A ROADMAP TO CREATING THE IDEAL AMBULATORY PATIENT AND FAMILY EXPERIENCE UHC CONFERENCE: PREPARING ACADEMIC MEDICAL CENTERS FOR CG-CAHPS JULY 11, 2014 emoryhealthcare.org
PRESENTERS S. Scott Davis Jr., M.D. Alan Dubovsky Redge Hanna Associate Professor, Director, Corporate Director, General Surgery Customer & Physician Engagement Service Performance Emory University School of Medicine Emory Clinic Emory Healthcare emoryhealthcare.org
AGENDA • Organizational Overview • Emory Healthcare’s Patient Experience • Emory Clinic’s Patient Experience Story: 2013: 2011: 2012: 2014: Establishing The Patient Creating The Accelerating Meaningful Experience Ideal Service Service Service Challenge Team Improvements Programs • Case Study: General Surgery Improvements • A Physician’s Perspective On The Patient Experience emoryhealthcare.org
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DONABEDIAN EQUATION (THE EMORY VERSION) S + P + C = O Structure + Process + Culture = Outcomes emoryhealthcare.org
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ALIGNING OUR CULTURE 2009: 2010: 2011: 2013: 2012: 2014: Defining Creating Establishing Accelerating Establishing Accelerating Our New The Ideal Accountable Metrics The Ideal The Ideal Team Culture Metrics Improvements Brand Brand Conduct emoryhealthcare.org
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2011: 2013: 2014: 2012: The Patient Establishing Accelerating Creating The Ideal Experience Meaningful Service Service Service Team Challenge Programs Improvements emoryhealthcare.org
2013: 2011: 2012: 2014: Establishing The Patient Creating The Accelerating Meaningful Experience Ideal Service Service Service Challenge Team Improvements Programs emoryhealthcare.org
2013: 2011: 2012: 2014: Establishing The Patient Creating The Ideal Accelerating Service Meaningful Service Experience Challenge Service Team Improvements Programs Finalized Structure Pilot Phase Focus Groups With Observations; Customers Benchmarking; Planning Discussions NEED NEW ROLE Greater line of sight engagement SERVICE AMBASSADOR with staff More concise and consistent PATIENT FEEDBACK ANALYST patient feedback Dedicated service SERVICE TRAINING SPECIALIST training and coaching
PATIENT EXPERIENCE AT EMORY Emory Healthcare Medical Practice Inpatient Nursing-Led Efforts Emory Clinic Department of Service Management Service Patient Patient Improvement: Experience: Feedback: - Ambassadors - Volunteers - Press Ganey - Patient - Guest - STARS Patient Advocacy Services Complaint & - Service Grievances - Access Training - Secret Emory/Emory - PSAT Shopping International emoryhealthcare.org
2013: 2011: 2012: 2014: Establishing The Patient Creating The Ideal Accelerating Service Meaningful Service Experience Challenge Service Team Improvements Programs
A New Welcome Guest Services Improvements Emory Clinic Volunteers Service Ambassadors
PATIENT FEEDBACK IMPROVEMENTS 1. Improved Survey Process: 2011 2013 46 question survey 29 question survey Mailed only Electronic only 6-8 week turnaround time Average turnaround time from visit to survey return = 48 hours Fewer than 3% of patients All patients eligible able to complete a survey Fewer than 25 responses per 300% increase in returned site/month surveys emoryhealthcare.org
PATIENT FEEDBACK IMPROVEMENTS 2. Ensured Consistent, Transparent Data: a. Conducted thorough Clinic-Wide education b. Centralized all reporting c. Updated reports (Clinic-Wide, Departmental, Role- Specific) d. Addition of weekly comments report 3. Updated Goal Setting: a. Selected UHC benchmarking group across Emory Healthcare b. Simple Green or Red performance indicators 4. Began CG-CAHPS surveys in 2013 to establish a baseline emoryhealthcare.org
2013: 2011: 2012: 2014: Establishing The Patient Creating The Accelerating Meaningful Experience Ideal Service Service Service Challenge Team Improvements Programs emoryhealthcare.org
ACCELERATING AMBULATORY PATIENT EXPERIENCE IMPROVEMENTS Step 1 – Focusing On Our Priorities: a. Ease Of Scheduling b. Ease Of Getting Clinic On The Phone c. Wait Time At Clinic d. Sensitivity To Patient’s Needs Step 2 - Targeting The High Opportunity Departments Step 3 – November 2012: Launch Of PSAT (Patient Satisfaction Acceleration Team) emoryhealthcare.org
PSAT 1. Modeled after Emory’s Quality Acceleration Team. 2. Meets every 2 weeks, for 2 hours, with all key members in attendance. 3. Benchmarking is critical. 4. Constant use of data to drive discussions and decisions. 5. Leave every meeting with decisions and specific action items. 6. Track all tests of change to establish best practice. emoryhealthcare.org
EMORY CLINIC’S PATIENT SATISFACTION SUCCESS STORY Medical Practice Mean Score Trend: 2006 - 2014 92 91.1 91 90.7 90.9 90.4 90.3 90 90.0 To the 75 th Percentile… 89 and Beyond! 88.7 88 87.9 87.7 87 From the 29 th Percentile… 86 2006 2007 2008 2009 2010 2011 2012 2013 2014TD emoryhealthcare.org
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THE ROADMAP TO THE IDEAL AMBULATORY PATIENT AND FAMILY EXPERIENCE Establish Accelerate Create The Ideal Meaningful Service Service Team Service Programs Improvements emoryhealthcare.org
CASE STUDY: PATIENT EXPERIENCE IMPROVEMENTS: EMORY CLINIC GENERAL SURGERY emoryhealthcare.org
GENERAL SURGERY IN 2012 General Surgery Medical Practice Mean Score 90 89.3 89 88.6 88.3 88 87 FY10 FY11 FY12 1. Downward trend in patient satisfaction. 2. Lack of engagement from physicians and staff. 3. Consistent areas of concern from patient feedback: a. Promptness in returning calls; b. Information about delays; c. Sensitivity to patient’s needs. emoryhealthcare.org
2013: 1. New administrative leadership. 2. Increase in physician engagement. 3. Volunteered to join inaugural PSAT group. 4. Formed section-based PSAT team. = Renewed focus on patient experience improvements emoryhealthcare.org
GENERAL SURGERY INITIATIVES Ease Of Scheduling: • Lag Time Reduction (goal of reducing from over 20 days to 10 days). Tests of change include: – Never Say No barriers removed. – Master schedule simplification- rules eliminated preventing barriers to appointment. – Overbooking opportunities. emoryhealthcare.org
GENERAL SURGERY INITIATIVES Ease Of Getting Clinic On The Phone: Medical Secretary Direct Contact: • – Return patients are given direct phone numbers to Medical Secretaries. – No voice mail allowed, overflow routes to call center. Same Time Implementation: • – Tool used by clinical staff and call center to improve communication. Live Nurse Call Handling: • – Phone tree option added to speak to a member of the care team: agent routes directly to nurses in clinic. emoryhealthcare.org
GENERAL SURGERY INITIATIVES Wait Time At Clinic: • First Time Starts: – Tracked all first time starts. – Data presented to faculty at Division meetings. • Master Schedule Template changes: – Schedule optimized for accurate length of visit by type. – Time study analysis in progress- breaking down parts of visit. emoryhealthcare.org
GENERAL SURGERY INITIATIVES Sensitivity To Patient’s Needs: Forms And Posters For ‘Questions On Your Visit’. • Profile screens placed in main lobby. • – Physician profiles; – Administrator profiles. Service Management training with clinic staff. • emoryhealthcare.org
GENERAL SURGERY IMPROVEMENTS General Surgery Medical Practice Mean Score 92 91.7 91 90 89.3 89.6 88.6 89 88.3 88 87 FY10 FY11 FY12 FY13 FY14TD emoryhealthcare.org
A PHYSICIAN PERSPECTIVE ON THE PATIENT EXPERIENCE emoryhealthcare.org
PHYSICIAN PERSPECTIVE Quality Value Cost emoryhealthcare.org
PHYSICIAN PERSPECTIVE Satisfaction surveys generally distrusted: • – Survey delivery/response : • Low response rates • Selection bias in responders • Low sample size • Narrow effective measurement range – Higher scores associated with worse patient outcomes and increased cost. • Fenton, JJ. Arch Int Med. Mar 2012 – Individual responsibility (personal and financial) for intangible factors. emoryhealthcare.org
Service Administrative Medical Care Value emoryhealthcare.org
INCREASING VALUE LEADING TO IMPROVED PATIENT SATISFACTION SCORES Better physician communication. • Optimized scheduling: • – Wait times highly cited complaint, balance against productivity Technology: • – Medical records; – Phone systems; – Patient reminders; – Guided scheduling; – Communication alternative to phones. emoryhealthcare.org
PHYSICIAN PERSPECTIVE SUMMARY • We are not making Teslas or iPads. We have bad news to deliver. • Most interested in delivering evidence based care. • Current patient satisfaction tools are: – Created to increase volume; – Not evidence based; – Blunt instruments with low sensitivity and operational challenges. • Easier to over treat than correct operational issues out of our control. emoryhealthcare.org
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