ThePatientExperienceatFloridaHospital

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LearningModuleforStudents

Introduc)on� AdventistHealthSystemanditsEastFloridaRegionhospitalswelcometheprivilegetoprovideawell-roundedlearningexperienceforyouandyourfellowstudentsduringyourrotationhere.

� Weknowthatyouwillleaveyourrotationwithagreaterunderstandingofyourclinicalresponsibilitiesinpatientcare.

� Thismoduleisdesignedtohelpyoualsounderstandsomeofthekeybehaviorsyouwillneedtofollowtoprovideanexceptionalexperienceforourpatientsasyouareprovidingqualityclinicalcare.

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GoalsfortheModule� Understandhowtodefine“PatientExperience”withinAdventistHealthSystem.

� Gainanunderstandingofthepatient’sperspectiveandperceptionofcare.

� UnderstandhowPatientExperienceismeasuredandwhyitiscriticallyimportantinhealthcaretoday.

� UnderstandthekeyservicebehaviorsthatareexpectedofallnursingstaffwithinAHStodriveapositiveexperienceforourpatients.

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WhatisPa)entExperience?

AdventistHealthSystemdefinesPatientExperienceinsimple,easyterms.Imagineitwasyourfather,mother,brotherorsisterinthebed.ALWAYStreateverypatientthesamewayyouwouldwanttotreatthatlovedone.

OurPa)ents

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Whenpatientscometothehospitaltheyareafraid,perhapsinpain,uncertainandanxious.Researchshowsthatmostfeellonely,alienatedandboredduringtheirstay,andthenabandonedandunpreparedtogohome.AtAdventistHealthSystem,wecombatthesefeelingsby:

§  BuildingTrust–Tellingthepatientwhoweareandwhatourroleisintheircare.

§  CreatingBelonging–Partneringwiththepatientandalwaystellingthemwhatwearedoingtocareforthem

§  DeliveringHope–Helpingthemunderstandthe“why”ofwhatwearedoingandhowitcanhelpthemhavethemostpositiveoutcomepossible.

CompassionandEmpathy� Approacheveryencounterwithcompassionandempathy.Itisnolongerenoughtojustprovidethecorrectmedicaltreatment.

� Aboveall,patientsjudgetheircarebyhowwetreatthemasindividuals–notbytheclinicalcaretheyreceive.Considerthesecomments:�  “Yourstaff--theircompassion,theirhearts,focus--wasthebestI'veever

experienced.Yourpeoplemakethedifference.”�  “Thishospitalalwaysmademefeelathomewithhumanloveandcomfort”�  “Thenursewaswonderfulandattentive.Likeafamilymember.Explained

procedureseverystepoftheway,discussedandexplainedeverydecisionmadeduringtreatment.”

CompassionandEmpathy� Ourpatientsappreciatethecaretheyreceivefromstudentsandoftencommentonhowmuchtheyappreciatetheattentiontheyreceive.

� Ourmissionisto“ExtendtheHealingMinistryofChrist,”andforus,thatmeansitisencouragedtoofferthatcomfortingtouch,asmileandkindword,orevenaprayerifappropriate.

� Whenyouareinourfacility,youarepartoftheFloridaHospitalandAdventistHealthSystemfamily!

MeasuringthePatientExperience

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WhatisHCAHPS?� HospitalConsumerAssessmentofHealthcareProviders&Systems

� CreatedbyCentersforMedicare&MedicaidServices(CMS).

� Thisnational,standardizedsurveyprovidesdataonthepatients’perspectivesandperceptionsofthecarethatweprovide.

� AllhospitalsthatreceivefundingfromCMSmustsurveypatients,andreimbursementisimpactedbytheresultsofthesurvey.

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TheHCAHPSSurveyProcess

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� AtAHS,weusePressGaneyAssociatestoadministerthesurveyprocessforus.

�  Surveysmaybesenttopatientswhoare:ü Admittedunder“inpatient”statusü Dischargedtohomeoranotheracutecarefacility

ü Overtheageof18ü Aliveattimeofdischargeü Noprimarypsychiatricdiagnosis.

WhatisHCAHPS?First25HCAHPSquestionsaregroupedintothefollowingcomposites:� Global(OverallRating1-10andWillingnesstoRecommend)

� NurseCommunication� DoctorCommunication�  StaffResponsiveness� Environment(CleanlinessandQuiet)

� PainControl� MedicationCommunication� DischargeInstructions� UnderstandingYourCareatHome

WhatisHCAHPS� TheresultsoftheHCAHPSsurveyarepublishedbyCMSonitsHospitalComparewebsite(www.medicare.gov/hospitalcompare).

� Consumerscanviewhowahospitalcomparestoitsneighboringfacilitiesinthesekeyareas.

� ThegoalofHCAHPS,aswiththequalitymeasures,istodriveperformanceimprovementacrossallhospitals.

� CMSincludestheHCAHPSsurveyresultsincalculatingthevalue-basedpurchasing(VBP)reimbursement.InFY2016,HCAHPSaccountsfor25%oftheoverallVBPscore. 12

AbouttheData�  Questionsalwaysaddressfrequencyofsomethinghappening.

�  Only“topbox”scoresarecountedbyCMS.

�  TopBoxmeansonly“always”answers.

�  So,if60outof100surveysshowedan“Always”answer,while18said“usually,”ourscorewouldonlybe60%.

�  Hospitalsarethenrankedaccordingtothattopboxpercentage.

StandardizedCMSQuestions

Note:WeaskadditionalquestionsbeyondtherequiredHCAHPSquestions.Thisprovidesadditionaldataforustomeasureourperformance.

Unlessotherwiseindicated,allquestionshavethefollowinganswerchoices:

� Never�  Sometimes� Usually�  Always

HowtoAnswer

1.Duringthishospitalstay,howoftendidthenursestreatyouwithcourtesyandrespect?

2.Duringthishospitalstay,howoftendidthenurseslistencarefullytoyou?

3.Duringthishospitalstay,howoftendidthenursesexplainthingsinawaythatyoucouldunderstand?

YourCarefromNurses

4.Duringthishospitalstay,afteryoupressedthecallbutton,howoftendidyougethelpassoonasyouwantedit?

q Alwaysq Usuallyq Sometimesq Neverq Ineverpressedthecallbutton

YourCarefromNurses

5.Duringthishospitalstay,howoftendidthedoctorstreatyouwithcourtesyandrespect?

6.Duringthishospitalstay,howoftendidthedoctorslistencarefullytoyou?

7.Duringthishospitalstay,howoftendidthedoctorsexplainthingsinawaythatyoucouldunderstand?

YourCarefromDoctors

8.Duringthishospitalstay,howoftenwereyourroomandbathroomkeptclean?

9.Duringthishospitalstay,howoftenwastheareaaroundyourroomquietatnight?

TheHospitalEnvironment

10.Duringthishospitalstay,didyouneedfromnursesorotherhospitalstaffingettingtothebathroomorusingabedpan?

q Yesq No(ifNo,gotoQuestion12)

YourExperiencesinThisHospital

11.Howoftendidyougethelpusingthebathroomorbedpanassoonasyouwanted?

q Alwaysq Usuallyq Sometimesq Never

YourExperiencesinThisHospital

12.Duringthishospitalstay,didyouneedmedicineforpain?

q Yesq No(IfNo,gotoQuestion15)

YourExperiencesinThisHospital

13.Duringthishospitalstay,howoftenwasyourpainwellcontrolled?

14.Duringthishospitalstay,howoftendidthehospitalstaffdoeverythingtheycouldtohelpwithyourpain?

YourExperiencesinThisHospital

15.Duringthishospital,wereyougivenanymedicinethatyouhadnottakenbefore?

q Yesq No(IfNo,gotoQuestion18)

YourExperiencesinThisHospital

16.Beforegivingyouanynewmedication,howoftendidhospitalstafftellyouwhatthemedicationisfor?17.Beforegivingyouanynewmedication,howoftendidhospitalstaffdescribethepossiblesideeffectsinawayyoucouldunderstand?

YourExperiencesinThisHospital

18.Afteryouleftthehospital,didyougodirectlytoyourownhome,tosomeoneelse’shome,ortoanotherhealthfacility?

q OwnHomeq SomeoneElse’sHomeq AnotherHealthFacility

(IfAnother,gotoQuestion21)

WhenYouLeGtheHospital

19.Duringthishospitalstay,diddoctors,nursesorotherhospitalstafftalkwithyouaboutwhetheryouwouldhavethehelpyouneededwhenyouleftthehospital?

q Yesq No

20.Duringthishospitalstay,didyougetinformationinwritingaboutwhatsymptomsorhealthproblemstolookoutforafteryouleftthehospital?

q Yesq No

WhenYouLeGtheHospital

21.Usinganynumberfrom0to10,where0istheworsthospitalpossibleand10isthebesthospitalpossible,whatnumberwouldyouusetoratethishospitalduringyourstay?

22.Wouldyourecommendthehospitaltoyourfriendsandfamily?

q Definitelynoq Probablynoq Probablyyesq Definitelyyes

OverallRa)ngoftheHospital

23.Duringthishospitalstay,stafftookmypreferencesandthoseofmyfamilyorcaregiverintoaccountindecidingwhatmyhealthcareneedswouldbewhenIleft.

q StronglyAgreeq Agreeq Disagreeq StronglyDisagree

UnderstandingYourCareWhenYouLeGtheHospital

24.WhenIleftthehospital,IhadagoodunderstandingofthethingsIwasresponsibleforinmanagingmyhealth.

q StronglyAgreeq Agreeq Disagreeq StronglyDisagree

UnderstandingYourCareWhenYouLeGtheHospital

25.WhenIleftthehospital,Iclearlyunderstoodthepurposefortakingeachofmymedications.

q StronglyAgreeq Agreeq Disagreeq StronglyDisagree

UnderstandingYourCareWhenYouLeGtheHospital

� Didanurseleadervisityouduringyourstay?

Yes No� Didastaffmembervisityouhourlyduringtheday?

Yes No

AHSAddedQues)ons

It’sNotCustomerSa)sfac)on

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Patientexperiencesurveyssometimesaremistakenforcustomersatisfactionsurveys.Patientexperiencesurveysfocusonhowpatientsexperiencedorperceivedkeyaspectsoftheircare,nothowsatisfiedtheywerewiththeircare.Patientexperiencesurveysfocusonaskingpatientswhetherorhowoftentheyexperiencedcriticalaspectsofhealthcare,includingcommunicationwiththeirdoctors,understandingtheirmedicationinstructions,andthecoordinationoftheirhealthcareneeds.Theydonotfocusonamenities.

--CMS(emphasisadded)

� Patientsdon’talwaysrecognizethecareyouprovide.Remember,theyareafraid,anxious,inpain,andmostlikelydidn’tgotonursingschoolormedschool.

� ThegoalofourPatientExperiencestrategiesistohelppatientsrecognizethegoodcaremoreeasily.

� Tobeeffective,thesestrategiesmustbecarriedoutconsistentlybyallmembersofthe

careteam–andthatincludesYOU!

DrivingPa)entExperience

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Strategy1:AIDETIneveryencountermakesuretofollowtheAIDETsteps:A=Acknowledgethepatientusinghisorherpropername(e.g.,Mr.SmithorMs.Jones)I=Introduceyourselfbyname,includingyourroleintheircare.D=Duration.Letthepatientknowhowlongyourinteractionwilllikelylast.E=Explain.ExplainEVERYTHINGthatyouaredoing.T=Thankyou.Thankthepatientfortheprivilegeofcaringforthem. 35

Strategy2:COLACOLA–orCaringOutLoudAlways–helpswiththat“E”in“AIDET”andissimplynarratingyouractionstothepatientatalltimes.�  “Iamgoingtomovethistraytableclosertothebedsoyouhaveeverythingwithinreach.”

�  “Iamgoingtoscanyourarmbandnowaspartofourmedicationsafetyprocedures.”

�  “Iamgoingtoclosethedoortokeepyourroomquietsoyoucanrestandheal.”

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Strategy3:BedsideReport

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� Hand-offbetweencaregiversiscritical!� Departingnurseandon-comingnursegointothepatient’sroomtogethertogivereportinfrontofthepatient,includingthepatientinthediscussion.

� Engagethepatientbyaskingifheorshehasanythingtoaddorhasanyquestions.

� Helpstokeepreportontargettothemostessentialaspectsofthecare.

� Makesuretomanage-uponeanother!

HowTheseImpactHCAHPSAIDET,COLAandBedsideShiftReportallhelpdriveperformanceintheNurseCommunicationdomain.

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Thedomainaskspatientsifwealwaysexplainedintermstheyunderstood,listenedcarefullytothem,andifwealwaystreatedthemwithcourtesyandrespect.

Strategy4:HourlyRounding�  THEMOSTIMPORTANTstrategyandhardesttohardwire.� HourlyRoundingisnotthesameasgoingintoaroomonceanhour.ItMUSTbedonewithintentionalityaroundthefollowingfourpatientneeds:�  PAIN–weneedtoalwaysdoeverythingwecantocontrolpainsafely.

�  POTTY–Attemptstogettotherestroomunassistedarethemostcommonreasonsforfalls.

�  POSITION–Repositionthepatienttomakethemcomfortableandreduceincidenceofskintears.

�  PERIPHERY–Keeptheroomtidyandmakesureallitemsarewithineasyreachtopreventfalls.

� RNsareresponsibleforensuringthatPurposefulHourlyRoundingisoccurring. 39

RoundingandHCAHPS� PurposefulHourlyRoundingpositivelyimpactsthepatient’sperceptionofcareoverallandisshowntohavethemostinfluenceonapositivepatientexperience.

�  Inparticular,ithelpsdriveStaffResponsiveness,PainControl,CleanlinessandNurseCommunication.

� Roundingdonewellalsohelpsthenursebyreducingthenumberofcallbells,whichsavestimeandcreatesefficiency.

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Whenpatientsanswer“Yes”tothequestionofwhetherastaffmembervisitedthemhourlyduringtheday,theyscoreourperformancemuchhigherthanthosethatsaid“No.”Noticehowclosethewhitecirclesaretothecenterofthebulls-eyegraph.Asasystem,ourgoalistohaveallofthecircleswithinatleastthelightergreenshadedarea,whichiswithinthe75thpercentile.

Strategy5:“NoPassZone”�  Anytimeacalllightison,anystaffmemberinthevicinityisexpectedtoentertheroomtoacknowledgethelightandofferassistance.

�  Ifyoucannotfulfilltherequestyourself,letthepatientknowyouwillalertthenurseoranotherstaffmemberwhocanhelp.

�  Personalattentiontothecalllightsletspatientsknowwecareabouttheirneedsandwilldoourbesttoaddressthemasquicklyaspossible.

�  ThisstrategyimpactstheStaffResponsivenessdomain,whichaskspatientsifweprovidedhelpassoonastheywantedit.

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Strategy6:KeyWords� Thetermsandphrasesweoftenuseinhealthcareareunfamiliartoourpatients.Tohelpthemrecognizethecareweareproviding,itishelpfulforallofustoincorporatekeywordsintoourdiscussions.

�  Forexample,whenperformingyourpurposefulhourlyround,tellthepatientyouarethereforyourhourlyround.Thishelpsthemrecognizehowoftenyouaretrulyintheroom.

� Anotherexampleistokeepthepatientdoorclosed,saying,“Iamgoingtoclosethedoortokeepyourroomquietforyou.”

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Strategy7:“SideEffects”� Weaskpatientshowoftenwetellthemwhateachnewmedicationisforandmentionpossiblesideeffects.

� Patientsmaynotequate“thismaymakeyoufeeldizzy”toadiscussionofsideeffects.

� Usethekeywords,“SideEffect,”andprovideatleastonesideeffectwitheverymedicationdelivery.

� Youwillalsoseethenursesgiving“GoldenTickets”attachedtoprintedmedicationeducationsheets.Thisisavisualreminderforthepatient.

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InReview� TheworkwedoatFloridaHospitalandAdventistHealthSystemissacredwork,andwearecompelledtonotjustdeliverthebestpossibleclinicaloutcome,butdosoinanenvironmentandmannerthatillustratesourcommitmenttoextendingthehealingministryofChristtoeverypatient,everytime.

�  Forourpatientstohavethebestperceptionofthecaretheyreceive,wemustallfollowevidence-basedbestpracticesaroundcommunicationandpatient-centeredcareatalltimes.

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InReview� Thismodulefocusedonsomeofthebestpracticesthatareespeciallyimportantfornursing.

� Thesebestpracticesinclude:�  AIDET(acknowledge,introduce,duration,explanation,thankyou)

�  PurposefulHourlyCareRounds�  BedsideShiftReport�  COLA–CaringOutLoudAlways� Usingkeywordssuchas“hourlyround”and“sideeffect”whenspeakingwiththepatient

�  The“NoPassZone”toquicklyaddresscalllights46

ReviewPoints•  PatientExperienceis“Treatingthepatientasyouwouldthepersonwhomyoulovethemost.”

•  AHSutilizesevidence-basedbestpracticestohelpbuildtrust,createbelonginganddeliverhopetoourpatientstoprovideanexceptionalexperience.

•  HCAHPSisastandardizedsurveyusedtomeasurethepatients’perceptionofthecaretheyreceived.

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ReviewPoints� Aboveall,patientsjudgetheircarebyhowwetreatthemasindividuals–notbytheclinicalcaretheyreceive.

� The“I”inAIDETrequiresthatallstafftellthepatienttheirnameandtheirroleinhisorhercare.

� Offeringtoassistthepatienttothebathroomduringeveryhourlyroundhelpstopreventfalls.

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ReviewPoints� COLAstandsfor“CaringOutLoudAlways.”� ThefollowingisexampleofusingKeyWordsatKeyTimes:“Iamclosingyourdoortohelpkeepyourroomquietforyou.”

� Nursesshouldalwaysgivereportinsidetheroomatthebedside.

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