Melissa Taylor Director, Patient Access/Pre-Access Cleveland Clinic

1. Creating a Positive Patient Experience Driven Culture Melissa Taylor Director, Patient Access/Pre-Access Cleveland Clinic

2. Cleveland Clinic – About us • Located in Cleveland, Ohio • Nonprofit multispecialty academic medical center, integrating clinical and hospital care with research and education • Main Campus • 8 Community Hospitals • 18 Family Health Centers • Lou Ruvo Center for Brain Health • Cleveland Clinic Florida • Cleveland Clinic Canada • Cleveland Clinic Abu Dhabi (2013)

3. Cleveland Clinic - Statistics • 1,300 beds on main campus • More than 4,400 beds system-wide • 4.2 million outpatient total visits • 167,100 admissions • 191,500 surgical cases • 2,700 physicians and scientists

4. State of Healthcare Reimbursement • CMS – Value Based Purchasing • Pay for Performance – reimbursement contingencies • Quality • Efficiency • Patient Satisfaction • Transparency • Published clinical measures • HCAHPS • Pricing • Informed Consumers Patient choice!

5. HCAHPS - Goals Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Three goals • Meaningful comparison for consumers • Public reporting is incentive for hospitals to improve • Enhance accountability by increasing transparency of quality Source: www.hcahpsonline.org

6. HCAHPS – The Survey • 18 questions about patient care, four screening questions and five demographic questions • Eight critical aspects of care, referred to as the HCAHPS Domains • Communication with doctors • Communication with nurses • Communication about medicine • Responsiveness of hospital staff • Cleanliness and quietness of hospital environment • Pain management • Discharge information • Overall hospital rating and recommendation Source: www.hcahpsonline.org

7. What is Patient Experience? ALL OF IT! “One bad interaction can define the impression. This is well documented in retail and other service business.” • James Merlino, MD Chief Experience Office, Cleveland Clinic Quote Source: HealthLeaders Media, February 24, 2012

8. Office of Patient Experience • Video Placeholder

9. Where is Patient Access in HCAHPs? • Overall rating • Would you recommend • Vendor Supplemental Questions • Speed of Admission Process • Courtesy of the person who admitted you

10. Organizational Efforts • Cleveland Clinic Experience Exceptional Employee Experience + World Class Patient Experience = Cleveland Clinic Experience • Caregivers • Caregiver Awards • Pre-hire survey – cultural fit • START with HEART ® • Patient Advisory Councils • Employee Engagement Survey

11. Patient Access Focus • Empower employees to be a part of the solution • Minimize calls post-service due to registration issues • Pre-Registration • Patient wait times • Registration times • Affect and behaviors • Non-patient interfacing registrants in registration area

12. Pre-Registration • Waiting room as first impression • Impact on department through-put • Set standard as 95% pre-service registration for scheduled services • Opportunity – Busiest surgery center in enterprise • Delaying patients to OR • Registered patients at point of decision for surgery • Provided business cards with Express Regi phone # • Leveraged online registration • Supported call center with onsite registration downtime capacity • Used autodialer to contact patients • 35% pre-registration rate to 97% - Sustained!

13. Customer Service Call Reduction We’re #1!

14. Comprehensive Scorecard

15. Scorecard Elements Quality Denials Insurance Ad Hoc Coaching Score = Future: Copay Contribution, Customer Service, Productivity

16. Patient Tracking Software - Benefits • Elimination of paper sign-in sheets • Identification of bottleneck via dashboard and reporting • Real-time staff monitoring with opportunity to adjust • Real-time patient flow technology • Constant spotlight on patient experience in Patient Access

17. Robust Reporting • Patient wait times • Summary • Detail to patient level • Patient flow • Productivity • On demand and scheduled reporting

18. Registration Through-put Monitoring • Patient Check-In • Patient to be greeted by person, not clipboard • Patient checked into software tracking tool by greeter • Clock begins to measure patient wait times • Simple and easy to use

19. Real-time Dashboard

20. Dashboard Features • Ability to prioritize patients • Area and priority color-coding for easy detection • Patient Wait Times on dashboard turn colors as service urgency thresholds met • Manager access to all service locations • Alerts • Via text or email • Patient wait extends threshold • Patient volume increase to adjust staffing • Registrant in particular status for extended period

21. Drill-down Reporting Reg Wt Time Patient Names Appear Here for Encounter Specific Detail Reg Time

22. Creative Utilization of Tool - ED • ED Tracking Board • Extension of patient tracking beyond registration • Radiology – Baseline 65th percentile • Current 90th percentile • Call center return call monitoring SUCCESS!!

23. Additional Software Features • Monitor patient flow and wait times • Registration • Ancillary Check Points • Anticipate patient arrival in ancillary areas • Identify scheduled or walk-in patients using "Visit Type" drop down menu • Prioritize by appointment time • Require delay code

24. Additional Software Features (Cont’d.) • Customize patient surveys • Detailed view • Report by visit type with average processing time • Utilize high-level dashboard to see all locations at enterprise level - hospitals, desks, and current wait times

25. Empowerment and Accountability • Scripting • Customer Service Standards Policy • Engagement in annual goals and monthly review of performance against metrics – as a team and individual • Accountability Statement

26. Patient Survey trays • Real-time patient feedback • Focused on experience with registration and the registrant • Paging to manager if patient ranks low on “compassion and sincerity” for real-time service recovery • Download nightly • Reporting - online • Individual • Department • Facility • By question

27. Results • Customer Service Tray Scores (registration specific) – above 95% Satisfaction • Cleveland Clinic HCAHPs – Top Box (Current – not yet published) • Rate Hospital 82% • Recommend Hospital 86% • Specific Domains • As high as 15% improvement in one year – 2010 to 2011

28. QUESTIONS?