©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Advancing Accountability for

Improving HCAHPS at Ingalls

A Case Study Webconference

iRound for Patient Experience

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Managing your audio

2

Use Telephone

If you select the “use telephone” option

please dial in with the phone number

and access code provided in the audio

panel (on the right of your screen).

If you select the mic & speakers options please

be sure that your computer’s

speakers/headphones are connected.

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Managing your screen

Questions panel

To ask the presenter a question, please

type it into the question panel and

press send.

Minimizing and maximizing

your screen

Use the orange and white arrow to

minimize and maximize the

GoToWebinar panel.

Use the blue and white square to

maximize the presentation area.

3

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

2

3

1

Road Map

Deeper Insights Into the Success to Date

Building a System of Accountability

Laying the Groundwork

4

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

About Ingalls Health System

5

Case in Brief

• 544-licensed beds; ADC 280

• 30 minutes south of Chicago in Harvey, IL

• Independent not-for-profit system founded in 1923

• Includes network of four ambulatory care centers

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

A Challenging Marketplace

New Leadership Charted a More Positive Course

Demographics

• Declining population

( 15.4% since 2000)

• Low and declining median

household incomes

( 9% from 2000 to 2011;

45% lower than IL

average)

New Focus on Patients

• CEO led transition from

“physician centric” to

“patient centric” thinking

• Improved inpatient

satisfaction scores from 6th

percentile to 39th percentile

(2008-2010)

Leadership Transformation

• Reduced RN vacancy rate

from 22% to <1%

• Radically cut agency use

• Reduced RN turnover to

below state average

• Transformed to a culture of

transparency

Minimal Funding

• High Medicaid/Self-Pay

population

• Last Medicaid inpatient

rate increase in Illinois

was in 1995

• Costly care with minimal

reimbursement

6

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Initial Steps in the Right Direction…

Organizational Imperative to Prioritize Patient Experience

7

Ingalls Launched a Patient Experience

Program in 2010

Trained staff on best practices

Introduced nurse manager daily rounding

Created rounding logs

CNO and other leaders reinforced focus on

patient experience

65% 59%

55%

70%

56% 64% 63%

Q22010

Q32010

Q42010

Q12011

Q22011

Q32011

Q42011

Saw Temporary Improvements, But Overall

Trend Not Positive

Overall Hospital Rating ≥ 9

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

…But Early Efforts Didn’t Have Desired Impact

8

Shortage of Data, Lack of Accountability Prove Challenging

Leadership Had No

Tracking Mechanism

No Easy Way to Document

Rounds or Follow-Up Items

Lacked a way to know if

rounds actually occurred,

how often, and for how many

patients

Had no mechanism to see

what service issues existed

or how/if they were being

addressed

Transferring rounding notes

into spreadsheet-based

rounding logs required an

extra step that was often

skipped

Busy nurse managers would

often identify a patient issue,

walk out of the room, and

forget to document or follow up

on the issue

We had implemented a rounding program

based on the latest best practices, but we

found that simply telling busy nurse

managers to round just does not work.

” Learning and

Improvement Hindered

Since rounding logs were

often not completed, there

was no reliable historical data

to learn from trends or

pinpoint the most effective

improvement opportunities

Also lacked a way to track

and follow up when staff were

recognized for their efforts by

patients, so staff recognition

was inconsistent

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

2

3

1

Road Map

Deeper Insights Into the Success to Date

Building a System of Accountability

Laying the Groundwork

9

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Made Decision to Invest in Technology

10

Easy-to-Implement System Enabled Rapid Adoption

January 2012

Began implementing

iRound technology

March 2012

Was rounding on every

unit with iRound

June 2012

Implemented ED

rounding

April 2012

Established goal to round

on 80% of patients (M-F)

Project Objectives:

Use rounding to support the transition to a patient-centric strategy

Enhance nursing engagement

Continue to improve HCAHPS performance

Q3 2013

Received results from

second VBP performance

period

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

A Brief Overview of the Technology

iRound for Patient Experience

Daily Patient

Satisfaction

Rounding

Service Recovery

Employee

Recognition

Executive Rounds

Real-Time Patient

Satisfaction Data

• Patient feedback is

captured daily at the

bedside

• Tailored smart forms with

quick-text and prompts

uncover critical patient

needs

• Detailed rounding data

automatically uploads to

backend analytical system

Hardwired Service

Recovery and Recognition

• Individual drivers of

satisfaction addressed

while patients are still in

the hospital

• Responsible service

department immediately

notified of problems

identified during rounds

• Issues are tracked to

completion

Accountability for

Results

• Executives make

decisions based on timely,

robust data

• Real-time unit-level and

aggregated metrics,

historical trends, and key

problems affecting

performance highlighted

• Correlations revealed

between HCAHPS and

specific rounding data,

service recovery trends

A Systems-Based Approach

iRound captures

real-time data for:

11

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Two Distinct, Complementary Uses for iRound Data

12

Take Care of Patient Needs Today, While Driving Lasting Improvement

Data-Driven

Improvement

Initiatives

Patient Experience

Reporting and

Analysis

Patient Satisfaction

Rounding

Cross-Department

Service Recovery

Coordination

Addressing

Patient Needs

In-the-Moment

Using Data

to Improve

the

Organization

Strengthening

Reputation

and Financial

Standing

Fostering

Daily

Conversations

with Patients

Mobile Data

Collection and

Service Recovery

Analytics and

Data-Driven

Improvement

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

How iRound Helped Ingalls Upgrade their Approach

New Emphasis on Capturing, Reviewing, Using Patient Feedback

Enabled Efficient, Effective Rounding

• Provided units with mobile devices to collect actionable patient

experience data quickly

• Eliminated what had been an onerous data entry step for staff

and instead made reporting automatic

Set Expectations and Changed Behavior

• Leaders reviewed rounding dashboards in weekly meetings and

followed up when compliance was low or issues were unresolved

• Leadership involvement drove cross-department collaboration on

service recovery issues

Leveraged More Comprehensive Data to Drive Decisions

• Trends were analyzed, allowing early detection of issues in key

areas affecting HCAHPS performance

• New wealth of patient experience data enabled effective root

cause analysis to ensure true problem was being addressed

13

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Loftier Expectations Led to Increased Accountability

14

Streamlined Rounding and Reporting Made Aggressive Goals Achievable

Number of Rounds Conducted

Not

tracked

2,047

5,642

2011 Q1 2012 Q2 2012

Elevated expectations drove new behaviors

• At first post-implementation huddle, some

managers had conducted few or no rounds

• Set new goal to round on 80% of all patients

each weekday

• Combination of rounding tool and new expectation

improved compliance rapidly

New rounding

goal created

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Produced Lasting Impact on HCAHPS Score

Improvements Achieved Across Many Dimensions

1) Estimated using CMS national HCAHPS database with performance through Q1 2013—the most recent period available—and Ingalls survey data through Q3 2013.

15

Enhanced

Communication Scores

23% Increase in ranking1

on Communication

with Nurses

32% Increase in ranking1

on Communication

with Doctors

37% Increase in ranking1

on Communication

about Medications

63%

72%

Pre iRound 17 Months PostImplementation

55%

66%

Pre iRound 17 Months PostImplementation

% of Patients Rating Overall

Hospital Experience 9 or 10

% of Patients Rating Hospital

Always Clean, Always Quiet

Corresponding National Percentile Rankings1

39th 70th 23rd 57th

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Positively Affected Ingalls’ Financial Position

Results of the Second Performance Period1

1) Performance Period used to determine scores for FY 2014 was April 1, 2012 through December 31, 2012. Dollar value

estimated by applying CMS VBP Percentage Payment figures to approximate Ingalls Medicare revenue.

100% Of at-risk base operating DRG

amount returned through

CMS’s VBP program

$250k+ Estimated FY 2014 Additional

VBP Incentive Payment

16

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

2

3

1

Road Map

17

Deeper Insights Into the Success to Date

Developing a System that Enables Accountability

Laying the Groundwork

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Actionable Data Enriched Weekly Huddles

18

Decisions Driven by Better Information

Teams reviewed trends by unit, identified

drivers and patient-specific issues:

1. Rounding performance versus goal by unit

and overall

2. HCAHPS correlation to iRound data

3. Performance in key HCAHPS areas and

overall

4. Deep dive on service recovery comments to

identify unmet needs, as well as opportunities

to recognize employees for stellar work

Representative Patient Feedback

“…a gentleman from housekeeping offered

help when I was unsure of where I was going.

He stopped, washed his hands and took me all

the way to the unit. Exceptional.”

”

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Rapid Feedback Engaged Staff in Achieving Goals

19

Improvements Made to Cumbersome Manual Processes

Real-time data engendered new levels of sensitivity

• New awareness of patient concerns and compliments

increased responsiveness

• Incorporating staff feedback on rounding forms fostered

ownership for outcomes

• Influencing patient experience and satisfaction scores

became more achievable in minds of staff

Leadership used the technology to round on staff

• Automatic tracking of quarterly one-on-ones improved

compliance and drove accountability for the process

• Effectively capturing staff-generated ideas generated better

targeted and more rapid improvements

• Efficient capturing of patient comments fueled more

consistent staff recognition and more targeted coaching

1

2

Connecting Staff to

Patient Complaints and

Compliments

“Since I came, I have

complained about this

sticky floor on my left

side of the bed, but

nobody came to check

or clean.”

“[Nurse] is a great

teacher, she really

explains everything…I

will write a letter about

my great care.”

”

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Technology Enabled a High-Reliability System

20

Removed Traditional Barriers that Hindered Performance

Fix issues in the

moment

Support new

leadership goals

Solve the right

problems

Capture pulse of

current patients

Previously relied on

HCAHPS survey

data received weeks

(or months) post-

discharge

Drives transparency

and accountability

for results, as well as

staff satisfaction and

engagement

Helps ensure that

service needs are

assigned promptly

and resolved while

patients are still in

our care

Lets us understand

and manage the

drivers of HCAHPS

scores using a much

broader and richer

set of our patients’

experiences

Key Process Enhancements

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Clear Correlation to Patient Satisfaction

Overall Hospital Rating ≥ 9

Navigated a Bump in the Road

21

The System Enabled a Quick Response to Dipping Scores

Managed Through a Challenge

• Closed two units in late 2012 (one due to

declining census, one for renovation)

• Most rooms became semi-private

• Dissatisfaction related to cleanliness,

nurse communication, and physician

communication began to emerge as drivers

of overall satisfaction

• By presenting this data, Ingalls’ CNO was

able to convince other leaders of the intense

effect on several HCAHPS categories, leading

to the mid-year reopening of the unit

72% 74%

64% 62%

54% 60% 60%

56%

66% 69%

76%

Oct'12

Nov'12

Dec'12

Jan'13

Feb'13

Mar'13

Apr'13

May'13

Jun'13

Jul'13

Aug'13

Closed

E4

Reopened E4

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Final Thoughts

Hardwire Positive Behaviors with Technology

1

2

3

Simply telling staff to round will not

improve results – an infrastructure is

required

Holding staff accountable from front-line

all the way to the executive level is key –

and this requires actionable data

Cross-department cooperation and

coordination are essential to fix service

issues – internal systems support is

needed to close communication loop

22

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

Now It’s Your Turn: Live Q&A

23

Use the GoTo Webinar Question Panel to Ask a Question

Enter a Question in the Question Panel

Type your question

and hit send

The presenter may

answer the question

here or respond aloud

to the entire audience

©2014 T

HE

AD

VIS

OR

Y B

OA

RD

CO

MP

AN

Y

For More Information

24

hobartl@advisory.com

(484) 690-0761

Lisa Hobart

Senior Director