A ROADMAP TO CREATING THE IDEAL AMBULATORY PATIENT AND FAMILY EXPERIENCE

Transcription

1 A ROADMAP TO CREATING THE IDEAL AMBULATORY PATIENT AND FAMILY EXPERIENCE UHC CONFERENCE: PREPARING ACADEMIC MEDICAL CENTERS FOR CG-CAHPS JULY 11, 2014

2 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

3 AGENDA Organizational Overview Emory Healthcare s Patient Experience Emory Clinic s Patient Experience Story: 2011: The Patient Experience Challenge 2012: Creating The Ideal Service Team 2013: Establishing Meaningful Service Programs 2014: Accelerating Service Improvements Case Study: General Surgery Improvements A Physician s Perspective On The Patient Experience

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6 DONABEDIAN EQUATION (THE EMORY VERSION) S + P + C = O Structure + Process + Culture = Outcomes

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8 ALIGNING OUR CULTURE 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

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10 2011: The Patient Experience Challenge 2012: Creating The Ideal Service Team 2013: Establishing Meaningful Service Programs 2014: Accelerating Service Improvements

12 2011: The Patient Experience Challenge 2012: Creating The Ideal Service Team 2013: Establishing Meaningful Service Programs 2014: Accelerating Service Improvements Observations; Benchmarking; Planning Discussions Focus Groups With Customers Pilot Phase Finalized Structure NEED Greater line of sight engagement with staff More concise and consistent patient feedback Dedicated service training and coaching NEW ROLE SERVICE AMBASSADOR PATIENT FEEDBACK ANALYST SERVICE TRAINING SPECIALIST

13 PATIENT EXPERIENCE AT EMORY Emory Healthcare Medical Practice Emory Clinic Department of Service Management Inpatient Nursing-Led Efforts Service Improvement: - Ambassadors - Patient Advocacy - Service Training - PSAT Patient Experience: - Volunteers - Guest Services - Access Emory/Emory International Patient Feedback: - Press Ganey - STARS Patient Complaint & Grievances - Secret Shopping

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16 A New Welcome Guest Services Improvements Emory Clinic Volunteers Service Ambassadors

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18 PATIENT FEEDBACK IMPROVEMENTS 1. Improved Survey Process: question survey 29 question survey Mailed only 6-8 week turnaround time from visit to survey return Fewer than 3% of patients able to complete a survey Fewer than 25 responses per site/month Electronic only Average turnaround time = 48 hours All patients eligible 300% increase in returned surveys

19 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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22 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)

23 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.

24 EMORY CLINIC S PATIENT SATISFACTION SUCCESS STORY 92 Medical Practice Mean Score Trend: To the 75 th Percentile and Beyond! From the 29 th Percentile TD

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26 THE ROADMAP TO THE IDEAL AMBULATORY PATIENT AND FAMILY EXPERIENCE Create The Ideal Service Team Establish Meaningful Service Programs Accelerate Service Improvements

27 CASE STUDY: PATIENT EXPERIENCE IMPROVEMENTS: EMORY CLINIC GENERAL SURGERY

28 GENERAL SURGERY IN General Surgery Medical Practice Mean Score FY10 FY11 FY12 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.

29 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

30 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.

31 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.

32 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.

33 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.

34 GENERAL SURGERY IMPROVEMENTS General Surgery Medical Practice Mean Score FY10 FY11 FY12 FY13 FY14TD

35 A PHYSICIAN PERSPECTIVE ON THE PATIENT EXPERIENCE

36 PHYSICIAN PERSPECTIVE Value Cost Quality

37 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 outcomes and increased cost. Fenton, JJ. Arch Int Med. Mar 2012 Individual responsibility (personal and financial) for intangible factors.

38 Administrative Service Medical Care Value

39 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.

40 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 operational challenges. Easier to over treat than correct operational issues out of our control.

41 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.

42 Thank You. Questions? 42