Using HCAHPS data to improve the quality of patient care

1. Using HCAHPS data to improve the quality of patient care Tenet Healthcare Cindy Larkin, Senior Director Measurement

2. Discussion Points Tenet OverviewTransition to HCAHPSService Strategy Measurement System Redesign

3. Tenet by the numbers 60,000+ employees 1M+ Admissions 18,149 licensed beds 64 free-standing outpatient centers 12 states 54 acute care 2 rehab hospitals

4. Tenet’s Patient Satisfaction System • Tenet has been conducting patient satisfaction surveys since 1982 • Approximately 100,000 telephone surveys conducted annually by Field Research Corporation, founded in 1945 • Programs: • Inpatient • Outpatient Surgery • Outpatient Services • Emergency Department • Inpatient Rehab • Outpatient Rehab • Mental Health

5. Discussion Points Tenet OverviewTransition to HCAHPSService Strategy Measurement System Redesign

6. Transition to HCAHPS • Piloted the questionnaire at eight hospitals in the fall of 2004 • Reviewed our system to ensure all CMS guidelines were met. Other than the questionnaire change, few modifications were necessary since Tenet’s system already met virtually all of CMS’s specifications • Participated in focus groups with the Agency for Healthcare Research and Quality (AHRQ) • In January 2005, transitioned to the HCAHPS questionnaire

7. Communication is key • Selected one person from each hospital as the HCAHPS liaison, responsible for internal communication and training • Explained rationale for transition, which was to prepare for public reporting as soon as possible • Shared results of the pilot study to prepare hospitals that the scores would likely be lower due to question and scale changes rather than performance • Based on the pilot results, estimated the potential score impact for each hospital • Developed training materials to help hospitals understand the reasoning behind various guidelines, such as adjusting the results based on patient characteristics, etc.

8. Questionnaire design • Transitioned entirely to HCAHPS rather than conducting two separate studies • Involved key hospital personnel in questionnaire design to obtain buy in • Selected custom questions to address issues not included in HCAHPS JCAHO issues Privacy and safety High impact areas Teamwork and sensitivity to family needs High use areas Patient Access Outsourced areas Food and Nutritional Services • Redesigned other questionnaires (OP Surgery, OP Services, and ED) to HCAHPS format

9. Survey design changes Adjusted sample to delete non-HCAHPS patients that would continue to be included in Tenet’s system; i.e., proxy interviews; non-medical, surgical, or OB patients; interviews conducted in non-HCAHPS approved languages. Unaccepted interviews need to be accounted for at each hospital to ensure we reach the minimum required sample size.

10. Keep current with CMS guidelines Composite/ Category Adjustment Changed the scoring methodology to include the mode adjustment. While we cannot at this time mirror CMS results exactly, we modify our system when new guidelines are published.

11. Discussion Points Tenet OverviewTransition to HCAHPSService Strategy Measurement System Redesign

12. Service restructuring • Added a corporate-based Service Team to: • Directly consult with hospitals • Collect the tools and resources hospitals were using • Changed priority focus • Adjusted “key words” used in initiatives

13. Previous service focus Focus areas Questions having a high correlation with overall satisfaction

14. Current service focus Focus areas All areas that will be publicly reported

15. Avoid trying to “Boil the Ocean” • Introduced initiatives that were broad in scope and would address several question areas • AIDET • Hourly Rounding • Empathy Training • Focused on Discharge Information; the only area Tenet scored slightly below average compared to the HCAHPS Chartbook data

16. Some hospitals purchased eye-catching, customized white boards to reinforce initiatives such as: Communication Pain goals Hourly Rounding White Boards

17. AIDET Five simple steps to make a positive first impression and to ensure continuous positive interaction throughout the patient’s experience First step in forming a relationship with the patient. Be attentive to and greet your patient in a positive manner with a warm and friendly smile. Upon introduction give the patient your name and the purpose for the encounter. Manage the patients expectations by educating them about the length of time a particular procedure or request will take. Better to over-estimate than under-estimate. Make sure the patients are knowledgeable and involved in their treatment. Use easily understood terms when providing information. Ask if they have any questions. Thank patients for waiting, providing information, choosing your facility, etc. Acknowledge Introduce Duration Explanation Thank You

18. Hourly Rounding PCAs round on the even hours Licensed staff round on the odd hours Documentation is kept on a clipboard outside of the room Use the “Three P’s” Pain Position Personal Needs

20. Discharge Information

21. Emphasis throughout all initiatives is continuous, positive, caring communication with the patient, family members, and each other. For example, rather than simply handing patients written instructions or brochures, tell them what they are for, what they include, what they should do with them, and ask if they have any questions.

22. Discussion Points Tenet OverviewTransition to HCAHPSService Strategy Measurement System Redesign

23. Highlighted HCAHPS questions in previously existing reports HCAHPS area more than 5% below the norm

24. Used a “back to basics” approach to help hospitals systematically review HCAHPS results Overall Score GENERAL Category Average Begin by analyzing the high-level results to identify problems, then drill down to pinpoint what specific area is driving the score Question Score Unit Report Patient Information SPECIFIC 24

25. Redesigned our reporting system to complement the approach and “push” the data into the hospital New System Goals • Expand employee access • User-friendly (three screens to learn) • Link Measurement and Service • Reduce report turnaround time • Identify problem areas • Benchmark with high performers This is not just a Tenet program. We helped Field Research design it, but it is being offered to other clients

26. Screen One Starting with the general results, the home page of the reporting system provides an overview of hospital results including comparison to previous month, previous year, and Tenet Targets. Internal Star rating system

27. Screen Two Provides drill down to category, question, unit, and patient level to identify problem areas. A white light bulb indicates the question scores at or above average, a red light indicates a problem area. Easily creates an Excel file from any screen shot.

28. Clicking on a light bulb accesses the improvement suggestion section, “Ideas with Impact.” Clicking on the links in the Additional Resources section accesses a toolkits or other resources they can use or refer to.

29. Links to a 103 page workbook describing exactly how to implement empathy training Written by Wendy Leebov

30. Screen Three Very Interactive. View any program, category, question, unit, by any time period selected with a click of a button. Helps hospitals track the specific service initiatives they are working on. Easily creates a PDF report to email or post.

38. Tenet-wide success in using HCAHPS results to improve the patient experience!!!

39. Contact Information Cindy Larkin (469) 893-2444 cindy.larkin@tenethealth.com