1. health and fitness
2. disease
3. chronic pain

5/13/2013
How to ‘Painlessly’
Leverage HCAHPS to
Drive Experience
Improvement
Learning Points
1. Describe how to use HCAHPS as a
platform for ongoing patient experience
improvement.
p
how loyalty,
y y HCAHPS and p
pain
2. Explain
are related.
3. Identify overarching strategies that can
positively impact all three areas.
4. Describe Ascension Health’s Pain
Management Model for Improvement.
5. Utilize specific strategies to improve
pain management.
Background on Ascension Health:
Who We Are
Ascension Health, part of Ascension Health Alliance, is the largest Catholic health
system, the largest private nonprofit system and the third largest system (based on
revenues) in the United States, operating in 23 states and the District of Columbia.
Facilities and Staff
Locations
1,500
Acute Care Hospitals
104
Long-term Acute Care Hospitals
3
Rehabilitation Hospitals
4
Psychiatric Hospitals
7
Available Beds
21,908
Associates
150,000
Physicians
30,000
Nurses
23,000
Daughters
of Charity
Health
System is
an affiliate
of
Ascension
Health
Pat Herrmann, Director, Experience
Research and Analytics
Staci Albenesius, Manager, Experience Team
Ascension Health
The Ascension Health Experience
Desired by Those We Serve
For Ascension Health, holistic care means caring for the physical, emotional, social and spiritual well being of
the whole person by:
• Attending to the spirit through compassionate relationships and empathetic, effective communication
• Inviting shared decision making among patients, providers, and care teams
• Delivering safe, reliable, evidence-based, and interdisciplinary care consistent with individual patient
preferences
Coordinated,
Efficient
Processes
(“Blue”)
Comfortable,
Convenient
Environment
Compassionate,
Respectful Care
Emotional
and Spiritual
Support
(“Green”)
Communication and
Empowerment
Administrative
Efficiency
Financial Information (FY 12) (in millions) *
Care of Persons Who Are Poor
and Community Benefit $1.3
Billion
*Financial information reflects
Ascension Health Alliance
Total Assets
$23,776
Operating Revenue
$16,611
Operating Income
$934
Excess of revenue & gains over
$968
expenses and losses, controlling interest
Patient Loyalty to Measure Success at
Providing Exceptional Patient Experiences
How likely is it that you would recommend [hospital x] to friends and family?
Extremely
likely
10
Not at all
likely
9
8
7
Promoter
% Promoters
Source:
6
5
4
3
Passive
―
% Detractors
2
1
Detractor
=
Net Promoter Score
Fred Reichheld in “The One Number You Need to Grow” (Harvard Business Review) and The
Ultimate Question (Advance Proof of Book from Harvard Business School Press); Bain &
Company
0
Safe, Effective
Evidencebased Care
(“Orange”)
Clinical Reputation
and Quality
Care Responsiveness
Necessary Preconditions for
Experience – Related Success
• Personable, visible top leaders strongly connected to community‐
at‐large
• Whole organization (especially leadership) embraces people and experience as top priorities
• Operant culture is fertile for experience delivery and features O
t lt
i f til f
i
d li
df t
healthy teaming
• Front‐line associates are empowered and equipped to perceive, prioritize and deliver the experience
• Delivers on the Promise of the Mission
• Builds Loyalty in Those We Serve
• Builds Market Share and Growth
1
5/13/2013
Key Strategy Areas for Delivering Patients’ Desired Experience
Staff Empowered &
Equipped to Solve
Problems
Real-time Closed
Loop Feedback
Hand-Offs and
Transitions
Empower staff to put
patients’ needs first, raise
productivity, and eliminate
waste
Provide the means for
associates to receive and
respond to feedback from
patients and families in a
more real-time manner
(e g rounding
(e.g.
rounding, post
discharge calls)
Manage effectively transitions
in care ensuring coordinated,
efficient processes especially
at key touchpoints
Emotional, Social &
Spiritual Support
Aligned People
Practices
Metrics
(Goals & Measures)
Make providing emotional,
social and spiritual support
an intentional part of the
“Ascension Health Way”
through initial workshops
and follow-ups
(e.g. formation & Providing
Holistic Reverent Care)
Implement HR policies and
practices which reinforce
delivery of the desired
experience—including
addressing experience
detractors, model
community
Set high level and
achievable goals; share
process and outcome
measures on key drivers of
loyalty broadly and
regularly
(e.g. department score
cards & trending reports)
(e.g. Lean, six sigma,
adaptive design)
(e.g. selection, reward and
recognition)
HCAHPS as a Driver of Loyalty
Strive for both: Loyalty AND Compliance
“Excellent” “Always”
Patient Loyalty/
NPS
(e.g. bed side report,
discharge checklists)
How do patients feel about the care they receive?
HCAHPS
How consistently are associates performing?
Sustainable Value to the Ministry/Operating Entity
Primary Source of Focus and Momentum
Relationship Between HCAHPS and
NPS/Patient Loyalty
Strive for both: Loyalty AND Compliance
“Excellent” • Spiritually
Centered,
Holistic Care
• Compassion
• Empowerment
• Teamwork
How do patients feel about the care they receive?
Communication
Cleanliness
The ‘Numbers’ Driving Improvement
Loyalty Dimensions
(r range of .706 to .847)
Common Areas
Respect
Responsiveness
Pain Management
The Influence of ‘Control of Pain’
Predictors of Overall Rating
(r = .897)
(r range of .771 to .836)
How consistently are associates performing?
• Medication
• Discharge
I f
Information
ti
• Noise
Key Predictors of Overall Rating and Likelihood to Recommend
(r range of .552 to .757)
HCAHPS Overall Rating of the Hospital
HCAHPS
How often was your pain well controlled?
(r range of .440 to .596)
HCAHPS Dimensions
“Always”
Patient Loyalty/
NPS
Likelihood to Recommend (Net Promoter
(Net Promoter Score)
•
•
•
•
Never
Nursing Care
g
Staff Care
Physician Care
Environment
Usually, Always
• Nursing Care
• Environment
• Staff Care
• Physician Care
Predictors of LTR
•
•
•
•
Never
Nursing Care
g
Staff Care
Physician Care
Environment
Usually, Always
• Nursing Care
• Environment
• Physician Care
• Staff Care
2
5/13/2013
HCAHPS Improvement Model
3
Tactics/ Strategies
2 Patient & Family Communications
1 Cultural Preconditions
Strategic Components of Pain
Management Improvement
HCAHPS Pain Management Goal
& Questions
By the end of Q4‐FY13, the targeted Health Ministries (N=25) will demonstrate HCAHPS performance improvement by achieving a Pain Management Dimension System average score at or above the national HCAHPS 75th percentile score of 77.7 (unadjusted)
Pain Dimension HCAHPS Survey Questions
• During your hospital stay, how often was your pain wellcontrolled?
• During your hospital stay, how often did hospital staff do
everything they could to help you with your pain?
Pain Management
Improvement Model
•Set system‐level goals and share regularly
•Identify and share best practices
•Work with key Affinity Groups
•Pain Management monthly webinar series
Assessment Planning
• Indicate baseline performance, trends, and areas of opportunity • Evaluate current practices
• Use assessment data to target areas & set goals
• Appoint a champion to guide efforts Strategies & Interventions
Preconditions
•Create an environment conducive to improving pain management including commitment
Tactics
•Implement specific approaches to improve pain management including: Education, Rounding, & Pain Assessment Tools
Evaluation & Reassessment
• Continuously monitor & assess performance through Pain Audit Tools & metrics
•Target ministries for improvement
Assessment & Planning
• Evaluate current HCAHPS data on PRC EasyView.com®
• Determine the “owner” & establish accountability of pain management
• Review pain management standards & protocols along with current practices/initiatives to determine areas for improvement
• Identify and leverage internal resources for planning and Identify and leverage internal resources for planning and
implementation including front‐line associates
• Determine near term and longer term process and outcome goals
• Target Units with highest volumes and greatest opportunities
• Educate and communicate with associates
Common Practices on HighPerforming Med/Surg Units
• Pain management is a top priority
• Use white boards and pain scales to help communicate about
pain and medication
• Assess pain regularly and obtain a baseline upon admission
• Rounding
• Hourly Rounding
• Manager rounding on patients and staff
• Many supplement with Integrative Approaches
• Evaluation and Reassessment of progress
3
5/13/2013
Specific Patient Communication
Effective pain management requires two-way communication
with patients. Key Points include:
Set Expectations
• Let patients know that managing their pain is important and they will be
assessed regularly to ensure it is being managed properly
Understand
U
d t d baseline
b
li pain
i history
hi t
• Obtain a good understanding of baseline pain levels and
medications/techniques that have been effective in the past
Communicate Pain Management Plan and Goals
• Explain your role in managing pain and processes for continued
reassessment and plan for pain management
Comprehensive Pain Assessment
1. Location
2. Intensity
3. Quality 4. Onset, duration, variation 5. Manner of expressing pain
6. Alleviating factors
7. Aggravating factors
8. Effect of pain
9. Medication history
10. A nonjudgmental attitude!
Integrative Therapies
Heat & Cold
Music therapy
Pet therapy
Massage
Pain Management
Guided Imagery Libraries
Clinical Aromath
erapy
Patient Communication Tools
White Boards
• Include pain management data on white boards
Pain Scales
• Ensure that patients
understand the
purpose of the scale
Rounding Strategies
Hourly Rounding
• 5th P= presence
• Use to regularly reassess pain
Manager Rounding
• Ask Open‐ended questions
• Focus on pain & responsiveness in general
Evaluation & Reassessment of
Progress
• Review random call light reports to ensure
compliance with hourly rounding and effective
pain management
• Audit pain reassessment and documentation
• Post data on units and discuss in meetings
• Rounding on patients by leaders
Reflexol
ogy
4
5/13/2013
HCAHPS Pain Management
Dimension Performance
78
77.7
77
76
75.3
75
74.5
74.8
75.1
74
73
FY12 Baseline
FY13 Q1
FY13 Q1 ‐ Q2 FY13 Q1 ‐ Q3
FY13 Goal
Q
Questions?
ti
?
5