the relationship between hcahps and facilities: how to improve scores in new and existing healthcare...
DESCRIPTION
In the healthcare world, results are defined by outcomes and patient satisfaction. Healthcare executives across the country are facing questions on how their organization can improve patient satisfaction and, as a result, scores on the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey. The importance of patient satisfaction results have evolved since the introduction of healthcare reform—which affects hospitals’ reimbursement partly based on scores they receive on the HCAHPS. Healthcare facility planners and designers have the responsibility to create a physical environment that enables improved results. After all, creating an atmosphere in hospitals that is safe, clean and quiet makes patients more comfortable and more likely to heal. The ability to identify the design elements that contribute to a healthy and positive patient experience allows hospitals to institute operational plans and design solutions that improve healing. In this presentation, planning and design experts from BSA LifeStructures will discuss the impact a hospitals’ environment can have on patients and then present design recommendations that have been proven to improve satisfaction scores and value for the hospital. BSA LifeStructures has developed methods to track the impact of design solutions in hospitals. And, in doing so, have given healthcare organizations a valuable tool to determine the value and effectiveness of their healing environment. The epicenter of patient experience is generally focused on the patient room. The different human interactions within the patient room create the paradigm for defining the patient experience…the people, the process and the place. People—the physical space of the patient room can contribute to engaging the caregiver by providing plenty of natural light, giving caregivers adequate space to work, and planning spaces that combine multiple functions. Process—Lean design principles should be used to improve the caregiver’s workflow and limit the number of value-wasted movements. By making their job more efficient they can save energy and leverage opportunities for rest and respite. Place—the physical space needs to be quiet and clean. Using easy-to-clean flooring materials and designing patient rooms to limit room-to-room and corridor-to-room noise transfer enables the space to address typical areas for satisfaction shortfalls. These three interactions need to work well collaboratively in order to yield a satisfactory patient experience and quality HCAHPS scores. It is the cause and effect flow to HCAHPS scores.TRANSCRIPT
1The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
THE RELATIONSHIP BETWEEN HCAHPS
AND FACILITIES: HOW TO IMPROVE
SCORES IN NEW AND EXISTING
HEALTHCARE FACILITIESNOVEMBER 7, 2013
2The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Learning Objectives
• Understand Patient Satisfaction (HCAHPS) questions and
scores and their relationship to the built environment.
• Learn how Facilities can respond to improve results in HCAHPS
scores.
• Identify specific ways that Facilities can impact scores on:
– Cleanliness
– Noise
– Courtesy, Listening and Respect
• Understand the relationship between hospital acquired
conditions (infections and patient falls), patient satisfaction and
the built environment.
• Identify specific facility strategies to improve outcome measures
through use of a value and cost relationship improvement tool.
3The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Presenters
Terry Thurston, RN, BSN, MBA
Director of Healthcare Operations Planning,
BSA LifeStructures
Joe Mynhier, AIA, ACHA, NCARB
Principal, BSA LifeStructures
4The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
What are HCAHPS?
HCAHPS
Hospital Consumer Assessment of
Health Care Providers and Systems
Hospital’s reimbursement is partly
based on scores they receive on the
HCAHPS
http://www.medicare.gov/hospitalcompare/compare.html#cmprTab=1&cmprID=150024%2C150056%2C150074&loc=INDIANAPOLIS%2C%20IN&lat=3 9.7685155&lng=-86.1580736
CMS LINK:
5The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Comparative Analysis by State
6The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Comparative Analysis by State
7The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Interpreting the HCAHPS Scores
8The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Interpreting the HCAHPS Scores
9The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
The Patient Experience Paradigm
10The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Operational & Facility Planning
Driven Design
11The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Value Based Purchasing – Aligned
Goals
Patient ExperienceMeasures(HCAHPS)
Outcome Measure(2014)
CoreMeasures
Hospital Acquired
ConditionMeasures
30% (+/-)
(+/-) 45%
(-) 25% (+/-)
SAFE
EFFECTIVE
PATIENT CENTERED
EFFICIENT
TIMELY
EQUITABLE
AFFORDABLE
12The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Accelerators
Relationship Between HCAHPS
& The Built Environment
HOSPITAL ENVIRONMENT
QUESTIONS
HOSPITAL ENVIRONMENT
QUESTIONS(QUESTIONS 8 & 9)
CARE COMPOSITE
QUESTIONS(QUESTIONS 1-3, 5-7)
During this hospital stay, how often
were your room and bathroom kept
clean?
During this hospital stay, how often
was the area around your room quiet at night?
Courtesy
Respect
Listen
Explain
13The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Built Environment Response To Care
Composites
Questions 1-3, 5-7
Adequate caregiver space at
the bedside1
Built
Environment Impact
Respect, Courtesy,
Listen, and Explain
(The Engaged
Employee) Off-stage collaboration areas
to facilitate manager rounding
& team communication2
Caregiver Support Spaces3
14The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Built Environment Response To Care
Composites
• Computer
orientation
• Staff Seating
• Supplies at bedside
(80/80/80
Guideline)
• Clear of Family
Zone and path of
travel to bathroom
• Collaborative areas
at patient bedside
Adequate Caregiver Space At Bedside
BSA LifeStructures
BSA LifeStructures
15The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Photo © John Durant | www.johndurant.com
Built Environment Response To Care
Composites
Caregiver Support Spaces
• Staff Lounges
• Entrance
• Respite Areas
• Natural Light
• Ergonomics
16The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Hospital Acquired Conditions: Patient
Falls
Condition
Travel path to and from the
patient bathroom are the most
frequent contributors to falls1
Built
Environment Impact
Unobstructed Pathways2
Lighting and Finishes
Patient falls in room
& bathroom
contribute to
increased patient
morbidity, mortality,
LOS, & cost of care
3
17The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
• Unobstructed path from bed to
bathroom in few steps
• Leafed double bathroom door
• Handrails to bathroom and vertically
outside bathroom door
• Non-slip flooring
• Lighted pathway from bed to
bathroom
• Visibility from corridor to bed or foot
of bed
• Toilet in center of bathroom (2
caregiver assist)
Preventing Patient Falls
Environmental Recommendations
Clemson University Patient Room of the Future
18The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Hospital Acquired Conditions:
Infection Prevention
Condition
Location of sink and hand
sanitizers1
Built
Environment Impact
Personal protective
equipment (PPE) location
Cleanability and surfaces3
Hospital Acquired
Infections
2
19The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
• Sink located at entry to patient
room
– Features: height, depth, faucets,
splash, visibility to patients
• Cubicle curtains: cleanable, hand
guards
• Enclosed toilet in ICU
• Personal Protective Equipment
Location
Hospital Acquired Conditions:
Infection Prevention
Dublin Methodist Hospital
© John Durant | www.johndurant.com
© The Chester County Hospital
http://www.cchosp.com/images/Tower/P_PatientRoom_lrg.jpg
Environmental Recommendations
20The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
PERCENTAGE OF MEDICARE PATIENT STAYS IN SINGLE
OCCUPANCY ROOMS 2002-2010
SOURCE: “HEALTH CARE CONSTRUCTION OUTLOOK FOR 2012 AND BEYOND” © 2012 THE
ADVISORY BOARD COMPANY
Private Rooms – Still Not There
2002 2003 2004 2005 2006 2007 2008 2009 2010
27.5%27.7%
28.2%
28.5%
29.0%
29.7%
30.2%30.0%
31.1%
21The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
The Hospital Environment: Patient
Room Cleanability And Finishes
Question #8
A clean room contributes to
higher patient satisfaction1
Built
Environment Impact
Due to surfaces and
products selected, a clean
room may not look clean
Contaminated environment
contributes to hospital
acquired infections3
During this hospital
stay, how often was
your room and
bathroom kept
clean? 2
22The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Keeping The Patient Room Clean:
Cleanability
Design Considerations For Furniture, Casework, & Built-ins
• Floor plan layouts
• Furniture locations
• Built-in casework locations
• Areas to collect dust
• Difficult areas to clean
23The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Keeping The Patient Room Clean:
Furniture Location & Design
• Fixed vs. Moveable
• Snug Fit vs. Awkward
Voids
• Appropriate Cleaning
Products
BSA LifeStructures BSA LifeStructures
BSA LifeStructures
24The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
• Floor plan configuration
– Avoid acute angles and corners
• Furniture location and placement
– Avoid tight and compact areas which will be difficult to clean
– Anticipate where furniture can be moved
• Areas that collect dust and dirt
– provide soffits above upper cabinets
– provide soffits for task down lighting
– provide sloped tops as an alternative to soffits
Keeping The Patient Room
Clean: Floor Plan Design
Environmental Recommendations
25The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Keeping The Patient Room
Clean: Finishes And Products
26The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Keeping The Patient Room Clean:
Finishes
Environmental Recommendations
Flooring, Walls, & Ceiling
• easy to clean
products
• products that look
clean
• simple cleaning
instructions
MDO Wall
The Mohawk Group Armstrong
27The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
The Hospital Environment: Patient
Room Internal & External Noise
Question #9
Noise contributes to lower
patient satisfaction1
Built
Environment Impact
Noise contributes to slower
recovery of the patient
Noise contributes to longer
lengths of stay3
During this hospital
stay, how often was
the area around your
room quiet at night?2
28The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Sound Levels In Decibels
• JACKHAMMER 130
• COMMERCIAL JET 120
• LEAF BLOWER 110
• BABY CRYING 110
• FLUSHING TOILET 80
• NORMAL CONVERSATION 60
• ARCHITECT-LATE PAYMENTS 200
29The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Preventing External Noise
Noise From Corridor To Patient Room
Noise From Other Sources To Patient Room
• From staff/physicians near
patient room door
• From caregivers/visitors in
corridor
• From equipment in corridor
alcoves & storage
• From decentralized nurse work
stations
• From mechanical and HVAC systems
30The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Preventing External Noise
Decentralized Nurse Work Stations
• Collaboration adds noise to corridor
• Work station adds noise at patient room entry
• Corridors remain same width despite function change
BSA LifeStructures
31The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
• Implement sound attenuation techniques
– Sound masking at door
– Sound insulation along corridor wall
• Implement caregivers/visitors “reduce voice volume” program
– Quiet zones
– Provide sound recording devices in key locations (green,
yellow, red light)
• Implement mitigation of external noise
– Remove moveable items, carts & equipment
– Sound insulation added at external sources
– Study door locations to avoid door alignment
Preventing External Noise
Environmental Recommendations
32The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Preventing Internal Noise
Noise Within The Patient Room
Noise From Patient Room To Patient Room
• From toilet in adjacent patient
room
• From television in adjacent
patient room
• From adjacent mechanical rooms
• From caregivers/visitors in
adjacent patient room
• From equipment in patient room
• From caregivers/visitors in patient
room
33The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Preventing Internal Noise
34The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
Information Overload?
• This year, 5 million times the information included in all the books ever written, will be created
• A majority of people say that less than half of the information they receive is valuable
• A majority of people wish they could spend more time working with the information they have versus trying to manage it
So how do you use the information we have given you?.......
35The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
HCAHPS Improvement Grid
36The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
HCAHPS Improvement Grid
37The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
HCAHPS Improvement Grid
38The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
HCAHPS Improvement Grid
39The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
THE RELATIONSHIP BETWEEN HCAHPS
AND FACILITIES: HOW TO IMPROVE
SCORES IN NEW AND EXISTING
HEALTHCARE FACILITIESNOVEMBER 7, 2013