Do No Harm: How Preventable
Suffering Impacts the
Patient Experience
ASHLEY BAUER, MHA
Conflict of Interest Disclosures
 None
Objectives
 High Level HCAHPS Overview
 FFY 2016 Questions & Measures
 Defining and Understanding Preventable Suffering
 Improve Patient Experiences & Care through
Reduced Suffering
CAHPS Family of Surveys
®
Hospital Consumer Assessment of Healthcare Providers & Systems
 Produce data for public reporting on the Hospital Compare
website
 Enhance public accountability and transparency
 Create incentives to improve by linking participation to
reimbursement
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Health Plan CAHPS
Hospital CAHPS
Home Health Care CAHPS
Clinician and Group CAHPS
Current Patient Eligibility
Client Exclusions:
 Patients who die while in the hospital
 Documented “No Publicity” patients
 Newborns
 Other patients excluded by law in your state
Press Ganey Exclusions:
 Patients admitted and discharged on the same day
 Patients under 18 at admission
 Patients with an ineligible MS-DRG
 Patients with an international address
 Patients admitted from or discharged to a correctional facility
 Patients discharged to hospice care
 Patients discharged to a nursing home or skilled nursing facility
The Survey
4 Scales, Frequency Questions
2 Waves, 6 Weeks
Data is Adjusted by CMS
Publicly Reported Data
www.hospitalcompare.hhs.gov
Overview of Value-Based Purchasing
Weighting for FFY 2016
25%
10%
25%
40%
Clinical
Pt Experience
Outcomes
Efficiency
FFY 2016 Performance Period: January 1, 2014-December 31, 2014
FFY 2016 VBP Measures
Measures
Measure Description
AMI
Clinical Process of Care
(10 @ 10%)
AMI-8a, HF-1, PN-3b,
SCIP-INF-1, & SCIP-INF-4
Patient Experience
(10 @ 25%)
Outcome
(7 @ 40%)
PN
PN-6
SCIP
SCIP-INF-2, SCIP-INF-3, SCIP-INF-9,
SCIP Card-2 & SCIP-VTE-2
IMM
IMM-2 Influenza immunization
HCAHPS
CAUTI
Catheter-associated UTI
CLABSI
Central line associated bloodstream infec
AMI
AMI 30-Day Mortality Rate
HF
HF 30-Day Mortality Rate
PN
PN 30-Day Mortality Rate
PSI-90
SSI
Efficiency (1 @ 25%)
AMI-7a
MSPB-1
Complication/patient safety (composite)
Surgical site infection (Colon & Abd Hyster)
Medicare Spending per Beneficiary
Hospitals Subject to Inpatient VBP
 General acute care hospitals paid by IPPS (inpatient
prospective payment system)
 Excluded
 Critical Access Hospitals
 Children’s and Specialty Hospitals
 Hospitals that lost APU under IQR reporting
 Base DRG Reimbursement at Risk
 2013 - 1% of payment
 2014 - 1.25%
 2015 - 1.5%
 2016 - 1.75%
 2017 - 2%
Redefine Patient Experience
You can’t separate the patient experience from
what actually happens to the patient.
 The patients’ experience includes everything that the
patient thinks feels and perceives as a result of anything
that touches or impacts them including clinical
processes, practices to ensure safety, service delivery and
outcomes of care.
 Integrating these metrics leads to better knowledge of
care and a single source of truth for improving careprevents waste of efforts and prevents creating
unintended consequences.
Reducing Suffering to Improve Performance
Redefining the Patient Experience
Patient suffering can be thought of in three ways:
1.
The unavoidable suffering that the patient brings to a medical experience
because of his or her diagnosed condition
2.
The unavoidable suffering that can occur as a part of receiving medical
treatment for a condition
3.
The avoidable suffering or harm that occurs when providers do not
provide optimal care
 Organization leadership should support and engage nursing staff to
develop suffering-reduction strategies that can be incorporated into what
they do already.
 Effectively transforming the patient experience requires redefining the
concept by expanding what it means and by promoting the understanding
that improving the patient experience is about mitigating unavoidable
suffering and preventing avoidable suffering.
Redefining the Patient Experience
Deconstructing Suffering: Sources and Examples
Further Refining the Model: Measurement & Action
Unavoidable Suffering
 Variability comes from individual differences in patient needs.
 Arises from within the individual in response to his/her illness and in
reaction to an optimally functioning care delivery system.
 Unavoidable does not mean un-addressable, though we may not be able to
completely eradicate this suffering.
Avoidable Suffering
 Variability comes from differences in how organizations provide care.
 Arises from the dysfunction present in the care delivery system.
 Avoidable implies that in an ideal state we would not create this suffering,
therefore our goal should be to reduce these defects to zero.
Outdated vs. Contemporary View
Outdated
 We need to delight to compete
 We need to focus on amenities
 We need to create wows- because we’ve already addressed defects
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(The above mindset predates transparency of performance)
Contemporary
 We need to understand the defects in the process – there are many
 Patients are reporting on critical issues: pain control, respect, clarity of
communication, education for self care, information re medication
 We don’t have the right to make care worse for patients (clinically or
experientially) – it’s against the mission of healthcare
It’s ok to improve amenities to distract patients from their suffering and
create a calming environment- but it’s part of a larger strategy- not the whole
strategy.
Adopting a Contemporary View
 Respond to Needs to Reduce Suffering
 Address Fear & Anxiety
 Reduced fear and anxiety leads to reduced suffering
 Recognize your routine is not “routine” for the patient
 Lean & Six Sigma to reduce variability and defect
 Patient-centered focus
Responding to Needs and Preventing Suffering
Elements of Suffering
Respond to Inherent
Patient Needs
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Promote Confidence in Skill
Manage Pain
Ensure Safety
Inform/Prepare
Personalize Care
Reduce Fear/Anxiety
Protect Privacy
Include in Decision/Choice
Demonstrate Empathy
Prevent Avoidable Suffering
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Lack of Teamwork
Lack of Courtesy
Unhelpful Staff
Unnecessary Wait
Difficult/Inefficient
Processes
• Noisy/Dirty Environment
• Inadequate Amenities
• Inadequate Service
Recovery
Reducing Fear & Anxiety
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Fear Examples
Anxiety Examples
The unknown
Suffering or pain
Infection or becoming ill
Dying
Needles
Hospitals
• Time, and time
constraints
• Costs and financial strain
• Effects on family/friends
• How will they be treated
or possibly judged
• Forgetting things, or not
asking the right
questions
Work Toward Right Increases
Not Reducing Fear & Anxiety
Increases
Reducing Fear & Anxiety
Increases
Healing time
Trust
Likelihood of infection
Patient satisfaction
Risk of poor outcomes
Patient compliance
Avoidable suffering
Relationship building
Patients changing facility/provider
Patient loyalty
Create Consistent Experiences
 Your routine is not “routine” for the patient
 Every day situations for you are major life events for
patients and their families
 Create consistency in processes and practice to
eliminate avoidable suffering
 Adopt Lean & Six Sigma techniques to reduce
variability and defect
Patient Centered Focus
 Patient Centered Care Nursing Models
 Put the patient at the CENTER of everything you do
from an administrative, organizational perspective
 Who does this benefit – us, or the patient?
Thank You
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