UHC CONFERENCE: PREPARING ACADEMIC MEDICAL CENTERS FOR CG-CAHPS - - PowerPoint PPT Presentation

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A ROADMAP TO CREATING THE IDEAL AMBULATORY PATIENT AND FAMILY EXPERIENCE UHC CONFERENCE: PREPARING ACADEMIC MEDICAL CENTERS FOR CG-CAHPS JULY 11, 2014 emoryhealthcare.org PRESENTERS S. Scott Davis Jr., M.D. Alan Dubovsky

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A ROADMAP TO CREATING THE IDEAL AMBULATORY PATIENT AND FAMILY EXPERIENCE

UHC CONFERENCE: PREPARING ACADEMIC MEDICAL CENTERS FOR CG-CAHPS

JULY 11, 2014

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PRESENTERS

  • S. Scott Davis Jr., M.D. Alan Dubovsky Redge Hanna

Associate Professor, Director, Corporate Director,

General Surgery Customer & Physician Engagement Service Performance Emory University School of Medicine Emory Clinic Emory Healthcare

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AGENDA

  • Organizational Overview
  • Emory Healthcare’s Patient Experience
  • Emory Clinic’s Patient Experience Story:
  • Case Study: General Surgery Improvements
  • A Physician’s Perspective On The Patient Experience

2011: The Patient Experience Challenge 2012: Creating The Ideal Service Team 2013: Establishing Meaningful Service Programs 2014: Accelerating Service Improvements

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DONABEDIAN EQUATION (THE EMORY VERSION)

S + P + C = O

Structure + Process + Culture = Outcomes

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2009: Defining Our New Culture 2010: Creating The Ideal Team Conduct 2011: Establishing Accountable Metrics 2012: Accelerating Metrics Improvements 2013: Establishing The Ideal Brand

2014: Accelerating The Ideal Brand

ALIGNING OUR CULTURE

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2011: The Patient Experience Challenge 2012: Creating The Ideal Service Team 2013: Establishing Meaningful Service Programs 2014: Accelerating Service Improvements

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2011: The Patient Experience Challenge 2012: Creating The Ideal Service Team 2013: Establishing Meaningful Service Programs 2014: Accelerating Service Improvements

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Observations; Benchmarking; Planning Discussions Focus Groups With Customers Pilot Phase Finalized Structure

NEED NEW ROLE

Greater line of sight engagement with staff SERVICE AMBASSADOR More concise and consistent patient feedback PATIENT FEEDBACK ANALYST Dedicated service training and coaching SERVICE TRAINING SPECIALIST

2011: The Patient Experience Challenge 2012: Creating The Ideal Service Team 2013: Establishing Meaningful Service Programs 2014: Accelerating Service Improvements

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PATIENT EXPERIENCE AT EMORY

Emory Healthcare Medical Practice Inpatient Nursing-Led Efforts Service Improvement:

  • Ambassadors
  • Patient

Advocacy

  • Service

Training

  • PSAT

Emory Clinic Department of Service Management Patient Experience:

  • Volunteers
  • Guest

Services

  • Access

Emory/Emory International Patient Feedback:

  • Press Ganey
  • STARS Patient

Complaint & Grievances

  • Secret

Shopping

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2011: The Patient Experience Challenge 2012: Creating The Ideal Service Team 2013: Establishing Meaningful Service Programs 2014: Accelerating Service Improvements

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A New Welcome Guest Services Improvements Emory Clinic Volunteers Service Ambassadors

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PATIENT FEEDBACK IMPROVEMENTS

  • 1. Improved Survey Process:

2011 2013 46 question survey 29 question survey Mailed only Electronic only 6-8 week turnaround time from visit to survey return Average turnaround time = 48 hours Fewer than 3% of patients able to complete a survey All patients eligible Fewer than 25 responses per site/month 300% increase in returned surveys

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PATIENT FEEDBACK IMPROVEMENTS

2. Ensured Consistent, Transparent Data:

  • a. Conducted thorough Clinic-Wide education
  • b. Centralized all reporting
  • c. Updated reports (Clinic-Wide, Departmental, Role-

Specific)

  • d. Addition of weekly comments report

3. Updated Goal Setting:

  • a. Selected UHC benchmarking group across Emory

Healthcare

  • b. Simple Green or Red performance indicators

4. Began CG-CAHPS surveys in 2013 to establish a baseline

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2011: The Patient Experience Challenge 2012: Creating The Ideal Service Team 2013: Establishing Meaningful Service Programs 2014: Accelerating Service Improvements

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ACCELERATING AMBULATORY PATIENT EXPERIENCE IMPROVEMENTS

Step 1 – Focusing On Our Priorities:

  • a. Ease Of Scheduling
  • b. Ease Of Getting Clinic On The Phone
  • c. Wait Time At Clinic
  • d. Sensitivity To Patient’s Needs

Step 2 - Targeting The High Opportunity Departments Step 3 – November 2012: Launch Of PSAT (Patient Satisfaction Acceleration Team)

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PSAT

  • 1. Modeled after Emory’s Quality Acceleration Team.
  • 2. Meets every 2 weeks, for 2 hours, with all key

members in attendance.

  • 3. Benchmarking is critical.
  • 4. Constant use of data to drive discussions and

decisions.

  • 5. Leave every meeting with decisions and specific

action items.

  • 6. Track all tests of change to establish best practice.
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EMORY CLINIC’S PATIENT SATISFACTION SUCCESS STORY

87.7 87.9 88.7 90.0 90.3 90.7 90.4 90.9 91.1 86 87 88 89 90 91 92 2006 2007 2008 2009 2010 2011 2012 2013 2014TD

Medical Practice Mean Score Trend: 2006 - 2014

To the 75th Percentile… and Beyond! From the 29th Percentile…

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THE ROADMAP TO THE IDEAL AMBULATORY PATIENT AND FAMILY EXPERIENCE

Create The Ideal Service Team Establish Meaningful Service Programs Accelerate Service Improvements

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CASE STUDY: PATIENT EXPERIENCE IMPROVEMENTS: EMORY CLINIC GENERAL SURGERY

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GENERAL SURGERY IN 2012

89.3 88.6 88.3 87 88 89 90 FY10 FY11 FY12

General Surgery Medical Practice Mean Score

1. Downward trend in patient satisfaction. 2. Lack of engagement from physicians and staff. 3. Consistent areas of concern from patient feedback: a. Promptness in returning calls; b. Information about delays; c. Sensitivity to patient’s needs.

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2013:

  • 1. New administrative leadership.
  • 2. Increase in physician engagement.
  • 3. Volunteered to join inaugural PSAT group.
  • 4. Formed section-based PSAT team.

= Renewed focus on patient experience improvements

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GENERAL SURGERY INITIATIVES

Ease Of Scheduling:

  • Lag Time Reduction (goal of reducing from over 20

days to 10 days). Tests of change include: – Never Say No barriers removed. – Master schedule simplification- rules eliminated preventing barriers to appointment. – Overbooking opportunities.

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GENERAL SURGERY INITIATIVES

Ease Of Getting Clinic On The Phone:

  • Medical Secretary Direct Contact:

– Return patients are given direct phone numbers to Medical Secretaries. – No voice mail allowed, overflow routes to call center.

  • Same Time Implementation:

– Tool used by clinical staff and call center to improve communication.

  • Live Nurse Call Handling:

– Phone tree option added to speak to a member of the care team: agent routes directly to nurses in clinic.

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GENERAL SURGERY INITIATIVES

Wait Time At Clinic:

  • First Time Starts:

– Tracked all first time starts. – Data presented to faculty at Division meetings.

  • Master Schedule Template changes:

– Schedule optimized for accurate length of visit by type. – Time study analysis in progress- breaking down parts of visit.

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GENERAL SURGERY INITIATIVES

Sensitivity To Patient’s Needs:

  • Forms And Posters For ‘Questions On Your Visit’.
  • Profile screens placed in main lobby.

– Physician profiles; – Administrator profiles.

  • Service Management training with clinic staff.
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GENERAL SURGERY IMPROVEMENTS

89.3 88.6 88.3 89.6 91.7 87 88 89 90 91 92 FY10 FY11 FY12 FY13 FY14TD

General Surgery Medical Practice Mean Score

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A PHYSICIAN PERSPECTIVE ON THE PATIENT EXPERIENCE

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Quality Cost

Value

PHYSICIAN PERSPECTIVE

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PHYSICIAN PERSPECTIVE

  • Satisfaction surveys generally distrusted:

– Survey delivery/response :

  • Low response rates
  • Selection bias in responders
  • Low sample size
  • Narrow effective measurement range

– Higher scores associated with worse patient

  • utcomes and increased cost.
  • Fenton, JJ. Arch Int Med. Mar 2012

– Individual responsibility (personal and financial) for intangible factors.

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Value

Medical Care Administrative Service

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INCREASING VALUE LEADING TO IMPROVED PATIENT SATISFACTION SCORES

  • Better physician communication.
  • Optimized scheduling:

– Wait times highly cited complaint, balance against productivity

  • Technology:

– Medical records; – Phone systems; – Patient reminders; – Guided scheduling; – Communication alternative to phones.

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PHYSICIAN PERSPECTIVE SUMMARY

  • We are not making Teslas or iPads. We have bad

news to deliver.

  • Most interested in delivering evidence based care.
  • Current patient satisfaction tools are:

– Created to increase volume; – Not evidence based; – Blunt instruments with low sensitivity and

  • perational challenges.
  • Easier to over treat than correct operational issues
  • ut of our control.
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PHYSICIAN PERSPECTIVE SUMMARY

  • Patients – our customers – deserve a voice.
  • Surveys are here to stay.
  • There is useful information to be found in results.
  • Physicians need to be engaged in the process to

help mold it with our interests in mind.

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Thank You. Questions?

sdavisj@emory.edu alan.dubovsky@emoryhealthcare.org redge.hanna@emoryhealthcare.org