1. Patient Centeredness: “ A Journey from Theory to Application” L.I.F.E. Concepts Veronica Cochran RN, MS

2. Learning Objectives Discuss patient-centric care delivery in the hospital setting – Patient Centeredness – Best practices for health care delivery – Customer satisfaction – Organizational Success Describe HCAHPS as a means of measuring perception of care – Measuring patient perception – Managing measurements – Measuring with more meaning

3. Opening Video

4. What is Patient Centeredness? Patient Centeredness

5. What is Patient Centeredness? An Organizational VALUE It must FIRST be well defined

6. Patient Centeredness… as a Value Beliefs and ideals shared by members of a culture about what is desirable or undesirable Influence attitude and behavior Serve as broad guidelines for situations Predict behavior Beliefs and ideals shared by members of a culture about what is desirable or undesirable Influence attitude and behavior Serve as broad guidelines for situations Predict behavior

7. Must be Defined to be Aligned

8. Patient Centered – Defined “Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” IOM Committee authors included patient centeredness as an essential component of quality care.

9. ValuesBehaviorsGoalsProcessesExperience

10. Driving Alignment… Job descriptions Behavioral interviewing 30, 60 and 90 day evaluations New hire orientation Annual service training Annual performance evaluations

11. “Until new behaviors are rooted in social norms and shared values, they are always subject to degradation as soon as the pressures associated with the change effort are removed.” - John Kotter, Leading Change

12. What is Patient Centeredness? Evidenced Based Practice

13. Shared Stewardship of Healthcare Informing and Engaging Patients/families Knowledge Understanding and Compliance Improved quality, safety and perception Self Management and Population Health The Why of Patient Centered Practice?

14. The Real Dollars and Sense… Earning back our dollars

15. Return On Investment… impacts patient loyalty impacts growth and market share impacts organizational brand impacts patient decision making and stewardship of health and healthcare resources impacts compliance impacts quality and safety impacts patient outcomes impacts employee morale and satisfaction impacts employee retention impacts VBP and financial reimbursement

16. To Be or Not To Be?

17. Patient Centered… Communication Consistency Compassion Collaboration

18. “Two words… information and communication are often used interchangeably but they signify quite different things, information is giving out; communication is getting through ~Sidney Harris

19. Communication Explain things in a way you could understand (Q3&7) Listen carefully to you (Q2&6) Staff told you what medicine was for (Q16) Staff described possible side effects in a way you could understand (Q17)

20. Collaboration Did they listen carefully to you (Q2&6) Treat you with courtesy and respect (Q1&5) Did staff talk with you about help you needed when you left the hospital (Q19) Did you get information in writing about what symptoms to look out for when you left hospital (Q20) New question: where your preferences taken into consideration

21. Consistency of Care Responsiveness to call light… (Q4) Help to BR as soon as you wanted…(Q11) Staff did everything they could to help you with you pain (Q14) How often was your pain well controlled (Q13) How often were you room and bathroom kept clean (Q8) How often was the area around your room quiet at night (Q9)

22. Compassion and Empathy Listened carefully to you” (Q2&6) Treat you with courtesy and respect” (Q1&5) Staff did everything to help with pain (Q14)

23. The Cost of Distrust…  Avoidance of discretionary healthcare  Higher rates of non-compliance  With-holding medically relevant information  Less than favorable quality outcomes

24. Real-Time…Validation Call lights, number of falls, and complaints can be used to validate rounding Asking patients knowledge based questions can be used to validate rounding and BSSR Assign all domains or questions to specific owner e.g. council, unit or department; develop daily PCP’s that can be tracked and measured Review every service failure for process improvement opportunities

25. What is Patient Centeredness? As an Outcome

26. Hospital Consumer Assessment of Healthcare Providers and Systems What Is H-CAHPS? ‘Measures adult inpatient perception of quality of care they received at a given hospital’

27. Measuring Perception Perception is Reality

28. HCAHPS Domain Scoring: Micro + Macro = Total ComponentDescription Maximum Points Micro: Achievement* and Improvement Evaluates each dimension based on achievement and improvement scores, similar to scoring methodology for clinical process measures. Micro Dimensions 80 Nurse communication 10 Doctor communication 10 Clean, quiet 10 Responsiveness10 Pain management 10 Comm. about meds 10 Discharge info 10 Overall rating 10 Macro:Consistency Evaluates consistency across dimensions 20 Total Combines micro and macro components to provide an overall HCAHPS score 100 *HCAHPS micro dimension scoring is similar to scoring for process measures. Achievement points are awarded on a 10-point scale, and improvement points are awarded on a 9-point scale. The 10-point maximum depicted in the figure indicates maximum achievement points.

29. HCAHPS Measures Frequency HCAHPS FREQUENCY SCALE: “Always” “Usually” “Sometimes” “Never” Top Box Score – “Always” TOP BOX FOR OVERALL QUESTIONS: Overall Hospital Rating (9 or 10) Likelihood to Recommend (Yes –Definitely)

30. Hospital Performance Exceeds Benchmark Full Achievement Points (10-point scale); Improvement Points N/A ThresholdBenchmark Hospital Performance Between Threshold & Benchmark Partial Achievement OR Improvement Points ThresholdBenchmark Hospital Performance Below Threshold No Achievement Points; Possible Improvement Points (9-point scale) ThresholdBenchmark HCAHPS…Reimbursement

31. HCAHPS EDRADLab EVS RT AS HCAHPS Myth?

32. Public Transparency

33. Public Transparency & Social Media

34. The Clock is Ticking…

35. Patient Centered… Real time measures Service Recovery Real time feedback Compliment or Coach

36. Real-Time…Validation Call lights, number of falls, and complaints can be used to validate rounding Asking patients knowledge based questions can be used to validate rounding and BSSR Assign all domains or questions to specific owner e.g. council, unit or department; develop daily PCP’s that can be tracked and measured Review every service failure for process improvement opportunities

37. Things to Consider… Communicate with Courtesy Compliance and Self Management

38. Things to Consider… Improved Listening Improved patient understanding and stewardship of health and healthcare resources

39. Patient Centeredness… an Outcome Reimbursement

40. Care Transition Questions When I left the hospital, I clearly understood the purpose for taking each of my medications.  Strongly disagree  Disagree  Agree  Strongly Agree  I was not given any medication when I left the hospital 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.  Strongly Disagree  Disagree  Agree  Strongly agree When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.  Strongly Disagree  Disagree  Agree  Strongly agree January 1, 2013

41. Looking at Measures in Complement

42. What is Patient Centeredness? As an Expectation

43. Patient Centeredness…an Expectation ValuePracticeOutcome

44. Patient Centeredness… A Key… Loyalty Satisfaction Experience Engagement Compliance Self Management Health Literacy

45. Loyalty is the result of CARE C A R E Communication Always Consistency Relational Collaboration Empathy Compassion

47. Resources Marketing Your Hospital, Traditional and Social Marketing Ideas for Hospitals: Hospital Marketing; It’s all about the Patient. March 6 2010 Jimmy Warren HCAHPS: Patient Experience & Impact of Value -Based Purchasing, HealthStream Research Quint Studer: Using HCAHPS to Drive Patient Satisfaction Lindsey Dunn (Becker’s Hospital Review 03-30-2010) HealthStream: Transitional Care Questions: Why Do They Matter to HCAHPS? (Pt. I) posted by Stephen McClure 10-25-12 StuderGroup