MBQIP Phase 2 Focus on HCAHPS

Copyright ©2011 Georgia Hospital Association

MBQIP Phase 2Focus on HCAHPS

Critical Access Hospital PresentationJuly 23 2014


Objectives

• Define the 3 phases of the Office of Rural Health MBQIP program

• Describe Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) • Understand the value of engaging in the

HCAHPS process• Identify the benefits and challenges of HCAHPS• Review HCAHPS Vendor Directory


Medicare Beneficiary Quality Improvement Project • Began September 2011, voluntary-register on Quality Net 100% participation goal by FY 2014• Nationwide quality improvement plan for rural healthcare

• Improves access for Medicare beneficiaries served, including EMS• Voluntary CAH quality benchmarking & reporting to CMS Hospital Compare• Builds a national data base to demonstrate effect of rural quality improvement

initiatives

• Phase I Process measures for inpatient Pneumonia & HF• Phase II- Outpatient measures 1-7 and HCAHPS• Phase III-Pharmacy CPOE review of orders in 24 hours

& ED transfer communication & report quality improvement data to state


MBQIP – Why participate?

• Promotes accountability & public disclosure

• Future of all hospital reimbursement will soon be tied to performance-Get ahead of the curve

• Only statistically significant volumes will be reported (>25 cases)

• Gives benchmark data to analyze and guide performance improvement

• It’s the RIGHT thing to do ! Evidence drives improvement


The Patient Experience of Care is Fundamental to Clinical Improvement

Understanding the patient experience of care is not an add-on activity: it should be used as a fundamental element in your other improvement efforts.

For those working on the GHA Partnership for Patients Hospital Engagement Network (HEN) your work will benefit directly from your efforts to improve the patient experience of care.

Patient-centered care is a driver of clinical outcomes

Employee and patient engagement are 2 sides of one coin

HCAHPS assesses key factors in ADEs and readmissions


New Care Transition composite will be publicly reported on Hospital Compare, October 2014


Approved Vendor list

• Review attachment A2


Vendors GA Rural/CAH hospitalsVENDOR List as of April 2014

AVATAR INTERNATIONAL INC (1)HEALTHSTREAM RESEARCH (8)JL MORGAN AND ASSOCIATES INC (2)NATIONAL RESEARCH CORPORATION ( 5)NO VENDOR (1)PRESS GANEY ASSOCIATES (6)RURAL COMPREHENSIVE CARE NETWORK (4)


• Hospital level results reported at http://www.hospitalcompare.hhs.gov

• Additional reports on HCAHPS website (http://hcahpsonline.org)– Top box scores by state– Percentiles– Correlations– Hospital Characteristics

HCAHPS reports

http://www.hospitalcompare.hhs.gov/

http://hcahpsonline.org/


Comparative DataJune 30 2012-July 1 2013

Patients who reported that their nurses "Always" communicated well.

Patients who reported that their doctors "Always" communicated well.

Patients who reported that they "Always" received help as soon as they wanted.

Patients who reported that their pain was "Always" well controlled.

Patients who reported that staff "Always" explained about medicines before giving it to them.

Patients who reported that their room and bathroom were "Always" clean.

Patients who reported that the area around their room was "Always" quiet at night.

Patients who reported that YES, they were given information about what to do during their recovery at home.

Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).

Patients who reported YES they would definitely recommend the hospital.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

84%

85%

74%

77%

71%

78%

72%

85%

72%

71%

78%

82%

65%

70%

64%

71%

66%

83%

70%

70%

GA Hospital Average FLEX hospital Average


Communication with Nurses

During this hospital stay…how often did nurses treat you with courtesy

and respect? (Q1)how often did nurses listen carefully to you?

(Q2)how often did nurses explain things in a way

you could understand? (Q3)


Communication with Nurses

Success Strategies:Hourly RoundingWhite Boards/Care BoardsBedside ReportingAIDETAscertain need for and obtain language

assistance.


Communication with Doctors

During this hospital stay…how often did doctors treat you with courtesy

and respect? (Q5)how often did doctors listen carefully to you?

(Q6)how often did doctors explain things in a way

you could understand? (Q7)


Communication with Doctors

Success Strategies: Using strategic language – I am washing my hands for your SAFETY.”– “I have TIME to answer your questions.”– “I want you to be INVOLVED in your treatment plan” – “I want to be sure I EXPLAIN everything to you…”– “To protect your PRIVACY, let me close the curtain.”– “For your COMFORT, I ordered pain medicine...”– “I want to keep you INFORMED…”– “I want to make sure we are THOROUGH”– “You are in good hands with the nurses on this floor.”

• STUDER


Responsiveness of Hospital Staff

During this hospital stay….

after you pressed the call button, how often did you get help as soon as you wanted it? (Q4)

How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted? (Q11)


Responsiveness of Hospital Staff

Success Strategies:“No Pass” ZonesHourly rounding


Pain Management

During this hospital stay,

how often was your pain well controlled? (Q13)

how often did the hospital staff do everything they could to help you with your pain? (Q14)


Pain ManagementSuccess Strategies:

• Patients’ experience of pain management is not entirely dependent on their level of pain

• Pain management perceptions are affected by many factors, including:– Effective communication with physicians and nurses– Responsiveness – Empathy

• Set Reasonable Expectations– Be candid about the pain to be expected– Keep the patient informed

• e.g., use the white board to keep the pain goal and plan visible, as well as next scheduled medication

• Respect the Patient’s Expertise– Discuss options, tradeoffs, and preferences, including what has worked previously – Develop pain goals and a plan

• Explain the purpose of the pain scale• Ask patients contextual questions

– e.g., at what point on the scale would they take an over the counter medicine for pain


Communication of Medications

Before giving you any new medicine,

how often did hospital staff tell you what the medicine was for? (Q16)

how often did hospital staff describe possible side effects in a way you could understand? (Q17)


Communication of Medications

Success Strategies:TV Education channel Involving multidisciplinary approach

Dietician Respiratory Clinical Pharmacist

White Boards– List new Medications– Document teaching for cross communication and

reinforcement


Discharge InformationDuring this hospital staydid doctors, nurses or other hospital staff talk

with you about whether you would have the help you needed when you left the hospital? (Q19)

did you get information in writing about what symptoms or health problems to look out for after you left the hospital? (Q20)


Discharge InformationSuccess Strategies:Identify the correct medicines and a plan for

the patient to obtain and take them.Use “target tool” to educate the patient about

his or her diagnosis and self management


Care Transition

During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left.(Q23)

When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. (Q24)

When I left the hospital, I clearly understood the purpose for taking each of my medications. (Q25)


Care Transition

Success Strategies:Make appointments for follow-up medical

appointments and post discharge tests/labs. Organize post-discharge outpatient services and

medical equipment.Provide telephone reinforcement of the Discharge

Plan.


HCAHPS: Global ItemsOverall rating of the hospital Using any number from 0 to 10, where 0 is the

worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay? (Q21)

Recommendation of hospital Would you recommend this hospital to your friends

and family? (Q22)


Individual Items

Cleanliness of Hospital Environment (Q8)

Quietness of Hospital Environment (Q9)


Individual ItemsSuccess Strategies: Staff returns if patient is not in room during

cleaning Gold stickers on toilet paper From: leaving tent cards To: “Get Well” cards Revise job descriptions and related materials

e.g., role is to prevent nosocomial infections

Bring out Quiet signs Inquire regarding quietness on unit during

rounding Ask about and preserve patient sleep rituals

e.g., a cup of tea, reading material, snack

Change EKG batteries & leads at a.m. shift change


How will HCAHPS Reinforce Focus on Quality?

• Patient-Centered care is a quality indicator• Quality no longer the domain of just the

clinicians• Gives a voice to the patient perception of safety• Highlights communication issues/barriers• Patient-centered care actively involves patients

in their care• More senior leaders are engaged and interested

in delivering patient-centered care


The Patient Experience of Care is Fundamental to Clinical Improvement

• HCAHPS is viewed as a valuable tool to help organizations achieve multiple objectives

• HCAHPS is part of a coordinated, comprehensive approach to partnering with patients and families

• Everyone works together as a team to identify opportunities for improvement, innovate and implement strategies, and celebrate success


HCAHPS Challenges

• Cost• Obtaining a meaningful response• Public perception that low volume could be a negative trait for a care provider


Foundational Elements of Patient-Centered Care

–Leadership–Patient/Family Partnership–Workforce Engagement–Data Use/Performance Improvement

HCAHPS Success Depends on A Strong Foundation

36


View patient experience data as an opportunity for “appreciative inquiry”Reveal hidden innovation within your own organizationExamine improvement (including change in “bottom

box” scores), not just achievement

Put HCAHPS data in context with other qualitative and quantitative information about the patient and staff experiencePreserve relationships by noting what is working well

Mine the Data for Solutions, Not Just Problems


Other Important Sources of Information

Patient Experience Post-discharge phone calls

Rounding

Patient and family focus groups

Patient and family advisory council/advisors

Ombudsman/patient advocate programs

Compliments

Staff Experience Employee Engagement Data

Staffing Levels

Patient Safety Culture Survey Data

38


Shadowing

A unique opportunity to gain a perspective on the experience through the patient’s eyes

Request patient permission Explain role is to observe and identify opportunities to improve care

that will help others Record observations

Patient/family perspective Your own reactions

39

http://www.pfcc.org/go-shadow/




Tools of the trade

Hunches, theories, ideas

Small scale test

Larger scale test of change

Implementation of change

Monitor change

Change that results is SUCCESS


Additional Resources

Fundamentals of HCAHPSUsing HCAHPS Data Effectively

Nurse Communication Responsiveness

Medication Communication Discharge Information

Physician Communication and Engagement Pain Management

Clean & Quiet

AHRQ/HRET Patient Safety Learning Network (PSLN) HCAHPS National Teleconference Series

http://www.psl-network.org/




Questions?

It is not just about scores, financial indicators, public reporting, % of

always…it is about compassionate care

and saving lives


GHA Contact Information

Kathy McGowan, Vice President of Quality & [email protected] 770-249-4519

Joyce Reid, Vice President of Community Health [email protected] 770-249-4545

Lisa Carhuff, Quality Improvement/Patient Safety Specialist Rural and Critical Access [email protected] 770-249-4553

mailto:[email protected]



MBQIP Phase 2 Focus on HCAHPS

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