The Power of Choice in Patient Experience Improvement: Moving …€¦ · The Power of Choice in Patient Experience Improvement: Moving from Ideas to Action Jason A. Wolf, Ph.D. President,

The Power of Choicein Patient Experience Improvement:

Moving from Ideas to Action

Jason A. Wolf, Ph.D.President, The Beryl Institute@jasonawolf / @berylinstitute

May 21, 2015

www.theberylinstitute.org

www.theberylinstitute.org 2


Our Journey

o Defining Patient Experienceo Operational Realityo A Market Shifto Driving Distinction – 5 Keyso A Call to Action


5

DEFINING PATIENT EXPERIENCEWithout definition, you have no basis for action!


The Performance Paradox


is not always

simple • clear • understandable

easy • trouble-free • painless

Patient Experience Defined


The Beryl Institute

PX Definitional Concepts & Themes


Sum of all

InteractionsOrganization

CulturePatient (& Family)

PerceptionsContinuum

of care

Integrated Nature(inclusion of quality, safety,

service, etc.)

Patient (& Family)Partnership Person Centeredness

Source: Wolf, Jason A. PhD; Niederhauser, Victoria DrPH, RN; Marshburn, Dianne PhD, RN, NE-BC; and LaVela, Sherri L. PhD, MPH, MBA (2014) "Defining Patient Experience," Patient Experience Journal: Vol. 1: Iss. 1, Article 3. Available at: http://pxjournal.org/journal/vol1/iss1/3

Experience versus Satisfaction

Satisfaction:

The idea of how positive someone feels about an encounter, yet satisfaction is in the moment

Experience:

Experience is the lasting story.It is defined in all that is perceived, understood and remembered.

It encompasses much more than creating “happy” patients.It is about ensuring the best in quality, safety and service outcomes.

AND it is what you will share with others…www.theberylinstitute.org 9

www.theberylinstitute.org10

A Macro Construct…

Safety

CostOutcomes

Quality

Service

Engagement

Activation

…and a shiftin perspective

At the end of the day…

…we are simply human beings caring for human beings!www.theberylinstitute.org 11

12

STATE OF PATIENT EXPERIENCE TODAY


Purpose & Methodology

• The overall purpose of this study was to determine what healthcare organizations are doing to “improve the Patient or Resident Experience across the continuum of care.”

• The Beryl Institute and Catalyst Healthcare Research collaborated on this important research initiative

• Online survey: Approximately 60 questions

• Survey period: Feb. 9 – Mar. 10, 2015


Prepared in partnership with

Respondent Profile

• 1561 Total Respondents• US Hospitals : 773• Non-US Hospitals : 174• LTC : 116• Practices : 93

• 48 US states + DC represented in this study

• 21 Countries represented covering 6 continents• Top 5 outside US included Canada, United Kingdom, Australia, Sweden and Saudi Arabia

• Just over 50% of respondents identified themselves as Manager/Director role, while 10% identified themselves as Senior Leaders

• Just under 40% of all respondents identified themselves as the person directly responsible for patient, resident and family experience


15

WHAT WE LEARNED:PATIENT EXPERIENCE AS PRIORITY


25%

26%

32%

37%

52%

61%

0% 20% 40% 60% 80%

ACO development/implementation

EHR / Meaningful Use / IT

Employee engagement / satisfaction

Cost management / reduction

PX or Patient Satisfaction

Quality / Patient safety

US Hospitals

Patient Experience remains a top priorityfor US hospitals and systems


Q: To understand where organizations are focusing their activities, efforts and actions, please review the items listed below and identify what you believe will be your organization’s TOP 3 priorities for the next 3 years. Please select only the top three priorities. (n=683)

16

A move to frame patient experience continues


Q: Does your organization have a formal definition of “Patient and/or Resident Experience”? (n=686)

17

69%81% 83%

2011 2013 2015

27%45% 47%

0%

20%

40%

60%

80%

100%

2011 2013 2015

Formal Definition Formal Structure Formal Mandate

58% 52% 58%

2011 2013 2015

US Hospitals/Systems

Of respondents acknowledging use of a definition,The Beryl Institute’s definition was cited most

often


Q: Question: What is your organization’s definition of Patient/Resident Experience?

18

The Beryl Institute

19

WHAT WE LEARNED:HOW IT’S GETTING DONE


63%56%

79%

53%

0%

20%

40%

60%

80%

US Hospitals Practices Non-US Hospitals LTC

More than half of the respondents in every segment report having a senior leader for PX


Q: : Does your organization currently have a specified senior-level leader role with primary responsibility and direct accountability for addressing Patient/Resident Experience, i.e., chief experience officer or equivalent? (n=524) (n=252)

20

A PX leader is now the most frequent waythat US hospitals are addressing PX


Q: Responses aggregated from multiple survey questions. (n=356)

21

Title 2013 2015

Experience Officer (CXO, Director, Manager, etc.) 22% 42%

Chief Nursing Officer (or equivalent) 14% 15%

Committee, Team, Work Group, or Multidisciplinary team 26% 14%

Chief Executive Officer/Administrator/Executive Director 8% 4%

Chief Operating Officer (or equivalent) 3% 4%

No one in particular 1% 3%

Patient Advocate N/A 3%

Individual Doctor, Nurse, or other Clinical Staff member 3% 3%

32%17%

41%38%

0% 10% 20% 30% 40% 50%

Under 50%

50%-99%

100%US Hospitals

Non-US Hospitals

LTC

Practices

Just over 1/3 of all PX leaders allocate 100% of their time to patient, resident and family

experience


Q: What percent of [your / that person’s] time is allocated to support Patient/Resident Experience efforts? (n=395) (n=190)

22

A larger number of full-time staff are now supporting the PX leader


Q: And how many other, if any, full-time staff members are designated to support these efforts? (n=395) (n=190)

23

28%

36%

11%

24%

18%

30%

19%

33%

0%

5%

10%

15%

20%

25%

30%

35%

40%

0 1 to 2 3 to 4 5 or more2013 US Hospitals 2015 US Hospitals

24

WHAT WE LEARNED:MOTIVATING FACTORS &

INFLUENCES


Motivating factors remain consistent with 2013 “Mandated measures” & “Leadership desire”


Q: Please select the top three (3) factors that are driving your organization toward taking action on Patient/Resident Experience. Please select the top 3. (n=457)

25

38%

40%

40%

41%

50%

58%

0% 25% 50% 75%

Movement toward value-based payments

Right thing to do

Desire to provide better outcomes

Becoming provider of choice

Leadership desire to provide betterexperience

Govt-mandated measurements(HCAHPS, etc.)

US Hospitals

2013

Top priorities moving away from survey domains to communication and people focus


Q: What are the top three (3) areas of focus or action for your organization’s current Patient/Resident Experience effort? (n=330)

26

2015

While surveying remains primary metric,increase in direct engagement of patient voice


Q: Aside from tracking the success of individual improvement activities and/or actions, which metrics are your organization using to measure overall improvement in the Patient/Resident Experience? Please select all that apply. (n=445)

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37%

41%

45%

49%

55%

71%

78%

91%

0% 20% 40% 60% 80% 100%

Patient/family focus groups or interviews

Outside ratings / rankings (US News & World Report;Healthgrades)

Monitoring social media

Bedside surveys / feedback during rounding

Patient/family advisory committee

Calls to patients after discharge

Patient sat / PX surveying (beyond govt req.)

Govt-mandated surveys (HCAHPS, etc)

US Hospitals

86%

80%

70%

32%

42%

n/a

n/a

29%

2013

28

WHAT WE LEARNED:INFLUENCES ON ACTION


Ro a d b lo c ksD r i ve r s

Drivers and roadblocks hold steady,as support shifts and focus increases…


Q: Which of the following, if any, have been most successful in supporting your organization’s Patient/Resident Experience efforts? Please select the top 3. Which of the following, if any, have been the biggest roadblocks to supporting your organization’s Patient/Resident Experience efforts? Please select the top 3. (n=434)

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US Hospitals US Hospitals2015 2013

Strong, visible support“from the top" 52% 62%

Having clinical mgrsvisibly support PX efforts 43% 55%

Formal process review & improvement focused on PX 36% 44%

Formal PX structure or role 35% 30%

Having physiciansvisibly support PX efforts 22% 13%

2015 2013

Other org priorities reduce emphasis on PX 49% 46%

Cultural resistance todoing things differently 46% 42%

PX leaders are pulledin too many other directions 38% 48%

Lack of sufficient budgetor resources 26% 26%

Lack of support from physicians 25% 29%

Purposeful leadership and a strong cultureseen as critical in achieving great PX


Q: Please RANK the following in order of importance you believe they have for achieving a positive Patient/Resident Experience from most to least important where 1 is the most important and 9 is the least important. Click and drag to rank. (n=732)

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Purposeful and visionary

leadership(3.3 avg rank) A healthy, positive &

strong organization culture

(3.8 avg rank)

A sharedmission/purpose

(4.1 avg rank)

Highly engaged staff/employees

(4.0 avg rank)

Staff development top area of investment along with culture change and focus on

PFA/Cs


Q: Of the following efforts, identify the top 3 items in which you expect your organization to invest, either as a new effort or with additional resources, over the next three (3) years to advance Patient/Resident Experience improvements. Please select the top 3. (n=497)

31

32%

32%

33%

37%

44%

59%

0% 20% 40% 60%

Facility upgrades

Patient portals / access to records

Measurement to support performanceimprovement

Patient & family engagement viaadvisory councils, etc.

Broader culture change efforts

Staff training and development

US Hospitals

Quality/clinical outcomes seen as most impacted by positive PX among US hospitals


Q: Please RANK the following in order based on how you believe they are impacted by a positive Patient/Resident Experience from most to least impacted where 1 is the most impacted and 7 is the least impacted. Click and drag to rank. (n=476)

32

24%

43%

52%

55%

56%

71%

0% 20% 40% 60% 80%

Business/financial outcomes

Community reputation

Consumer loyalty

Safety outcomes

Level of customer service

Quality/clinical outcomes

US Hospitals

33

PATIENT EXPERIENCE:PROGRESS & PERSPECTIVES


The optimist’s perspective:A realistic view continues as focus expands


Q: At this point, how do you feel about the progress (or lack of progress) your organization is making toward improving the Patient/Resident Experience? (n=493)

34

Positive, 61% Positive54% Positive

46%

Very positive25% Very positive

17% Very positive20%

0%

20%

40%

60%

80%

100%

2011 2013 2015

US Hospitals/Systems

The consumer is speaking:Patient experience matters


Q : As a consumer of healthcare, how significant is the Patient/Resident Experience on your decisions or choices in healthcare (i.e., selecting hospitals, doctors, nursing homes, etc.)? As a consumer of healthcare, how significant is the Patient/Resident Experience on your decisions or choices in healthcare (i.e., selecting hospitals, doctors, nursing homes, etc.)? (n=842)

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87%

0% 50% 100%

Minimallyimportant

Not at allimportant

Somewhatimportant

Extremelyimportant

Importance of PX

28%

67%

0% 50% 100%

Not at allsignificant

Minimallysignificant

Somewhatsignificant

Extremelysignificant

Significance in Decisions

The state of patient experiencecontinues to grow stronger

Patient experience remains a top priority for organizations across all segments

More than half of all respondents have a specified senior-level experience leader role and resources committed to patient experience efforts are increasing

Experience priorities shifting to communication and broader inclusion of patient, resident and family voice

Committed leadership and strong culture strengthen as primary drivers in patient experience success

Quality/clinical outcomes seen as most impacted by positive patient experience

A realistic perspective of patient experience progress and the effort it requires continues

Consumer sentiment reflects that patient, resident and family experience matters and is a significant factor in healthcare decisions


“TALKING” POINT


What INTERNAL organizational factors are influencing your ability to impact patient experience outcomes……positively as supports of success?…negatively as roadblocks to action?

How are you addressing this?

38

A FOCUS ON VALUE IS ALL ULTIMATELY ABOUT EXPERIENCE…Three significant shifts for healthcare


Value-based

Preventing readmission

Meaningful use of IT

Relationship-based care

Retention

ACO model Patient experience

Length of stay

Managing budget impact of IT

Episodic care

Acquisition

Volume based payment Clinical results

Volume-based

A Market Shift and Balancing Act


Our Dynamic Marketplace


AND THE LIST GOES ON…

41

BEYOND PATIENT TO CONSUMERwww.theberylinstitute.org

The Waiting Roomwww.theberylinstitute.org 42

Definitely or probably will use hospital patient satisfaction ratings from a 3rd party for future hospital selection decisions

Implications of Patient Choice

Say reputation for skill and quality of care most important criterion in selecting a hospital


80%

77%

60%Indicate high levels of patient satisfaction one of top 3 issues influencing hospital selection

J.D. Power and Associates National Hospital Service Performance StudySM: (2005)

Power of Staff Attitude


Percent of consumers attributing positive moments of truth to friendly staff

45

BEYOND OUTCOMES TO THE BOTTOM LINEwww.theberylinstitute.org

The Call


Snowball Effect in a Value-Based World

47

FundingDiminished

Adapted from: Joan’s Family Bill of Rights (http://joansfamilybillofrights.com)

EmployeesLeave

PatientsGo Elsewhere

Payor $ Impacted

Reimbursement $ Impacted

Scores revealgap between expectation &

perception


Ideal Experience Prompts Choice


Consumer willingness to switch companies

49

BEYOND CENTEREDNESS TO EXPERIENCEwww.theberylinstitute.org

Through the Patient’s Eyes


© Thomas G. Murphy, MD, from JAMA. 2012;307(23):2497-2498. doi:10.1001/jama.2012.4946.

The Patient’s Perception Matters


“I am the patient and I need to be heard!”Video: https://www.youtube.com/watch?v=iVt3eHAsdK4

Impact of Personal Experiences


Influence of personal experiences and peer recommendations in selecting a provider



The Beryl Institute

EXPERIENCE:All that is perceived, understood,

and remembered…

54

VIEWS FROM THE INDUSTRYwww.theberylinstitute.org

As a very large payer in the system, we believe we have a responsibility to lead. For the first time, we’re going to set clear goals and establish a clear timeline for moving from volume to value in the Medicare system.

Sylvia Mathews BurwellSecretary, US Health and Human Services

January 26, 2015

A Responsibility to Lead


• 30% fee-for-service Medicare payments tied to quality or value through ACOsor other alternative payment models by 2016, 50% by 2018

• Overall, 85% of all Medicare payments tied to quality or value by 2016, 90% by 2018

5 4 3 2 1

251

1205

1414

582

101

CMS Star Ratings – April 2015


Roadmap for Patient &Family Engagement


Carman KL, Dardess P, Maurer ME, Workman T, Ganachari D, Pathak-Sen E. A Roadmap for Patient and Family Engagement in Healthcare Practice and Research. (Prepared by the American Institutes for Research under a grant from the Gordon and Betty Moore Foundation, Dominick Frosch, Project Officer and Fellow;

Susan Baade, Program Officer.) Gordon and Betty Moore Foundation: Palo Alto, CA; September 2014. www.patientfamilyengagement.org.

Compassion & Patient Experience


Successful organizations understand:• Employee experience drives patient experience

And have common characteristics including:• A commitment to involving patients and families• Hiring practices and training programs that focus

on compassion• A culture of experimentation• A willingness to share patient experience data

Building Compassion into the Bottom Line: The Role of Compassionate Care and Patient Experience in 35 U.S. Hospitals and Health Systems, 2015, The Schwartz Center for Compassionate Care

Key organizational level factors include:• Meaningful involvement &

engagement• Strong, committed senior leadership• Emphasis on data and intelligence• A focus on the workforce

Improving Experience


Experience can be understood in:• WHAT the person experiences, i.e.,

interactions and processes involved in or affected by

• HOW that made them feel

Improving experiences of care: Our shared understanding and ambition, National Quality Board, January 2015. http://www.england.nhs.uk/wp-content/uploads/2015/01/improving-experiences-of-care.pdf

Driving Distinction Across theContinuum of Care

• Acknowledge individuality

• Reinforce the importance of choice

• Give voice to all

• Recognize the value of team focus

• Maintain a systemic perspective

• Focus on leadership at all levels

• Positive, strong, healthy and vibrant organization culture

• A continuous action, requiring relentless intention

www.theberylinstitute.org 60Source: The Power of Person Centeredness in Long-Term Care: A View Across the Continuum (2015), The Beryl Institute

The Consumer is Coming…


Consumer Voice, Patient Experience& Reality of Risk


Consider these implications for including voice:• Experience measures more predictive• Best predicted by patients’ perceptions of skill

and responsiveness of nurses and physicians1

0

10

20

30

40

TopMiddle

Bottom

17.5 22

36.75

Law

suits

/100

,000

Dis

char

ges

Satisfaction Tertile

Malpractice Lawsuits• Relationships matter between

patient/family members and providers and they drive choice2

• Quality of interaction with patient and physician negatively correlated with complaints3

1. Boulding, William, et al. “Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission Within 30 Days.” The American Journal of Managed Care 17.1 (2011): 41-48.

2. Stelfox, Henry Thomas, et al. “The relation of patient satisfaction with complaints against physicians and malpractice lawsuits.” American Journal of Medicine 118 (2005): 1126-1133.

3. Rodriguez, Hector, et al. “Relation of patients’ experiences with individual physicians to malpractice risk.” International Journal for Quality in Health Care 20.1 (2008): 5-12.

“TALKING” POINT


What do you see as the most significant market factors facing patient experience efforts today?

How do they impact your efforts and how can we address these opportunities?

64

HOW DO WE DRIVE DISTINCTION IN A VALUE BASED WORLD…5 keys for positive outcomes



DEFINITIONDefined Focus & Purpose

“So what can we do?” - Definition

• Get clarity, alignment and input from all voices

• Identify key elements you want everyone to share

and

• Commit to create one!



LEADERSHIPVision & Support

“So what can we do?” - Leadership

• Declare your personal vision & purpose

• State your (and the orgs) expectations &consequences for inaction

• Model these ideas in your own actions

• Coach for success

• Ensure people recognize they are leaders in every moment

• Reinforce the power of communication and our most elusive but profound tool, purposeful rounding



ENGAGEMENTAt all Levels &Across all Touch Points


Ms. Betty, Ochsner Health

"I may have the best job in the world. I help people, I hear happy stories and

those real sad, but these people come to know me, trust me and look for me. I

am here to make them know they are welcome!”

ENGAGEMENT…in action

“So what can we do?” - Engagement

• Commit to ensuring the right people on board– Rigorous selection– Willingness to make tough decisions

• Provide people the opportunity to see themselves as leaders

• Reinforce a sense of ownership for outcomes

• Ensure a connection toaccountability & reinforceexpectations

• Be transparent with information,scores and communication

• Reward & recognize consistently



CULTUREAlignment & Accountability


The Birthday Crew, Presbyterian Health“Happy Birthday to you!”

CULTURE…in action

“So what can we do?” - Culture

• Remain focused on purpose,leadership and engagement

• Ensure the space to providefeedback without fear of reprisal

• Create opportunities for input andrapid change - agility

• Celebrate victories, act quickly to address misses

• Reinforce accountability and inspire ownership

• Commit to collaboration and break down silos


In executing on PX - Interactions are grounded in our culture and influence perceptions

"As soon as you can show me the patient who deserves less care then the person

that came before him/her, that is when we can relax.”

Dr. David FeinbergCEO, Geisinger Health www.theberylinstitute.org 75

MOVEMENTRelentless Commitment & Continuous Action

76

A FRAMEWORK FOR MOVING FROM IDEAS TO ACTION


www.theberylinstitute.org77

An integrated view…

Safety

CostOutcomes

Quality

Service

Engagement

Activation

…and priorities for action Amenities

Processes

Interactions

PeoplePatientsFamily

Community

Personal InteractionsEngaging with the Human Being• Acknowledging vulnerability,

anxiety, fear• Communication/Info• Expected Behaviors

Operational ProcessesProviding Excellence in User Experience• Access/Registration• Wait Times• Discharge

Superior AmenitiesGoing Above & Beyond• Parking• Food Service• Environment

PeopleProcess

Place

Leading Forward: Taking a Stand

We believe organizations and systems committed to providing the best in experience WILL:

• Identify and support accountable leadership with committed time and focused intent to shape and guide experience strategy

• Establish and reinforce a strong, vibrant and positive organizational culture and all it comprises




• Develop a formal definition for what experience is to their organization

• Implement a defined process for continuous patient and family input and engagement




• Engage all voices in driving comprehensive, systemic and lasting solutions

• Look beyond clinical experience of care to all interactions and touch points




• Focus on alignment across all segments of the continuum and the spaces in between

• Encompass both a focus on healing and a commitment to well-being


…and tactics for all• Right people• Identifying/understanding patient &

family expectations• Avenues for collecting patient voice

– Advisors & GPFACs• Whiteboards/communication

processes• Rounding

– Purposeful hourly– Team– Leadership

• No passing zones/all call• Medication info cards/sheets• Care plans• Bedside handoffs• Post visit follow-up/care transitions

and more…

Plus• Amenities

– Food– Parking

• Environment– Cleanliness– Noise


One more story from the front


The Performance Paradox

is not always

simple • clear • understandable

easy • trouble-free • painless

84www.theberylinstitute.org



The Beryl Institute



Talking Point – The Power of Choice

Three questions/consideration in impacting patient experience:

What choices will I make?

What choices will I helpmy organization make?

How will I honor the choicesof those we care for & serve?



- Dalai Lama

We are all the Patient Experience


Video: http://www.theberylinstitute.org/?page=IMPX_VIDEO

THANK YOU and Q & A

Jason A. Wolf, PhDPresident, The Beryl [email protected]

202.650.7491www.theberylinstitute.org

@jasonawolf / @berylinstitute

91www.theberylinstitute.org

Documents

The Power of Choice in Patient Experience Improvement: Moving …€¦ · The Power of Choice in Patient Experience Improvement: Moving from Ideas to Action Jason A. Wolf, Ph.D. President,