Keys to Improving the Patient Experience ... and TheirEvaluations

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Keys to Improving the Patient Experience …and Their Evaluations

The burning question …

Are you assessing

the patient experience from the patient’sperspective?

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It starts with our mindset and language choices

We make sure patients meet our clinical criteria.

We sometimes assume we know what the patient needs.

We admit patients into our program.

We develop our care plan for the patient.

We

Our

My…

What if we flipped that mindset to the patient’s POV?

We listen to the patient’s understanding of their condition, needs and wishes.

We accept an invitation into the patient’s home to provide care.

We develop their care plan to meet their needs and wishes.

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Clinical expertise must be balanced with emotional intelligence

A different dynamic exists when we care for someone in their home.

We have to be careful to not judge a home environment.

We must be aware of intimacy and vulnerability when invited into a home.

Shifting from a transaction to a relationship

Signs of a transaction: First home health visit is typically by an RN who wants to get

diagnosis coding right.

The patient and family never see that RN again.

If patient disagrees with plan of care, they’re “non-compliant.”

We look for productivity and time efficiency of each “visit.”

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Shifting from a transaction to a relationship

Signs of a relationship: First visit is from the RN and team assigned to the patient.

Conversation is focused on patient’s understanding, goals, preferences and wishes.

Collaborate with patient on their care plan for a sense of ownership.

A “visit” becomes an “encounter” that invests time necessary to build relationship.

Needs for relationship-based care

Staffing models that allow more time with patients for in-depth goals of care discussions.

Innovations from telemedicine and other technologies.

Focus on quality of encounter not quantity of time.

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Changing our cultures through language

Harvard Business Review: Culture is fast becoming the only true differentiator.

Is your mission/vision/values about your organization or your patients?

Avoid the “little piggy syndrome.”

Changing our operations to improve every touchpoint

What does your admission process feel like to the patient … and to the patient’s family?

What does the touch prior to the first encounter feel like?

What elements are designed for the caregiver and patient’s support network?

Are you still emphasizing visits as the primary metric for staff productivity?

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Changing our operations to improve every touchpoint (cont’d)

Do you value “patient experience” as highly as “productivity” (number of visits) in evaluating staff performance?

How are outcomes of clinical performance measured by your organization?

How is the phone answered? How are the front desk/switchboard staff trained? Do they have time to engage with callers or are they triaging and directing phone traffic?

How are the aides trained?

How do your staff members feel treated by your organization? Are you the place your staff feel like they can live out their passion for delivering care?

Are high-volume producing staff that create a lower quality culture managed up or out?

What is Emotional Journey Mapping?

Journey maps are a visualization of an end-to-end experience from a consumer perspective. This visualization empowers an organization to make value-driven decisions based on a customer experience model of ideal performance.

By mapping the entire experience we can see the impact of patient care on the HHCAHPs survey at each touch point.

Process at Duke HomeCare and Hospice was led by Kelli Anderson.

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Findings – first 14 visits

After each visit, we debriefed with both clinicians and patients separately.

Score out of 10

– Clinicians rate themselves: 8.46– Patient/Caregiver rate Clinicians: 9.62– Patient/Caregiver rate Agency overall: 7.77

Opportunities were identified in scheduling, follow-up and patient education.

The positive scores we received were not reflective of the negative comments/scores from patient feedback in HHCAHPs.

Clinician feedback

What questions am I least equipped to answer?

– When will I see another team member?

– Why are you here?

– What do I do for a Medicaid denial?

Opportunity to assist clinicians in getting to know each other:

– Nurses rated knowing their peers 2.8 out of 10

Feel more time in the field for new hires is needed for orientation success.

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Clinician feedback (cont’d)

Average familiarity with HHCAHPs survey 1.9 out of 5

– Only speaking to Home Health survey when patient asks how to leave feedback.

Scheduled for more patients than I have availability for, which makes it difficult for quality visits.

– Clinicians contacting scheduling to resolve with mixed results.

Observations – adherence to best practice

Clinicians may not fully understand what patient experience encompasses.

– What is their role in the patient’s clinical journey?

Clinicians consistently used body language putting patient at ease, explained in a way the patient understood and made sure patients felt comfortable.

Med rec performed in 26 of 29 applicable visits.

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Observations – adherence to best practice (cont’d)

Observed gaps• Body language used instead of asking if patient is ready to begin.

• Only 58.3% of visits explained who to call in case of emergency.

• Documentation not completed in home.

– Many clinicians feel that computer takes away from visit.

• Questions about billing or insurance not asked.

Re-evaluate your focus on family caregivers

Surveys with more than 18,000 family healthcare decision makers reveal:

> 80% say the hospice provider should be the patient and family’s choice.

85%OF FAMILIESSAY THEY WOULD FEEL COMFORTABLE CALLING A HOSPICE DIRECTLY

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Re-evaluate your focus on family caregivers (cont’d)

Crisis of care vs. crisis of caregiver confidence

Family caregivers have a sacrificial mindset

They rank “making the patient more comfortable” as their top priority. However …

Re-evaluate your focus on family caregivers (cont’d)

The other attributes family caregivers value highly support them in their caregiving role:

Being available for 24/7 assistance

Emotional support for the caregiver

Teaching caregivers how to provide the best care

Spiritual support

Grief support

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100

On the front end of a growing caregiver crisis

More than 40 million Americans currently provide care for a loved one at home.

By 2030, there will be a national shortage of 151,000 paid direct care workers, resulting in 3.8 million unpaid family caregivers spending significant time to provide care.

By 2040, that shortage of paid care workers will increase to 355,000 with 11 million unpaid family caregivers picking up the slack.

Source: Reuters, “The future of U.S. Caregiving: High Demand, Scarce Workers,” August 3, 2017

BY 2020

MILLIONAMERICANS WILL NEED CARE ASSISTANCE

Concentrating on the caregiver

How are you training your “unpaid staff,” the family caregiver?

How much time is (or should be) devoted to ensuring caregiver confidence? Does your staff have time to invest in caregiver confidence?

What tools do you have in place to support lay members of the care team, i.e. family and friends?

What expectations for responsiveness does the family have? Are there alternative/nontraditional means to meet caregiver responsiveness expectations? Technology?

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Impact of marketing hospice directly to family caregivers

25% to more than 100% increases in admissions from family referrals

60% to 265% increases in ALOS

INCREASES IN PATIENT DAYS

84%-320%

Improving patient and family evaluations through communications

Although surveys are supposedly objective because all patients/families receive the same questions, the language can be highly subjective …

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Hospice compare language

“Getting timely help”

“Treating patient with respect”

“Training family to care for patient”

The first and last bullets rank two of the bottom three in national average

Home Health compare language

“… gave care in aprofessional way”

“How well did the … team communicate with the patient”

These two bullets rank as the top two in national average

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Use language and discussions that align with evaluation criteria

Ask patients and families their expectations of you.

Find out their definitions of terms like “timely” and “communicates well.”

Beef up your caregiver training support and materials; be clear when you’re training.

Remember …

Improving

the patient experience

means living

the patient perspective

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Cooper LintonAssociate Vice PresidentDuke HomeCare and Hospice at Duke University Health Systemcooper.linton@duke.edu

Stan MasseyLead ConsultantTranscend Strategy Groupsmassey@r-p.com

Questions?