The Patient Experience: The Good, the Bad, the Ugly
Hiloni Bhavsar, MD
Internal Medicine Chief Resident
UHCMC
Henry Koon, MD
Director, Medical Oncology Cutaneous
Malignancy Program
Seidman Cancer Center
UHCMC
Jeffrey Beers RN, BSN, MA
Manager, Clinical Risk Management
and Patient Safety
UHCMC
Lynda Reilly, BS Ed, RN, BSN
Sr. Clinical Content Analyst
UH Electronic Medical Records
Physician Design Team
University Hospitals
Jane Dus, ND, RN, NE-BC
Vice President, Medical Surgical Services Maureen Broscoe, RD,
UHCMC
PMP
Manager Core Team
Marcie Manson, Esq. Associate
Electronic Medical Record
General Counsel
University Hospitals
University Hospitals
Objectives
• Understand changes that have taken place to
improve patient satisfaction across the
system
• Understand patient perception/perspective
• Identify specific action items for
implementation in practice
October 27, 2012
University Hospitals
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HCAHPS…
Hospital Consumer Assessment of
Healthcare Providers and Systems
10/29/2011
University Hospitals Case Medical Center
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HCAHPS…
1. CMS partnered with Agency for Healthcare
Research and Quality (AHRQ) to develop it
2. The first national, standardized, publicly
reported survey of patients’ experience of
care
3. Three items used to adjust for the mix of
patients across hospitals
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University Hospitals Case Medical Center
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HCAHPS…
4.
Two items relate to race and ethnicity
5. AHRQ carried out a rigorous and
scientific process to develop this
6. In 2005, the HCAHPS survey was
endorsed by the National Quality
Foundation (NQF)
University Hospitals Case Medical Center
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Eligible Patients
•
•
•
•
10/29/2011
Adult
Medical, surgical or maternity care
Overnight stay or longer
Alive at discharge
University Hospitals Case Medical Center
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Eligible Patients
•
Excludes hospice discharges, prisoners,
foreign addresses & patients discharged to
nursing homes or skilled nursing facilities
•
Excludes Pediatric, Psychiatric & Specialty
Hospitals
•
Encompasses 85% of patients
10/29/2011
University Hospitals Case Medical Center
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HCAHPS Administration
• Random sample of adult patients
• UH does 100% sampling
• Between 48 hrs and 6 weeks after
discharge
• Not restricted to Medicare
• Hospitals may use vendor or collect their
own data
10/29/2011
University Hospitals Case Medical Center
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HCAHPS Administration
• May use email, telephone, mail with
telephone follow up or interactive voice
recognition
• Hospitals can use HCAHPS alone or
include questions after the core items
• Must survey throughout all months
• Available in several languages
10/29/2011
University Hospitals Case Medical Center
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Prohibited Actions
•
Attempt to influence answers
•
Indicate the hospital will be rewarded
•
Offer incentive
•
Indicate hospital’s goal of high rating
10/29/2011
University Hospitals Case Medical Center
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HCAHPS Content:
• 27 questions
• 18 core - critical aspects of patient experience
• 4 direct patients to relevant questions
• Answer choices:
○ Never
○ Sometimes
○ Usually
● Always
10/29/2011
University Hospitals Case Medical Center
○ Yes
OR
○ No
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Final HCAHPS Measures for VBP FY 2013
• Communication with Nurses
• Communication with Doctors
• Responsiveness of Hospital Staff
• Pain Management
• Communication about Medicines
• Cleanliness and Quietness of Hospital Environment
• Discharge Instructions
• Overall Rating of Hospital
10/29/2011
University Hospitals Case Medical Center
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Medicine Quality Summit
HCAHPS Questions
COMMUNICATION WITH DOCTORS
1. During this hospital stay, how often did Doctors treat
you with courtesy and respect?
2. During this hospital stay, how often did doctors
listen carefully to you?
3. During this hospital stay, how often did doctors
explain things in a way you could understand?
10/29/2011
University Hospitals Case Medical Center
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UH Wholly Owned Hospitals
Value Based Purchasing
Patient Satisfaction
HCAHPS Patient Satisfaction
Target 55%
Ahuja Bedford Conneaut Geauga Geneva Richmond St. JohnUH CMC
Nurse Communication
78% 77% 77% 82% 83% 89% 79% 75% 80%
Doctor Communication
81% 77% 76% 83% 71% 86% 78% 74% 76%
Hospital Staff Responsiveness
64% 54% 59% 86% 81% 78% 72% 65% 46%
Pain Management
71% 70% 66% 76% 75% 82% 68% 67% 62%
Communi8cation about Medicines 62% 57% 57% 78% 67% 72% 66% 57% 64%
Hospital Cleanliness and Quietness 65% 62% 54% 77% 63% 70% 63% 57% 63%
Discharge Information
83% 82% 79% 91% 88% 91% 86% 83% 83%
Overall Hospital Rating
69% 75% 60% 82% 73% 84% 70% 70% 65%
YTD % Top Box Responses as of August 18, 2012
October 27, 2012
University Hospitals
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Physician Satisfaction (Geneva)
• Monthly CMO report to all physicians with tips on
patient satisfaction. (Press Ganey & HCAHPS primer /UHC Webcast)
• Physician Satisfaction discussed at each MEC
meeting with hard data sharing.
• Quarterly individual scores with each patient
answer shared with each physician (ED included)
• Data is extracted from the PG website
• Follow up with poor performers (< 50th percentile)
• Expectations made clear (ED- reimbursement tied to scores)
UH Richmond Physicians Plan
• Attending Physicians
– Share personal data
– Post data publicly
– Encourage compliance
• Hospitalists
– Monthly reporting and discussion of scores
– Direct Observation initiative
•
Simulation training
– HCAHPS training videos (CWRU psych dept)
– Payment incentives
• Resident Staff
– Direct Observation plus training videos
– Continued education
•
•
HCAHPS
Professionalism
UHCMC In-patient 2012 Plan
Patient Satisfaction Bundle Processes
Interventions/Processes
* Introduce/shake hands
* Use names
* Make eye contact/sit
* White board
Aim
Drivers
To consistently
• Connect with me
* Daily rounds
achieve excellence
* Don’t interrupt/watch tone
in patient
• Communicate and involve
me in my care
experience as
• Check on me
* Speak with families
measured by top
• Teach me
quartile outcomes
• Follow-up with me
* Show empathy
* Daily rounds
* Stay up to date on tests
on HCHAPS and
Press Ganey
surveys
* Explain meds in a complete way
* Explain diagnosis
* Teach back methods
* Recommendations for treatment
* Explain the clinical course
* Clear follow up appts
* Explain how to get advice/help
* Follow up phone call
UHCMC Resident Pilot Data: 199 patients and 58
physicians comparative study
How much time do you want your physician to spend
with you daily?
A.
B.
C.
D.
E.
5-10 minutes
10-15 minutes
15-20 minutes
20-30 minutes
Greater than 30
minutes
0%
A.
0%
0%
B.
C.
0%
0%
D.
E.
What percentage of patients could name their
physician?
A.
B.
C.
D.
E.
F.
G.
5%
10%
20%
30%
50%
70%
100%
0%
0%
0%
0%
0%
0%
A.
B.
C.
D.
E.
F.
0%
G.
UHCMC Resident Pilot Data: 199 patients and
58 physicians comparative study
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
October 27, 2012
Physician
Patient
Know
Physician
University Hospitals
Name
Physician
Describe
Physician
Updated
on Plan
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UHCMC Resident Pilot Data: 199 patients and
58 physicians comparative study
18
16
14
12
10
8
6
4
2
0
Physician
Patient
How Much
Time
October 27, 2012
University Hospitals
How Many
Times
25
UHCMC Resident Pilot Data: 199 patients and 58
physicians comparative study
70%
60%
50%
Patient Excellent
or Above
Average
Patient Average
or Poor
40%
30%
Physician
Excellent or
Above Average
Physician
Average or Poor
20%
10%
0%
Physician Communication
October 27, 2012
University Hospitals
Time Spent with Physician
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Patient Advocate Data
• 2012 Jan - Sept
• Total # of Patient Advocate Entries: 2996
–
–
–
–
–
Complaint: 2063
Compliment: 79
Grievance: 293
Request Info: 145
Non-patient issues/visitor: 416
Patient Advocate Data
• Communication Issues play a part in 1947 complaints
• Of those, the top 5 breakdown issues under
communication
–
–
–
–
–
General Communication Issue: 947
Rude Behavior: 399
No Clinical Feedback: 165
Lack of information: 95
Miscommunication: 65
Advocate Office
• Complaint:
– Lack of information regarding treatment
– Poor pain control
– Don’t know name of attending
• MD response to Advocate
– I round everyday
– Complaints ridiculous
Advocate Office
• Complaint:
– MD asked about patient’s HIV meds with visitors in room
– Visitors unaware of patient’s HIV status
• Compliance Office:
– Office of Civil Rights follow up in similar case
Patient Advocate
• Complaint:
–
–
–
–
–
Called office nurse and MD lines 3-4 times without call back
Went to ED for treatment
After ED visit called office without return call
Did get MD office appointment
At visit MD states unaware patient ever called office
Patient Advocate
• Complaint:
– MD not listening to pain issues
– Request another physician
– Now with planned surgery patient concerned regarding surgical
pain and chronic pain
Thank You.
October 27, 2012
University Hospitals
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