How Facilities Can Improve HCAHPS - ISHE · How Facilities Can Improve HCAHPS ISHE Fall Conference...

© 2016 The Center for Health Design

How Facilities Can Improve HCAHPS

ISHE Fall Conference

Lynn Kenney, Director of Industry Relations

The Center For Health Design


Improving the connection between health

and the built environment…


Learning Objectives

1. Why we do what we do-improve health & safety

2. HCAHPS and patient satisfaction and how it impacts hospital reimbursement and reputation

3. Review the people, process, place framework

4. Review case studies and examples that illustrate how facilities professionals impact HCAHPS and patient experience

5. Review resources and tools


Where to Begin?

Experience Your Facility Through the Eyes

of the Patient


What Is Involved?


HCAHPS – Hospital Consumer Assessment of Healthcare Providers and Systems Survey

32 Survey Questions Measure Patient

Experience of Care Dimensions

1. Communication with Nurses

2. Communication with Doctors

3. Responsiveness of Hospital Staff

4. Pain Management

5. Communication about Medicines

6. Cleanliness and Quietness of Hospital

Environment

7. Discharge Information

8. Overall Rating of Hospital


The CMS HCAHPS Survey

http://hcahpsonline.org/files/March%202016_Survey%20Instruments_English_Mail.pdf

http://hcahpsonline.org/files/March 2016_Survey Instruments_English_Mail.pdf

http://hcahpsonline.org/files/March 2016_Survey Instruments_English_Mail.pdf


Survey of Patient Experiences http://www.medicare.gov/hospitalcompare


So many phrases and terms… • Patient-centered design

• Patient-centered care

• Patient and staff satisfaction

• Patient and family experience

• Px

• HCAHPS

• CAHPS


Why is there so much emphasis on patient-centered care?

ACA

ROI/Reimbursement

Outcomes

The HCAHPS Impact

Reputation/

Branding

Staff, Patient and Family Experience


Hospital Value Based Purchasing Domains:

• Patient experience measured using the

HCAHPS survey

• Clinical Process of care measures

• Outcome measures - Patient

safety/mortality indicators

• Efficiency Measures beginning in FY 15 - Medicare Spending/ Beneficiary

Efficiency Outcomes

Patient Experience

Processes of Care

Can Lose up to 2.0% of Medicare payments by FY 17

Slide by Eileen Malone

Patient experience & safety outcomes are now tied to reimbursement


Expansion of the CAHPS Survey Program

Hospitals Hospital Consumer Assessment of Healthcare Providers and Systems Survey

(HCAHPS)

Outpatient facilities Outpatient and Ambulatory Surgery CAHPS (OAS CAHPS)

Emergency Departments Emergency Department Patient Experiences with Care (EDPEC) Survey

“The surveys provide patient experience data that enables comparison of facilities across the nation and promotes effective communication and coordination.” www.cms.gov

http://www.cms.gov/


Why is there so much emphasis on patient-centered care?

Patient-

Centered Care

More Transparency More Consumer-driven More Competitive Reimbursement tied to

performance across the continuum of care


Patient Experience (Px)

People-A Culture of Caring

Place-Physical Environment

Process-Process Improvement


Solving a Common Hospital Problem: Noisy at Night

Infrastructure (Place) Culture (People) (Process) Reengineering

Building •Single patient rooms •Use of sound absorbing materials •Design to separate noisy entities (ice machine)

Identify Desired End-State • Identify current state: decibel level, HCHAP score, & staff satisfaction re: noise •Establish sense of urgency •Identify target goals

Staff Interventions •Nighttime care guidelines •Quiet voices •Resupply and equipment movement

Technology •Hands-free communication •Beepers on vibrate •No overhead paging

Develop Noise Reduction Campaign Plan •Set the stage using research and best practices •Clarify values, vision

Patient Interventions •Rights •Earplugs •Television and radio headphones

Equipment •Fix squeaks •Decrease equipment volumes – link to hands-free devices

Measure and Reward Progress •Celebrate successes •Find and tell the best stories

Visitor Interventions •Orientation to noise reduction •Cell phone use


Patient Experience/HCAHPS Case Studies

• Quiet/Privacy (question 9) • Responsiveness (question 4) • Communication (questions 1,2,5,6,7) • Cleanliness (question 8)

•


Quiet-Privacy (Question 9)


Key elements for improving the patient experience

The Beryl Institute


Survey of Patient Experiences http://www.medicare.gov/hospitalcompare


“How am I supposed to sleep with all this

racket?”


Reducing noise

Private rooms reduce exposure to

noise levels that can cause stress and

negative health effects Ulrich et al., 2008.

Reduced noise levels improved sleep

and mood, better pain tolerance Janssen et al., 2000


Columbia-Bassett Medical School Quiet Project


Quiet - PRIVACY Case Study by Dr. Lorissa McAllister at Enviah

ROOM or UNIT modification for

Improved Outcomes COMMUNITY HOSPITAL-

MICHIGAN


1,600 people didn’t like our

physical surroundings –

#1 Sound and #2 Privacy

complaints

10

% D

islik

ed

Quiet – PRIVACY COMMUNITY HOSPITAL-MICHIGAN


Pre-Panel Comments Related to Sound

Jan-May 2012 (study conducted by Enviah)

• Arbor Question:

WAS THERE ANYTHING ELSE ABOUT THE HOSPITAL'S PHYSICAL SURROUNDINGS THAT YOU FOUND UNPLEASANT? (IF YES) PLEASE EXPLAIN:

• Patient Comment: “The emergency room is pretty old. The rest of the hospital is updated and modern looking. The emergency room is not. There is not a lot of patient privacy. Most of the rooms have two beds in them. You can hear other patients' responses to questions and all of their personal information. I do not feel that is good.”



• Arbor Question:

DID YOU FEEL THAT THE HOSPITAL TOOK ADEQUATE PRECAUTIONS FOR

YOUR SAFETY? (IF NO) PLEASE EXPLAIN:

• Patient Comment: “I do not think that people being able to hear all of your information is safe”.


Pre-Panel Comments Related to Sound

Jan-May 2012


June 2012 –

1st Month Post Panels

Improvement!

Zero negative comments

about sound.

5%

dissatisfied



Privacy for Ambulatory Surgery Patients at Bassett Healthcare


Responsiveness (Question 4)


No Passing Zone Codes

Call Lights:

Red Flashing Bath, toilet or shower / Staff assist Door will typically be closed, knock on door to let patient know that you hear them and will get help. If restroom is empty, ok to cancel call light.

White Steady Normal calls Flashing Bulb, Cord, Bed, Pillow speaker Pulled Out & Bed Exit alarm

Blue Flashing Code Blue Calls Support Services can help by removing equipment, chairs or other guests.

Green Flashing RN Service Needed Solid RN in Room

Yellow Flashing PCA Needed Solid PCA in Room

No Passing Zone-Bassett

Support & Ancillary Services Mobilized!


Logistics and Supplies Matter


Communication (Questions 1,2,5,6,7)


Expansion of White Boards and the 5-10 Rule…


Wayfinding: Reducing Anxiety

NSHE


Wayfinding


ROOM or UNIT modification for Improved Outcomes

VIRGINIA Communication - ENGAGEMENT Case Study


ROOM or UNIT modification for Improved Outcomes HOSPITAL- FLORIDA

Communication - ENGAGEMENT Case Study


Rooms that have hand wash

sinks that face patients have an

increased mean scores of 1.3-

7.31

point

Lorissa MacAllister 2014, All rights Reserved, Do not distribute or cite

Location of the first encounter-communication

Study by Dr. Lorissa McAllister


Rooms that have the head

of the bed inside the room

have an increased Mean

Score of 4.55 points

Head of the bed at the door

Head of the bed in the room

Lorissa MacAllister 2014, All rights Reserved, Do not distribute or cite

Location of head of bed

Communication - ENGAGEMENT

Study by Dr. Lorissa McAllister


Cleanliness (Question 8)


Continuous Improvement

Cleanliness and Clutter

Cleanliness and Lighting


Before

After

ROOM modification=Improved Outcomes DOW HEALTH SERVICES-MICHIGAN Satisfaction improved by 25%

CLEAN – PRIDE Case Study by Dr. Lorissa McAllister


Tools, resources, and next steps…


Make Patient Experience Part of Routine Activities

1. Get involved in the PI committee

2. Accreditation – Look at Px elements during EOC Rounding

3. Offer Ideas and Suggestions

1. Get involved in HCAHPS committees

4. Know Your Scores! http://www.medicare.gov/hospitalcompare

5. Familiarize yourself with best practices

http://www.medicare.gov/hospitalcompare


Know your “HCAHPS” scores

and make sure your solution

provider know them too! http://www.medicare.gov/hospitalcompare




HCAHPS Worksheet

Infrastructure (place) Culture (people) Process Reengineering

Building Identify Desired End State Staff Interventions

Technology Develop A Campaign

Patient Interventions

Equipment Measure and Reward Progress Visitor Interventions


Refer to the list in the HPOE Guide…

Source: The HPOE Guide www.hpoe.org/physicalenvironment

http://www.hpoe.org/physicalenvironment


Material Selections That Support Px, Maintenance and EVS Processes

Limiting Paint Selections

• To decrease confusion in matching when doing touch ups as well as limiting stored paint

Ceiling Tiles

• Understanding how often ceiling tiles are moved around as they need to gain access to above –ceiling pipes, etc. and planning tiles to make their lives easier. (Less edges to break)

Lighting Strategies

• Sharing lighting success strategies related to LED advancements, and understanding the process in switching an all-fluorescent facility over to LED

Flooring

• Choose dark colored flooring or flooring with specks to reduce the appearance of shoe marks which can impact perception of cleanliness

Source: The HPOE Guide www.hpoe.org/physicalenvironment

http://www.hpoe.org/physicalenvironment


Words and actions to live by…

The trick to remembering the big picture is to remember to keep experiencing your facility through the eyes of the patient.

People, Process, Place


Resources

www.hope.org www.ashe.org

www.healthdesign.org/knowledge-repository

http://www.hope.org/

http://www.ashe.org/

http://www.healthdesign.org/knowledge-repository




Thank you for all that you do to

improve the patient experience!

Resources are available at: www.healthdesign.org/knowledge-repository www.ashe.org www.hpoe.org [email protected]

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