1. Responsiveness February 13, 2013 Carrie Brady, JD, MA
Ashka Dave
David Schulke

2. 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.
AHRQ is a federal agency within the U.S. Department of Health and Human Services (DHHS) whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.
HRET is a charitable and educational organization affiliated with the American Hospital Association whose mission is Transforming health care through research and education. HRET’s vision is to leverage research and education to create a society of healthy communities, where all individuals reach their highest potential for health.

3. 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
Employee and patient engagement are 2 sides of one coin
HCAHPS assesses key factors in ADEs and readmissions

4. HCAHPS Curriculum 2012-13 All Web conferences are scheduled for 12-1pm Eastern
December 7, 2012: Fundamentals of HCAHPS
December 18/19, 2012: Using HCAHPS Data Effectively
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. 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
Exemplary hospital peers
Sharp Memorial Hospital, San Diego, CA
Verna Sitzer, MN, RN, CNS, Manager, Nursing Innovation and Performance Excellence
Laurie Ecoff, PhD, RN, NEA-BC, Director, Research, Education, and Professional Practice
At the 90th percentile nationally in responsiveness

6. Research Update Based on a review of 55 studies:
“[P]atient experience is consistently positively associated with patient safety and clinical effectiveness across a wide range of disease areas, study designs, settings, population groups and outcome measures.”
Doyle C., Lennox L., Bell D., A Systematic Review of Evidence on the Links Between Patient Experience and Clinical Safety and Effectiveness, BMJ Open, 2013;3e Available at no charge at:

7. HCAHPS Responsiveness Domain
During this hospital stay:
After you pressed the call button, how often did you get help as soon as you wanted it?
How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?
Source: CMS Summary of HCAHPS Survey Results and HCAHPS Percentiles December 2012 Public Report (April 2011 – March 2012 Discharges)
66% “Always” is the national average
Third lowest scoring HCAHPS domain
Medication communication and quiet are lower
Best performing hospitals in the country (95th percentile) get 83% or more “Always”

8. Thinking About Responsiveness
Reactive
Proactive
Pervasive

9. Reactive Responsiveness: Consider Staff Perception
Nursing staff from four hospitals asked to complete a survey on call lights
Survey questions related to:
Reasons for use of lights
Number of calls per hour
Average length of time to answer call
Opinion on call lights

10. Nursing Staff Opinions on Call Lights
Opinion on Call Lights
% positive responses
Most of the reasons for call lights are meaningful
77%
Most of the call lights require nursing staff’s attention and care
52%
Most of the call lights pertain to patient safety
49%
Answering call lights prevents you from doing the critical aspects of your role
53%
Nearly half of the nurses in the study did not perceive answering call lights as a critical aspect of their role.
Source: Tzeng Huey-Ming. “Perspectives of staff nurses of the reasons for and the nature of patient-initiated call lights: an exploratory survey study in four USA hospitals” BMC Health Services Research 2010, 10:52.

11. Reactive Responsiveness: Patient Perception
Elapsed Time
Perceived Time
Time
Initial Acknowledgment
Resolution of Request
Response
Informed
Uninformed
Waiting

12. Elapsed v. Perceived Time

13. Response Initial acknowledgment Manage attitudes Set expectations
In person or through speaker
Manage attitudes
Identify “words that don’t work” (e.g. short-staffed)
Set expectations

14. Waiting
When patient need cannot be met immediately (e.g. because physician order is required):
explain to the patient what next steps are necessary
update the patient as each step in taken
estimate how long it will be before the next step and why

15. Expanding the Reactive Team
Engage every staff member in responding to call lights (e.g. “no pass zones”)
Emphasize that each call light could be an urgent patient safety issue – you won’t know until you answer it
Provide direct access to services (e.g. number on white board)
Consider experiential learning techniques
Sit (fully clothed) on bed pans in a staff meeting
Hold an ice cube while it melts

16. Be Proactive
Implement consistent purposeful rounding* by nursing staff
Tell patients when you will return
Plan for continual coverage
Plan for toileting
Especially for patients on diuretics or high fluids
*See Halm M. Hourly Rounds: What Does the Evidence Indicate? Am J Critical Care 2009;18: (hourly rounding decreased call lights in 5 of 6 studies described)

17. Expanding the Proactive Team
Provide multiple points of contact
e.g. leadership rounding, non-clinical staff serving as patient ambassadors
Encourage all staff to identify patient needs
Engage family and friends as partners
Provide guidance for family on how to meet certain patient needs
Has the added benefit of helping prepare family for involvement in post-discharge care

18. Pervasive
Being aware of and responding to patient/family needs is second nature (e.g. wayfinding)
The organization is responsive to staff
e.g. regular rounding on staff with follow-up,
shadowing, trading places
Staff have their own “call buttons”
e.g. “All Hands on Deck” initiative

19. Case Study Exemplar: Sharp Memorial Hospital
Responsiveness to Call Bells
Verna Sitzer, MN, RN, CNS
Laurie Ecoff, PhD, RN, NEA-BC

20. Sharp Memorial Hospital
The magazine's top 10 most beautiful facilities were:
1. Sharp Memorial Hospital (San Diego, Calif.) 2. Henry Ford West Bloomfield Hospital (Bloomfield, Mich.) 3. Matilda International Hospital (Hong Kong, China) 4. Florida Hospital Waterman (Tavares, Fla.) 5. The City Hospital (Dubai, United Arab Emirates) 6. UPMC Hamot Women's Hospital (Erie, Pa.) 7. Bumrungrad International Hospital (Bangkok, Thailand) 8. St. Rose Dominican Hospitals-Siena Campus (Las Vegas, Nev.) 9. The London Clinic (London, England) 10. Children's Hospital of Pittsburgh (Pa.)

21. Effectiveness Formula
Responsiveness Task Force
Effectiveness formula:
Q x A2 = E
Quality of the solution
Acceptance & Accountability
Effective results

22. Quality of Solution

23. Patients - “always” get help as soon as they want it
Q: Define
Who are our customers and what are their requirements?
Patients - “always” get help as soon as they want it

24. Q: Measure
How is the process currently performing in meeting our customer requirements?

25. Q: Analyze
What is causing us to not meet customer requirements?

26. Q: Analyze
Why are customers pressing their call buttons?

27. Q: Improve
What is the strategy to meet customer requirements and does it work?
Address root causes:
Set Expectations for responding to call lights
Round Effectively
Standardize Whiteboard
Educate Care Partner/Family
Leverage Technology

28. Q: Improve Plan Strategy
Set expectations for responding to call lights
Rules and tools for responsiveness
Round effectively
7 Ps for responsiveness
Educate Care Partner/Family
Instructions on how to get help
Standardize whiteboard
Electronic whiteboard
Leverage technology
Nurse call system upgrade

29. Q: Improve
Badge Card
Bulletin Board Sign

30. Q: Improve
Electronic Whiteboard

31. Q: Improve Nurse Call System Upgrade Direct alerting to caregiver
Nurse locator
Call/information transfer
Detailed reporting

32. A2: Acceptance of Solution
Elevator Speech
This project is about improving patients’ HCAHPS score on: During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
It’s important because HCAHPS scores that don’t meet target affect financial reimbursement via value-based purchasing. $$$ is currently at stake.
Success looks like patients’ perceiving that after they press the call button, they “always” get help as soon as they wanted it. The goal is HCAHPS scores of 90 or greater.
We need you to understand the new strategies, use the tools developed by your peers, and give feedback on ways we can further improve responsiveness.

33. A2: Accountability for Solution
Charge nurses, leads, managers monitor rounding by asking patient 3 questions:
Have staff been in your room every hour to check on you and meet your needs?
Have you been shown the whiteboard and does it have all the information you need?
Do you or your family members know who to call and how to call for help?
“Pulse Check” monthly reporting to Task Force

34. E: Effective Results

35. E: Control
What is the plan to consistently meet customer requirements?
Integrate into new employee orientation
Revise Rounding competency
Monitor implementation strategy at defined intervals
Report responsiveness data to direct-care providers
Implement and evaluate technological aids
Continue to seek best practices

36. Questions and Discussion
Ways to Get Involved in the Discussion
Follow operator’s instructions to ask a question
Type your question in chat
Use the HRET listserv or discussion board to ask questions or share your experiences

37. Wanted: HCAHPS Success Stories
If you have a success story to share in any HCAHPS domain, please Ashka Dave at

38. HCAHPS Curriculum 2012-13 All Web conferences are scheduled for 12-1pm Eastern
December 7, 2012: Fundamentals of HCAHPS
December 18/19, 2012: Using HCAHPS Data Effectively
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