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Rates of Change During Public and Private Rates of Change During Public and Private Reporting Cycles of Hospital Performance:Reporting Cycles of Hospital Performance:Implications for Mechanisms Driving Quality ImprovementImplications for Mechanisms Driving Quality Improvement

Cathy E. Duquette, Ph.D., RN, CPHQCathy E. Duquette, Ph.D., RN, CPHQVice President, Nursing and Patient Care ServicesVice President, Nursing and Patient Care Services

Newport Hospital – Newport, RINewport Hospital – Newport, RI

~~~~~~~~~~~~~~~~~~~~June 27, 2006

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Acknowledgements:Acknowledgements:

Judith Barr, Tierney Giannotti, and Marcia Petrillo – Judith Barr, Tierney Giannotti, and Marcia Petrillo – QualidigmQualidigmShoshanna Sofaer – Consultant/Baruch CollegeShoshanna Sofaer – Consultant/Baruch CollegeWilliam Waters – RI Department of HealthWilliam Waters – RI Department of HealthDeirdre Mylod and staff – Press GaneyDeirdre Mylod and staff – Press GaneyHospital Association of Rhode IslandHospital Association of Rhode Island

Barr, J.K., Giannotti, T.E., Sofaer, S., Duquette, C.E., Waters, Barr, J.K., Giannotti, T.E., Sofaer, S., Duquette, C.E., Waters, W.J. and Petrillo, M.K. 2006. “Using Public Reports of Patient W.J. and Petrillo, M.K. 2006. “Using Public Reports of Patient Satisfaction for Hospital Quality Improvement”. Satisfaction for Hospital Quality Improvement”. Health Health Services ResearchServices Research 41(3), Part I (June 2006); 663-682. 41(3), Part I (June 2006); 663-682.

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Rhode Island– Rhode Island– Setting the Stage:Setting the Stage:

Small state just over 1,000,000 populationSmall state just over 1,000,000 population– 39 cities/towns; very limited county government39 cities/towns; very limited county government1 State Department of Health1 State Department of Health16 hospitals in the state16 hospitals in the state– 13 hospitals: 10 acute care, 1 women & infants’,1 adult 13 hospitals: 10 acute care, 1 women & infants’,1 adult

psychiatric and 1 rehabilitation hospital participate in psychiatric and 1 rehabilitation hospital participate in patient satisfactionpatient satisfaction survey and report survey and report

– 10 acute care hospitals participate in the 10 acute care hospitals participate in the clinical clinical measuresmeasures data collection and report data collection and report

– All eligible hospitals were early participants in the All eligible hospitals were early participants in the Hospital Quality AllianceHospital Quality Alliance

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The Rhode Island Legislation:The Rhode Island Legislation:

Passed in July 1998 called for public reporting of:Passed in July 1998 called for public reporting of:– Comparable, statistically valid patient satisfaction Comparable, statistically valid patient satisfaction

measuresmeasures– Standardized data set of clinical performance Standardized data set of clinical performance

measures, risk-adjusted for patient variablesmeasures, risk-adjusted for patient variablesAddressed the general health environment in RI Addressed the general health environment in RI and the potential impact on quality:and the potential impact on quality:

Impending mergersImpending mergersFor-Profit vs. Not-For-Profit For-Profit vs. Not-For-Profit

Applies to all licensed health care facilities in the Applies to all licensed health care facilities in the state, starting with hospitalsstate, starting with hospitalsDirector of the Department of Health (HEALTH) is Director of the Department of Health (HEALTH) is responsible for program development and responsible for program development and implementationimplementation

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Program Development - SProgram Development - Structuretructure and Process and Process::

Director of HEALTH is responsibleDirector of HEALTH is responsibleSteering Committee and Work Group structureSteering Committee and Work Group structureProcess very open and publicProcess very open and public– Committee format; consensus as goalCommittee format; consensus as goal– Consumer, minority and interested party inputConsumer, minority and interested party input

Input and feedback incorporated into each step of Input and feedback incorporated into each step of program developmentprogram developmentHospitals represented by Hospital Association of Rhode Hospitals represented by Hospital Association of Rhode Island (HARI) through all stages of program developmentIsland (HARI) through all stages of program development– Opportunities to discuss issues and concerns among hospitals Opportunities to discuss issues and concerns among hospitals

within HARI structure within HARI structure

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Program Development – Program Development – Considerations:Considerations:

Outcome needed to address both public Outcome needed to address both public accountability AND quality improvementaccountability AND quality improvementAimed to balance desire to report on all patients/all Aimed to balance desire to report on all patients/all conditions vs. what was feasibleconditions vs. what was feasibleNeeded to develop a report that was meaningful to Needed to develop a report that was meaningful to consumers AND hospitalsconsumers AND hospitalsReport format and method of reporting needed to be Report format and method of reporting needed to be determined before data were availabledetermined before data were availableStarted with public reporting of patient satisfactionStarted with public reporting of patient satisfactionHospital approach was collaborative vs. competitiveHospital approach was collaborative vs. competitive

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Program Development - Program Development - Outcome:Outcome: The Private ReportsThe Private Reports

All hospitals in RI had a mechanism for measuring All hospitals in RI had a mechanism for measuring patient perception pre-programpatient perception pre-program– Variation to method, process, frequencyVariation to method, process, frequency

Hospitals agreed to select the same vendor and process Hospitals agreed to select the same vendor and process to meet program requirementsto meet program requirements– Transition to mail survey conducted by Parkside Associates and Transition to mail survey conducted by Parkside Associates and

then Press Ganeythen Press Ganey– Agreement to pilot data collection phase with each process Agreement to pilot data collection phase with each process

change (2000 and 2002) to evaluate process and provide early change (2000 and 2002) to evaluate process and provide early data and information to hospitals to refine and target ongoing data and information to hospitals to refine and target ongoing quality improvement effortsquality improvement efforts

– Process created to establish ongoing data collection and Process created to establish ongoing data collection and feedback for internal use between public reporting cyclesfeedback for internal use between public reporting cycles

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Program Development - Program Development - Outcome:Outcome: The Public ReportsThe Public Reports

Patient Satisfaction I – Nov 2001Patient Satisfaction I – Nov 2001– Public General Report Public General Report – Public Technical ReportPublic Technical Report

Patient Satisfaction II – Oct 2003Patient Satisfaction II – Oct 2003– Public General Report Public General Report – Public Technical ReportPublic Technical Report

Patient Satisfaction III – TBDPatient Satisfaction III – TBD– Currently participating in “dry run”Currently participating in “dry run”– Awaiting HCAHPS for public reportAwaiting HCAHPS for public report

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Program Development - Program Development - Outcome:Outcome: The Public ReportsThe Public Reports

Evaluation of Public Reporting Evaluation of Public Reporting on Hospital Patient Satisfaction on Hospital Patient Satisfaction in Rhode Island – 2003in Rhode Island – 2003

Statewide Effort to Improve Statewide Effort to Improve Hospital Patient Satisfaction Hospital Patient Satisfaction Ratings - 2004Ratings - 2004

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Public Report Development:Public Report Development:

State committee process – Patient Satisfaction Public State committee process – Patient Satisfaction Public Release Work Group with hospital, consumer, and health care Release Work Group with hospital, consumer, and health care stakeholder inputstakeholder input– Hospital staff and leadership actively engaged in processHospital staff and leadership actively engaged in process

Two types of public reports: general public and technicalTwo types of public reports: general public and technicalKey reporting decisions made before results availableKey reporting decisions made before results available– Methods for translating raw data into different formatMethods for translating raw data into different format– Method and “standard” against which comparisons madeMethod and “standard” against which comparisons made

Private report format designed for quality improvement and Private report format designed for quality improvement and not appropriate for public reportingnot appropriate for public reportingDraft reports went through formative testing process with Draft reports went through formative testing process with consumersconsumers

1111Patient Satisfaction Report Excerpt 2001

Sample Page from Public Report 2001:Sample Page from Public Report 2001:

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Sample Page from Public Report 2003:Sample Page from Public Report 2003:

Patient Satisfaction Report Excerpt 2003

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Findings: RI Scores over TimeFindings: RI Scores over Time

Hospitals in RI started out and continue to be Hospitals in RI started out and continue to be higher than national average score higher than national average score Steady improvement in RI scoreSteady improvement in RI scoreNo spikes around or following public reporting No spikes around or following public reporting time periodstime periodsRate of increase is not faster than that of Rate of increase is not faster than that of national upward trendnational upward trend

RI Trend Analysis vs. National:RI Trend Analysis vs. National:

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Hospital ResponseHospital Response

Commitment to Commitment to Quality ImprovementQuality Improvement

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Initial Responses:Initial Responses:

Hospitals supportive of public reportingHospitals supportive of public reporting– Hospital CEOs supported enabling legislationHospital CEOs supported enabling legislation

Hospital acceptance of program value in Hospital acceptance of program value in driving and coordinating quality improvement driving and coordinating quality improvement efforts statewide vs. influencing consumer efforts statewide vs. influencing consumer “choice”“choice”Significant hospital involvement in process Significant hospital involvement in process from the beginning of program developmentfrom the beginning of program development

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Quality Improvement Efforts:Quality Improvement Efforts:

Internal:Internal:Senior leadership involvement and intense Senior leadership involvement and intense organizational commitment organizational commitment Reaching clinical staff and Boards of TrusteesReaching clinical staff and Boards of TrusteesIncrease in focus and coordinationIncrease in focus and coordination

External:External:Collaborative vs. competitive modelCollaborative vs. competitive model– Sharing of best practices Sharing of best practices – Coordinated efforts through HARICoordinated efforts through HARIDemonstrating improvement over timeDemonstrating improvement over time

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For More Information:For More Information:

www.health.ri.govwww.health.ri.gov– RI Background Reports; RI Background Reports; – Public and Technical Reports; and Public and Technical Reports; and – Evaluation Reports on Findings and Quality Evaluation Reports on Findings and Quality

Improvement EffortsImprovement Efforts

www.health.ri.gov/chic/performance/series.phpwww.health.ri.gov/chic/performance/series.php – Direct link to list of reportsDirect link to list of reports

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Questions?Questions?