Improving Healthcare Blog

Saluting the Beacons of Patient-Centered Care

Christina Dempsey, MSN MBA CNOR CENP, Chief Nursing Officer — Thu, 09 May 2013 17:01:27 GMT

National Nurses Week was established by the American Nurses Association to help celebrate nurses and all that they do. At Press Ganey, we recognize the importance of nurses in the patient experience every day. Our own nursing base includes more than 33 nurses working with four physicians and other clinical specialists to promote and support the development of patient-centered care models in health care systems nationwide.

The theme of Nurses Week this year is especially relevant to our mission: Delivering Quality and Innovation in Patient Care. The commemorative week began on May 6 and will end on May 12, the birthday of Florence Nightingale, the “Lady with the Lamp.”

Florence Nightingale was adamant about the patient experience – from her early work with infection control (she had the audacity to suggest that caregivers actually wash their hands and patient bedding) to her calming and warm demeanor with the dying soldiers during the Crimean War to her focus on education and the advancement of nursing as a profession. Through her words and actions, she was a beacon of excellence who demonstrated an instinctive understanding that providing quality health care requires focus on the clinical, operational, cultural and behavioral aspects of the care we provide.

Nursing is and always has been hard work. Technology has helped make it safer, and we have reaped the benefits of efficiency with data analysis, process redesign and an understanding of how operations management science applies to the care we provide and how we provide it. We have magnificent drugs, surgical techniques and diagnostic equipment that influence how we provide care every day. And we have the tools to measure and compare performance so that we can learn from each other and improve what we do. There is no question that healthcare and the nursing profession have come a long way. We have resources that Florence Nightingale could have only imagined. But it is still hard work.

Florence Nightingale achieved what she did with virtually no resources – no electricity, no infection-control policies, no antibiotics, no laundry facilities and no robust ways to offset the pain and suffering of those around her. But she had a strong will, a dedication to her patients and a small group of nurses who shared her passion and worked with her as a team. Together with the physicians and small cadre of volunteers, they saved many lives and helped ease the suffering of those they could not save. Imagine what she could have done with the tools, information and communication abilities that we have today!

The spirit and mission of nurses haven’t changed much since the days of Florence Nightingale. We are still a strong-willed, dedicated team of professionals working with our health care partners to save lives and ease suffering. We still very much carry the lamp of Florence Nightingale. She would be proud!

How Engaged are Your Nurses?

Krista Mahalchik, Principal Consultant , Press Ganey — Mon, 06 May 2013 12:11:44 GMT

As a nurse, we have the opportunity to heal the heart, mind, soul and body of our patients, their families and ourselves. They may forget your name, but they will never forget how you made them feel. -- Maya Angelou

Registered nurses are critical players in the quest for high-quality, value-based, patient-centered care, and make up the largest portion of the health care workforce in the country. Today, there are more than 3.1 million registered nurses nationwide, according to the US Department of Health and Human Services. They represent a unique and significant group for health care leaders’ attention.

Because nurses comprise such a significant portion of a health care organization’s workforce and their direct interaction with patients has been shown to influence treatment, recovery and satisfaction, the value of improving nurse engagement cannot be overstated and is well supported.

Our data indicate that health care organizations with highly engaged workforces receive higher HCAHPS scores, and have lower staff turnover and better clinical outcomes relative to organizations with low levels of engagement.

Further, a white paper published by the Institute of Healthcare Improvement indicates that the engagement of staff and providers in the organization are one of the five primary drivers of the patient and family experience.

However, nurses are a highly discerning group. They have a more critical view of their workplace and lower levels of engagement than other health care professionals, based on a recent review of our data. Specifically, registered nurses scored significantly lower than employees as a whole on approximately 75% of the areas that were explored, while only about 15% scored significantly higher than the workforce average – findings that point to nurse engagement as a promising improvement target.

To improve the engagement of the nurses in your organization:

Provide clarity and purpose. Across organizations, nurses tend to perform favorably with respect to teamwork and patient care within work units, and when there is good job-person fit (when they know what their responsibilities are and enjoy their work).
Create an ongoing dialogue and feedback loop. Determine what they struggle with the most; discover why these issues exist and what can be done to remediate them. Common themes stand out when looking at nurses across organizations:

Time and resources. Nurses seek the staffing, tools and resources to be able to provide safe, quality care while also maintaining a positive work-life balance.

Patient care at the organization level. They are concerned about measureable performance improvement over the past year and making patient safety a priority.

Satisfaction with benefits.

Leadership. Nurses want to be confident that nurse, physician and administrative leaders are listening and that their input is informing improvement decisions.

Organizational culture. They want to know that the organization cares about things such as employee safety and well-being and environmental responsibility.

Identify and respond to the unique engagement drivers for Nurses:. Nationally, key drivers of nurse engagement include clear job responsibilities, respect, work-life balance, job stress and benefits. Key drivers point you directly to areas that will give you the greatest ROI when trying to improve. Among these key drivers, work-life balance tends to be a low-scoring item for nurses, nationally. Thus, targeting this area for improvement would be a good place to start for many organizations.

While national trends for drivers of nurse engagement are useful as general guides, the strengths, opportunities, and key drivers within individual organizations will be unique. Therefore, it is important to understand what drives engagement for nurses in your organization and to target areas for improvement accordingly.

Data Ahead! Proceed with Caution, Context and Understanding

Nell Wood Buhlman, MBA, Vice President, Product Strategy — Thu, 25 Apr 2013 14:29:19 GMT

If you have been in health care quality measurement and improvement as long as I have, you probably share my excitement about all of the media attention it’s getting these days. And it’s not just showing up in “our” media. It is also making headlines in the popular media, thanks to the accountability and pay-for-performance programs at the heart of the Affordable Care Act.

At the same time, you may also find yourself concerned about the way hospital performance data are frequently misinterpreted or misrepresented, and by the erroneous conclusions that are sometimes drawn.

Last week I read an industry news item that summarized a scholarly article titled “Patient satisfaction as a possible indicator of quality of surgical care,” which appears in the April issue of JAMA Surgery. I was instantly drawn in — this would be something new and exciting if there were a relationship. My excitement was short-lived as no relationship was observed by the authors. But the real disappointment was what I perceived to be a lack of support for the use of patient-experience measures to evaluate hospital performance.

The study compares 31 hospitals’ performance on the Overall Rating within HCAHPS to their performance on the Surgical Care Improvement Program (SCIP) core measures. The SCIP measures evaluate compliance with a set of evidence-based standards of care for surgical procedures — most of them related to infection control and the prevention of venous thromboembolism (VTE). Not surprisingly, the study authors found no association.

While there is a fair amount of variation in hospital performance on HCAHPS — on all the domains, not just the Overall Rating domain — there is very little variation in hospital performance on the SCIP measures. Therefore, the likelihood of finding an association between the two is practically non-existent. This is not meant to disparage the investigation undertaken by the study authors, who would not have been familiar with the performance trends of the measures. On this point, my understanding is not intuitive; I owe it to the fact that my research colleagues at Press Ganey look at these measures from every possible angle and continue to do so as new measures and more granular data become available.

The findings are also limited by inaccuracies with respect to core measures and HCAHPS. For example, the study includes an outpatient measure, yet outpatients do not receive HCAHPS surveys. Further, the researchers reported finding no correlation between patient satisfaction and performance on process measures, including appropriate hair removal for patients undergoing surgery, yet CMS does not require measurement of appropriate hair removal for submission. This measure is not used currently, nor is it a candidate for any of the national pay-for-performance programs.

On the HCAHPS side, the study focuses solely on the relationship between SCIP compliance and Overall Rating, an HCAHPS measure which is somewhat “distant” from the surgical suite. The authors acknowledged that using a global score for hospital-wide patient satisfaction was a “limitation” necessitated by the fact that surgery-specific satisfaction scores were not available. In the absence of surgery specific data, an examination of the relationship between SCIP compliance and physician and nursing domains, both of which are available for analysis, might have been more informative.

But most importantly, I am troubled by the possibility that these findings might diminish the perception of the value of the patient’s voice in understanding and improving hospital performance.

The authors do acknowledge that patient satisfaction encompasses the important customer service component of a patient’s experience. They also suggest the possibility that performance on the various experiential domains “may be surrogates of a well-coordinated and patient-centered level of service.” But they are not supportive of the use of these measures for assessing anything beyond service quality when, in fact, patient experience-of-care metrics, on their own, speak volumes about the presence or absence of defects in the care-delivery process. Additionally, when used in concert with other performance measures — clinical, outcomes and utilization — they reveal the degree to which an organization is truly delivering patient-centered care.

A truly patient-centered approach considers the patient an active participant in his or her own care and takes patients’ assessments of their care very seriously. Hospitals that put the patient at the center of all they do look to their performance on patient experience-of-care metrics for important insights about whether they are delivering care that is defect-free. In addition, patient-centered organizations recognize stress and anxiety as a form of harm, which can be detrimental to both healing and recovery. They use survey performance data to determine if their care environment is a healing one, to identify areas in which they have been able to minimize patient stress and anxiety and to uncover areas in which there is opportunity to improve.

The study authors conclude by challenging the idea that a “patient’s level of satisfaction reported in isolation of other surgical outcome metrics reflects the quality of a surgeon’s procedure or the perioperative expertise associations with the care.” Agreed, but the HCAHPS survey does not ask patients to rate surgical technique or anything else of that nature. Additionally, HCAHPS performance is not considered “in isolation” by any of CMS accountability or pay-for-performance programs. Rather, it is part of a balanced approach that looks at hospital performance on a variety of domains.

While I am not asserting that any of the mandatory reporting programs is perfect, I do think they encourage progress toward greater accountability and a commitment to capturing the voice of the patient with the intent of identifying improvement opportunities. The integration and prominence of the patient’s assessment into these programs is the very thing that will ultimately help the industry achieve true patient-centeredness.

A Day Not Soon Forgotten

Patrick T. Ryan, Chief Executive Officer — Fri, 19 Apr 2013 23:06:30 GMT

This week in Boston, we have seen both tragedy and hope.

On Patriot’s Day, known in Boston as Marathon Monday, my wife and I were in town excitedly following my daughter’s progress along the course as she ran her first marathon. We met her at several spots along the way, each time offering words of encouragement. Each time, as planned, we met her on the right side of the street.

Less than two miles from the finish line, we met again and I jumped into the race to join her for the home stretch. She had spiritedly done the same for me years ago! When we met up, I called my wife to give her a heads up that we’d be at the finish line in minutes – where, like any proud mother, she was stationed, thankfully on the right side of the street. The mood was euphoric.

Minutes later, everything changed. As we approached the turn on to Boylston Street, I received a text from my wife, “Bomb just went off at finish line.” My heart sunk. The next text said, “I’m ok heading to hotel.” A sigh of relief.

The ensuing minutes and hours after the race were surreal. Faces were grim, runners were confused, cold and exhausted. My daughter and I headed for the safety of her apartment as my wife went to a friend’s home nearby. The walk seemed to last forever – people’s faces had the look of shock and horror. All the while, ambulance sirens blared and black SUVs screeched through the streets. By early evening, we were reunited as a family, safe and unhurt. My wife, who witnessed the blast, was shaken, but strong.

As I reflect on this week’s tragic events, which are still unfolding, I am incredibly grateful for the health and safety of my family. My thoughts are also with the families of the victims and others suffering physical and emotional trauma, who now face a long road to recovery.

Watching the broadcasts and seeing the video of the event over and over again, I continue to be in awe of the local hospitals and health care professionals who worked tirelessly to respond to the unexpected. This is yet another example of the strength and selflessness of the health care community, which is often at the epicenter of response in times of tragedy. The physicians, nurses and other caregivers were heroes, as they are every day in your facilities, and gave support that comforted thousands and saved the lives of many. I will forever remember their work on April 15, 2013.

During this difficult time, I wish strength to you and your communities. Although this event struck my hometown of Boston, we have all faced periods of distress that bring us together as a nation. I vow to use this experience to inform and inspire the work we do at Press Ganey to support health care organizations in providing high-quality care for every patient, every day.

Disconnection from Organizational Goals: Canary in the Coal Mine?

Trevor Byrd, Ph.D., Managing Consultant — Tue, 02 Apr 2013 18:45:56 GMT

One of the best things about my job is the opportunity it gives me to contribute to health care organizations. Most health care providers entered their chosen professions to satisfy a desire to help others. This is just as true for those individuals within health care organizations who work in support areas such as finance, human resources, food services and environmental services. The common thread that ties patient-facing and support staff together is a shared dedication to the mission of the organization.

The fact that the health care workforce feels so deeply connected to this organizational mission is a critically important consideration in the current health care climate, in which leaders are facing unprecedented financial challenges and employees are often being asked to share some of the burden. While such challenges can lead to increased stress and strain, employees’ commitment to providing quality, compassionate care – either directly or indirectly – can help them persevere.

Given the importance of this deep-seated connection, it is surprising to note that we have observed a statistically significant decline on a survey item within our national health care workforce database that assesses how well employees understand the connection between their work priorities and the goals of their organization.

While this item refers to organizational goals rather than mission specifically, the two are typically directly related. If health care employees across the country are potentially losing their line of sight to their organizations’ goals, chances are good that they are also losing the ability to see how their work connects to the mission of the organization. In turn, this could weaken their ability to draw on their intrinsic motivation to meet some of the challenges that leadership needs them to overcome in order for the organization to succeed.

Although the benchmark score on this item is relatively strong – above 4.30 on a 5.0 scale – the fact remains that it has declined significantly. This begs the question “why?”

Is this decline due to fewer efforts across organizations to communicate with employees about how their work directly connects to the success of the organization? Is it a reflection of the changes we are observing within health care – the alignments, acquisitions and introductions of new services – that make employees less certain about how their work connects to the organization’s ultimate goals?

If the answer to these questions is “yes,” the next question should be, what can health care leaders do to reconnect employees with their organizations’ fundamental mission in meaningful and personally rewarding ways?

What do you believe could be causing this decline? What are you doing within your own organization to help employees keep sight of how their work contributes to the organization’s mission and goals?

Health Care Costs: A Balanced Discussion

Christina Dempsey, MSN MBA CNOR CENP, Chief Nursing Officer — Thu, 28 Mar 2013 20:20:28 GMT

In his recent Time magazine article, “Bitter Pill: Why Medical Bills Are Killing Us,” Steven Brill provides a thought-provoking review of the issues related to health care economics. Though somewhat sensational, the article forces us to ask critical questions about health care costs in this country: Why do we charge what we do? Can we deliver quality care for less? If so, who is going to take the lead, and how are we going to do it?

The questions sound simple. The solutions are not. They will require cross-sector collaboration between and among hospitals, providers, government, payers and even patients.

As a nurse manager years ago, I was asked by one of the newer nurses, “Why does Tylenol cost so much when you’re in the hospital?” It was a valid question. Steven Brill expressed a similar sentiment: If generic acetaminophen costs less than 2 cents per tablet at the drug store, why are hospitals charging $1.50 per tablet?

The answer is not “because they can.” It is because the in-hospital cost reflects both the price of the drug, and also all of the costs associated with the administrative and safety processes involved in getting the medication from the manufacturer to the patient, including but not limited to receiving, counting, checking, delivering, dispensing, documenting, and administering it.

Every step in the process is associated with underlying labor, material resources and capital costs. In many ways, these are the “hidden” costs of inpatient care, because patients do not receive line-item bills for nursing care, pharmacists, orderlies, dispensing machines and so forth. Certainly, some of these costs are built into the room charge, but not enough to compensate for the “price” of the all of the processes intended to improve health care safety and quality. And the costs are even higher for things like invasive procedures.

So, yes, running a hospital is expensive, but consumers are not powerless in the face of rising health care costs. Most of us would never go to a store and load up on items without checking prices and considering whether we could afford the items in our cart. We should assess our non-emergency hospital “purchases” in the same way by asking providers to explain the services and treatments they are suggesting, the associated costs, and whether similarly effective, but less expensive options, are available. That is the foundation of informed decision making.

In its document titled “Ensuring a Healthier Tomorrow: Actions to Strengthen Our Health Care System and Our Nation’s Finances,” the American Hospital Association recognizes that all parties — government officials, hospital administrators, health care providers, payors and patients – have a role in ensuring that health care dollars are spent wisely and recommends ways to promote and reward this type of accountability across the board.

It has been said, “Culture eats strategy for lunch every day.” It will be very difficult to change the culture we have in place for health care, but change will absolutely happen because the status quo is not sustainable. The question all of us should be asking is whether we want change to happen to us or by us.

Tell Us, What’s the Secret?

Melissa Dobereiner, Patient Experience Advisor, Press Ganey — Fri, 22 Mar 2013 15:58:05 GMT

“What’s the secret?”

As an advisor with Press Ganey for more than seven years, I am asked this question often.

In this era of health care reform and value-based purchasing, when all eyes are firmly fixed on improving quality, it is no surprise that health care administrators are searching for that “sure thing” — the quick fix that will effect meaningful change and substantial return on investment.

So, here it is: there is no secret.

Success is hard-earned, and when it comes, it is well deserved.

Coast to coast, health care organizations are dedicating time, energy and resources to create a culture where change is not only possible, but also sustainable. Always, it is the product of a concerted organizational effort, requiring the hard work of many. And while there is not one specific secret to success, there are a number of factors that will increase the likelihood of a successful outcome.

Here are some of the key hallmarks of consistently top-performing organizations:

Leadership Engagement. Engaged leaders focus their attention on the specific factors that will have the most impact on the quality scores, rather than on the scores themselves. Through open, consistent communication with staff, these leaders gain support for their priorities through positive example;
Accountability. In my experience, every organization knows what practices and behaviors they could employ to improve the patient experience. A key differentiator separating organizations that are struggling to reach their goals and those that are consistently top performers is their ability to implement those practices and behaviors on a consistent basis. The commitment to ensuring that every staff person is held accountable to the expected standards is not an easy task. Maintaining accountability is not an easy task, but it is a valuable one.
Transparency. Sharing data with staff not only helps them feel a sense of ownership and empowers them to drive the patient experience, but it uncovers the opportunities that will help them refine their approach with patients.

Individual organizations incorporate these tenets of success in different ways. For example, Oakwood Heritage Hospital in Taylor, MI, a 2012 Press Ganey Success Story Award recipient, integrated creative strategies to propel their HCAHPS scores to top decile performance. In 2009, new division President Kelly C. Smith partnered with the service excellence staff to create a fresh spin on some standard best practices, such as rounding and discharge calls. To keep their progress transparent, the team created a “90 in 90” campaign that reminded staff of the goal to reach the 90th percentile, as measured every 90 days. To promote accountability, the team utilized weekly line-up and daily patient-rounding reports. To sustain this success and promote additional improvement, the hospital keeps staff engaged with reward and recognition, and relies on multidisciplinary work teams to identify new opportunities for progress.

Rather than seeking out the “secret” to success in terms of improving quality measures, a more relevant question that organizations should be asking is “what can we do to pave the road to success?”

Strategies for Success under Sequestration

Diana Mahoney, Editorial Manager, Press Ganey — Wed, 13 Mar 2013 13:03:11 GMT

In the days leading up to the March 1 sequestration deadline, the frenzy surrounding the legislation took on a life of its own. As zero hour for the across-the-board spending cuts approached, those ringing the warning bells portrayed sequestration as a finite cataclysmic event. In reality, the only finite aspect of it would be the one-time trigger pull that would set into motion a complex cascade of events.

With respect to health care, the order called for a 2 percent cut in government reimbursements to Medicare providers for services provided on or after April 1, effectively reducing Medicare spending by about $11 billion for the year and $100 billion over a decade. Providers will feel the first impact with the April monthly payment for Medicare Advantage (Part C) and drug plans (Part D).

The sequestration cuts come on top of already scheduled payment reductions mandated by the Affordable Care Act, including a 0.8% reduction in the inpatient market basket update for acute-care hospitals, aggregate payments for excess readmissions, and the value-based purchasing program, which links financial incentives and penalties to quality measures.

Understandably, there are significant concerns regarding the impact of these cuts on the ability of Medicare providers to manage profitability while providing safe, cost-effective, quality care — especially those with disproportionally large Medicare populations. With that in mind, there are a number of things hospitals and health centers can do to take action:

Ask patients what they need, and listen to what they have to say. Their input is as critical if not more than national trends or theoretical models of volume-drivers.
Engage clinicians and other staff in cost-savings brainstorming. Caregivers and support personnel are critical to the delivery of quality healthcare, and their insight should be valued as such. Frank discussions with key staff may lead to new ideas for achieving cost savings that would not be apparent otherwise.
Consider increasing the number of advanced practice nurses and mid-level providers in an effort to deliver quality primary care at a lower cost where appropriate.
Invest in quality improvements. A significant body of research indicates that increases in quality lead to decreases in cost in the long run.
Implement new efficiencies by focusing on patient flow improvements; consider shifting the focus to more ambulatory and primary care; and removing redundancies in the processes that add cost, but not value.
Keep your eyes on the prize. Continue to make quality health care the goal, and communicate your commitment as a shared objective across the organization.

Making the Case for Healthcare Workforce Engagement: 2013 Edition

Anna Vordermark, MBA, CSMA — Thu, 24 Jan 2013 15:44:28 GMT

Editor’s note: In Q4 2012, Press Ganey acquired Morehead Associates, combining the market leaders in measuring and understanding the voices of patients, employees, and physicians. Anna Vordermark joins Press Ganey from Morehead Associates’ Product Management team, based in Charlotte, North Carolina.

New Year’s Day 2013 was a stressful time in healthcare: uncertainty about the long-term implications of the fiscal cliff compromise measure weighed heavily on the minds of administrators who worry about the economic tradeoff for blocking the sharp cut in Medicare payments to doctors.

Additionally, on the first of the year, the clock started ticking on the countdown to the January 1, 2014 implementation of the Affordable Care Act, under which all Americans are guaranteed access to health care. Using conservative estimates, approximately 30 million people who were not insured in 2013 will have health insurance coverage in 2014. In other words, our current system needs to make room for 82,192 more patients every day of 2013—that’s approximately 3,400 new patients every hour.

The pervasive fear, of course, is that the swollen healthcare system, which is already plagued by a shortage of physicians, will collapse under its own weight. In the “State of the Healthcare Employee Engagement” report published last January, Morehead Associates presented the cumulative findings of more than 37 million data points from health care employee engagement surveys. The lowest-scoring survey item for the U.S. workforce was, “My work unit is adequately staffed.” Ironically, the highest scoring survey item in the same report was, “I like the work I do,” followed closely by, “Patient safety is a priority in this organization.” The message couldn’t be any clearer: We have a health care workforce that is dedicated to providing excellent patient experiences, but a health care system that doesn’t always support those efforts.

Without question, the healthcare workforce of 2014 and beyond will be expected to do more with less, which will ultimately require the adoption of a different type of healthcare delivery system. As Kenneth Kaufman and Mark Grube point out in their report, “The Transformation of America’s Hospitals,” (Society for Healthcare Strategy and Marketing Development, 2012), the physician-centric approach to episodic patient care “will need to be replaced by a team-centric approach to population health management, which will require the close integration of hospitals, physicians, and other providers.”

In anticipation of the upcoming demands on the healthcare system, the American College of Healthcare Executives (ACHE) recently revised its policy statement on staff shortages. The updated document recommends that health system leaders conduct employee opinion surveys and exit interviews to identify and address issues that negatively affect job satisfaction. It also suggests identifying employee engagement opportunities to support recruitment and retention efforts; using department-specific data to diagnose staff morale challenges, and looking to best practices from similar organizations to avoid staff shortages.

The benefits of workforce engagement extend beyond employee retention. Morehead’s most recent research using 2012 HCAHPS data, shows that healthcare organizations who achieve top decile employee engagement scores significantly outperform the rest of the health care industry in the percentage of employees who give the highest positive rating of the hospital as a place to receive care and the highest positive rating of their likelihood to recommend the hospital to friends and family. In the coming months and years, with the progressive implementation of value-based purchasing (VBP) protocols and other performance-based financial incentives, the value of this association will have an ever-greater impact on an organization’s bottom line. Health care providers who understand the link will be in the best position to use the metrics to their advantage, and by so doing will be better able to maximize clinical outcomes without sacrificing a quality patient experience.

Creating a healthcare system based on a foundation of engaged employees and satisfied patients is definitely a New Year’s resolution worth making.

References:
Society for Healthcare Strategy and Marketing Development (2012). Futurescan 2012: Healthcare Trends and Implications 2012-2017. Chicago, Il: Health Administration Press.

News from the 2012 National Client Conference – Innovation Pavilion

Press Ganey — Fri, 30 Nov 2012 21:37:53 GMT

Throughout the National Client Conference, attendees had the opportunity to experience the innovative and seamless solutions Press Ganey delivers from several different angles. An intriguing entryway drew curious crowds into the Innovation Pavilion, a colorful and welcoming space that provided clients the opportunity to interact with staff and learn more about the company’s integrated solutions. In keeping with the conference theme of transformation, a team of local D.C.-area artists, led by Matt Reckeweg, worked steadily at the center of the pavilion on an installation whose form and meaning emerged as the conference progressed.

“The goal with the pavilion and the installation was to give our clients a better understanding of Press Ganey’s innovative solutions and expertise, and our commitment to helping them transform their patients’ experiences,” said Michele Ahern, creative director. “This space was unlike anything we have done before, and people responded very positively.”

Special lighting helped set the stage while the artists painted and affixed everyday medical paraphernalia — including syringes, test tubes, and pill dispensers — on multi-colored panels that gradually, over the course of three days, took the shape of an enormous butterfly. Juxtaposing Press Ganey offerings with this kind of art-in-progress helped to underscore the conference theme, according to Gwendalyn Hadley, marketing manager, lead generation and events.

“We wanted it to be educational as well as experiential,” she explained. “By delivering our message in several different ways — through the breakout sessions, the pavilion and the artwork — we were hoping to reinforce the need for our clients to see the patient experience in different ways, and how we can help them do that.”

News from the 2012 National Client Conference – Transformation to Excellence: A Model for Patient-centered Care in the Emergency Department

Press Ganey — Fri, 16 Nov 2012 14:00:00 GMT

While the 24-bed emergency department at Allen Memorial Hospital had a solid reputation, its waiting room had become a patient room for many of the 35,500 visits it had each year, according to Tami W. Jones, director of emergency services and critical care. Non-acute patients routinely waited up to six hours just to be seen.

“Press Ganey saw a good ED, but not an efficient one,” she said. “We needed to move from a staff-centric to a patient-centric triage process."

Working with Press Ganey’s Sandy Myerson, a clinical consultant, Jones and Christopher Hill, DO, medical director, began in 2011 to use an adaptive design methodology to observe, learn and solve problems with the hands-on staff. They also closely analyzed data, using it to drive their decisions. By clearly specifying the role of everyone in the department and charting patient flow, they ultimately eliminated the existing formal and cumbersome triage process in favor of immediate bedding whenever possible. ED staff also transported patients to inpatient units to eliminate delays.

“We had to own our part of the process,” said Hill. “It wasn’t the most popular thing, but it’s what the patients wanted. That’s our rationale to the doctors on the floor and to the hospital board.”

A one-room, four-bed rapid treatment center dedicated to non-acute patients cut wait times to less than two hours and led to an increase in market share.

“Our numbers have picked up – we’re very busy,” said Jones, “but our waiting room is often empty.”

News from the 2012 National Client Conference – Hartford Hospital’s Journey Toward Excellence

Press Ganey — Fri, 16 Nov 2012 13:43:13 GMT

The 12” retractor a surgeon left inside a patient in 2007 was hardly representative of the quality of care provided at Hartford Hospital, an 867-bed, urban Level I trauma center. But the incident was emblematic of how the flagship of Connecticut’s Hartford HealthCare was introduced in 2008 to its new president and CEO, Jeffrey A. Flaks, as “a place of bad news.”

With razor thin margins, static market share and poor staff morale, Flaks and Jamie Roche, MD, vice president of patient safety & quality, rolled out H3W (How Hartford Hospital Works), a comprehensive strategy that over four years would lift the then 155-year old hospital out of probationary status and raise patient satisfaction from 15% to 54%. They built an operational structure centered on balanced scorecards and mandatory monthly work groups for all employees. Designed to improve quality, communications and performance, the facilitator-led work groups are rigorously structured to foster employee involvement and serve as a place for ideas to percolate and develop as change processes unfold.

“Before, every unit, including each of our 22 nursing units, had their own processes, so creating change was impossible,” explained Flaks. “Now everyone follows the same process.”

Organization-wide issues are brought to the work groups with plenty of lead time to support a culture of ownership and transparency, and garner input and buy-in. And the work groups are required to spend the allocated quarter of a million dollars to celebrate and recognize their achievements.

“The structure is built around idea generation, and every idea must have a resolution, even if it’s a decision not to address it,” said Flaks.

News from the 2012 National Client Conference – Taking the Time to Understand What Customers Want

Press Ganey — Thu, 15 Nov 2012 21:58:15 GMT

Few questioned the commitment of the 55 paid associates and 100 volunteers of the Mary Washington Hospice who annually tend to 1,000 patients and their families. But in July 2011, when devastating comments from client families shed light on the meaning of its third percentile ranking, Manager Jessica L. Dederer and Nancy L. Jackson, hospital liaison nurse, knew they needed to earn back the trust of the community they’d been serving for 20 years.

“We thought our service was excellent,” said Jackson. “But our patients’ families saw it differently.”

In order to achieve the culture change that would reflect what their clients wanted, Dederer and Jackson added patient-facing caregivers and social workers to its patient satisfaction team and developed the buy-in, collaboration and communication efforts to create a successful turnaround. They used Press Ganey’s Priority Index to hone their focus and networked with other organizations for best practices that would help them bypass common mistakes. As they worked to standardize as many processes as possible, external and internal focus groups helped pinpoint the kinds of actions that would bring about lasting change. Most of those, the presenters underscored, came down to communication.

“Frequent, consistent and clear communication is the key to making all of this work,” Jackson said.

For the last four quarters, ending in Q3 2012, Mary Washington Hospice’s overall patient satisfaction scores were over 95%, which Dederer admits is “more than a fluke.”

“The feedback lets us know that we’re listening to them,” she said.

News from the 2012 National Client Conference – Compassionate Care with Schwartz Center Rounds

Press Ganey — Thu, 15 Nov 2012 18:33:10 GMT

It was a case that went terribly wrong. Seven-year old Conor, who loves reading and LEGOs, was six weeks into his second foster home placement when he spun out of control and talked about committing suicide, despite treatment for his symptoms of ADHD and attachment and oppositional defiant disorders. On the advice of his psychiatrist, his foster parents brought him into the local emergency room where, once evaluated, they waited for him to be admitted to the area’s psychiatric hospital.

Hours passed. Conor’s social worker relieved his exhausted foster father; his pediatrician was called in. But 24 hours later, there was still no place for him and no one knew what to do for the stranded boy.

With this scenario, conference participants got a taste of how Schwartz Center Rounds, the multidisciplinary forum of the Schwartz Center for Compassionate Healthcare, address the emotional and social challenges inherent in patient care while exploring the role that teamwork plays in improving patient quality. Both clinical and non-clinical members of the audience offered their insights on what went wrong for Conor, along with questions and possible solutions based on their own experience, expertise and compassion.

“This is what you get when people have a way to open up, to transform how they work with one another and with patients,” said Pano Rodis, PhD, lecturer in the Geisel School of Medicine at Dartmouth and one of the session’s presenters. “It is of immense value to the core of medical practice.”

News from the 2012 National Client Conference — Improving Patient Experience and Flow

Press Ganey — Wed, 14 Nov 2012 15:49:37 GMT

The rapid expansion of North Shore-LIJ Health System’s Physician and Ambulatory Network Services (PAAN) at the same time it moved toward accountable care and bundled payments required a special approach. It selected two practices — orthopedics and general and vascular surgery — and designed a template of replicable best practices to test and refine in-office patient experience, quality and financial performance.

“The physicians in both practices were all successful in their own worlds,” explained Rosalie Long, NS-LIJ’s vice president of Ambulatory Services. “Our job was to teach each practice to work as a single team and to move from physician-centric to patient-centric thinking.”

The PAAN team worked with Press Ganey’s Senior Vice President of Consulting Services Christina Dempsy to examine every aspect of patient flow, from appointment scheduling through the end of the visit. Using both quantitative and qualitative approaches, including data analyses, simulation modeling and queuing theory, as well as process maps, leadership coaching, change management and overhauling communication strategies, it involved every member of both office staffs and more.

“Stakeholder buy-in — senior leadership, physicians and practice managers — is essential,” said Long. “We began with a visioning process to engage them, drove improvements with patient satisfaction data we shared at every staff and business meeting, and used science and operations management tools to assure its sustainability.

Between January and July, significant improvements in all of its patient satisfaction categories were evident. And the team continues to follow Dempsy’s advice.

“You can be better than the benchmark,” she said. “You can be the benchmark.”