The Relationship Between HCAHPS and Facilities: How to Improve Scores In New and Existing Healthcare...

1The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities

THE RELATIONSHIP BETWEEN HCAHPS

AND FACILITIES: HOW TO IMPROVE

SCORES IN NEW AND EXISTING

HEALTHCARE FACILITIESNOVEMBER 7, 2013


Learning Objectives

• Understand Patient Satisfaction (HCAHPS) questions and

scores and their relationship to the built environment.

• Learn how Facilities can respond to improve results in HCAHPS

scores.

• Identify specific ways that Facilities can impact scores on:

– Cleanliness

– Noise

– Courtesy, Listening and Respect

• Understand the relationship between hospital acquired

conditions (infections and patient falls), patient satisfaction and

the built environment.

• Identify specific facility strategies to improve outcome measures

through use of a value and cost relationship improvement tool.


Presenters

Terry Thurston, RN, BSN, MBA

Director of Healthcare Operations Planning,

BSA LifeStructures

Joe Mynhier, AIA, ACHA, NCARB

Principal, BSA LifeStructures


What are HCAHPS?

HCAHPS

Hospital Consumer Assessment of

Health Care Providers and Systems

Hospital’s reimbursement is partly

based on scores they receive on the

HCAHPS

http://www.medicare.gov/hospitalcompare/compare.html#cmprTab=1&cmprID=150024%2C150056%2C150074&loc=INDIANAPOLIS%2C%20IN&lat=3 9.7685155&lng=-86.1580736

CMS LINK:

http://www.medicare.gov/hospitalcompare/compare.htmlcmprTab=1&cmprID=150024%2C150056%2C150074&loc=INDIANAPOLIS%2C%20IN&lat=39.7685155&lng=-86.1580736


Comparative Analysis by State


Interpreting the HCAHPS Scores


The Patient Experience Paradigm


Operational & Facility Planning

Driven Design


Value Based Purchasing – Aligned

Goals

Patient ExperienceMeasures(HCAHPS)

Outcome Measure(2014)

CoreMeasures

Hospital Acquired

ConditionMeasures

30% (+/-)

(+/-) 45%

(-) 25% (+/-)

SAFE

EFFECTIVE

PATIENT CENTERED

EFFICIENT

TIMELY

EQUITABLE

AFFORDABLE


Accelerators

Relationship Between HCAHPS

& The Built Environment

HOSPITAL ENVIRONMENT

QUESTIONS

HOSPITAL ENVIRONMENT

QUESTIONS(QUESTIONS 8 & 9)

CARE COMPOSITE

QUESTIONS(QUESTIONS 1-3, 5-7)

During this hospital stay, how often

were your room and bathroom kept

clean?

During this hospital stay, how often

was the area around your room quiet at night?

Courtesy

Respect

Listen

Explain


Built Environment Response To Care

Composites

Questions 1-3, 5-7

Adequate caregiver space at

the bedside1

Built

Environment Impact

Respect, Courtesy,

Listen, and Explain

(The Engaged

Employee) Off-stage collaboration areas

to facilitate manager rounding

& team communication2

Caregiver Support Spaces3



Composites

• Computer

orientation

• Staff Seating

• Supplies at bedside

(80/80/80

Guideline)

• Clear of Family

Zone and path of

travel to bathroom

• Collaborative areas

at patient bedside

Adequate Caregiver Space At Bedside

BSA LifeStructures

BSA LifeStructures


Photo © John Durant | www.johndurant.com


Composites

Caregiver Support Spaces

• Staff Lounges

• Entrance

• Respite Areas

• Natural Light

• Ergonomics


Hospital Acquired Conditions: Patient

Falls

Condition

Travel path to and from the

patient bathroom are the most

frequent contributors to falls1

Built

Environment Impact

Unobstructed Pathways2

Lighting and Finishes

Patient falls in room

& bathroom

contribute to

increased patient

morbidity, mortality,

LOS, & cost of care

3


• Unobstructed path from bed to

bathroom in few steps

• Leafed double bathroom door

• Handrails to bathroom and vertically

outside bathroom door

• Non-slip flooring

• Lighted pathway from bed to

bathroom

• Visibility from corridor to bed or foot

of bed

• Toilet in center of bathroom (2

caregiver assist)

Preventing Patient Falls

Environmental Recommendations

Clemson University Patient Room of the Future


Hospital Acquired Conditions:

Infection Prevention

Condition

Location of sink and hand

sanitizers1

Built

Environment Impact

Personal protective

equipment (PPE) location

Cleanability and surfaces3

Hospital Acquired

Infections

2


• Sink located at entry to patient

room

– Features: height, depth, faucets,

splash, visibility to patients

• Cubicle curtains: cleanable, hand

guards

• Enclosed toilet in ICU

• Personal Protective Equipment

Location

Hospital Acquired Conditions:

Infection Prevention

Dublin Methodist Hospital

© John Durant | www.johndurant.com

© The Chester County Hospital

http://www.cchosp.com/images/Tower/P_PatientRoom_lrg.jpg



PERCENTAGE OF MEDICARE PATIENT STAYS IN SINGLE

OCCUPANCY ROOMS 2002-2010

SOURCE: “HEALTH CARE CONSTRUCTION OUTLOOK FOR 2012 AND BEYOND” © 2012 THE

ADVISORY BOARD COMPANY

Private Rooms – Still Not There

2002 2003 2004 2005 2006 2007 2008 2009 2010

27.5%27.7%

28.2%

28.5%

29.0%

29.7%

30.2%30.0%

31.1%


The Hospital Environment: Patient

Room Cleanability And Finishes

Question #8

A clean room contributes to

higher patient satisfaction1

Built

Environment Impact

Due to surfaces and

products selected, a clean

room may not look clean

Contaminated environment

contributes to hospital

acquired infections3

During this hospital

stay, how often was

your room and

bathroom kept

clean? 2


Keeping The Patient Room Clean:

Cleanability

Design Considerations For Furniture, Casework, & Built-ins

• Floor plan layouts

• Furniture locations

• Built-in casework locations

• Areas to collect dust

• Difficult areas to clean



Furniture Location & Design

• Fixed vs. Moveable

• Snug Fit vs. Awkward

Voids

• Appropriate Cleaning

Products

BSA LifeStructures BSA LifeStructures

BSA LifeStructures


• Floor plan configuration

– Avoid acute angles and corners

• Furniture location and placement

– Avoid tight and compact areas which will be difficult to clean

– Anticipate where furniture can be moved

• Areas that collect dust and dirt

– provide soffits above upper cabinets

– provide soffits for task down lighting

– provide sloped tops as an alternative to soffits

Keeping The Patient Room

Clean: Floor Plan Design



Keeping The Patient Room

Clean: Finishes And Products



Finishes


Flooring, Walls, & Ceiling

• easy to clean

products

• products that look

clean

• simple cleaning

instructions

MDO Wall

The Mohawk Group Armstrong


The Hospital Environment: Patient

Room Internal & External Noise

Question #9

Noise contributes to lower

patient satisfaction1

Built

Environment Impact

Noise contributes to slower

recovery of the patient

Noise contributes to longer

lengths of stay3

During this hospital

stay, how often was

the area around your

room quiet at night?2


Sound Levels In Decibels

• JACKHAMMER 130

• COMMERCIAL JET 120

• LEAF BLOWER 110

• BABY CRYING 110

• FLUSHING TOILET 80

• NORMAL CONVERSATION 60

• ARCHITECT-LATE PAYMENTS 200


Preventing External Noise

Noise From Corridor To Patient Room

Noise From Other Sources To Patient Room

• From staff/physicians near

patient room door

• From caregivers/visitors in

corridor

• From equipment in corridor

alcoves & storage

• From decentralized nurse work

stations

• From mechanical and HVAC systems



Decentralized Nurse Work Stations

• Collaboration adds noise to corridor

• Work station adds noise at patient room entry

• Corridors remain same width despite function change

BSA LifeStructures


• Implement sound attenuation techniques

– Sound masking at door

– Sound insulation along corridor wall

• Implement caregivers/visitors “reduce voice volume” program

– Quiet zones

– Provide sound recording devices in key locations (green,

yellow, red light)

• Implement mitigation of external noise

– Remove moveable items, carts & equipment

– Sound insulation added at external sources

– Study door locations to avoid door alignment




Preventing Internal Noise

Noise Within The Patient Room

Noise From Patient Room To Patient Room

• From toilet in adjacent patient

room

• From television in adjacent

patient room

• From adjacent mechanical rooms

• From caregivers/visitors in

adjacent patient room

• From equipment in patient room

• From caregivers/visitors in patient

room


Preventing Internal Noise


Information Overload?

• This year, 5 million times the information included in all the books ever written, will be created

• A majority of people say that less than half of the information they receive is valuable

• A majority of people wish they could spend more time working with the information they have versus trying to manage it

So how do you use the information we have given you?.......


HCAHPS Improvement Grid


THE RELATIONSHIP BETWEEN HCAHPS

AND FACILITIES: HOW TO IMPROVE

SCORES IN NEW AND EXISTING

HEALTHCARE FACILITIESNOVEMBER 7, 2013

The Relationship Between HCAHPS and Facilities: How to Improve Scores In New and Existing Healthcare...

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Transcript of The Relationship Between HCAHPS and Facilities: How to Improve Scores In New and Existing Healthcare...