Copyright ©2011 Georgia Hospital Association MBQIP Phase 2 Focus on HCAHPS Critical Access Hospital Presentation July

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association

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

Copyright ©2011 Georgia Hospital Association Approved Vendor list Review attachment A2

Copyright ©2011 Georgia Hospital Association Vendors GA Rural/CAH hospitals VENDOR 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)

Copyright ©2011 Georgia Hospital Association Hospital level results reported at Additional reports on HCAHPS website ( – Top box scores by state – Percentiles – Correlations – Hospital Characteristics HCAHPS reports

Copyright ©2011 Georgia Hospital Association Comparative Data June July

Copyright ©2011 Georgia Hospital Association 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)

Copyright ©2011 Georgia Hospital Association Communication with Nurses Success Strategies: Hourly Rounding White Boards/Care Boards Bedside Reporting AIDET Ascertain need for and obtain language assistance.

Copyright ©2011 Georgia Hospital Association 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)

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association

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)

Copyright ©2011 Georgia Hospital Association Responsiveness of Hospital Staff  Success Strategies:  “No Pass” Zones  Hourly rounding

Copyright ©2011 Georgia Hospital Association 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)

Copyright ©2011 Georgia Hospital Association Pain Management Success 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

Copyright ©2011 Georgia Hospital Association 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)

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association Discharge Information During this hospital stay  did 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)

Copyright ©2011 Georgia Hospital Association Discharge Information Success 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

Copyright ©2011 Georgia Hospital Association 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)

Copyright ©2011 Georgia Hospital Association 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.

Copyright ©2011 Georgia Hospital Association HCAHPS: Global Items Overall 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)

Copyright ©2011 Georgia Hospital Association Individual Items  Cleanliness of Hospital Environment (Q8)  Quietness of Hospital Environment (Q9)

Copyright ©2011 Georgia Hospital Association Individual Items Success 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

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association HCAHPS Challenges Cost Obtaining a meaningful response Public perception that low volume could be a negative trait for a care provider

Copyright ©2011 Georgia Hospital Association Foundational Elements of Patient-Centered Care – Leadership – Patient/Family Partnership – Workforce Engagement – Data Use/Performance Improvement HCAHPS Success Depends on A Strong Foundation 36

Copyright ©2011 Georgia Hospital Association  View patient experience data as an opportunity for “appreciative inquiry” Reveal hidden innovation within your own organization Examine 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 experience Preserve relationships by noting what is working well Mine the Data for Solutions, Not Just Problems

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association 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

Copyright ©2011 Georgia Hospital Association Additional Resources Fundamentals of HCAHPS Using 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

Copyright ©2011 Georgia Hospital Association Questions? It is not just about scores, financial indicators, public reporting, % of always…it is about compassionate care and saving lives

Copyright ©2011 Georgia Hospital Association GHA Contact Information Kathy McGowan, Vice President of Quality & Safety Joyce Reid, Vice President of Community Health Connections Lisa Carhuff, Quality Improvement/Patient Safety Specialist Rural and Critical Access Hospitals