Using HCAHPS Data Effectively

1. Using HCAHPS Data Effectively December 18, 2012 Carrie Brady, JD, MA cbradyconsulting@gmail.com

2. AHRQ/HRET Patient Safety Learning Network (PSLN) Project • This program is supported by the U.S. Agency for Healthcare Research and Quality (AHRQ) through a contract with the Health Research and Educational Trust (HRET). • HRET is a charitable and educational organization affiliated with the American Hospital Association, whose mission is to transform health care through research and education. • AHRQ is a federal agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.

3. The Patient Experience of Care is Fundamental to Clinical Improvement • Understanding the patient experience of care is not an add-on activity: it should be used as a fundamental element in your other improvement efforts. • For those working on the HRET Partnership for Patients Hospital Engagement Network (HEN) or another HEN, your work will benefit directly from your efforts to improve the patient experience of care (e.g., readmissions, ADEs). • Lessons you learn in this HCAHPS Learning Network will help you succeed in the HEN project because— • Patient-centered care is a driver of clinical outcomes • Employee and patient engagement are 2 sides of one coin • HCAHPS assesses key factors in ADEs and readmissions

4. HCAHPS Curriculum 2012-13All Web conferences are scheduled for 12-1pm Eastern • December 7, 2012: Fundamentals of HCAHPS • December 18, 2012: Using HCAHPS Data Effectively • December 19, 2012: Using HCAHPS Data Effectively (this date for workshop PSLN participants only) • January 16, 2013: Nurse Communication • February 13, 2013: Responsiveness • March 13, 2013: Medication Communication • April 24, 2013: Discharge Information • May 15, 2013: Physician Communication and Engagement • June 5, 2013: Pain Management • July 17, 2013: Clean • August 14, 2013: Quiet

5. HCAHPS Technical Assistance Faculty • Carrie Brady, MA, JD • HRET’s primary HCAHPS faculty • Former senior Connecticut Hospital Association staffer • Previously a vice president at Planetree • Experienced hospital peers • To be identified using performance data and PSLN partner recommendation • Will provide case studies

6. Today’s Web Conference • Overview of HCAHPS Data Use • Reporting • Analysis and Action • Questions DATA 1: factual information (as measurements or statistics) used as a basis for reasoning, discussion, or calculation 2:  information output by a sensing device or organ that includes both useful and irrelevant or redundant information and must be processed to be meaningful Merriam-Webster Online Dictionary 2012

7. HCAHPS Success Depends on A Strong Foundation Foundational Elements of Patient-Centered Care • Leadership • Patient/Family Partnership • Workforce Engagement • Data Use/Performance Improvement

8. HCAHPS Data Can Be Used To: Understand and Improve the Patient Experience, Patient Safety and Outcomes Inspire Action Spotlight Hidden Innovations Build Organizational Culture and Confidence Strengthen Staff Teams and Partnerships with Patients/Families Align the Tool with your Goals

9. How HCAHPS Data is Used:Views from the Front Line “Data tends to be interpreted as ‘don’t do this,’ rather than ‘let’s work together on this’ . . .” “Give true consideration to employees’ ideas for improvements . . . Offer suggestions and strategies to implement. Just telling us employees that patient satisfaction must improve doesn’t tell us HOW to get to that point.”

10. Levels of HCAHPS Data Use

11. Using HCAHPS Data Effectively: Reporting

12. Common Sources of HCAHPS Reporting Confusion • Differentiating vendor questions and HCAHPS • Organizational priorities and goals • Percents v. percentiles • Trending implications “It is difficult to understand the percentages, when it says 88th does that mean 88 hospitals are better than us, or we are better than 88 other hospitals?”

13. Common Sources of HCAHPS Reporting Confusion Continued • Time Period • Publicly reported scores v. internal current scores • CMS survey mode and patient mix adjustments • Phone v. mail • Maternity v. med/surg • Appropriate sample sizes • Gather enough responses to generate valid reports

14. Effective Reporting Is Essential “What information consumes is rather obvious: it consumes the attention of its recipients. Hence, a wealth of information creates a poverty of attention and a need to allocate that attention efficiently among the overabundance of information sources that might consume it.” Herbert Simon, economist

15. *Placeholder for Polling Question* • How often do you distribute HCAHPS/patient experience data reports in your organization? • Answer choices: • Daily • Weekly • Monthly • Quarterly

16. Calculating the Hidden Potential of Reporting How are you allocating attention in your organization?

17. More Isn’t Always Better • This sign was posted daily on a hospital unit • Staff did not know what the number meant: • Was it a good score or a bad score? • What questions was it based on? • What time period was included in the score? • What could be done to improve?

18. Are Your HCAHPS Reports Worthy of Attention? • Are they easy to understand? • Are they encouraging? • How frequently are they issued? • Are they meaningful and actionable? • Are they integrated with other information? • Do they connect the dots between interventions and results?

19. Creative Approaches to HCAHPS Reporting Example courtesy of Avera DeSmet Memorial Hospital, South Dakota • SBAR format • Letter grades • Staff “scoreboard” • Trend lines annotated with effect of intervention

20. Using HCAHPS Data Effectively: Analysis and Action Reporting without analysis and action is like trying to pole vault without a pole.

21. Lessons from HCAHPS Patient Safety Learning Network Year 1 • HCAHPS results are commonly disseminated at meetings and/or by posting • Many organizations are focused on distribution of the data without guidance on use • Many share HCAHPS scores without improvement strategies • Coaching and support in using HCAHPS data for improvement isn’t widespread

22. Build Individual and Organizational Aptitude • Many managers need support in understanding the data and using it effectively • Develop shared standards for data use and reporting • Consider both content and format • Provide education and coaching in data use and quality improvement • Routine training, including new managers • Safe opportunities to ask questions • Customized analyses • Unleash the power of curiosity

23. HCAHPS Analysis Tools Standard CMS Reports Commonwealth Fund Why Not The Best? Reports Wide variety of benchmarks Ability to select by individual hospitals or by group Uses CMS Hospital Compare Data Available at www.whynotthebest.org • Patient-level Correlations Table • Percentiles Table • Hospital Characteristics Comparison Charts • Summary of HCAHPS Survey Results Table Available at www.hcahpsonline.org in “Summary Analyses” section

24. Mine the Data for Solutions, Not Just Problems • View patient experience data as an opportunity for “appreciative inquiry” • Reveal hidden innovation within your own organization • Examine improvement (including change in “bottom box” scores), not just achievement • Put HCAHPS data in context with other qualitative and quantitative information about the patient and staff experience • Preserve relationships by noting what is working well

25. Example provided courtesy of Spotlighting Hidden Innovation

26. Creating Positive Momentum • “Collabetition” • Recognize units with best HCAHPS performance and most improved performance • Each unit awarded trophy received a second trophy to give to a group that supported them • Team Trades • Redesign Reports • Ask staff what information they need and how they would like it to be presented

27. Applying Clinical Logic to HCAHPS Improvement We don’t clinically assess, diagnose, and treat a patient using only quantitative data – we also rely on examination, observation and discussion. Why do we often assess, diagnose and treat organizational performance based solely on quantitative metrics?

28. Other Important Sources of Information Patient Experience Staff Experience Employee Engagement Data Staffing Levels Patient Safety Culture Survey Data • Post-discharge phone calls • Rounding • Patient and family focus groups • Patient and family advisory council/advisors • Ombudsman/patient advocate programs • Compliments

29. Integration Provides Multiple Perspectives on Issues of Common Concern • Higher AHRQ patient safety culture survey scores are associated with better HCAHPS scores – Sorra et al, J of Pat Safety, September 2012, 8 (3), p 131–139 SOPS (HSOPS) Communication Openness Feedback and Communication About Error Frequency of Events Reported Handoffs and Transitions Management Support for Patient Safety Nonpunitive Response to Error Organizational Learning/Continuous Improvement Overall Perceptions of Patient Safety Staffing Supervisor/Manager Expectations and Actions Promoting Safety Teamwork CAHPS (HCAHPS) Communication with Nurses Communication with Doctors Communication about Medicines Responsiveness Discharge Information Pain Management Cleanliness Quiet Overall Rating Recommend Communication Teamwork Leadership Transitions Staffing Staff Perspective Patient Perspective

30. To Motivate Action, Focus on Patient Care • Emphasize that HCAHPS Matters Clinically • Preserve the Patient in the Data • Storytelling • Shadowing *Studies discussed during 12/7/12 Webinar

31. Shadowing • A unique opportunity to gain a perspective on the experience through the patient’s eyes • Your suggested assignment: • Shadow a patient before the next webinar • Describe your experiences on the PSLN online discussion forum

32. Preparing for Shadowing • Decide on process to be shadowed • Notify staff • Request patient permission • Explain role is to observe and identify opportunities to improve care that will help others • Record observations • Patient/family perspective • Your own reactions

33. Additional Resources PFCC Partners at the Innovation Center of the University of Pittsburg Medical Center Patient and Family Shadowing Go Guide Shadowing Field Journal Video (www.pfcc.org/go-shadow/)

34. PSLN Extranet

35. Creating an account will give you access to… • Archived webinars • Medication Reconciliation • HCAHPS and Value Based Purchasing • Project RED • Discussion Forum (coming soon) • Registration links for upcoming events (coming soon)

36. Questions?