MBQIP Phase 2
Focus on HCAHPS
Critical Access Hospital Presentation
July 23 2014
Copyright ©2011 Georgia Hospital Association
Objectives
• Define the 3 phases of the Office of Rural Health
MBQIP program
• Describe Hospital Consumer Assessment of
Health Providers and Systems (HCAHPS)
• Understand the value of engaging in the HCAHPS
process
• Identify the benefits and challenges of HCAHPS
• Review HCAHPS Vendor Directory
Copyright ©2011 Georgia Hospital Association
Medicare Beneficiary Quality Improvement Project
• Began September 2011, voluntary-register on Quality Net
100% participation goal by FY 2014
• Nationwide quality improvement plan for rural healthcare
• Improves access for Medicare beneficiaries served, including EMS
• Voluntary CAH quality benchmarking & reporting to CMS Hospital Compare
• Builds a national data base to demonstrate effect of rural quality
improvement initiatives
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Phase I Process measures for inpatient Pneumonia & HF
Phase II- Outpatient measures 1-7 and HCAHPS
Phase III-Pharmacy CPOE review of orders in 24 hours
& ED transfer communication & report quality
improvement data to state
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MBQIP – Why participate?
• Promotes accountability & public disclosure
• Future of all hospital reimbursement will soon be tied to
performance-Get ahead of the curve
• Only statistically significant volumes will be reported (>25
cases)
• Gives benchmark data to analyze and guide performance
improvement
• It’s the RIGHT thing to do ! Evidence drives improvement
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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 GHA Partnership for Patients Hospital
Engagement Network (HEN) your work will benefit directly from
your efforts to improve the patient experience of care.
 Patient-centered care is a driver of clinical outcomes
 Employee and patient engagement are 2 sides of one coin
 HCAHPS assesses key factors in ADEs and readmissions
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New Care Transition composite will be publicly
reported on Hospital Compare, October 2014
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Approved Vendor list
• Review attachment A2
Copyright ©2011 Georgia Hospital Association
Vendors GA Rural/CAH hospitals
VENDOR List as of April 2014
AVATAR INTERNATIONAL INC (1)
HEALTHSTREAM RESEARCH (8)
JL MORGAN AND ASSOCIATES INC (2)
NATIONAL RESEARCH CORPORATION ( 5)
NO VENDOR (1)
PRESS GANEY ASSOCIATES (6)
RURAL COMPREHENSIVE CARE NETWORK (4)
Copyright ©2011 Georgia Hospital Association
HCAHPS reports
• Hospital level results reported at
http://www.hospitalcompare.hhs.gov
• Additional reports on HCAHPS website
(http://hcahpsonline.org)
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Top box scores by state
Percentiles
Correlations
Hospital Characteristics
Copyright ©2011 Georgia Hospital Association
Comparative Data
June 30 2012-July 1 2013
Patients who reported YES they would definitely recommend
the hospital.
70%
71%
Patients who gave their hospital a rating of 9 or 10 on a scale
from 0 (lowest) to 10 (highest).
70%
72%
Patients who reported that YES, they were given information
about what to do during their recovery at home.
83%
85%
Patients who reported that the area around their room was
"Always" quiet at night.
66%
72%
Patients who reported that their room and bathroom were
"Always" clean.
71%
Patients who reported that staff "Always" explained about
medicines before giving it to them.
64%
Patients who reported that their pain was "Always" well
controlled.
71%
70%
Patients who reported that they "Always" received help as
soon as they wanted.
78%
65%
77%
74%
Patients who reported that their doctors "Always"
communicated well.
82%
85%
Patients who reported that their nurses "Always"
communicated well.
78%
84%
0%
GA Hospital Average
Copyright ©2011 Georgia Hospital Association
10%
20%
30%
40%
FLEX hospital Average
50%
60%
70%
80%
90%
Communication with Nurses
During this hospital stay…
how often did nurses treat you with courtesy
and respect? (Q1)
how often did nurses listen carefully to you?
(Q2)
how often did nurses explain things in a way
you could understand? (Q3)
Copyright ©2011 Georgia Hospital Association
Communication with Nurses
Success Strategies:
Hourly Rounding
White Boards/Care Boards
Bedside Reporting
AIDET
Ascertain need for and obtain language
assistance.
Copyright ©2011 Georgia Hospital Association
Communication with Doctors
During this hospital stay…
how often did doctors treat you with courtesy
and respect? (Q5)
how often did doctors listen carefully to you?
(Q6)
how often did doctors explain things in a way
you could understand? (Q7)
Copyright ©2011 Georgia Hospital Association
Communication with Doctors
Success Strategies: Using strategic language
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I am washing my hands for your SAFETY.”
“I have TIME to answer your questions.”
“I want you to be INVOLVED in your treatment plan”
“I want to be sure I EXPLAIN everything to you…”
“To protect your PRIVACY, let me close the curtain.”
“For your COMFORT, I ordered pain medicine...”
“I want to keep you INFORMED…”
“I want to make sure we are THOROUGH”
“You are in good hands with the nurses on this floor.”
• STUDER
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Copyright ©2011 Georgia Hospital Association
Responsiveness of Hospital Staff
During this hospital stay….
after you pressed the call button, how often
did you get help as soon as you wanted it?
(Q4)
How often did you get help in getting to the
bathroom or in using a bedpan as soon as you
wanted? (Q11)
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Responsiveness of Hospital Staff
Success Strategies:
“No Pass” Zones
Hourly rounding
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Pain Management
During this hospital stay,
how often was your pain well controlled?
(Q13)
how often did the hospital staff do everything
they could to help you with your pain? (Q14)
Copyright ©2011 Georgia Hospital Association
Success Strategies:
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Pain Management
Patients’ experience of pain management is not entirely dependent on their level of
pain
Pain management perceptions are affected by many factors, including:
– Effective communication with physicians and nurses
– Responsiveness
– Empathy
Set Reasonable Expectations
– Be candid about the pain to be expected
– Keep the patient informed
• e.g., use the white board to keep the pain goal and plan visible, as well as
next scheduled medication
Respect the Patient’s Expertise
– Discuss options, tradeoffs, and preferences, including what has worked previously
– Develop pain goals and a plan
Explain the purpose of the pain scale
Ask patients contextual questions
– e.g., at what point on the scale would they take an over the counter medicine for
pain
Copyright ©2011 Georgia Hospital Association
Communication of Medications
Before giving you any new medicine,
how often did hospital staff tell you what the
medicine was for? (Q16)
how often did hospital staff describe possible
side effects in a way you could understand?
(Q17)
Copyright ©2011 Georgia Hospital Association
Communication of Medications
Success Strategies:
 TV Education channel
 Involving multidisciplinary approach
 Dietician
 Respiratory
 Clinical Pharmacist
 White Boards
– List new Medications
– Document teaching for cross communication and
reinforcement
Copyright ©2011 Georgia Hospital Association
Discharge Information
During this hospital stay
did doctors, nurses or other hospital staff talk
with you about whether you would have the
help you needed when you left the hospital?
(Q19)
did you get information in writing about what
symptoms or health problems to look out for
after you left the hospital? (Q20)
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Discharge Information
Success Strategies:
Identify the correct medicines and a plan for
the patient to obtain and take them.
Use “target tool” to educate the patient about
his or her diagnosis and self management
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Care Transition
 During this hospital stay, staff took my
preferences and those of my family or caregiver
into account in deciding what my health care
needs would be when I left.(Q23)
 When I left the hospital, I had a good
understanding of the things I was responsible for
in managing my health. (Q24)
 When I left the hospital, I clearly understood the
purpose for taking each of my medications. (Q25)
Copyright ©2011 Georgia Hospital Association
Care Transition
Success Strategies:
 Make appointments for follow-up medical
appointments and post discharge tests/labs.
 Organize post-discharge outpatient services and
medical equipment.
 Provide telephone reinforcement of the Discharge
Plan.
Copyright ©2011 Georgia Hospital Association
HCAHPS: Global Items
Overall rating of the hospital
 Using any number from 0 to 10, where 0 is the
worst hospital possible and 10 is the best hospital
possible, what number would you use to rate this
hospital during your stay? (Q21)
Recommendation of hospital
 Would you recommend this hospital to your friends
and family? (Q22)
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Individual Items
Cleanliness of Hospital Environment (Q8)
Quietness of Hospital Environment (Q9)
Copyright ©2011 Georgia Hospital Association
Individual Items
Success Strategies:
 Staff returns if patient is not in room during
cleaning
 Gold stickers on toilet paper
 From: leaving tent cards To: “Get Well” cards
 Revise job descriptions and related materials
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e.g., role is to prevent nosocomial
infections
 Bring out Quiet signs
 Inquire regarding quietness on unit during
rounding
 Ask about and preserve patient sleep rituals
 e.g., a cup of tea, reading material, snack
 Change EKG batteries & leads at a.m. shift
change
Copyright ©2011 Georgia Hospital Association
How will HCAHPS Reinforce Focus on Quality?
• Patient-Centered care is a quality indicator
• Quality no longer the domain of just the
clinicians
• Gives a voice to the patient perception of
safety
• Highlights communication issues/barriers
• Patient-centered care actively involves
patients in their care
• More senior leaders are engaged and
interested in delivering patient-centered care
Copyright ©2011 Georgia Hospital Association
The Patient Experience of Care is
Fundamental to Clinical Improvement
• HCAHPS is viewed as a valuable tool to help
organizations achieve multiple objectives
• HCAHPS is part of a coordinated,
comprehensive approach to partnering with
patients and families
• Everyone works together as a team to identify
opportunities for improvement, innovate and
implement strategies, and celebrate success
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HCAHPS Challenges
• Cost
• Obtaining a meaningful response
• Public perception that low volume could
be a negative trait for a care provider
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HCAHPS Success Depends on A Strong
Foundation
Foundational Elements
of Patient-Centered Care
–Leadership
–Patient/Family Partnership
–Workforce Engagement
–Data Use/Performance Improvement
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Copyright ©2011 Georgia Hospital Association
Mine the Data for Solutions,
Not Just Problems
 View patient experience data as an opportunity for
“appreciative inquiry”
 Reveal hidden innovation within your own organization
 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
Copyright ©2011 Georgia Hospital Association
Other Important Sources of
Information
Patient Experience
 Post-discharge phone calls
 Employee Engagement Data
 Rounding
 Staffing Levels
 Patient and family focus
groups
 Patient and family advisory
council/advisors
 Ombudsman/patient
advocate programs
 Compliments
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Staff Experience
 Patient Safety Culture
Survey Data
Shadowing
 A unique opportunity to gain a perspective on the
experience through the patient’s eyes
 Request patient permission
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Explain role is to observe and identify opportunities to
improve care that will help others
 Record observations
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Patient/family perspective
Your own reactions
http://www.pfcc.org/go-shadow/
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Copyright ©2011 Georgia Hospital Association
Tools of the trade
Hunches, theories, ideas
Small scale test
Larger scale test of change
Implementation of change
Monitor change
Change that results is SUCCESS
Copyright ©2011 Georgia Hospital Association
Additional Resources
AHRQ/HRET Patient Safety Learning Network (PSLN)
HCAHPS National Teleconference Series
http://www.psl-network.org/
Fundamentals of HCAHPS
Using HCAHPS Data Effectively
Nurse Communication
Responsiveness
Medication Communication
Discharge Information
Physician Communication and Engagement
Pain Management
Clean & Quiet
Copyright ©2011 Georgia Hospital Association
It is not just about
scores, financial
indicators, public
reporting, % of
always…it is about
compassionate care
and saving lives
Questions?
Copyright ©2011 Georgia Hospital Association
GHA Contact Information
Kathy McGowan, Vice President of Quality & Safety
kmcgowen@gha.org 770-249-4519
Joyce Reid, Vice President of Community Health Connections
jreid@gha.org 770-249-4545
Lisa Carhuff, Quality Improvement/Patient Safety Specialist
Rural and Critical Access Hospitals
lcarhuff@gha.org 770-249-4553
Copyright ©2011 Georgia Hospital Association