Cathy E. Duquette, Ph.D., RN, CPHQ Vice President, Nursing and Patient Care Services

1. Rates of Change During Public and Private Reporting Cycles of Hospital Performance:Implications for Mechanisms Driving Quality Improvement Cathy E. Duquette, Ph.D., RN, CPHQ Vice President, Nursing and Patient Care Services Newport Hospital – Newport, RI ~~~~~~~~~~ June 27, 2006

2. Acknowledgements: • Judith Barr, Tierney Giannotti, and Marcia Petrillo – Qualidigm • Shoshanna Sofaer – Consultant/Baruch College • William Waters – RI Department of Health • Deirdre Mylod and staff – Press Ganey • Hospital Association of Rhode Island • Barr, J.K., Giannotti, T.E., Sofaer, S., Duquette, C.E., Waters, W.J. and Petrillo, M.K. 2006. “Using Public Reports of Patient Satisfaction for Hospital Quality Improvement”. Health Services Research 41(3), Part I (June 2006); 663-682.

3. Rhode Island– Setting the Stage: • Small state just over 1,000,000 population • 39 cities/towns; very limited county government • 1 State Department of Health • 16 hospitals in the state • 13 hospitals: 10 acute care, 1 women & infants’,1 adult psychiatric and 1 rehabilitation hospital participate in patient satisfaction survey and report • 10 acute care hospitals participate in the clinical measures data collection and report • All eligible hospitals were early participants in the Hospital Quality Alliance

4. The Rhode Island Legislation: • Passed in July 1998 called for public reporting of: • Comparable, statistically valid patient satisfaction measures • Standardized data set of clinical performance measures, risk-adjusted for patient variables • Addressed the general health environment in RI and the potential impact on quality: • Impending mergers • For-Profit vs. Not-For-Profit • Applies to all licensed health care facilities in the state, starting with hospitals • Director of the Department of Health (HEALTH) is responsible for program development and implementation

5. Program Development - Structure and Process: • Director of HEALTH is responsible • Steering Committee and Work Group structure • Process very open and public • Committee format; consensus as goal • Consumer, minority and interested party input • Input and feedback incorporated into each step of program development • Hospitals represented by Hospital Association of Rhode Island (HARI) through all stages of program development • Opportunities to discuss issues and concerns among hospitals within HARI structure

6. Program Development – Considerations: • Outcome needed to address both public accountability AND quality improvement • Aimed to balance desire to report on all patients/all conditions vs. what was feasible • Needed to develop a report that was meaningful to consumers AND hospitals • Report format and method of reporting needed to be determined before data were available • Started with public reporting of patient satisfaction • Hospital approach was collaborative vs. competitive

7. Program Development - Outcome:The Private Reports • All hospitals in RI had a mechanism for measuring patient perception pre-program • Variation to method, process, frequency • Hospitals agreed to select the same vendor and process to meet program requirements • Transition to mail survey conducted by Parkside Associates and then Press Ganey • Agreement to pilot data collection phase with each process change (2000 and 2002) to evaluate process and provide early data and information to hospitals to refine and target ongoing quality improvement efforts • Process created to establish ongoing data collection and feedback for internal use between public reporting cycles

8. Program Development - Outcome:The Public Reports • Patient Satisfaction I – Nov 2001 • Public General Report • Public Technical Report • Patient Satisfaction II – Oct 2003 • Public General Report • Public Technical Report • Patient Satisfaction III – TBD • Currently participating in “dry run” • Awaiting HCAHPS for public report

9. Program Development - Outcome:The Public Reports • Evaluation of Public Reporting on Hospital Patient Satisfaction in Rhode Island – 2003 • Statewide Effort to Improve Hospital Patient Satisfaction Ratings - 2004

10. Public Report Development: • State committee process – Patient Satisfaction Public Release Work Group with hospital, consumer, and health care stakeholder input • Hospital staff and leadership actively engaged in process • Two types of public reports: general public and technical • Key reporting decisions made before results available • Methods for translating raw data into different format • Method and “standard” against which comparisons made • Private report format designed for quality improvement and not appropriate for public reporting • Draft reports went through formative testing process with consumers

11. Sample Page from Public Report 2001: Patient Satisfaction Report Excerpt 2001

12. Sample Page from Public Report 2003: Patient Satisfaction Report Excerpt 2003

13. Findings: RI Scores over Time • Hospitals in RI started out and continue to be higher than national average score • Steady improvement in RI score • No spikes around or following public reporting time periods • Rate of increase is not faster than that of national upward trend

14. RI Trend Analysis vs. National:

15. Hospital Response Commitment to Quality Improvement

16. Initial Responses: • Hospitals supportive of public reporting • Hospital CEOs supported enabling legislation • Hospital acceptance of program value in driving and coordinating quality improvement efforts statewide vs. influencing consumer “choice” • Significant hospital involvement in process from the beginning of program development

17. Quality Improvement Efforts: Internal: • Senior leadership involvement and intense organizational commitment • Reaching clinical staff and Boards of Trustees • Increase in focus and coordination External: • Collaborative vs. competitive model • Sharing of best practices • Coordinated efforts through HARI • Demonstrating improvement over time

18. For More Information: • www.health.ri.gov • RI Background Reports; • Public and Technical Reports; and • Evaluation Reports on Findings and Quality Improvement Efforts • www.health.ri.gov/chic/performance/series.php • Direct link to list of reports

19. Questions?