Agency for Healthcare Research and Quality Advancing Excellence in Health Care Setting the Stage for HCAHPS Success December 7, 2012 Carrie Brady, JD, MA

Advancing Excellence in Health Care Overview of Today’s Web Conference Introduction to Year Two of the AHRQ-HRET HCAHPS Patient Safety Learning Network Introduction to Year Two of the AHRQ-HRET HCAHPS Patient Safety Learning Network HCAHPS and Why It Matters HCAHPS and Why It Matters Opportunities and Challenges of HCAHPS Opportunities and Challenges of HCAHPS The Unique Nature of HCAHPS The Unique Nature of HCAHPS HRET Curriculum Overview HRET Curriculum Overview 2

Advancing Excellence in Health Care AHRQ/HRET Patient Safety Learning Network (PSLN) Project  This program is supported by the U.S. Agency for Healthcare Research and Quality (AHRQ) through a contract with the Health Research and Educational Trust (HRET).  HRET is a charitable and educational organization affiliated with the American Hospital Association, whose mission is to transform health care through research and education.  AHRQ is a federal agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. 3

Advancing Excellence in Health Care 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 HRET Partnership for Patients Hospital Engagement Network (HEN) or another HEN, your work will benefit directly from your efforts to improve the patient experience of care (e.g., readmissions, ADEs).  Lessons you learn in this HCAHPS Learning Network will help you succeed in the HEN project because— Patient-centered care is a driver of clinical outcomes Patient-centered care is a driver of clinical outcomes Employee and patient engagement are 2 sides of one coin Employee and patient engagement are 2 sides of one coin HCAHPS assesses key factors in ADEs and readmissions HCAHPS assesses key factors in ADEs and readmissions 4

Advancing Excellence in Health Care HCAHPS Curriculum All Web conferences are scheduled for 12-1pm Eastern  December 7, 2012: Fundamentals of HCAHPS  December 18, 2012: Using HCAHPS Data Effectively  December 19, 2012: Using HCAHPS Data Effectively (this date for workshop PSLN participants only)  January 16, 2013: Nurse Communication  February 13, 2013: Responsiveness  March 13, 2013: Medication Communication  April 24, 2013: Discharge Information  May 15, 2013: Physician Communication and Engagement  June 5, 2013: Pain Management  July 17, 2013: Clean  August 14, 2013: Quiet 5

Advancing Excellence in Health Care HCAHPS Technical Assistance Faculty  Carrie Brady, MA, JD  HRET’s primary HCAHPS faculty  Former senior Connecticut Hospital Association staffer  Previously a vice president at Planetree  Experienced hospital peers  To be identified using performance data and PSLN partner recommendation  Will provide case studies 6

Advancing Excellence in Health Care HCAHPS At A Glance Standardized national survey of hospital inpatients Standardized national survey of hospital inpatients – Administered after discharge 27 questions 27 questions – 18 substantive questions – 4 screening questions – 5 demographic questions 5 questions to be added January 1, questions to be added January 1, 2013

Advancing Excellence in Health Care HCAHPS Topics  CMS reports individual scores for:  Cleanliness  Quiet at night  Overall rating  Willingness to recommend  CMS reports composite scores for 6 topics:  Nurse Communication  Doctor Communication  Medication Communication  Responsiveness  Pain Management  Discharge Information 8

Advancing Excellence in Health Care New HCAHPS Questions: Care Transitions 9 Scale: Strongly Disagree, Disagree, Agree, Strongly Agree 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. 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. When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. When I left the hospital, I clearly understood the purpose for taking each of my medications. When I left the hospital, I clearly understood the purpose for taking each of my medications.

Advancing Excellence in Health Care New HCAHPS Questions: Patient Information 10 During this hospital stay, were you admitted to this hospital through the Emergency Room? During this hospital stay, were you admitted to this hospital through the Emergency Room? (Yes, No) In general, how would you rate your overall mental or emotional health? In general, how would you rate your overall mental or emotional health? (Excellent, Very Good, Good, Fair, Poor)

Advancing Excellence in Health Care Why HCAHPS Matters: CMS Value-Based Purchasing Your performance today affects your value-based purchasing payments 11

Advancing Excellence in Health Care CMS Value-Based Purchasing 30% HCAHPS 12

Advancing Excellence in Health Care Increasing Relative Importance of Patient Experience for Value-Based Purchasing

Advancing Excellence in Health Care The Evidence Is Mounting HCAHPS Matters Clinically

Advancing Excellence in Health Care HCAHPS and Readmissions For the core clinical areas (HF, PN), HCAHPS performance was more predictive of readmission rates “than the objective clinical performance measures often used to assess the quality of hospital care.” Source: Boulding W et al. Relationship between Patient Satisfaction with Inpatient Care and Hospital Readmissions Within 30 Days, Am J Manag Care. 2011; 17(1):

Advancing Excellence in Health Care HCAHPS and Quality/Safety “[T]here were consistent relationships between patient experiences and technical quality as measured by the measures used in the HQA program, and complication rates as measured by the AHRQ PSIs.” Source: Isaac T et al., The Relationship between Patients’ Perception of Care and Measures of Hospital Quality and Safety, Health Services Research 45:4 (August 2010) 16

Advancing Excellence in Health Care Patient Experience and Clinical Outcomes “[W]hen we controlled for a hospital’s clinical performance, higher hospital-level patient satisfaction scores were independently associated with lower hospital inpatient mortality rates.” Source: Glickman SW et al, Patient Satisfaction and Its Relationship with Clinical Quality and Inpatient Mortality in Acute Myocardial Infarction, Circ Cardiovasc Qual Outcomes 2010;3:

Advancing Excellence in Health Care How Are You Using HCAHPS? Is HCAHPS a tool to develop a shared understanding of patient and staff needs? OR Is HCAHPS driving a wedge between patients and staff? 18

Advancing Excellence in Health Care The Opportunities and Challenges of HCAHPS Challenges If used incorrectly, HCAHPS data can:  Drive a wedge between patients and staff  Create frustration and distrust between administration and staff  Be perceived as invalid or simply irrelevant  Become an excuse not to listen Opportunities If used correctly, HCAHPS data is a valuable tool to:  Understand the patient experience  Gain useful information not available from other sources  Highlight important ways to improve clinical outcomes and safety  Monitor and deepen relationships with patients 19

Advancing Excellence in Health Care Ideal Scenario 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 20

Advancing Excellence in Health Care More Common Scenarios HCAHPS is used as a weapon by managers who:  Feel pressured to improve scores but don’t know how  Have run out of improvement strategies/need fresh ideas Response of staff members:  Ignore data completely  Become angry with patients  Try to improve, but are overwhelmed by tasks that are not well aligned or prioritized 21

Advancing Excellence in Health Care The Nature of HCAHPS HCAHPS is a quantitative tool designed to evaluate the qualitative relationship between patients and staff. 22

Advancing Excellence in Health Care HCAHPS is Different and the Difference is Important  Clinical process measures have objective answers that are capable of independent validation.  e.g., Did you give the patient aspirin?  HCAHPS tells us how we are meeting our patients’ unique needs.  HCAHPS asks for reports of experience rather than ratings, because reports are more objective.  The patient’s perception is reality for that patient and we need to understand that reality to provide effective clinical care. 23

Advancing Excellence in Health Care Patients See Things Differently Than Providers  22% of 193 patients reported a “recent unsafe episode”  More than 80% of the reported experiences were classified by reviewers as “service quality incidents”  33% related to waits and delays  21% related to poor communication and information for patients  13% related to poor coordination of care among staff Source: Weingart SN et al. “Patient-Reported Safety and Quality of Care in Outpatient Oncology” Joint Commission Journal on Quality and Patient Safety; 33:2,

Advancing Excellence in Health Care Patients’ Perspectives are Invaluable CONCLUSIONS: “Patient-reported service quality deficiencies were associated with adverse events and medical errors. Patients who report service quality incidents may help to identify patient safety hazards.” (emphasis added) Taylor BB et al. Medical Care 2008 Feb;46(2): Taylor BB et al. Medical Care 2008 Feb;46(2):

Advancing Excellence in Health Care We Also Need to Know What Patients Don’t Know Source: Olson DP and Windish DM, “Communication Discrepancies Between Physicians and Hospitalized Patients” Arch Intern Med 2010; 170 (15):

Agency for Healthcare Research and Quality Advancing Excellence in Health Care HRET Curriculum: A New Way of Thinking about HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems

Advancing Excellence in Health Care What HCAHPS Can Also Mean How Can you Always Help Patients/ Providers Succeed? 28

Advancing Excellence in Health Care Foundational Elements of Patient-Centered Care – Leadership – Patient/Family Partnership – Workforce Engagement – Data Use/Performance Improvement HCAHPS Success Depends on A Strong Foundation 29

Advancing Excellence in Health Care Curriculum Objective To support hospital teams in effectively using HCAHPS as a tool for improving quality, safety, and the patient experience. 30

Advancing Excellence in Health Care HCAHPS Team Members Patients/families Patients/families Frontline staff Frontline staff Organizational leaders Organizational leaders Clinical and non-clinical departments Clinical and non-clinical departments Don’t forget: Quality Improvement Quality Improvement Pharmacy Pharmacy Environmental Services Environmental Services Physicians Physicians 31

Advancing Excellence in Health Care Strategies to Achieve the Objectives  Provide expertise, research, and practical tools  Harness participants’ institutional wisdom  Build internal teams and external communities for ongoing improvement work 32

Advancing Excellence in Health Care Our Secret Ingredient You! Your experience and enthusiasm is an essential component of the curriculum 33

To Make the Most of HCAHPS: “The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.” Marcel Proust 34

Advancing Excellence in Health Care What’s Next for HCAHPS PSLN Participants? 1) Resource list and compilation of successful strategies 2) Series of Webinars at noon Eastern  December 18, 2012 Web conference: Using HCAHPS Data Effectively  December 19, 2012 Web conference: Using HCAHPS Data Effectively  Dec 19th Webinar is for workshop PSLN participants only  January 16, 2013: Nurse Communication will be the first in a series of 8 monthly HCAHPS domain-specific Web conferences, also at noon Eastern time 35

Advancing Excellence in Health Care PSLN Extranet – 36

Advancing Excellence in Health Care Archived webinars Archived webinars – Medication Reconciliation – HCAHPS and Value Based Purchasing – Project RED Discussion Forum (coming soon) Discussion Forum (coming soon) Registration links for upcoming events (coming soon) Registration links for upcoming events (coming soon) Creating an account will give you access to… 37

Agency for Healthcare Research and Quality Advancing Excellence in Health Care Questions?