A Collaborative Approach to Rapidly Improve the Patient Experience Allina Health Clinics. Janet Wied Steve Bergeson, MD April 8, 2014

Transcription

1 A Collaborative Approach to Rapidly Improve the Patient Experience Allina Health Clinics Janet Wied Steve Bergeson, MD April 8, 2014

2 Agenda for today Introduction who is Allina Learning Objectives Background Set the stage What was the problem Describe the solution Tools & resources 2

3 About Allina Health Allina Health is a not-for-profit organization of clinics, hospitals and other health care services, providing care throughout Minnesota and western Wisconsin. 3

4 About Allina Health Serving the community 57 primary care clinics 23 hospital-based clinics 12 hospitals 15 retail pharmacies 3 ambulatory care centers Home care, hospice, palliative care offerings Emergency medical services Home medical equipment Service & specialty lines Virginia Piper Cancer Institute Courage Kenny Rehabilitation Institute Penny George Institute for Health & Healing Phillips Eye Institute John Nasseff Neuroscience Institute Allina Health Mental Health Heart Care Mother Baby 4

5 Allina Health Clinics 57 Clinics organized into 8 Regions 700 clinicians Primary care (Family Medicine, Internal Medicine, Pediatrics) Specialty (Ob/Gyn, Orthopedics, General surgery, ENT, Rheumatology, Endocrinology, Eye services, Mental Health) Physicians & APCs 180 Hospitalist clinicians 3.3 million clinic visits annually Leadership is organized in a dyad from site to region to division 5

6 Learning Objectives A. Understand how process improvement skills can be applied to rapidly improve the experience of care by improving processes as well as staff and clinician communication. B. Describe the leadership accountability required for successful patient experience improvement. C. Understand how Allina Health designed and implemented clinician improvement plans without shame. D. Implement similar tools and tactics to start to improve patient experience in their organization. 6

7 7 Background-Set the Stage

8 2012 Mandate was Delivered Allina Health Clinics will achieve the 75 th percentile in overall patient experience by December 31, 2015 with a further goal of the 90 th percentile by???? 8

9 The Problem Allina Clinics 2012: Quality 75 th -90 th Percentile Patient Experience 40 th Percentile We knew how to do quality We should know how to do experience 9

10 Background- Before 2011 Mailed survey Clinics were improving No external benchmarks Home grown survey Overall, how would you rate this clinic visit 100% 80% 10 Percent 60% 40% 20% 0% February April July October January April July October January April July October Months (Feb 2002, Feb ) January April July October January April July October January April July October January April July October Excellent Very Good Good Fair Poor

11 Changes in 2011 Transitioned to CG CAHPS Changed to mode web based National benchmarks Patient comments We became aware not all clinicians got reports or all patient comments were reviewed All of this led to. A Rude Awakening! 11

12 CG CAHPS at Allina Health 12 Implemented Spring 2011 Visit based survey Adult Primary Care Version Pediatric Version implemented late ed 2010 study: Equivalence of mailed and ed results except for access, despite differences in populations who responded to each mode Faster and less costly 82,000 responses about their care Working to increase response rates Sept Nov Mailed CG CAHPS (Publicly reported)

13 We did what we always did Sent the data Told them to share at their sites Gave them instructions on how to access comments Made some suggestions on how to improve And Not much was happening 13

14 2012 Plan Back to Basics Standard Reports starting in May 2012 Provider results in National Percentiles not top box Quicklearn so all would understand their reports Patient Comments All comments reviewed every month by leadership All named persons receive their comments both + and - (most were +) Tools: Newsletters - Specific ideas on how to improve not about being nicer Accountability to ensure the above was occurring But PE was not improving fast enough 14

15 Patient Experience Reports Based on CG CAHPS (Web based survey) Clinician and Clinic Level Reporting in the same format National Percentiles Reporting on all questions: Care Team performance Questions from the same dimension are the same color: Provider Communication (6 questions) Access to Care (5 questions) Staff Courtesy (2 questions) 15

16 Patient Experience Reports P1

17 Patient Experience Reports P2

18 National Percentile or Percent Top Box? (Percentiles are in yellow, all other numbers are % Top Box) 18

19 Getting to Always Q20. During your most recent visit, did this provider seem to know the important information about your medical history? Yes, Definitely Yes, Somewhat No 19

20 20 Solution

21 2013-Time for a Different Approach Question: Could we improve more quickly by working with one region using a focused approach? 21

22 An Improvement Collaborative Based on a proven model (IHI) An Improvement Strategy Nine sites learning and working together Structured leadership accountability Without accountability we will not improve 22

23 Collaborative Structure 6 months in length 2 months of pre-work prior to start Combination of Objective Data & Observations Site wide work and clinician focused work Resources from Patient Experience team Supplemented with PI & service educators Clear roles & responsibilities articulated 23

24 Collaborative Cycle Prework A P D A P D A P D Participants LS* 1 S LS 2 S LS 3 S Final Session/ Celebration Supports Clinic Visits Phone Calls Assessments Senior Leader Reports *LS = Learning Session 24

25 Collaborative Interventions 1. Site wide Improvement: Service Action Teams (SAT) at each site Multidisciplinary Team using data and the ideas of front line staff Performance improvement training for all Report training and grounding, use of data Innovate, Test and Implement using P-D-S-A methodology 25

26 Collaborative Interventions 2. Clinicians: Improvement plans (IP) Those below the 50 th National Percentile on Communication Dimension Written Plan by clinician Face to face meetings with clinician leader to Share data and develop plan 30 day, 90 day, 180 day check in and refine Coaching Training for clinician leader 26

27 Improvement Plan Example INDIVIDUAL CLINICIAN PATIENT EXPERIENCE IMPROVEMENT PLAN Provider Name Clinic Name Defined Goal What changes or ideas are you willing to try? JD, MD Increase provider communication score to 60 th national percentile Target Date Current Status 45 th national percentile Action Steps 1. Establish a more personal connection. Use post it note feature 2. Narrate my care physical exam especially, but also computer 3. Write plan in AVS 4. Have CMAs keep patients updated on my status staying on time Measurement How will you know if you have made a difference? 1. Self assessment 2. Patient rounding by management 27

28 Improvement Plan Example Outcomes What did you learn? What barriers or need for additional resources did you identify? 30-Day Review Nov. 8, 2013 Establishing social connection makes my work more fun for me and patients Did not take more time Next Steps What will you try next, how will you refine your plan? How will you measure it? Write plans in AVS Try Teachback Eliminate double books to stay on time Narrating exam 28

29 Collaborative Approach Overlaid with a clear structure of accountability with clear expectations and timelines for deliverables 29

30 Collaborative Approach Accountability Structure Service Action Teams Clinician Improvement Plans 30

31 Let s talk about Accountability Attendance at meetings & phone calls required Deadlines must be met: Operational Leads Delegate but still on point Communicate Communicate Communicate Assistance from Patient Experience but cannot defer the work to them Coaching to improvement Performance Improvement Moves upwards to all levels 31

32 Clinician Improvement Plans 32 Provider Name Site N % Top Box Conv IP (3/15) IP (4/15) IP (6/15) IP (8/15) A Burnsville X X X X X B Burnsville X X X X X C Chaska X X X X X D Chaska X X X X X E Dean Lakes X X X X X F Dean Lakes X X X X X G Dean Lakes X X X X X H Edina X X X X X I Edina X X X X X J Edina X X X X X K Edina X X X X X L Hopkins X X X X X M Hopkins X X X X X N Lakeville X X X X X O Savage X X X X X P Savage X X X X X Q Shakopee X X X X X R Shakopee X X X X X

33 33 The Expedition Reports Back

34 Lead for Improvement Kick-Off How to make a movement.html 34

35 Collaborative Work 6 months, 182 days, 4380 hours 2 months pre-work prior to start 118 Tests Of Change completed by 9 clinics 18 clinicians completed Improvement Plans (3 face to face meetings for revisions & follow-up with lead physicians 10 clinicians were shadowed 19 call-in meetings 4 face to face meetings 35

36 It was not a perfect 6 months! Change in leadership at one site New manager for 2 sites (new to Allina) Initial of lack of buy in by some clinician leaders Some managers did the work for the clinicians (IP s) Role clarity was an issue Accountability to senior leadership was unclear Clinic wide communication was lacking Performance management was needed 36

37 How did they do? Willingness to Recommend Trends by Percentile Collaborative Kick-Off 2012-Q Q Q Q Q Q Q Q4 Southwest Region Collaborative Close 37

38 How did they do? Willingness to Recommend By Percentile 38 Start of Collaborative 2013-Q1 End of Collaborative 2013-Q3 Today 2013-Q4

39 Statistical Data Question 2012 top box N 2013 top box N SW Region Access Composite 64.70% % Provider Communication Composite 91.27% % Provider % % Office Staff Composite 89.14% % 3610 < Willingness to recommend clinic 87.83% % Improvement plan clinicians Provider Communication Composite 81.32% % 1311 < Provider % % P value - simple proportions test (considering the fact some are composites and the p value would be smaller) 39

40 What did we learn Simple specific changes made big differences Don t start with complicated TOC (test of change) Clinics with the same opportunities should work together to create solutions/workflows Measurement doesn t need to be complicated Need to engage entire staff Need to balance a blank slate & prescriptive plan Employee engagement drive the results It is all about getting to always 40

41 Conclusion: Collaborative Approach works Changes and refinements for next collaborative More prescriptive but room for ideas Foundational changes not optional Performance management brought in earlier More clarity on expectations as well as roles More coaching of leaders up front Collaborative model will continue 2 regions at a time until complete in 2015 Implement a sustainability plan and a loop back to bring learnings forward 41

42 Sustainability Plan Permanent infrastructure to continue focus on improvement of patient experience once collaborative ends Regional approach following the collaborative Site wide and clinician specific Different levels of interventions based on progress being made or not Continuing to improve Improved but plateaued Improved but declining No real improvement 42

43 Sustainability Plan Combination of written plans and structured work Back to the basics Accountability rests with site & regional leadership Needs to include a venue to obtain the voice of the patient Patient and Family Advisory councils 43

44 Where are we today Just ended our second collaborative 2 regions-more sites Implemented our learnings from the first Encountered different issues this time (Specialists, Access) Third Collaborative will kick-off this month Started to use a similar approach across the division Every Patient Every Time 44

45 Willingness to Recommend by Percentiles -Rolling 3 Month Data Collaborative Kick-Off Baseline Collaborative Kick-Off Jun-Aug Jul-Sep Aug-Oct Sep-Nov Oct-Dec Nov-Jan East Metro Region Northwest Region Willingness to Recommend by Percentiles -Quarterly Data 2012-Q Q Q Q Q4 Nov 2013-Jan 2014 East Metro Region Northwest Region 45 *Data Source Allina EDW ; *Percentiles are based on the 2011 CG-CAHPS National Database

46 Doctor Communication CGCAHPS Composite Performance East Metro and Northwest Region Providers

47 Every Patient Every Time A set of behaviors for all clinic staff Includes providers Tools and timeline to implement Video produced from a local theater/improv group Discussion guides Action plans The question is not do they work? The question is are you performing them? Every Patient Every Time 47

48 Every Patient Every Time The importance of first impressions Link to the Every Patient Every Time Video: mms://aknvideo01.allina.com/amc/point of View v3.wmv 48

49 Patient Comment Don't have suggestions for improvement - just observations about what has improved over the last 6-12 months: - it's much easier to get through on the phone to make an appointment; in the past there have been extremely long wait times, but now I seem to get to the appointment desk right away. - when I got to the clinic, all of the staff were very intentional about introducing themselves, being very friendly, courteous, professional and respectful. - it didn't feel rushed like it has in the past; all of the staff - office, nurses, doctors seemed to be very focused on me, not the next appointment. - the signage to move around the clinic has improved - there are simple, taped lines on the floor from reception to lab. - the equipment has been upgraded so that it doesn't take long at all (I had a mammogram, which used to take forever!). - the follow-up and communication with online messages is terrific. 49

50 50 Conclusion

51 Why this approach works Clear Structure Leadership support Resources to implement Clear Accountability across all levels Concrete tools that will work if used Change management Stay the course 51

52 Our Team for Patient Experience 2 Project leads-dyad approach-half time each 2 full-time Patient Experience Advisors Work with clinicians and site leadership Most focus on collaboratives Consultative approach Project Management support Service educator support Process Improvement experts Utilize system office of Patient Experience for Measurement & Analysis Training on coaching, shadowing, facilitation skills Any system wide initiatives survey process 52

53 Questions

54 Thank you!

55 55