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How to Create a Five-Star Patient Experience

Patient experience is a commitment from which there is no turning back. The entire health care sector must find new ways of thinking about how care is delivered. Consumers, meanwhile, are increasingly relying on patient experience as a decisive factor in their health care decision making.

Health care organizations recognize patient experience as an increasingly important part of their mandate and are devoting more resources to it. More than 80% of health care organizations report that they already have patient experience programs in place, with many of these “well established,” while only 1% have not yet started with these efforts.

But the decision to launch a patient experience program is no guarantee of its success; fewer than one hospital in 12 receives a five-star rating from its own patients.

In order to be successful, patient experience programs must be planned and implemented properly, applying knowledge of what has real impact and what doesn’t.

According to Becker’s Hospital Review, about 3,500 hospitals participate in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ranking, which uses a patient-assigned star rating to measure patient experience. Out of these hospitals, approximately 29% receive a one- or two-star rating, 34% receive three stars, and about 21% are awarded four stars, while only less than 8% receive five stars.

What is it that sets these high-performing, five-star organizations apart? Why are they so rare? In order to be successful, what issues must be prioritized? What practices deliver sustained results?

To help answer these questions, Siemens Healthineers and The Beryl Institute conducted a study of more than 1,100 patient experience professionals, including 294 from high-performing units as well as 175 patients and their family members, to identify the most important influence factors on patient experience. Participants in the study rated more than 35 different factors.

The results of high-performing units and patient organizations have been summarized in a scorecard that displays the most influential factors along the continuum of care. This scorecard can be used to gauge systemwide patient experience efforts as well as to identify gaps and potential improvement areas.

The factors have been mapped to the continuum of care, including the following areas:

– Engage patients and families
– Optimize diagnostic experience
– Deliver outcomes that matter to patients
– Must-haves

An illustration of how an enhanced patient experience can help deliver better health outcomes can be found at the Baylor Clinic in Houston, Texas, a facility dedicated to patient-centered primary care and home to some of the leading breast health specialists in the U.S.

Emily Sedgwick, MD, served as chief quality officer for Baylor College of Medicine and recognized that one of the greatest barriers to women getting timely breast cancer screening was anxiety and fear associated with these tests. She and her team developed a five-step process to enhance the patient experience at Baylor:

1. Engage with patients and their families
2. Hone talent and ensure staff acceptance
3. Standardize protocols and optimize image interpretation
4. Enhance imaging referral
5. Implement patient-friendly technology

By deploying these five steps, Sedgwick and her team were able to create a comfortable and more relaxed environment and – perhaps even more important – put in place processes allowing them to perform mammography and biopsy and then deliver outcomes that matter to patients, all in one day. This package of same-day service not only delivers outcomes to patients more quickly, it also makes treatment available as early as the next day if signs of cancer or abnormal results are detected.

The results are clear:
• More accurate and timely diagnoses leading to better patient outcomes
• A demonstrably better patient experience
• Increased revenue, largely as a result of higher patient numbers

Providing a better patient experience is not a one-off project but rather an ongoing improvement cycle that must take into account organizational needs, staff, and environmental fluctuations.

Learn more about how you can improve the patient experience in your organization contact TPMG Global here!

Improving HCAHPS Scores and The Patient Experience

Gerald Taylor MBA

Managing Director, TPMG Global

Patient satisfaction is an important and commonly used indicator to measure the value of health care. Across the United States, shifts in health-care policy have tied hospital and physician compensation to patient experience measures that focus on patient engagement.  As of late, understanding and improving the patient experience has become almost a burning platform for U.S. healthcare executives.  The patient experience survey, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), serves as a remarkably effective guide for the success of doctors and hospitals.

Res Ipsa Loquitur – Facts About the Patient Satisfaction

According to McKinsey & Company, many health systems make large investments in initiatives to improve the patient experience but fail to achieve their desired objectives. 

Here are some interesting facts about patient satisfaction:

  1. Performance on the HCAHPS survey can affect up to 33% of a physician’s reimbursement.
  2. 25% of value-based purchasing reimbursements are tied directly to HCAHPS scores.
  3. In fiscal year 2020, 55% of the approximately 2,800 participating hospitals received approximately $1.9 billion in CMS value-based purchasing program incentive payouts – roughly $1.3 million per hospital.
  4. Health system executives find that roughly 70 percent of their patient experience initiatives fail.

McKinsey also concludes that hospital in-depth data analysis and research can be better at pinpointing which factors most strongly influence patient satisfaction levels.  Moreover, TPMG Global® research has discovered more than half of healthcare facilities across the United States find the most difficult barrier to improving HCAHPS scores is focusing on the right drivers of “Would Recommend Hospital.”  And that is what this article is about.

In this piece we will discuss how to pinpoint the drivers that most strongly influence “Would Recommend Hospital,” and how to overcome common flaws which wreak havoc in patient experience initiatives. 

Improving HCAHPS Scores and The Patient Experience

Many in the healthcare industry believe there are few financial rewards for improving and sustaining respectable HCAHPs scores.  However, according to a study by the Deloitte Center for Health Solutions:  Hospitals with excellent HCAHPS patient ratings between 2008 and 2014 realized an average net margin of 4.7%, as compared to just 1.8% for those with low ratings.   

At TPMG Global, we believe improving patient satisfaction is not about making patients happy – par se’, but about improving the patient’s entire experience across the continuum of care.   The patient experience encompasses not just the clinical aspects of care delivery, but also the administrative, operational, cultural and behavioral characteristics of the entire care delivery system.   The object of improving the patient experience is to yield greater value by not only producing higher HCAHPS scores, but to also maximizing a facility’s reimbursements and sustaining meaningful improvements in real patient satisfaction.

To that end, we offer a simple 5 step method for improving the patient experience.

  1. Put the HCHAPS survey into the field
  2. Conduct the appropriate data analysis
  3. Pinpoint the drivers that most strongly influence “Willingness to Recommend Hospital”
  4. Conduct the appropriate qualitative analysis
  5. Implement a plan, do, check, act test of change

This article will provide you with two easy step-by step data analysis methods that will pinpoint those drivers that most strongly influence a patient’s willingness to recommend a hospital.

An HCAHPS Case Study – Hospitals in the Same System are Not Alike

A large hospital, part of an even larger system:  HCAHPs Survey Analysis 2014 – 2018

Case Study Problem Statement:  This healthcare facility is part of a larger healthcare system on the eastern cost of the United States.  For more than 4 years they have not been able to improve their stagnant patient satisfaction scores.  The head of the facility’s patient experience team instinctively knew the patient satisfaction driver report they received from their system’s central office was not focusing on the right factors.  They needed a change.

Baseline Analysis:  Since 2014, their HCHAPS “Willingness to Recommend” score has averaged 77.32 – ranking the facility between the 50th and 75th percentiles.  Though their scores are better than both the state (69) and national (72) results, the baseline analysis covers a serious weakness.  The facility’s scores fall below the national ratings almost 17% of the time and its performance misses the 90th percentile mark of 84 (their goal) 94% of the time. 

Interpreting HCAHPS: Pinpointing the Determinants of Patient Satisfaction

To pinpoint the right drivers that most strongly influence willingness to recommend, there are 2 kinds of analysis you must perform.  The first type establishes linear cause and effect relationships between the drivers of patient satisfaction and their willingness to recommend a hospital. The other proves dependencies between those drivers and the same outcome.  Most importantly, the data analysis must be “statistically significant” to have the predictive power and confidence needed to ensure an initiative will generate a strong return on the time, hard work, and capital invested.

The Results:  Drivers of Patient Satisfaction – Linear Relationships

Drivers of Willingness to RecommendRelative Strength
Governing StrengthR – Square:  .74
Drs Explained Things UnderstandablyImpact  -0.40
Treated w/ C&R by DrsImpact  0.35
RNs Listened Carefully to YouImpact  0.50
Told What Medicine Was ForImpact  0.30
Treated w/ C&R by RNsImpact  0.42
Received Phone Call at HomeImpact  0.14
P-Value0.000000021

The table above identifies 6 statistically significant drivers of the patient experience that best determines Willingness to Recommend Hospital.  The key performance indicators suggest the following:

  1. R-Square:  the subset of characteristics, outlined here, are a 74% driver of patient satisfaction.  Other variables (26%) may also drive Patient Satisfaction but may not be captured by the survey.
  2. P-Value:  we can be 99.9999979% confident these are the appropriate drivers of patient satisfaction for this facility.

Critical to Satisfaction Characteristics

The model indicates, a one-point improvement in “Treated with Courtesy and Respect by Doctors” drives Willingness by 0.35 points; a one-point improvement in “RNs Listened Carefully” drives Willingness by 0.50 points etc…  (Linear Relationships)

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Drivers of Patient Satisfaction – Dependent Relationships

Now that we have determined the fundamental drivers of patient satisfaction, we move forward to discover the extent to which patient satisfaction is dependent upon them.  Here, we evaluate the relationship between the attribute “Treated w/ C&R by RNs” and “Willingness to Recommend.”  The approach tells us the extent to which Willingness to Recommend is dependent on Treated w/C&R by RNs.

The basic idea of the method is to compare the observed performance of the driver with its expected performance.  If there is no dependent relationship between the potential driver and outcome, the actual frequencies at which willingness to recommend is observed will be close to their expected frequencies (in the norm).

Conclusions 

All other things remaining equal – the analysis indicates that we can be 99.995% confident – patients punish Very Good performance but reward Excellent performance in this category.  It appears performing very good in this category is not good enough. The hospital must be excellent to be rewarded with a willingness to recommend rating. For Very Good performance, patients are 59% less likely to “Definitely Recommend Hospital”.  For Excellent Performance in this category, patients are 89% more likely to “Definitely Recommend Hospital”.  Only 23% of patients give an excellent rating for this category!  

At the end of the day, we can safely conclude Willingness to Recommend Hospital is not only strongly driven by Treated with Courtesy and Respect by RNs, but it is also dependent on the driver for improvement.   In addition, the opportunity for improvement (OFI) is substantial!    The charter for the patient experience initiative should include an objective and key result (OKR) for this driver, like:  Improve the percentage of respondents for “Treated w/ C&R by RNs” with an excellent rating by 77% (predicted target date – here). 

I trust this article has provided you with insight and approaches that can help you pinpoint those drivers that most strongly influence a patient’s willingness to recommend a hospital. If you are interested in learning more about using these methods, contact us at:  TPMG Global® – Improving HCAHPS Scores and The Patient Experience

Gerald Taylor is the Managing Director at TPMG Global®

Cleveland Clinic’s Patient Satisfaction Strategy: A Millennial-Friendly Experience Overhaul

Micah Solomon

If you want to improve the patient experience — and your patient satisfaction and HCAHPS scores — here’s a good place to start: Reconsider how your hospital or practice thinks about time. And get to work swapping a patient-centered approach to time for your provider-centered viewpoint.

To see this in action, try a quick phone call to Cleveland Clinic. Here’s precisely what you’ll hear, after just a bit of voice jail navigation:

“Thank you for calling Cleveland Clinic. Would you like to be seen today?”

And they mean it.  They do “about a million” same-day appointments a year, according to James Merlino, MD, Cleveland Clinic’s Chief Experience Officer (CXO). 

Now, doing a good job in healthcare does take time. Scans take time to read properly. Cultures take time to grow. Thoughtful diagnoses and effective discharges absolutely take time.

The last thing I want to do is turn your hospital or practice into the healthcare equivalent of a fast food joint.

But some of the wait times your patients suffer through don’t add anything to successful clinical outcomes. And the reason you’re making patients wait? Probably it’s partly because you’ve always done things this way, and everyone else in healthcare is making patients wait as well.

Well, you can’t use that last rationalization anymore. Not if you’ve been watching what Cleveland Clinic has been doing on the timeliness front.

Let’s go back to listening to Cleveland Clinic, and that mind-blowing greeting:

“Thank you for calling Cleveland Clinic. Would you like to be seen today?” (After 4PM the greeting rolls over to”Would you like to be seen tomorrow?”)

This is for real. According to Dr. Merlino,

“Anybody calling [Cleveland Clinic] for an appointment for any specialty can be seen today.”

Getting people in to see a doctor the same day they call is an extreme and extraordinary move by Cleveland Clinic to take patient satisfaction to a new level.

Which is something that’s come a long way since the bad old days, when their incoming CEO, Toby Cosgrove, would joke, “Patients come to us for high quality care– but they don’t like us very much. ” (Which wasn’t much of a joke, really.  When Cosgrove took the reins at Cleveland Clinic in 2004, patient satisfaction was in the lowest 10 percent of the nation.)

An eye on the millennial generation of patients

While nobody of any age likes to wait, this commitment to speed comes partly from Cleveland Clinic’s eyes being trained specifically on the incoming millennial generation of patients. (Millennials are a crucial generation of customers for any business—including healthcare—to consider. They are 80 million strong in the U.S., making them larger than the baby boom, and much larger than Generation X, the generation that immediately preceded them. And their expectations are quite different, being the first generation to take the internet, and smartphones, entirely for granted. A historical reality which changes their perception of time, convenience, and more.)

A million same-day appointments

They pull this off… how? Well, the same-day appointment commitment required Cleveland Clinic to get through some operational hurdles. Actually, Dr. Merlino corrects me on this: “‘operational hurdles’ is an understatement.”  An extraordinary amount of work has had to be put into “managing the flow and ensuring we have the capacity.”

The same-day appointment promise is also dependent on a sophisticated triage process.

In other words: I can’t just call up and say

“I have a headache. I want to see a neurosurgeon.”

Well, actually, I can call in and say that—and they’ll be ready to deal with it. Here’s what happens: I’m taken through a series of questions on the phone; depending on how I answer those questions, the Cleveland Clinic telephone agent will be able to determine whom I should see, and will ensure I get that appointment today.

Dr. Merlino:

“So, Micah, [in the example above] you may not see a neurosurgeon for your headache, but you may see somebody who is a headache specialist or you may need to talk to a nurse who can better triage what you need. But we will get you to the right provider at the right time.

“If you call and say, ‘Look, I was in the emergency department last night with a headache and they did a CAT scan and they say I have a brain tumor. I need to be seen by a neurosurgeon today,’ you will see that neurosurgeon today.  If you call in with a headache [and] you say certain things which are warning signs—answering yes to ‘is this the worst headache you ever have in your life?’ is one — you will immediately be transferred to a nurse who will do a more assessment and then guide you to an emergency department.

If it’s just a garden variety headache, as determined by the agent’s triage questions, they’ll still “get you an appointment with somebody today who can help you with the headache.”

Speak the patients’ language, use the patients’ channels

The same-day appointment commitment isn’t the only time-bending patient satisfaction change Cleveland Clinic has introduced.   Another one that struck me is their understanding that patients these days, especially but not only millennial patients, want to communicate with their healthcare providers through the same communication channels they use to run their social lives. Which is a theme I am seeing in every arena of business. Appointments via mobile, information via mobile, chat online, doctors (after HIPAA waivers) corresponding with patients via email. Using telepresence for followup care with homebound patients. and more.

All of which, if you think about it, are ways to stretch, bend, mitigate the effect of time on the patient experience. Emails are asynchronous: they don’t have to be read at the time the doctor wrote them, a fact that can make things more convenient for both parties. Online chat is immediate when you need it to be immediate, again reducing wait. Information on mobile apps (Mayo is another leader in this) is another time — and potentially life— saver as well.

—–

So what’s next on the speed front? Chief Experience Officer Merlino, who is also a practicing colorectal surgeon, jokes it might be, “Thank you for calling Cleveland Clinic. We’ve already solved your medical issue; is there anything else we can help with?”

Micah Solomon is a customer experience and patient satisfaction consultant, customer service keynote speaker, and author.

I trust this article has provided you with insight and approaches that can help you pinpoint those drivers that most strongly influence a patient’s willingness to recommend a hospital. If you are interested in learning more about using these methods, contact us at:  TPMG Global® – Improving HCAHPS Scores and The Patient Experience

Building A Culture of Nurse Excellence to Drive Patient Satisfaction

Driving nurse excellence and engagement will be essential to delivering on patient satisfaction and experience.

  By Sara Heath

– When it comes to nurse engagement, efforts must go a lot further than just driving good job satisfaction. In fact, nurse excellence isn’t entirely about the nurses at all, although they are important. Instead, nurse engagement is an essential means to yield an overall positive patient experience, connecting all of the key elements of healthcare into one cohesive picture.

The call for good patient experiences is not something new. Healthcare has long valued the patient, striving for excellent bedside manner and good clinical quality outcomes. But in an age where healthcare consumerism reigns supreme and CMS reimbursements hinge on good satisfaction scores, driving that positive hospital experience has become even more crucial.

But building that experience is extremely nuanced, most industry experts can appreciate. A good patient experience requires a balance of certain hospitality elements, patient safety, and meaningful interactions between patients and staff.

And that’s hard, experts say. Hospitals only have so many resources to dedicate to facility amenities and clinicians are strapped for time, seriously hindering their ability to connect with patients on a personal level. Patient safety, although essential to clinical quality outcomes, can falter to human error in the most unfortunate cases, despite best efforts. Communicating those lapses then present a whole new challenge.

But those challenges aren’t insurmountable, especially when nurses are engaged. These clinicians are on the frontlines of everything ranging from patient interactions to medical care. So, when nurses thrive, everything else thrives, too, according to Christy Dempsey, DNP, MSN, MBA, CNOR, CENP, FAAN, the chief nursing officer at healthcare consulting firm, Press Ganey.

READ MORE: Pushing for Nurse Engagement to Drive Better Patient Experience

“A culture of nursing excellence really does impact everything,” Dempsey said in a recent interview with PatientEngagementHIT. “If you have a good culture of nursing excellence, then you’re more likely to have better physician engagement. You’re more likely to see that patient experience of their physicians, not just of the nurses, is better. Clinical quality is better. It’s the rising tide that lifts all boats in healthcare.”

As noted above, nursing excellence looks like a lot more than just good job perks and satisfaction, although those factors can be important. Instead, nursing excellence is about developing and advancing strong nurse leaders, who are then able to advocate for their patients and nurse peers.

“Nursing excellence requires a structure within the organization that supports shared governance so that nurses at every level are helping and involved in making decisions, measuring transparency of data, and establishing performance benchmarks and promoting autonomy for nurses inside that shared governance framework,” Dempsey explained.

Nurturing a culture of provider teamwork and implementing care frameworks that emphasize not just clinical quality, but safety and patient experience as well, is another key hallmark of nursing excellence.

But although the industry has a good model of what nursing excellence is – strong team-based care that gives all stakeholders the tools to succeed – it isn’t always happening.

READ MORE: Supporting Nurses to Address the Social Determinants of Health

“We are in an environment that is constantly changing. It’s complex in terms of the patients and the venues, the continuum of care,” Dempsey said. “There are a lot of pressures within healthcare today.”

But it’s those very factors that hamper efforts for nurse excellence that nurse engagement and empowerment can solve. When nurses are empowered, Dempsey maintained, the patient can thrive because the team can thrive.

“Even in today’s complex, constantly changing healthcare environment, that culture of nursing excellence can be fostered, promoted, and then impact everything else that happens in healthcare,” Dempsey asserted.

Healthcare organizations on a journey to nurse excellence need to start where they are today. Understanding their current competency in patient safety, nurse experience, and clinical quality and experience will be important for understanding the root causes of any underperformance they see in their facility, Dempsey instructed.

From there, organizations can design a path forward.

READ MORE: Nurse-Led Education Program Boosts Older Patient Experience

“Define what the nursing professional practice model in your practice is,” Dempsey said. “Once you have determined that, you’ve got to make sure that you have CEO and board support for that model and that the chief nursing officers and nursing leadership are involved in executive level decision making at the C suite and the board level.”

A nursing shared governance that included nurse managers and engages bedside nurses will help organizations build their accountability structure, leading nurses and other stakeholders to take ownership of the process. Stakeholders should also play a hand in writing out job descriptions, performance reviews, and standards for clinical practice.

After that, teams must scale that plan organization-wide.

“You need to establish a communication plan so that you are able to disseminate information and initiatives that help you drive towards nursing excellence,” Dempsey said. “You must have an organizational strategy for data transparency in how you talk about the data. You can’t just post it on the wall. How do you talk about the data and wrap stories around that data to make it come to life? Then, look at the specific work unit information and communication strategies.”

All of this must lead to an optimized work environment, Dempsey continued. Work environment, or the factors that make a job doable and even enjoyable, is even more important that staffing levels, Dempsey reported.

“Optimizing that nursing work environment is so important,” she said. “That includes the leadership development plan, how you are engaging nurses and fostering their development, and how you are providing incentives for professional development.”

Organizations must also assess how they are assuring they have the appropriate resources – both human and material – and emotional support for nurses. This will allow nurses to continue efforts for patient-centered care.

“Make sure that you’re optimizing staffing so that you have the right people taking care of the right patients in the right place at the right time,” Dempsey stated.

“Then, finally, track integrated metrics, so reducing silos both in terms of operations, but also in terms of the way we look at data,” she continued. “Integrate that data so that you can see things and how things move together — or don’t. This will help you draw insights from that integrated data and then build improvement plans, and accountability and ownership plans based on that integrated data.”

All of this will hinge on a culture of team-based care. The organizations that Dempsey sees fully committed to a culture of excellence are already deploying strong team-based care strategies, fostering collaboration, communication, and support across the team. This is a symbiotic relationship, she said, because the culture of excellence also draws on the whole hospital team.

And at the end of the day, that is what will help organizations push to the next level in value-based and patient-centered care.

“Driving nursing excellence is not just a good idea, it makes good fiscal sense,” Dempsey concluded. “It makes good sense to recruit and retain the best and the brightest. It is the rising tide that will help health care. We need to really promote that.”

I trust this article has provided you with insight and approaches that can help you pinpoint those drivers that most strongly influence a patient’s willingness to recommend a hospital. If you are interested in learning more about using these methods, contact us at:  TPMG Global® – Improving HCAHPS Scores and The Patient Experience

How Hospitals Can Raise Patient Satisfaction, CAHPS Scores

Sara Heath

Editor
sheath@xtelligentmedia.com

Improving patient satisfaction scores, such as CAHPS, is key for driving practice reputation and reimbursements.

Healthcare organizations with high patient satisfaction and CAHPS scores see a multitude of benefits. High patient satisfaction scores usually result in higher reimbursement payments from CMS, better patient retention rates, and the assurance for hospital staff that they fostered a positive experience for patients.

A May 2016 report from Vocera showed that patient satisfaction is the top-ranked priority at healthcare organizations. Due to the importance of ensuring favorable feedback from patients, the demand for patient experience officers and patient advocate executives is increasing, with these professionals pulling equal rank with other C-suite executives, the report said.

The primary measure for patient satisfaction is the Consumer Assessment of Healthcare Providers and Systems (CAHPS). The CAHPS survey is developed and funded by the Agency for Healthcare Research and Quality (AHRQ) in partnership with CMS, and forms a component of some value-based reimbursement programs.

CMS also uses CAHPS scores to inform its star ratings, which are publicly available ratings about the quality of healthcare facilities.

Several types of CAHPS surveys are utilized throughout the care continuum, ranging from hospitals to nursing homes to health plans. However, the Hospital CAHPS (HCAHPS) and Clinician and Group CAHPS (CGCAHPS) are the most prominent and commonly used surveys.

Both surveys measure many of the same factors, including nurse care, doctor care, and facility environment.

The HCAHPS survey also includes questions about experiences within the hospital, including pain management, and continuity of care experiences.

CGCAHPS surveys target their questions to the general practitioner, asking questions about ease of healthcare access and how often the patient has been visiting the office.

Because HCAHPS and CGCAHPS are used for both reimbursement and patient rating purposes, it is important for healthcare organizations to improve their scores. Healthcare organizations can improve their CAHPS scores by understanding what is important to patients, what the surveys measure, and how to meet patient needs.

Improving Patient-Provider Communication

Provider Picture

The first two sets of HCAHPS questions pertain to nurse and physician communications with patients. These questions ask whether nurses and physicians communicated clearly with patients, and whether patients understood their diagnoses, prognoses, and treatment options.

Clear communication about healthcare information is integral to a positive healthcare experience, experts say. Hospitalization is often a stressful and worrying time for patients, and made even worse when clinicians do not adequately communicate what is going on and how they will treat a patient’s ailments.

In addition to allaying patient worry, providing meaningful explanations of conditions and treatments will help the patient taken ownership of her own health.

“Patients have a need for information,” explained Deirdre Mylod, PhD, Executive Director of the Institute for Innovation and Senior Vice President of Research and Analytics at Press Ganey.

“It’s not just making consumers happy to meet that need, but it’s also providing the right care. When you give people the right information, they can engage in care, they can be active participants, they’re better prepared to care for themselves at home, they’re less likely to be readmitted.”

Clear communication will require collaboration between the different members of the care team, added Mylod.

“As a patient, when one team member tells me one thing and somebody else tells me another, now I’m afraid and I’m thinking you’re not working together. Now I’m more scared than I need to be in a hospital,” she pointed out.

HCAHPS also asks patients whether nurses and physicians treated them with respect and empathy. Clinicians must tap into their interpersonal skills to provide compassionate care to their patients, while being mindful of cultural norms and barriers.

The healthcare industry might be falling short in this respect. A January 2017 survey conducted by Oliver Wyman and the Altarum Institute found that 40 percent of low-income patients have walked away from appointments feeling disrespected.

The survey, funded by the Robert Wood Johnson Foundation, showed that in addition to reducing patient satisfaction, lacking compassion also lowered quality of care. Patients who felt disrespected were three times less likely to trust their clinicians, and two times less likely to adhere to treatments.

Healthcare organizations should support their clinicians in pursuit of being more empathic. Organizations can host cultural sensitivity seminars, work with patients to continue to develop their interpersonal skills, and educate clinicians on evidence-based best practices for enhancing patient-provider communication.

Improving the Physical Hospital Environment

Hospital Setting

Two HCAHPS questions pertain to the hospital environment: hospital cleanliness and hospital noise levels.

In order to maintain an appropriately clean and sanitary facility, organizations must support their custodial staff and reinforce the importance of a healthcare facility being clean.

The American Hospital Association has long advocated for improving the hospital setting for patient satisfaction. In a 2016 guide, AHA listed the ways in which organizations can create environments more suitable for patient rest and recovery.

To create a quiet and peaceful environment, AHA says hospitals should implement and enforce rules about quiet hours and lights-out times.

“It makes sense that patients rate hospitals poorly when they cannot get good sleep or rest and have the additional stress of noise added to the already stressful situation of being unwell,” AHA wrote. “Data shows that noise in hospitals is the factor that scores lowest on HCAHPS scores nationwide.”

Healthcare organizations can take it a step further than HCAHPS mandates. Many hospitals are turning to their patients to inform room design that will facilitate a more comfortable experience.

When designing its new facilities in Delaware and Orlando, leaders at Nemours Children’s Health consulted with its patient and family advisory board to decide which features would best suit pediatric patient rooms.

“The parents came in and tested all of the furniture that they might be sleeping on in the rooms. They provided input into what we actually purchased,” recalled Nemours Chief Information Officer Bernie Rice.

“The children came in as well and helped pick colors and room layouts as far as if the counter was too high,” he continued. “They were very valuable and heavily influenced our construction and design to make sure it was a very family- and patient-friendly environment.”

Being Attentive and Reducing Unnecessary Discomfort

Improving Patient Discomfort

One highly-debated part of patient experience surveys is pain management. Amidst a raging opioid abuse epidemic, many experts question whether pain management should be a part of patient satisfaction scores that result in provider reimbursements. By tying payments to pain management, some clinicians may feel compelled to prescribe opioids when there could be other potentially less-risky forms of pain management.

In November 2016, CMS removed the pain management questions from the HCAHPS survey. However, the agency maintained that pain management is an important part of patient care and experience.

“CMS continues to believe that pain control is an appropriate part of routine patient care that hospitals should manage, and is an important concern for patients, their families, and their caregivers,” CMS said in a public statement. “CMS is continuing the development and field testing of alternative questions related to provider communications and pain, and will solicit comment on these alternatives in future rulemaking.”

While the pain management portions of the HCAHPS survey are currently under construction, clinicians should still work to reduce unnecessary patient discomfort.

Press Ganey is adopting this approach when consulting on patient experience, Mylod said.

“The way that we approach improvement for patient experience measures is to reframe it,” she explained. “The exercise is not to make consumers happy. The exercise is to reduce patient suffering.”

To boost scores in this realm, Mylod suggests clinicians – especially nurses – become even more attentive. This means not only answering call buttons, but also making regular rounds to hospital beds to ensure they meet all patient needs.

During these rounds, nurses can ask if the patient needs assistance using the restroom or if they need an object, such as a television remote, handed to them. Paying attention to these seemingly inconsequential needs could reduce adverse safety events, Mylod explained. If a patient gets up to retrieve a book, for example, he could fall and hurt himself, affecting the patient experience, increasing length of stay, or requiring additional expenses related to an injury.

Streamlining discharge processStreamlining the Discharge and Follow-up Process

HCAHPS asks patients about how doctors and nurses managed continuous care and the discharge process. The survey asks whether clinicians checked in on post-discharge care plans, made it clear which provider will follow-up with ongoing needs, and whether that care will be adequate for the patient’s condition.

At patient advocacy group Planetree, leaders have developed a hospital discharge plan to ensure clinicians meet patient needs.

The plan includes identifying a family care partner that will help take care of the patient following hospital discharge, said Planetree’s Director of Research Jill Harrison, PhD.

From there, clinicians check in with the patient and appointed caregiver to determine which functions they will need to learn for optimal at-home care.

“Planetree has a program that allows people to say that they want help with wound changes, or help ambulate their loved one, or help check a tracheotomy if the patient has one,” Harrison said. “Caregivers go through a training program with the nursing staff and learn how to provide that care so that when patients get out of the hospital setting their family members are ready to take that all on.”

Other key healthcare players are advocating for a similar strategy. AARP has been sponsoring a law in state legislatures across the country to support family caregiver engagement. The organization says caregiver engagement will help support continuity of care.

Research confirms that family caregiver engagement can reduce hospital readmissions by up to 25 percent.

Hospitals that implement family caregiver engagement and discharge plans may see not only increases in HCAHPS scores, but in quality of healthcare, as well.

The importance of improving patient satisfaction and CAHPS scores is well-founded. These scores help inform CMS value-based reimbursements and hospital ratings published on the CMS website. Many healthcare organizations also use these scores to inform their own internal practice improvement processes.

However, when it comes to improving patient satisfaction, it is also important for practice leaders to look beyond the survey. Improving patient satisfaction means understanding the facility’s unique patient population and its needs. What will please one group of patients may not satisfy another, and hospital leaders must bear that in mind.

While supporting initiatives specifically geared toward improving CAHPS scores, healthcare organizations should also consider projects that will serve their unique population.

Issuing practice-specific patient input surveys or consulting with a patient advisory council will help healthcare organizations move beyond surface-level satisfaction and find solutions that will be truly meaningful for patients.

I trust this article has provided you with insight and approaches that can help you pinpoint those drivers that most strongly influence a patient’s willingness to recommend a hospital. If you are interested in learning more about using these methods, contact us at:  TPMG Global® – Improving HCAHPS Scores and The Patient Experience

Lean Six Sigma in Healthcare: Improving Patient Satisfaction

Riverview Hospital Association
For providers like Riverview Hospital Association, serving Wisconsin Rapids, Wis. and surrounding areas, recent changes in the U.S. healthcare system have placed more emphasis on improving the quality of care and increasing patient satisfaction. “In this era of healthcare reform, it is even more essential for providers to have a systematic method to improve the way care is delivered,” says Christopher Spranger, director of Lean Six Sigma and Quality Improvement at Riverview Hospital Association. “We have had a Lean Six Sigma program in place for four years, and we are continuously working on ways to make our hospital safer and more efficient.

The Challenge

Under what is known as Hospital Inpatient Value-Based Purchasing (VBP), a portion of the Medicare payments hospitals receive are tied directly to patient satisfaction metrics and the quality of care, rather than entirely on the volume of Medicare patients treated. A new rule from the Centers for Medicare and Medicaid Services (CMS) grants Medicare incentive payments to hospitals that are meeting high quality of care standards, or have shown sufficient improvements. Hospitals that do not meet these standards are subject to a reduction in Medicare payments. “Nearly all hospitals treat a sufficiently large percentage of Medicare patients,” says Spranger, “so this rule presents a significant challenge with substantial financial implications for us—and for many other hospitals.”

Incentive payments are determined by how well hospitals score on two point-based domains. One domain takes into account the clinical process of care, where the hospital is judged on its performance in meeting twelve predefined clinical measures. The second domain is based upon the overall patient experience and measured through a survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS scores depend on the percentage of positive responses received for each question within each specific ”dimension,“ or category. Dimensions include communication with doctors and nurses, clarity of discharge information, overall hospital rating and more.

When Spranger and the Lean Six Sigma team at Riverview discovered that the hospital’s overall HCAHPS survey scores were lower than desired for the discharge information dimension, they set out to improve scores with Lean Six Sigma techniques and data analysis.

How Data Analysis Helped

The Lean Six Sigma team’s goal was to increase the percentage of “yes” responses for the following yes/no HCAHPS survey question: “During this hospital stay, did doctors, nurses, or other hospital staff talk to you about whether you would have the help you needed when you left the hospital?” To start, the team assessed their baseline performance by plotting outcomes from the previous 24 months with a Minitab control chart. The chart revealed a stable process and a current average positive monthly response rate of 85 percent. The goal was to improve positive monthly responses and exceed the preset benchmark of 91 percent.

Minitab Control Chart

To determine underlying factors that could be causing low scores, Spranger and the team chose to analyze data the hospital already had on-hand about the patient, which was collected as part of the HCAHPS survey. They had access to the responder’s age, gender, length of stay, primary language, education level, hospital unit visited and more. With Minitab charts, histograms and plots, they were able to explore the variables and responses graphically.

The team analyzed the variables further, and used the Minitab Assistant to guide their statistical analysis. They followed interactive decision trees to determine which analysis to use, and selected Analysis of Variance (ANOVA) to compare sample means and to look for significant differences within variables that could be impacting the HCAHPS survey question.

Minitab Assistant

The Riverview team began this project with a preset assumption that differences in the education level or the primary language of the respondent might offer insight into the low scores, but their analyses of these variables revealed no statistical significance. However, analysis of other variables uncovered statistically significant differences within respondent age groups and the hospital unit visited.

Surpassing the Benchmark

The Riverview Lean Six Sigma team was able to narrow the project scope and use the insights they gathered to improve patient satisfaction for groups identified as scoring the lowest. “Historically, health organizations try to increase patient satisfaction through staff training and other large-scale solutions,” says Spranger. “Now, with a data-driven approach, we are able to better target improvements.” The improvements for this project targeted low-scoring patient groups from specific age ranges, as well as patients who stayed in specific hospital units.

The team also used the improvement effort to solve key problems identified in the current process for handling patient discharges, which included timing of education, ensuring the involvement of a family caregiver, and clarifying outcomes with the patient. They redesigned the discharge education process into three phases to address previous issues with timing, collaborated with primary care physician clinics to ensure consistency, created a process to ensure that a primary family caregiver was identified to engage in care management after discharge, and clarified terminology in discharge documentation that was considered vague.

After implementing these improvement strategies, the team compared the current proportion of “yes” responses to responses before the project began. They achieved an impressive gain in the proportion of “yes” responses and met their goal to surpass the 91 percent benchmark for average positive monthly responses.

I trust this article has provided you with insight and approaches that can help you pinpoint those drivers that most strongly influence a patient’s willingness to recommend a hospital. If you are interested in learning more about using these methods, contact us at:  TPMG Global® – Improving HCAHPS Scores and The Patient Experience

Learn more about lean six sigma in healthcare :  Six Sigma Master Class – Improving Healthcare Processes

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