using hcahps data to improve the quality of patient care tenet healthcare cindy larkin, senior...
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Using HCAHPS data to improve the quality of patient care
Tenet HealthcareCindy Larkin, Senior Director Measurement
Discussion Points
Tenet OverviewTransition to HCAHPSService Strategy Measurement System Redesign
Tenet by the numbers
60,000+ employees
1M+ Admissions 18,149 licensed
beds 64 free-standing
outpatient centers
12 states 54 acute care 2 rehab
hospitals
Tenet’s Patient Satisfaction System
Tenet has been conducting patient satisfaction surveys since 1982
Approximately 100,000 telephone surveys conducted annually by Field Research Corporation, founded in 1945
Programs: Inpatient Outpatient Surgery Outpatient Services Emergency Department Inpatient Rehab Outpatient Rehab Mental Health
Discussion Points
Tenet OverviewTransition to HCAHPSService Strategy Measurement System Redesign
Transition to HCAHPS
Piloted the questionnaire at eight hospitals in the fall of 2004
Reviewed our system to ensure all CMS guidelines were met. Other than the questionnaire change, few modifications were necessary since Tenet’s system already met virtually all of CMS’s specifications
Participated in focus groups with the Agency for Healthcare Research and Quality (AHRQ)
In January 2005, transitioned to the HCAHPS questionnaire
Communication is key Selected one person from each hospital as the HCAHPS
liaison, responsible for internal communication and training
Explained rationale for transition, which was to prepare for public reporting as soon as possible
Shared results of the pilot study to prepare hospitals that the scores would likely be lower due to question and scale changes rather than performance
Based on the pilot results, estimated the potential score impact for each hospital
Developed training materials to help hospitals understand the reasoning behind various guidelines, such as adjusting the results based on patient characteristics, etc.
Questionnaire design
Transitioned entirely to HCAHPS rather than conducting two separate studies
Involved key hospital personnel in questionnaire design to obtain buy in
Selected custom questions to address issues not included in HCAHPS
JCAHO issues Privacy and safetyHigh impact areas Teamwork and sensitivity to family needsHigh use areas Patient Access Outsourced areas Food and Nutritional Services
Redesigned other questionnaires (OP Surgery, OP Services, and ED) to HCAHPS format
Survey design changes
HospitalCurrent Sample
size
Adjustment FactorPost-AdjSample
Size
Proxies Language Service Line
AdjTotal
A 400 32 10 8 50 350
B 400 18 20 9 47 353
C 400 64 0 5 69 331
Adjusted sample to delete non-HCAHPS patients that would continue to be included in Tenet’s system; i.e., proxy interviews; non-medical, surgical, or OB patients; interviews conducted in non-HCAHPS approved languages. Unaccepted interviews need to be accounted for at each hospital to ensure we reach the minimum required sample size.
Keep current with CMS guidelines
Nurse Communication -4.2
Doctor Communication -1.4
Physical Environment -5.9
Responsiveness of Staff -4.8
Pain Management -4.9
Comm about Meds -4.0
Discharge Information -1.4
Willing to Recommend -4.5
Hospital Rating Question -3.0
Composite/ Category
Adjustment
Changed the scoring methodology to include the mode adjustment.
While we cannot at this time mirror CMS results exactly, we modify our system when new guidelines are published.
Discussion Points
Tenet OverviewTransition to HCAHPSService Strategy Measurement System Redesign
Service restructuring
Added a corporate-based Service Team to: Directly consult with hospitals Collect the tools and resources
hospitals were using
Changed priority focus
Adjusted “key words” used in initiatives
Previous service focusPATIENT SATISFACTION QUESTIONS r*
Willing to Recommend 0.759Staff worked together as a team 0.571Nurses listened carefully 0.564Staff helped with pain 0.551Nurses courtesy and respect 0.545Staff sensitive to families' needs 0.515Staff provided safe patient care 0.511Nurses explanations clear 0.505Call button answered 0.500Staff helped with bathroom needs 0.496Room and bathroom kept clean 0.428Staff explained medicine 0.426Staff clearly described side effects 0.417Pain well controlled 0.415Staff clearly explained financial/insurance matters 0.412Staff respected patient privacy 0.409Admissions staff courtesy and respect 0.402Doctors listened carefully 0.386Doctors explanations clear 0.360Doctors courtesy and respect 0.349Satisfaction with food service 0.344Area around room kept quiet at night 0.335Staff discussed discharge help 0.289Written symptom/health info provided 0.261
*r = correlation coefficient
Focus areas
Questions having a high correlation with overall satisfaction
Current service focusPATIENT SATISFACTION QUESTIONS r*
Willing to Recommend 0.759
Staff worked together as a team 0.571
Nurses listened carefully 0.564
Staff helped with pain 0.551
Nurses courtesy and respect 0.545
Staff sensitive to families' needs 0.515
Staff provided safe patient care 0.511
Nurses explanations clear 0.505
Call button answered 0.500
Staff helped with bathroom needs 0.496
Room and bathroom kept clean 0.428
Staff explained medicine 0.426
Staff clearly described side effects 0.417
Pain well controlled 0.415
Staff clearly explained financial/insurance matters 0.412
Staff respected patient privacy 0.409
Admissions staff courtesy and respect 0.402
Doctors listened carefully 0.386
Doctors explanations clear 0.360
Doctors courtesy and respect 0.349
Satisfaction with food service 0.344
Area around room kept quiet at night 0.335
Staff discussed discharge help 0.289
Written symptom/health info provided 0.261
*r = correlation coefficient
All areas that will be publicly reported
Focus areas
Avoid trying to “Boil the Ocean”PATIENT SATISFACTION QUESTIONS r*
Willing to Recommend 0.759
Staff worked together as a team 0.571
Nurses listened carefully 0.564
Staff helped with pain 0.551
Nurses courtesy and respect 0.545
Staff sensitive to families' needs 0.515
Staff provided safe patient care 0.511
Nurses explanations clear 0.505
Call button answered 0.500
Staff helped with bathroom needs 0.496
Room and bathroom kept clean 0.428
Staff explained medicine 0.426
Staff clearly described side effects 0.417
Pain well controlled 0.415
Staff clearly explained financial/insurance matters 0.412
Staff respected patient privacy 0.409
Admissions staff courtesy and respect 0.402
Doctors listened carefully 0.386
Doctors explanations clear 0.360
Doctors courtesy and respect 0.349
Satisfaction with food service 0.344
Area around room kept quiet at night 0.335
Staff discussed discharge help 0.289
Written symptom/health info provided 0.261
*r = correlation coefficient
Introduced initiatives that were broad in scope and would address several
question areas
•AIDET•Hourly Rounding•Empathy Training
Focused on Discharge Information; the only area
Tenet scored slightly below average compared to the HCAHPS Chartbook data
White Boards
Some hospitals purchased eye-catching, customized white boards to reinforce initiatives such as:
Communication Pain goals Hourly Rounding
AIDETFive simple steps to make a positive first impression and to ensure continuous positive interaction throughout the patient’s experience
First step in forming a relationship with the patient. Be attentive to and greet your patient in a positive manner with a warm and friendly smile.
Upon introduction give the patient your name and the purpose for the encounter.
Manage the patients expectations by educating them about the length of time a particular procedure or request will take. Better to over-estimate than under-estimate.
Make sure the patients are knowledgeable and involved in their treatment. Use easily understood terms when providing information. Ask if they have any questions.
Thank patients for waiting, providing information, choosing your facility, etc.Thank You
Explanation
Duration
Acknowledge
Introduce
Hourly Rounding
4 Tower - Hourly Rounding Excellence in Patient Care
Pain PositionPersonal
Needs
Describe Hourly Rounding “Because we want you to receive very good care, we are going to round every hour from 8 a.m. to 10 p.m. and every 2 hours from10 p.m. to 8 a.m. We will not wake you if you are sleeping, unless your physician has asked us to do so. During this time, we will check on your pain, your comfort and ask if you need to use the bathroom.” Hourly Rounding Specifics for 4T
PCA’s round on the even hours Licensed staff round on the odd hours Documentation is kept on a clipboard
outside of the room Be sure to use the 3 P’s! Pain,
Position and Personal Needs!
Address the 3 P’s m . . . Pain “How is your pain?” Offer pain medication, schedule during upcoming rounds, notify the physician or offer non pharmacological options.
m . . . Position “Are you comfortable?” Move up in bed. Re-arrange pillows. Turn patients at risk for skin breakdown.
m . . . Personal Needs / Potty “Do you need to use the bathroom?” Assist the patient to the bathroom.
Assess the environment Ensure that the patient can reach his / her phone and immediate personal needs.
In Addition Perform schedule tasks Communicate when you will return. Close with “Is there anything else that
I can do for you?” Document your round.
,Move up in bed. Re-arrange pillows. Turn patients at risk for skin breakdown “How is your pain?” Offer pain medication, schedule during
Rounding Results Improves clinical outcomes - Builds patient’s confidence and trust – Increases satisfaction for both employees and staff - Reduces call lights – Saves steps for nursing staff
PCAs round on the even hours
Licensed staff round on the odd hours
Documentation is kept on a clipboard outside of the room
Use the “Three P’s”
Pain
Position
Personal Needs
Discharge Information
Emphasis throughout all initiatives is continuous, positive, caring
communication with the patient, family members, and each other.
For example, rather than simply handing patients written instructions or brochures, tell them what they are for, what they include, what they should do
with them, and ask if they have any questions.
Discussion Points
Tenet OverviewTransition to HCAHPSService Strategy Measurement System Redesign
Highlighted HCAHPS questions in previously existing reports
HCAHPS area more than 5% below the norm
Patient Information
Used a “back to basics” approach to help hospitals systematically review HCAHPS results
Overall Score
Category Average
Question Score
Unit Report
24
Begin by analyzingthe high-level resultsto identify problems,
then drill down to pinpoint what specific
area is driving the score
GENERAL
SPECIFIC
Redesigned our reporting system to complement the approach and “push” the data into the hospital
Expand employee access User-friendly (three screens to learn) Link Measurement and Service Reduce report turnaround time Identify problem areas Benchmark with high performers
This is not just a Tenet program. We helped Field Research design it, but it is being offered to other clients
New System Goals
Screen One
Starting with the general results, the home page of the reporting system provides an overview of hospital results including comparison to previous month, previous year, and Tenet Targets.
Internal Star rating system
Screen Two
Provides drill down to category, question, unit, and patient level to identify problem areas.
A white light bulb indicates the question scores at or above average, a red light indicates a problem area.
Easily creates an Excel file from any screen shot.
Clicking on a light bulb accesses the improvement suggestion section, “Ideas with Impact.”
Clicking on the links in the Additional Resources section accesses a toolkits or other resources they can use or refer to.
Links to a 103 page workbook describing exactly how to implement empathy training
Written by Wendy Leebov
Screen Three
Very Interactive. View any program, category, question, unit, by any time period selected with a click of a button.
Helps hospitals track the specific service initiatives they are working on.
Easily creates a PDF report to email or post.
Tenet-wide success in using HCAHPS results to improve the patient experience!!!
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