Building Patient-Centered Care

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1 Building Patient-Centered Care Liz Boehm Director September 12, 2012

2 You re healthy enough for discharge, but not healthy enough to go home. Page 86

3 How did we get here? Chart source: UC Atlas, UCSD

4 There s plenty of blame to go around Patients/families Demand services they don t need Don t comply with medical advice Fail to follow lifestyle guidance Don t self-educate Focus only on their costs Health professionals/ systems Cave in to unreasonable patient demands Practice defensive medicine Allow organizational silos to persist Tack new checklists onto broken processes Fail to address burnout Insurers/ regulators Treat medicine like a cookie-cutter profession Bully doctors/systems into inefficient processes Allow lawyers to dictate medicine Fail to address systemic problems Over-regulate Page 88

5 Enter process improvement Page 89

6 Page 90 Copyright ExperiaHealth, Inc.

7 Patient-Centered Care Defined Effective, safe, and efficient care that addresses patient s medical, health, and emotional needs across care settings and over time. Page 91

8 Effective, Safe, and Efficient is a Requirement, not a Differentiator Page 92 Copyright ExperiaHealth, Inc.

9 Ascension Health breaks out the patient experience Coordinated, Efficient Processes ( Blue ) Comfortable, Convenient Environment Compassionate, Respectful Care Emotional and Spiritual Support ( Green ) Administrative Efficiency Communication and Empowerment Safe, Effective Evidencebased Care ( Orange ) Clinical Reputation and Quality Care Responsiveness 93

10 Ascension correlates HCAHPS with NPS 9-10 Promoters 7-8 Passively Satisfied 0 6 Detractors % Promoters % Detractors % Net promoters

11 Likelihood to delight A Framework For Exploring Driver Analysis DRIVERS OF NET PROMOTER SCORE BY ATTRIBUTE 40% 0 0 Potential 40% to anger Note: Based on 1699 respondents at six sites Columbia St. Mary s (Milwaukee), St. Agnes Hospital (Baltimore), St. Joseph Hospital (Kokomo), Carondelet Health (Kansas City), St. Vincent s Medical Center (Bridgeport), and Seton Medical Center (Austin) 95

12 Likelihood to delight A Framework For Exploring Driver Analysis DRIVERS OF NET PROMOTER SCORE BY ATTRIBUTE 40% Critical for promoter creation 0 0 Potential 40% to anger Critical for detractor avoidance Note: Based on 1699 respondents at six sites Columbia St. Mary s (Milwaukee), St. Agnes Hospital (Baltimore), St. Joseph Hospital (Kokomo), Carondelet Health (Kansas City), St. Vincent s Medical Center (Bridgeport), and Seton Medical Center (Austin) 96

13 Likelihood to delight A Framework For Exploring Driver Analysis DRIVERS OF NET PROMOTER SCORE BY ATTRIBUTE 40% Critical for promoter creation Compassionate and respectful care Care responsiveness Communication and empowerment Administrative efficiency Clean and comfortable environment NPS impact size 0 Clinical reputation 0 40% Potential Critical for to anger detractor avoidance Note: Based on 1699 respondents at six sites Columbia St. Mary s (Milwaukee), St. Agnes Hospital (Baltimore), St. Joseph Hospital (Kokomo), Carondelet Health (Kansas City), St. Vincent s Medical Center (Bridgeport), and Seton Medical Center (Austin) 97

14 In the Eyes of the Patient, Quality = Compassion 70% 65% 60% Q: In your own words, define Quality 50% 40% 30% 20% 38% 36% 27% 10% 0% Staff Compassion Clean Facility Experienced Med Staff Updated Equip/Proc Source: Quality and reputation survey, Consumer Advisory Panel, 2007 (n=103) Page 98

15 Experience Impacts Quality Patients' Satisfaction with Care and Quality of Care We found that patients' satisfaction with care was associated with the quality of clinical care in the hospitals for all four conditions measured. In unadjusted analyses, the HQA scores for 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. The results were similar when we adjusted the analysis for key hospital characteristics Page 99 Copyright ExperiaHealth, Inc.

16 Human connection affects outcomes even in technology Source: Health Media

17 Experimental Design: KP members 4,041 3 mo 6 mo 12 mo Source: Health Media

18 Average weight loss (lbs) Average weight loss (lbs) between Balance and comparison at 3, 6, and 12 month follow-up.* Balance Comparison BASELINE 3 MONTH 6 MONTH 12 MONTH Time *Adjusted for baseline BMI. Repeated measures MANOVA: F=3.4; p=.017 Source: Health Media

19 Average # outpatient visits over previous six months Outpatient visits over six months (self-reported) by treatment group, 6- and 12-months post-enrollment Balance Comparison BASELINE 6 MONTH 12 MONTH Time Repeated measures MANOVA, adjusted by baseline BMI: F=4.1; p<.05 Source: Health Media

20 We owe them journeys-not fragments Don Berwick, MD September 13, 2010 Page 104

21 Human-centered care can only be delivered by well-centered, cared-for humans.

22 The Depth of the Problem 53% of practicing physicians reported moderate to severe stress* 64% of surgeons feel their work schedule does not leave enough time for personal and family life** 40% of surgeons report burnout and 30% screen positive for symptoms of depression** 26% of Nurses who leave the field report stress as the cause*** 57% of Nurses reported stress*** * Survey of 763 practicing physicians in California, source WSJ May 25, 2010, Checking up on the Doctor ** Study of 7905 surgeons - Annals of Surgery: September 2009, Burnout and Medical Errors Among American Surgeons *** Nursing Economics 2005;23(1):25-30.; Carol Reineck; Antonio Furino; Nursing Career Fulfillment: Statistics and Statements From Registered Nurses Page 106

23 Medical Errors & Emotional Fatigue Source: * Study of 7905 surgeons - Annals of Surgery: September 2009 Burnout and Medical Errors Among American Surgeons Page 107

24 Traditional Approach Behavioral Coaching Disruptive Physician Programs Punitive Use of Satisfaction Data and Metrics Page 108

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28 How can Patient-Centered Care promote a Caring Community in Northeast Florida? Page 112

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30 THANK YOU! Liz Boehm Director, Patient Experience Collaborative