheduling

Communication

Payments

Insurance

Appointments

Therapies

Touchpoints

A touchpoint is the interaction between your hospital and those you serve

Patient touchpoints or interactions with health care facilities and professionals define patient centered care

They determine the total patient experience and satisfaction, affecting not only the clinical tasks but patient outcomes

Touchpoints

There are more nonclinical patient touchpoints with patients than there are clinical

Touchpoints can occur on the phone, thorough a website, at a OPD visit, in an emergency…

Touchpoints happen:

Before the patient comes into a hospital

At the hospital

After the patient is discharged

Touchpoints affect the experience of:

Patients

Family

Friends

Care Givers

Scheduling

Admitting

Signage/Way finding

Theatres/Surgery

Physicians

Nurses

Technicians

Hospital Room

Facilities

Testing Facilities

Patient transport

Porters

Food

Treatment/Procedure

Communication/updates

Patient information

Discharge

Payment/ Billing

Parking

Touchpoints for Inpatient Journey

Level of privacy

Single or shared room

Cleanliness

Bathroom facilities

Visiting hours/Policies

Noise levels

Entertainment (TV/Radio/Newspaper)

Temperature

Comfort

Storage

Security

Lighting

Accessibility

Communication links to staff

Hospital Room Touchpoints

Improvement

How Do We Improve?

National: National policies, infrastructure, budget

Organizational: Strategies, Performance and monitoring, macro-management

Team and Individual: Individual accountability, clinical service provisions

How Do We Improve?

National: National policies, infrastructure, budget

MOPH form national policies for all healthcare facilities to adhere towards

National Patient experience/ satisfaction surveys

IHI Triple Aim

How Do We Improve?

Organizational: Strategies, Performance and monitoring, macro-management

Monthly feedback Reliable ‘on-hand’ data – Near real time Complaints feedback Board reviews Fast access to results

Motivation and Communication Patient stories Face to meeting with patients and staff Complaints and compliments

How Do We Improve?

Team and Individual: Individual accountability, clinical service provisions

Management, Quality improvement and monitoring Comparisons between own services/ departments and

others Frequent, near real time data Targets and measures

Motivation Stories and personal accounts to motivate staff Complaints and feedback Face to face involvement Empathy No blame culture

Start

Reception

Cashier

Schedule for

follow-up?

EXIT

Doctor’s Room (scheduling for the

next follow up

appointment)

No

Yes

Start

Reception

Consultation

Schedule for

follow-up?

EXIT

Reception(scheduling for the

next follow up

appointment)

No

Yes

Prepared by: Center for Patient Experience and Staff Engagement | e-Referrals Implementation and Patient Crowd Reduction

Optimized FlowBaseline Flow

Cashier

Qatari

Patient?

No

Assessment

Room

Yes

Qatari

Patient?

No

Assessment

Room

Consultation

Yes

We map the system from the patients perspective and follow their journey

What we do — CPESE — Process Mapping

This helps staff understand how complex and confusing some patient journeys are

Estimate that 30 - 70% of work doesn’t add value for the patient

Up to 50% of process steps involve a ‘hand-off’, leading to error, duplication or delay

No one person is accountable for the patient’s ‘end to end’ experience – All processes need to be joined up

What we do — CPESE — Process Mapping

Simulation is the process of replicating the behavior of acomplex system (like the healthcare system) using acomputer program.

It is considered as an operational research technique thatallows the end user (hospital administrators, managers) toassess the efficiency of existing health care delivery systems,to ask ‘what if?’ questions and to design new systems, ifnecessary.

What we do — CPESE — Simulation

What can simulation do?

Simulate hospital processes, model length of stay and patient flows

Perform bottleneck analysis to discover where improvement work is necessary

Test facility design and building layouts without committing resources for theiracquisition or construction

Test ideas without limits and costs involved

Forecast the impact of changes in patient flow

Forecast how changes in staffing, referral patterns, or patient mix affect a unit in afuture state

What we do — CPESE — Simulation

What we do – CPESE – Simulation

• Insert simulation video clip

Strategies for Improvement


Take a holistic approach

— Look beyond just the care given, take every touchpoint into consideration before, during, and after care


Simplify

— Find ways to simplify the patient journey and integrate accuracy, timeliness and compassion into every patient interaction


Make it personal

— From admission to discharge, every interaction by every stakeholder should be focused on how best to satisfy the patients needs


Improve communications

— Strong communications create clarity, understanding and consistency leading to higher patient engagement and increased satisfaction


Benchmark

— Benchmark against the leaders in the field and against other departments

— Set new standards of care


Involve users

— Patients and Families are essential partners in quality improvement and health care redesign

Barriers

Barriers

What are the barriers to providing good patient experience?

Barriers

A lack of good decision-making processes

Leadership is crucial — they must be engaged and willing to improve - Bad leadership and management will create a barrier

Systems — Providers must have clear systems for improvements

Barriers

A lack of accountability

Everyone must be accountable —from top to bottom

Employees must be held to account

Barriers

The wrong attitude

Staff must be motivated to provide a good experience

Culture plays an important role — a positive working culture will improve staff morale and ultimately improve patient experience

Barriers

A lack of patient focus

Patients must be at the forefront of all members of staff

Patient care must take precedent over other matters such as finance

Patient must be at the center of all decisions made throughout the facility

Barriers

Conflicting Priorities

Too often there are too many priorities for an organization

A focus must be placed on patient experience for it to see benefits

Other priorities must run alongside improving experience

TOOLS: Effective Communication

Improves patient satisfaction Like et al., 1987; Kaplan et al., 1989; Ong et al., 1995; Weinman et al., 1998

Decreased patient emotional stressRoter, 1995

Improves adherence/complianceDiMatteo et al., 1993; Squier et al., 1990; Brashers et al., 2000; Ciechanowski et al., 2001

Improves health outcomes Woolley et al., 1978; Patrick et al., 1983; Stewart et al., 1995

Reduces medical errors and malpracticeLevinson et al., 1997; Lester et al., 1993; Beckman et al., 1994; Sutcliffe et al., 2004

Improves physician satisfactionSuchman et al., 1993,Educ for Health, 2004

95

TOOLS: Effective Communication

H – Hear the story

E – Empathize

A – Apologize

R – Respond to the problem

T – Thank them

START

Smile and greet

Tell your

name/role/what to

expectActive

Listening/AssistanceRapport and

relationship building

Thanks

“The most direct route to the Triple Aim is patient and family centered care in its fullest form”

Don Berwick (2012)

Triple Aim

Additional Information

Beryl Institute

Planetree

Picker Institute

Press Ganey

hmc patient experience 2017 · co –founder of hamad healthcare quality institute key role in...

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