Focus On Value. Value Based Purchasing. The Pa'ent Experience: Hospitals as Bou'que Hotels? Policy (ACA) Patients. Payors And Employers

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1 The Pa'ent Experience: Hospitals as Bou'que Hotels? Patrick Kneeland MD Medical Director for Pa'ent and Provider Experience University of Colorado Hospital Focus On Value Patients Policy (ACA) Providers (It s why we re in this!) Payors And Employers Value Based Purchasing

2 Poten'al Financial Impact Possible Percentage Withheld % % % 4 Table Topic When I reflect on the widespread use of pa5ent surveys in hospitals and clinics to measure pa5ent sa5sfac5on or pa5ent experience, I am skep5cal for the following reasons:

3 Table Topic What is the difference between pa5ent sa5sfac5on and pa5ent experience? Key Principles 1. Survey scores shouldn t be our north star. 2. Value in health care is a complex phenomenon. 3. The focus should be on the human experience.

4 Significant Adverse Event

5 IHI: Access Science Relationships Michael Porter (NEJM): Health Status Achieved/Retained Process of Recovery Sustaining Health Kano: Must-be s Performance Attributes Attractive Quality Significant Adverse Event Tom Lee: Relief of Suffering, Bringing Peace of Mind Beyond HCAHPS: What Do Pa'ents Really Value? (1) Confidence in Provider (2) Teamwork and Coordina5on (3) Empathy (concern for worries and comfort) 2-4% Points Hospital Quality Alliance program scores hospitals in the highest quartile of HCAHPS ratings were, on average, about 2 to 4 percentage points higher than the HQA scores for hospitals in the lowest quartile of HCAHPS ratings Experience Impacts Quality High pa5ent sa5sfac5on is linked to: decubitus ulcer rates post opera5ve respiratory failure, Falls hospital infec5on rates Experience Impacts Safety Hospitals with a patient-centered care approach, see decreases in malpractice claims, despite an increases in patient care activity. 41% of patients choose providers based on non-clinical experience Experience Impacts Malprac7ce Claims Experience Impacts Market Share

6 Strategy Level Experience Improvement Strategies Example Environmental Individual Leadership prac5ces Local care delivery design System care delivery design Healthcare policy Private rooms, cleanliness, way- finding Interpersonal communica5on Purposeful rounding, commitment to transparency Accountable care units, Pain control protocols, Hourly rounding, Always Events Coordinated care, IPUs HIPAA, VBP Pa5ent Empathy Gain + AZen5on Provider Experience Strategy Level Experience Improvement Strategies Example Environmental Individual Leadership prac5ces Local care delivery design System care delivery design Healthcare policy Private rooms, cleanliness, way- finding Interpersonal communica5on Purposeful rounding, commitment to transparency Accountable care units, Pain control protocols, Hourly rounding, Always Events Coordinated care, IPUs HIPAA, VBP Pa5ent Empathy Gain + AZen5on Provider Experience

7 Communica'on E5queZe Informa5on Empathy Cleveland Clinic

8 Always Events Strategy Level Experience Improvement Strategies Example Environmental Individual Leadership prac5ces Local care delivery design System care delivery design Healthcare policy Private rooms, cleanliness, way- finding Interpersonal communica5on Purposeful rounding, commitment to transparency Accountable care units, Pain control protocols, Hourly rounding, Always Events Coordinated care, IPUs HIPAA, VBP Pa5ent Empathy Gain + AZen5on Provider Experience

9 Accountable Care Units: Building Real Teams Unit- based physician and nurse teams Structured interdisciplinary bedside rounds Unit- level performance reports Strategy Level Experience Improvement Strategies Example Environmental Individual Leadership prac5ces Local care delivery design System care delivery design Healthcare policy Private rooms, cleanliness, way- finding Interpersonal communica5on Purposeful rounding, commitment to transparency Accountable care units, Pain control protocols, Hourly rounding, Always Events Coordinated care, IPUs HIPAA, VBP Pa5ent Empathy Gain + AZen5on Provider Experience

10 Strategy Level Experience Improvement Strategies Example Environmental Individual Leadership prac5ces Local care delivery design System care delivery design Healthcare policy Private rooms, cleanliness, way- finding Interpersonal communica5on Purposeful rounding, commitment to transparency Accountable care units, Pain control protocols, Hourly rounding, Always Events Coordinated care, IPUs HIPAA, VBP Pa5ent Empathy Gain + AZen5on Provider Experience

11 Patient

12 Amplifica'on of Pa'ent Perspec've Easier Required surveys Less ac5onable Enhanced voice of the pa'ent surveys/ interviews More difficult Empathy mapping More ac5onable Pa'ent and Provider Toward the Quadruple Aim

13 Enhancing Pa5ent Experience Reducing Costs Improving the Work Life of Health Care Providers Improving Popula5on Health

14 Table Topic The next 5me I am talking to a colleague or administrator about pa5ent experience in hospital based medicine, I will remember to men5on: Pa'ent experience is an important part of the healthcare value equa'on. (It makes business sense, and it makes human sense) Pa'ent experience is an important part of the healthcare value equa'on. (It makes business sense, and it makes human sense) CAHPS scores are lagging indicators. Organiza'ons and providers that think beyond scores will be more likely to succeed.

15 Pa'ent experience is an important part of the healthcare value equa'on. (It makes business sense, and it makes human sense) CAHPS scores are lagging indicators. Organiza'ons and providers that think beyond scores will be more likely to succeed. Improvement efforts should focus on what pa'ents value. (This means innova'ng around true empathy gain) Pa'ent experience is an important part of the healthcare value equa'on. (It makes business sense, and it makes human sense) CAHPS scores are lagging indicators. Organiza'ons and providers that think beyond scores will be more likely to succeed. Improvement efforts should focus on what pa'ents value. (This means innova'ng around true empathy gain) Pa'ents come second.

16 Backup How Are We Doing? Overall Ra'ng: Inpa'ent FYTD Average TB Score: CMS Percentile: 87 th %ile 47 Inpa'ent Areas of Opportunity: Responsiveness of Hospital Staff FY Top Box Score Na'onal %ile th %ile Communica5on with Doctors FY Top Box Score Na'onal %ile th %ile Communica5on with Nurses FY Top Box Score Na'onal %ile th %ile 48

17 Willingness to Recommend- Ambulatory FYTD Performance Average TB Score: CMS Percentile: 65 th %ile 49 Ambulatory Areas of Opportunity: Provider Communica5on Composite FY Top Box Score Na'onal %ile th %ile Helpfulness of Office Staff FY Top Box Score Na'onal %ile th %ile 50 Table 1. Defini5ons and Frameworks for Pa5ent Experience Example Defini'ons of Pa'ent Experience The sum of all interac5ons, shaped by an organiza5on s culture, that influence pa5ent percep5ons, across the con5nuum of care. Everything we say and do that affects our pa5ents thoughts, feelings and well- being. Example Frameworks for Describing Pa'ent Experience Source The Beryl Ins5tute The Society of Hospital Medicine, Pa5ent Experience CommiZee working defini5on Source Three key components of pa5ent experience: (1) Access - to appropriate care; (2) Science - Don Berwick reliable evidence based care; (3) Rela5onships - between care providers and pa5ents The extent to which we as healthcare providers are able to reduce preventable suffering Tom Lee, CMO of Press Ganey and bring pa5ents and their families peace of mind. Five core drivers of pa5ent and family experience in hospitals: (1) Leadership; (2) staff hearts and minds; (3) respeclul partnership including shared decision making with pa5ents; (4) reliable care; IHI and (5) evidence- based care Eight elements of op5mized pa5ent experience: (1) Effec5ve treatment delivered by staff you can trust; (2) Involvement in decisions and respect for pa5ents preferences; (3) Fast access to reliable health care advice; (4) Clear, comprehensible informa5on and support for self- care; (5) Physical Picker Ins5tute comfort and a clean, safe environment; (6) Empathy and emo5onal support; (7) Involvement of family and friends; and (8) Con5nuity of care and smooth transi5ons. Seven core elements for op5mized pa5ent experience: (1) Pa5ent as ac5ve par5cipant in care, (2) Warwick Framework Responsiveness of services, (3) An individualized approach, (4) Lived experience, (5) Con5nuity of care and rela5onships, (6) Communica5on, (7) Informa5on and support. Six core elements for op5mized pa5ent experience: (1) Compassion, empathy, and responsiveness, (2)Co- ordina5on and integra5on of care, (3) Informa5on and communica5on, (4) Physical comfort, Ins5tute of Medicine (5) Emo5onal support and relief of anxiety, (6) Involvement of family and friends

18 Figure 1. Public Repor'ng of HCAHPS Data at Figure 2. Stakeholders and Elements of Value in Healthcare Pa5ents Policy- Makers Reliable Delivery of Evidence- Based Care (Quality) Preven'ng Avoidable Harm to Pa'ents (Safety) Pa'ent Experience of Care (Experience) Low Cost and Efficient Use of Resources (Cost) Providers Payers and Employers Table 2. Pa5ent Experience as A Propor5on of CMS Hospital Reimbursement for Value- Based Purchasing Incen5ve Rela've Domain Weight (%) for Hospital Payments Each Fiscal Year Value- Based Purchasing Domain Pa'ent Experience Quality of Care (Processes) Quality of Care (Outcomes) Efficiency Pa'ent Safety % Of Hospital Payment Witheld Source:

19 Table 3. The 8 HCAHPS Dimensions Communica'on with doctors Overall Ra'ng of Hospital Discharge Informa'on Communica'on About Medicines Pain Management Communica'on with nurses Responsiveness of hospital staff Hospital Cleanliness and Quietness Increasing likelihood of direct hospitalist impact on dimension Table 4. HCAHPS Ques5ons Most Likely to be Directly Impacted by Hospitalists Communica'on with Doctors Dimension During this hospital stay, how ohen did doctors treat you with courtesy and respect? During this hospital stay, how ohen did doctors listen carefully to you? During this hospital stay, how ohen did doctors explain things in a way you could understand? Other Ques'ons 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 leh the hospital? During this hospital stay, did you get informa'on in wri'ng about what symptoms or health problems to look out for aher you leh 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? Would you recommend this hospital to your friends and family? 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 leh. When I leh the hospital, I had a good understanding of the things I was responsible for in managing my health. When I leh the hospital, I clearly understood the purpose for taking each of my medica'ons. Figure 3. The quadruple AIM Enhancing Pa5ent Experience Improving the Work Life of Health Care Providers Reducing Costs Improving Popula5on Health