1. Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Using HCAHPS Data Effectively December 18, 2012 Carrie Brady, JD, MA cbradyconsulting@gmail.com

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. 2

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 3

4. Advancing Excellence in Health Care HCAHPS Curriculum 2012-13 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 4

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 5

6. Advancing Excellence in Health Care Today’s Web Conference Overview of HCAHPS Data Use Overview of HCAHPS Data Use Reporting Reporting Analysis and Action Analysis and Action Questions QuestionsDATA 1: factual information (as measurements or statistics) used as a basis for reasoning, discussion, or calculation 2: information output by a sensing device or organ that includes both useful and irrelevant or redundant information and must be processed to be meaningful Merriam-Webster Online Dictionary 2012 6

7. 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 7

8. Advancing Excellence in Health Care Understand and Improve the Patient Experience, Patient Safety and Outcomes Understand and Improve the Patient Experience, Patient Safety and Outcomes Inspire Action Inspire Action Spotlight Hidden Innovations Spotlight Hidden Innovations Build Organizational Culture and Confidence Build Organizational Culture and Confidence Strengthen Staff Teams and Partnerships with Patients/Families Strengthen Staff Teams and Partnerships with Patients/Families Align the Tool with your Goals HCAHPS Data Can Be Used To: 8

9. Advancing Excellence in Health Care “Data tends to be interpreted as ‘don’t do this,’ rather than ‘let’s work together on this’...” “Give true consideration to employees’ ideas for improvements... Offer suggestions and strategies to implement. Just telling us employees that patient satisfaction must improve doesn’t tell us HOW to get to that point.” How HCAHPS Data is Used: Views from the Front Line 9

10. Advancing Excellence in Health Care Coordinated Improvement Action Meaningful Analysis Data Collection and Reporting Levels of HCAHPS Data Use 10

11. Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Using HCAHPS Data Effectively: Reporting

12. Advancing Excellence in Health Care Common Sources of HCAHPS Reporting Confusion Differentiating vendor questions and HCAHPS Differentiating vendor questions and HCAHPS Organizational priorities and goals Organizational priorities and goals Percents v. percentiles Percents v. percentiles – Trending implications “It is difficult to understand the percentages, when it says 88 th does that mean 88 hospitals are better than us, or we are better than 88 other hospitals?” 12

13. Advancing Excellence in Health Care Common Sources of HCAHPS Reporting Confusion Continued Time Period Time Period – Publicly reported scores v. internal current scores CMS survey mode and patient mix adjustments CMS survey mode and patient mix adjustments – Phone v. mail – Maternity v. med/surg Appropriate sample sizes Appropriate sample sizes – Gather enough responses to generate valid reports 13

14. Advancing Excellence in Health Care Effective Reporting Is Essential “What information consumes is rather obvious: it consumes the attention of its recipients. Hence, a wealth of information creates a poverty of attention and a need to allocate that attention efficiently among the overabundance of information sources that might consume it.” Herbert Simon, economist 14

15. Advancing Excellence in Health Care How often do you distribute HCAHPS/patient experience data reports in your organization? How often do you distribute HCAHPS/patient experience data reports in your organization? – Answer choices: Daily Daily Weekly Weekly Monthly Monthly Quarterly Quarterly *Placeholder for Polling Question* 15

16. Advancing Excellence in Health Care Number of HCAHPS Data Reports Per Year Number of People to Whom Reports are Distributed Average Number of Minutes Spent Reviewing Each Report HCAHPS Attention Resources Calculating the Hidden Potential of Reporting 16 How are you allocating attention in your organization?

17. Advancing Excellence in Health Care More Isn’t Always Better  This sign was posted daily on a hospital unit  Staff did not know what the number meant:  Was it a good score or a bad score?  What questions was it based on?  What time period was included in the score?  What could be done to improve? 17

18. Advancing Excellence in Health Care Are Your HCAHPS Reports Worthy of Attention?  Are they easy to understand?  Are they encouraging?  How frequently are they issued?  Are they meaningful and actionable?  Are they integrated with other information?  Do they connect the dots between interventions and results? 18

19. Advancing Excellence in Health Care Creative Approaches to HCAHPS Reporting 19  SBAR format  Letter grades  Staff “scoreboard”  Trend lines annotated with effect of intervention Example courtesy of Avera DeSmet Memorial Hospital, South Dakota

20. Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Using HCAHPS Data Effectively: Analysis and Action Reporting without analysis and action is like trying to pole vault without a pole.

21. Advancing Excellence in Health Care HCAHPS results are commonly disseminated at meetings and/or by posting HCAHPS results are commonly disseminated at meetings and/or by posting Many organizations are focused on distribution of the data without guidance on use Many organizations are focused on distribution of the data without guidance on use – Many share HCAHPS scores without improvement strategies – Coaching and support in using HCAHPS data for improvement isn’t widespread Lessons from HCAHPS Patient Safety Learning Network Year 1 21

22. Advancing Excellence in Health Care Build Individual and Organizational Aptitude 22 Many managers need support in understanding the data and using it effectively Many managers need support in understanding the data and using it effectively Develop shared standards for data use and reporting Develop shared standards for data use and reporting – Consider both content and format Provide education and coaching in data use and quality improvement Provide education and coaching in data use and quality improvement – Routine training, including new managers – Safe opportunities to ask questions – Customized analyses Unleash the power of curiosity Unleash the power of curiosity

23. Advancing Excellence in Health Care HCAHPS Analysis Tools Standard CMS Reports Patient-level Correlations Table Patient-level Correlations Table Percentiles Table Percentiles Table Hospital Characteristics Comparison Charts Hospital Characteristics Comparison Charts Summary of HCAHPS Survey Results Table Summary of HCAHPS Survey Results Table Available at www.hcahpsonline.org in “Summary Analyses” section Commonwealth Fund Why Not The Best? Reports Wide variety of benchmarks Ability to select by individual hospitals or by group Uses CMS Hospital Compare Data Available at www.whynotthebest.org 23

24. Advancing Excellence in Health Care  View patient experience data as an opportunity for “appreciative inquiry” Reveal hidden innovation within your own organization Reveal hidden innovation within your own organization Examine improvement (including change in “bottom box” scores), not just achievement 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 Preserve relationships by noting what is working well Mine the Data for Solutions, Not Just Problems

25. Spotlighting Hidden Innovation Example provided courtesy of

26. Advancing Excellence in Health Care “Collabetition” “Collabetition” – Recognize units with best HCAHPS performance and most improved performance – Each unit awarded trophy received a second trophy to give to a group that supported them Team Trades Team Trades Redesign Reports Redesign Reports – Ask staff what information they need and how they would like it to be presented Creating Positive Momentum 26

27. Advancing Excellence in Health Care Applying Clinical Logic to HCAHPS Improvement We don’t clinically assess, diagnose, and treat a patient using only quantitative data – we also rely on examination, observation and discussion. Why do we often assess, diagnose and treat organizational performance based solely on quantitative metrics? 27

28. Advancing Excellence in Health Care 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 28

29. Advancing Excellence in Health Care Integration Provides Multiple Perspectives on Issues of Common Concern CAHPS (HCAHPS) Communication with Nurses Communication with Doctors Communication about Medicines Responsiveness Discharge Information Pain Management Cleanliness Quiet Overall Rating Recommend Patient Perspective SOPS (HSOPS) Communication Openness Feedback and Communication About Error Frequency of Events Reported Handoffs and Transitions Management Support for Patient Safety Nonpunitive Response to Error Organizational Learning/Continuous Improvement Overall Perceptions of Patient Safety Staffing Supervisor/Manager Expectations and Actions Promoting Safety Teamwork Staff Perspective Communication Teamwork Leadership Transitions Staffing 29 Higher AHRQ patient safety culture survey scores are associated with better HCAHPS scores – Sorra et al, J of Pat Safety, September 2012, 8 (3), p 131–139

30. Advancing Excellence in Health Care To Motivate Action, Focus on Patient Care Emphasize that HCAHPS Matters Clinically Preserve the Patient in the Data - Storytelling - Shadowing *Studies discussed during 12/7/12 Webinar

31. Advancing Excellence in Health Care Shadowing  A unique opportunity to gain a perspective on the experience through the patient’s eyes  Your suggested assignment: Shadow a patient before the next webinar Shadow a patient before the next webinar Describe your experiences on the PSLN online discussion forum Describe your experiences on the PSLN online discussion forum 31

32. Advancing Excellence in Health Care Preparing for Shadowing  Decide on process to be shadowed  Notify staff  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 32

33. Advancing Excellence in Health Care Additional Resources PFCC Partners at the Innovation Center of the University of Pittsburg Medical Center Patient and Family Shadowing Go Guide Shadowing Field Journal Video (www.pfcc.org/go-shadow/) 33

34. Advancing Excellence in Health Care PSLN Extranet 34

35. 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… 35

36. Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Questions?