Management Engineering & Process Improvement Community February …s3.amazonaws.com/rdcms-himss/files/production/public... · 2015-08-05 · Management Engineering & Process Improvement

Management Engineering & Process Improvement Community

February 6, 2015

Cynthia Hartmann, MBA, CPHIMS, Six Sigma Lean

Black Belt

Committee Chair

MEPI COMMUNITY MISSION

Support and promote the profession of management engineering and process improvement among the members of HIMSS by providing opportunities for networking, collaboration, publication, promotion and professional development of Management Engineers and Process Improvement professionals in healthcare organizations.

©2014 The Advisory Board Company • advisory.com

Rising Consumerism and the Impact on

Patient Experience, Quality, and Safety The New Standard for Hospital Rounding in a Changing Health Care Environment

Presentation Prepared for HIMSS

February 6, 2015

Presented by:

Jeffrey Bunting

Executive Director, Patient Experience

The Advisory Board Company

iRound

©2014 The Advisory Board Company advisory.com 4

No Longer Insulated From Market Forces

Catalyzing a Shift in Network Demands

Source: Health Care Advisory Board interviews and analysis.

Traditional Market Retail Market

Growing number of buyers

1

Proliferation of product options

2

Increased transparency

3

Reduced switching costs

4

Greater consumer cost exposure

5

Passive employer,

price-insulated employee

Activist employer,

price-sensitive individual

Broad, open networks Narrow, custom networks

No platform for apples-to-

apples plan comparison

Clear plan comparison on

exchange platforms

Disruptive for employers to

change benefit options

Easy for individuals to

switch plans annually

Constant employee premium

contribution, low deductibles

Variable individual premium

contribution, high deductibles

Characteristics of a Traditional vs. Retail Market


Exchanges Fuel Patient Consumerism

Health Care Economics Shifting, With Potential to Disrupt Networks

1) “Are You Ready? Private Health Exchanges Are Looming,” Accenture, 2013

Participation in Exchanges Skyrockets…

Annual Exchange Enrollment (Public & Private) in Millions1

…Changing Market Dynamics

1 Increased transparency and plan comparisons

2 Decentralization of purchasing

3 Multiplication of plan options

10

60

2014 2017

4 Decreased switching costs


Welcome to the Renewals Business

New Imperative to Secure Purchaser Choice Year Over Year

Source: Health Care Advisory Board interviews and analysis.

Day 1

Day 365

Care Decision

Network Selection

Care Decision Care Decision

Care Decision

Clinical interactions

represent repeated

opportunities to reinforce

patient preference through

superior experience

Annual network selection in

fluid insurance market

implies consistent

reevaluation of network

performance

Patient

Experience


Service Experience Drives Patients’ Provider Choice

Cultivating Patient Loyalty Increasingly Seen as Mission Critical

1) “Market Insights Survey 2012” by NRC Picker.

2) Assumes 17,500 annual admissions, average 71% likely to recommend, $8-12K average

value of follow-up & ancillary care resulting from typical admission

Patients Make Choices Based on Service & Experience

69%

83%

88%

High scores on patient sat report cards

Previous experience with hospital

Doctor recommendation

Select Factors Influencing Patient Likelihood to Return to Hospital for Care¹

n = 264,892 consumers

Additional reimbursement

from converting 5% of

detractors to loyal patients

for follow-up care²

$2-3M

Consistent Focus on Patient Loyalty Delivers Value


Moving Beyond Quality and Efficiency

Patient Experience = New Battleground

Patient Experience: Common Underpinning of Strategic Initiatives

Broadening Our Definition of “Quality”

“Quality is more than just whether you live or die or not. Quality has to be the clinical experience, the physical experience and the emotional experience,

[…] we realized that the emotional aspect of it was anyone in the hospital could affect the entire outcome, [...] if your room was dirty, it undid the work of

the cardiac surgeon, the anesthesiologist, the cardiologist, the fusionist, the intensive care nurse.”

Delos “Toby” Cosgrove, MD

CEO & President, Cleveland Clinic

Network

Integration

• Visibility into patient encounters

across continuum critical to

delivering consistent service level to

support “brand”

• Substandard service disrupts carefully

constructed referral networks by

encouraging patients defections

Workforce

Alignment

• Diversification of care teams makes

measuring patient perceptions and precisely

attributing feedback more important than

ever

• Putting patients—not process—at center of

care redesign efforts reinforces sense of

“purpose” throughout the workforce

Population Health

Management

• Effectively partnering with patients to

improve outcomes key to managing

risk and population health more broadly

• Ensuring patients stay in-network

requires constant, consistent feedback

and commitment to making

improvements


Meeting Patient Needs is Integral to the Overall Experience

Source: Malott D, et al., “The Root of All Satisfaction,” Partners, Mar/Apr

2010: 12-15; Nursing Executive Center interviews and analysis. 1) Drivers tied for number 5 ranking

Elements of Patient Experience Correlated With Likelihood to Recommend

1

2

3

4

5

How well staff worked together to care for you

Response to concerns/complaints made during your stay

Amount of attention paid to your special or personal needs

How well the nurses kept you informed

Nurses’ attitude toward requests¹

Degree to which hospital staff addressed your emotional needs¹

Driver of Likelihood to Recommend Rank


Crucial System For Surfacing and Addressing Patient Needs

1) “Three Nursing Interventions' Impact on HCAHPS Scores.” Journal of Nursing Care

Quality; March 20, 2013. Bryan Kennedy et al

Rounding Has Rapid Impact, Absence Felt Immediately

% Patients Rating Care “Excellent”¹

52%

71%

46%

Month Prior Month Introduced Month Discontinued

Rounding More Efficacious Than Other Interventions

% Patients Rating Care “Excellent” After Specific Interventions

Were Introduced Sequentially, in Isolation

46%

50%

56%

71%

Dischargecalls

Teach-back

Dischargepacket

Managerrounding


What is Rounding? An Evolution.

PRESENT PAST

Physicians make “rounds”—visiting patients to

assess their conditions and plan care

Physician Physicians Nurses Executives Dept. Leaders

Over the last decade, many different types of rounding have come into

practice in hospitals and other healthcare settings

These newer types of rounding include rounding on patients in a

structured way by nursing, executives, and representatives of different

departments using new technologies

The term has even been extended to observations and audits not even

involving patients.


Hourly and Daily Leader Rounding

Hourly

Rounding

Daily Leader

Rounding

• Nurses visit each patient each hour

• Assess for 3 or 4 P’s (Pain, Potty, Position,

Placement)

• Sets expectation for next visit

• Traditionally not automated; paper-driven

• Aka…Daily Rounding, Leader Rounding,

Purposeful Rounding; typically conducted by

nursing leaders

• Confirm hourly rounding performance, check

overall patient experience (e.g., pain, noise,

room condition, etc.)

• Surface issues driving poor patient experience

and get feedback on caregiver staff

Improved patient and staff satisfaction

Reductions in life-threatening falls,

pressure ulcers (bed sores)

Higher patient satisfaction scores

under Medicare value-based

purchasing

Increase in patient loyalty drives

recurring revenues for health system

Results


Leader Rounding on Staff Physicians

Leader Rounding on Staff Physicians

• Aka Manager or Executive Rounding

• Periodic, face-to-face, one-on-one

discussions between leaders at different

levels and staff

• Identify opportunities for improvement,

surface staff recognition, ensure

communication of strategy

• Important to have buy-in from upper

management

• Studies show can dramatically improve staff

satisfaction and engagement

• In turn, happy employees = happier patients

• Meaningful reduction in staff turnover and

vacancy and resulting cost savings

Results Key Components


Consistent, Systematic Staff Recognition Drives Engagement

Recognition is tightly bound to

hourly, daily and staff rounding

Recognition drives staff engagement

and satisfaction, resulting in

improved performance and retention

Best programs have different forms of

recognition (e.g., executive cards to public

recognition to gifts and rewards)

Important to incorporate

recognition into automated rounding

KEY COMPONENTS OF SUCCESSFUL STAFF ENGAGEMENT


Service Recovery

Solving Issues Before They Affect Satisfaction

The Service Recovery Paradox

The “service recovery paradox” states that with a

highly effective service recovery, a service or

product failure offers a chance to achieve higher

satisfaction ratings from customers than if the

failure had never happened. A little bit less

academically, this means that a good recovery

can turn angry and frustrated customers into

loyal customers. In fact it can create even more

goodwill than if things had gone smoothly in the

first place

Customer Experience Academy

Better Not to Have Asked?

Likelihood of Repeat Purchase After Service Failure

54%

19%

Satisfactory Resolution Non-satisfactory Resolution


Quality and Safety

Quality and Safety: Medication

administration, pressure ulcer audits,

bedside reports, discharge checklists

Critical data is captured without additional

entry steps, saving time and reducing

potential for error

Paper-based checklists

difficult to audit, require data

entry steps

Infection Control: hand sanitation,

Foley/tube/line audits, staff vaccination

tracking

Identified improvement projects are

assigned on-the-spot and tracked in

automated reports

Tracking results of audits,

making hand-washing

observations discreet

Regulatory Compliance: Environment of

care audits, restraint audits, TJC probe

data collection

With mobile devices, staff quickly deploy

any audit they need; improvement

projects are assigned on-the-spot, tracked

in automated reports

Maintaining multiple paper-

based audits is challenging;

following through on issues

can be difficult

POTENTIAL PROBLEMS FROM

SUBOPTIMAL PROCESSES CHALLENGES FACING

HEALTH CARE PROVIDERS

AUTOMATION-DRIVEN

IMPROVEMENTS

Turn Virtually Any Imperfect Process Into a Closed-Loop Reliable System

Example Applications of iRound Enterprise


Lack of Timely and Actionable Insights

• Paper-based daily rounding cumbersome, unsustainable

• Post-discharge surveys with low response rates, delayed insights

• Post-discharge calls conducted inconsistently, generate limited

insights

Lack of Staff Engagement

• Narrow focus, dependence on nursing organization; inadequate resource allocation

• Vague anecdotes without data discourages ownership of performance

improvement

• Inability to emotionally engage staff

Lack of Accountability

• Uneven service recovery processes leave patient issues unresolved

• Absence of tracking mechanisms prevents timely correction of poor

individual performance

Lack of Cross-Departmental Coordination

• Siloed and short-lived improvement campaigns

• Coordination with service departments unwieldy, time and effort wasted

• Performance data not shared broadly, inability to measure impact of initiatives

Doing More of the Same: An Insufficient (and Potentially Harmful) Strategy

Key Challenges to Driving Performance Improvement Using Traditional Processes

* Nurse leaders spent an average of 6 minutes per round, 20 minutes per

issue surfaced, and 4 hours per week on data entry and reporting

A Worthy Aspiration Gone Awry

• 300-bed hospital in Midwest implemented best practice of daily nurse leader rounding on every patient to

improve patient experience

• Conducted paper-based rounding and manual data entry; data was outdated by the time it was available for

review, failed to deliver insight into house-wide performance and trends

• Manual issue resolution processes consumed additional nursing time, issue follow up was poor

• Despite significant investment, daily rounding initiative created staff frustration and diverted significant nursing

time from patient care - which ultimately hurt patient experience

$480K Annualized cost of nurse leader

hours spent on manual rounding,

data analysis, issue resolution*

$376K Estimated cost of replacing

nursing staff frustrated by issues

associated with manual rounding

and issue resolution processes


Case Study

Sightlines to Patients and Staff Produce Bounty of Benefits

Case in Brief: Crosstown Medical Center1

• 300-bed independent hospital with a service area

spanning two states in the Mid-Atlantic region.

• Regional acute care hospital with affiliated

cancer center, diagnostic center, surgery center,

and ambulatory network.

25 Percentile point

improvement in HCAHPS

Overall Hospital Rating

Before iRound After iRound

11-fold

increase

Manager Compliance with Daily Patient Experience Rounds

Patient Experience

• More consistent, productive daily

rounding helped move HCAHPS scores

across multiple dimensions

• Units with the highest rounding rates2

achieved scores on average 9% points

higher across all 10 HCAHPS categories

Staff Engagement

• Automated system used to collect and

disseminate more rapid, meaningful staff

recognition based on real-time feedback

• Automated employee rounds led to quicker

implementation of staff improvement ideas,

further supporting engagement level

Patient Safety

• Automating daily rounding helped nurse

managers ensure that hourly rounding

needs were being met consistently

• Managers able to intervene with individual

caregivers based on data, leading to 20%

lower falls rate after just four months

Virtuous Cycle of Improvements

Visibility Drives Improvements for Patient Experience, Safety, and Staff Engagement


Patient-Centered Approach Impacts Many Outcomes

Visibility Improves Patient Experience, Safety, and Staff Engagement

1) Pseudonym

2) Rounds conducted divided by patients available for rounding

Case in Brief: Brahms Hospital1

• 270-bed hospital in the Northeast U.S.

• Regional acute care hospital with affiliated cancer center, diagnostic center,

surgery center, and ambulatory network.


Levels of Automation Sophistication: Basic Automation of Paper

20

Mobile Rounding WOW

Administration Database


Levels of Automation Sophistication: Use On Any Device

21

Database

Web application

Mobile Rounding WOW

Administration


Levels of Automation Sophistication: Basic Data Integration

22

Database

Web application

Census Interface

HCAHPS Data

Mobile Rounding

WOW

Administration


Levels of Automation Sophistication: Patient Centric

23

Patient Centric

Database

Web application

Census Interface

HCAHPS Data ADT Interface

Mobile Rounding

WOW

Administration


Levels of Automation Sophistication: Fully Integrated

24

Patient Centric

Database

Web application

Census Interface

HCAHPS Data ADT Interface

Task Management / Ticket

Interface(s)

HR Interface –

Staff Reporting

Relationships

Mobile Rounding

WOW

Administration


Nurse Manager Checks Unit Rounding Status

Overall rounding status of

the unit.

Status of each room in each

unit: Who is the patient?

Have we rounded yet? Are

there any issues?


Nurse Manager Checks Patient Service History

Demographic history of

patient and full history of

service issues and rounds


Nurse Manager Rounds on Patient

Forms include both yes/no questions

to allow quick data entry and open-

ended questions to solicit patient

improvement, recognition

suggestions


Nurse Leader Enters Service Recovery Issue


Unit Manager Reviews Patient Comments With Staff at Huddle

Actionable Real-Time Patient Feedback

Capturing patient

comments about individual

staff members

Identifying unmet

patient needs


Hospital COO Reviews Patient Feedback vs. Other System Facilities


System Level Management Reviews Facility Performance


Other Important Considerations

Mobile Device Policy Integration


Conclusions


Q&A and Contact Information

Jeffrey Bunting

Executive Director, Patient Experience

The Advisory Board Company

[email protected]

(415) 432-3905

mailto:[email protected]

Management Engineering & Process Improvement Community February …s3.amazonaws.com/rdcms-himss/files/production/public... · 2015-08-05 · Management Engineering & Process Improvement

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