Creating a Positive Patient Experience
Driven Culture
Melissa Taylor
Director, Patient Access/Pre-Access
Cleveland Clinic
Cleveland Clinic – About us
• Located in Cleveland, Ohio
• Nonprofit multispecialty academic medical center,
integrating clinical and hospital care with research and
education
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Main Campus
8 Community Hospitals
18 Family Health Centers
Lou Ruvo Center for Brain Health
Cleveland Clinic Florida
Cleveland Clinic Canada
Cleveland Clinic Abu Dhabi (2013)
Cleveland Clinic - Statistics
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1,300 beds on main campus
More than 4,400 beds system-wide
4.2 million outpatient total visits
167,100 admissions
191,500 surgical cases
2,700 physicians and scientists
State of Healthcare Reimbursement
• CMS – Value Based Purchasing
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Pay for Performance – reimbursement contingencies
Quality
Efficiency
Patient Satisfaction
• Transparency
• Published clinical measures
• HCAHPS
• Pricing
• Informed Consumers
Patient choice!
HCAHPS - Goals
Hospital Consumer Assessment of Healthcare Providers
and Systems (HCAHPS)
Three goals
1. Meaningful comparison for consumers
2. Public reporting is incentive for hospitals to improve
3. Enhance accountability by increasing transparency of
quality
Source: www.hcahpsonline.org
HCAHPS – The Survey
• 18 questions about patient care, four screening
questions and five demographic questions
• Eight critical aspects of care, referred to as the
HCAHPS Domains
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Communication with doctors
Communication with nurses
Communication about medicine
Responsiveness of hospital staff
Cleanliness and quietness of hospital environment
Pain management
Discharge information
Overall hospital rating and recommendation
Source: www.hcahpsonline.org
What is Patient Experience?
ALL OF IT!
“One bad interaction can define the impression. This is
well documented in retail and other service business.”
- James Merlino, MD
Chief Experience Office, Cleveland Clinic
Quote Source: HealthLeaders Media, February 24, 2012
Office of Patient Experience
• Video Placeholder
Where is Patient Access in HCAHPs?
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Overall rating
Would you recommend
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Vendor Supplemental Questions
1. Speed of Admission Process
2. Courtesy of the person who admitted you
Organizational Efforts
• Cleveland Clinic Experience
Exceptional Employee Experience
+ World Class Patient Experience
= Cleveland Clinic Experience
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Caregivers
Caregiver Awards
Pre-hire survey – cultural fit
START with HEART ®
Patient Advisory Councils
Employee Engagement Survey
Patient Access Focus
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Empower employees to be a part of the solution
Minimize calls post-service due to registration issues
Pre-Registration
Patient wait times
Registration times
Affect and behaviors
Non-patient interfacing registrants in registration
area
Pre-Registration
• Waiting room as first impression
• Impact on department through-put
• Set standard as 95% pre-service registration for scheduled
services
• Opportunity – Busiest surgery center in enterprise
• Delaying patients to OR
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Registered patients at point of decision for surgery
Provided business cards with Express Regi phone #
Leveraged online registration
Supported call center with onsite registration
downtime capacity
• Used autodialer to contact patients
• 35% pre-registration rate to 97% - Sustained!
Customer Service Call Reduction
We’re #1!
Comprehensive Scorecard
Scorecard Elements
Quality
Denials
Insurance Ad Hoc
=
Coaching
Score
Future: Copay Contribution, Customer Service, Productivity
Patient Tracking Software - Benefits
• Elimination of paper sign-in sheets
• Identification of bottleneck via dashboard and
reporting
• Real-time staff monitoring with opportunity to adjust
• Real-time patient flow technology
• Constant spotlight on patient experience in Patient
Access
Robust Reporting
• Patient wait times
• Summary
• Detail to patient level
• Patient flow
• Productivity
• On demand and scheduled reporting
Registration Through-put Monitoring
• Patient Check-In
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Patient to be greeted by person, not clipboard
Patient checked into software tracking tool by greeter
Clock begins to measure patient wait times
Simple and easy to use
Real-time Dashboard
Dashboard Features
• Ability to prioritize patients
• Area and priority color-coding for easy detection
• Patient Wait Times on dashboard turn colors as
service urgency thresholds met
• Manager access to all service locations
• Alerts
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Via text or email
Patient wait extends threshold
Patient volume increase to adjust staffing
Registrant in particular status for extended period
Drill-down Reporting
Reg Wt Time
Patient
Names
Appear
Here for
Encounter
Specific
Detail
Reg Time
Creative Utilization of Tool - ED
• ED Tracking Board
• Extension of patient tracking beyond registration
• Radiology – Baseline 65th percentile
• Current 90th percentile
SUCCESS!!
• Call center return call monitoring
Additional Software Features
• Monitor patient flow and wait times
• Registration
• Ancillary Check Points
• Anticipate patient arrival in ancillary areas
• Identify scheduled or walk-in patients using "Visit
Type" drop down menu
• Prioritize by appointment time
• Require delay code
Additional Software Features (Cont’d.)
• Customize patient surveys
• Detailed view
• Report by visit type with average processing time
• Utilize high-level dashboard to see all locations at
enterprise level - hospitals, desks, and current wait
times
Empowerment and Accountability
• Scripting
• Customer Service Standards Policy
• Engagement in annual goals and monthly review of
performance against metrics – as a team and
individual
• Accountability Statement
Patient Survey trays
• Real-time patient feedback
• Focused on experience with registration
and the registrant
• Paging to manager if patient ranks low
on “compassion and sincerity” for realtime service recovery
• Download nightly
• Reporting - online
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Individual
Department
Facility
By question
Results
• Customer Service Tray Scores (registration specific)
– above 95% Satisfaction
• Cleveland Clinic HCAHPs – Top Box (Current – not
yet published)
• Rate Hospital
• Recommend Hospital
82%
86%
• Specific Domains
• As high as 15% improvement in one year – 2010 to 2011
QUESTIONS?