The Patient Experience at Florida Hospital · 19. During this hospital stay, did doctors, nurses or...
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The Patient Experience at Florida Hospital 1 Learning Module for Students
Transcript of The Patient Experience at Florida Hospital · 19. During this hospital stay, did doctors, nurses or...
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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