Rates of Change During Public and Private
Reporting Cycles of Hospital Performance:
Implications for Mechanisms Driving Quality Improvement
Cathy E. Duquette, Ph.D., RN, CPHQ
Vice President, Nursing and Patient Care Services
Newport Hospital – Newport, RI
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June 27, 2006
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Acknowledgements:
Judith Barr, Tierney Giannotti, and Marcia Petrillo –
Qualidigm
Shoshanna Sofaer – Consultant/Baruch College
William Waters – RI Department of Health
Deirdre Mylod and staff – Press Ganey
Hospital Association of Rhode Island
Barr, J.K., Giannotti, T.E., Sofaer, S., Duquette, C.E., Waters,
W.J. and Petrillo, M.K. 2006. “Using Public Reports of Patient
Satisfaction for Hospital Quality Improvement”. Health
Services Research 41(3), Part I (June 2006); 663-682.
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Rhode Island– Setting the Stage:
Small state just over 1,000,000 population
– 39 cities/towns; very limited county government
1 State Department of Health
16 hospitals in the state
– 13 hospitals: 10 acute care, 1 women & infants’,1 adult
psychiatric and 1 rehabilitation hospital participate in
patient satisfaction survey and report
– 10 acute care hospitals participate in the clinical
measures data collection and report
– All eligible hospitals were early participants in the
Hospital Quality Alliance
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The Rhode Island Legislation:
Passed in July 1998 called for public reporting of:
– Comparable, statistically valid patient satisfaction
measures
– Standardized data set of clinical performance
measures, risk-adjusted for patient variables
Addressed the general health environment in RI
and the potential impact on quality:
Impending mergers
For-Profit vs. Not-For-Profit
Applies to all licensed health care facilities in the
state, starting with hospitals
Director of the Department of Health (HEALTH) is
responsible for program development and
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implementation
Program Development - Structure
and Process:
Director of HEALTH is responsible
Steering Committee and Work Group structure
Process very open and public
– Committee format; consensus as goal
– Consumer, minority and interested party input
Input and feedback incorporated into each step of
program development
Hospitals represented by Hospital Association of Rhode
Island (HARI) through all stages of program development
– Opportunities to discuss issues and concerns among hospitals
within HARI structure
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Program Development – Considerations:
Outcome needed to address both public
accountability AND quality improvement
Aimed to balance desire to report on all patients/all
conditions vs. what was feasible
Needed to develop a report that was meaningful to
consumers AND hospitals
Report format and method of reporting needed to
be determined before data were available
Started with public reporting of patient satisfaction
Hospital approach was collaborative vs. competitive
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Program Development - Outcome:
The Private Reports
All hospitals in RI had a mechanism for measuring
patient perception pre-program
– Variation to method, process, frequency
Hospitals agreed to select the same vendor and process
to meet program requirements
– Transition to mail survey conducted by Parkside Associates and
then Press Ganey
– Agreement to pilot data collection phase with each process
change (2000 and 2002) to evaluate process and provide early
data and information to hospitals to refine and target ongoing
quality improvement efforts
– Process created to establish ongoing data collection and
feedback for internal use between public reporting cycles
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Program Development - Outcome:
The Public Reports
Patient Satisfaction I – Nov 2001
– Public General Report
– Public Technical Report
Patient Satisfaction II – Oct 2003
– Public General Report
– Public Technical Report
Patient Satisfaction III – TBD
– Currently participating in “dry run”
– Awaiting HCAHPS for public report
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Program Development - Outcome:
The Public Reports
Evaluation of Public Reporting
on Hospital Patient Satisfaction
in Rhode Island – 2003
Statewide Effort to Improve
Hospital Patient Satisfaction
Ratings - 2004
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Public Report Development:
State committee process – Patient Satisfaction Public
Release Work Group with hospital, consumer, and health care
stakeholder input
– Hospital staff and leadership actively engaged in process
Two types of public reports: general public and technical
Key reporting decisions made before results available
– Methods for translating raw data into different format
– Method and “standard” against which comparisons made
Private report format designed for quality improvement and
not appropriate for public reporting
Draft reports went through formative testing process with
consumers
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Sample Page from Public Report 2001:
Patient Satisfaction Report Excerpt 2001
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Sample Page from Public Report 2003:
Patient Satisfaction Report Excerpt 2003
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Findings: RI Scores over Time
Hospitals in RI started out and continue to be
higher than national average score
Steady improvement in RI score
No spikes around or following public reporting
time periods
Rate of increase is not faster than that of
national upward trend
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RI Trend Analysis vs. National:
Hospital Response
Commitment to
Quality Improvement
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Initial Responses:
Hospitals supportive of public reporting
– Hospital CEOs supported enabling legislation
Hospital acceptance of program value in
driving and coordinating quality improvement
efforts statewide vs. influencing consumer
“choice”
Significant hospital involvement in process
from the beginning of program development
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Quality Improvement Efforts:
Internal:
Senior leadership involvement and intense
organizational commitment
Reaching clinical staff and Boards of Trustees
Increase in focus and coordination
External:
Collaborative vs. competitive model
– Sharing of best practices
– Coordinated efforts through HARI
Demonstrating improvement over time
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For More Information:
www.health.ri.gov
– RI Background Reports;
– Public and Technical Reports; and
– Evaluation Reports on Findings and Quality
Improvement Efforts
www.health.ri.gov/chic/performance/series.php
– Direct link to list of reports
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Questions?
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