ROI and PatientCentered Care

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ROI and Patient-Centered Care

• GMCF Home Health Meeting
• August 23, 2007

Karen Voll Press Ganey Primary Consultant Home
Health Division
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Our Objectives

• Trends in Satisfaction
• Return on Investment
• Connections between Clinical and Satisfaction
  Measures
• Improvement Strategies

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Press Ganey Associates

• First company to provide satisfaction
  benchmarking to health care organizations
• Founded in 1985 by Dr. Irwin Press and Dr. Rodney
  Ganey
• Largest comparative database
• Process 9 million surveys a year
• Almost 500 Home Health agencies and over 40 of
  hospitals over 100 beds

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Top Line Considerations

• Attract more patients- helps agency grow
• Improve patient loyalty
• Recruit and retain healthcare staff during a time
  of workforce shortage
• Enhanced trust in provider

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Bottom Line Considerations

• Increased market share
• Improved earnings and profitability
• Reduced malpractice risk

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Effects on Clinical Outcomes

• Reduced Patient Stress
• Results in fewer medical complications
• Increased Trust
• Results in greater compliance

Source Press, Irwin. Patient Satisfaction and
the Placebo Effect. Satisfaction Monitor,
May/Jun 2000.
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Harvard Business ReviewThe One Number You Need
to Grow

• Research on loyalty and customer retention found
  that the measure most predictive of financial
  growth was the Likelihood of recommending a
  service to friends and family a standard
  question on PG surveys.

• If growth is what youre after, you wont learn
  much from complex measurementsyou simply need to
  know what your customers tell their friends about
  you.
• The only path to profitable growth may lie in a
  companys ability to get its loyal customers to
  become, in effect, its marketing department.

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Research Questions

• What type of patients are more/less satisfied
  than others?
• How do events that take place during care relate
  to patient satisfaction?
• What is the relationship between
  clinical/functional outcomes and patient
  satisfaction?

OCS National vendor providing analytical data
from OASIS Client Home Health agency serving
more than 20,000 patients per year with 30
diverse programs
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Variables being considered

• Patient Characteristics
• Top ICD-9 codes
• Discharge prior to start of care
• Health Conditions
• Lives Situation
• Risk factors
• Events
• Visit utilization
• Emergent care
• Hospitalizations
• Improvement in clinical/functional outcomes

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Primary Diagnoses
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Satisfaction By ICD-9 Code

• Other and Unspecified Aftercare/Care Involving
  Rehab
• No significant differences in satisfaction rates
• Other Orthopedic Aftercare
• Significantly higher ratings for likelihood to
  recommend the agency
• Heart Failure
• Significantly higher ratings overall than any
  other type of patient
• Diabetes
• Significantly lower ratings on arranging visits
  and concern shown for privacy
• Pneumonia
• Significantly lower ratings on likelihood to
  recommend the agency

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Improvement Tips Arranging Visits

• Stonewall Jackson Hospital Lexington, VA
• Improved satisfaction by 5.8 mean score points
• Provide a calendar to be posted on the patients
  refrigerator identifying the dates and
  approximate times of visits
• Use scripting that includes language that
  emphasizes the patient choice for visit times

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Improvement Tips Privacy

• Knock and ask permission to enter
• Handle patients belongings with care
• Provide information that outlines how the patient
  can expect their privacy to be protected

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Key Factors that Drive Satisfaction Discharge
Prior to Start of Care

• Discharged from hospital care
• Significantly higher ratings on billing, cost,
  nurses contacting ability and technical skill
• Not discharged from hospital
• Less satisfied with billing, cost, nurses
  sensitivity to personal difficulties and
  inconveniences as well as how well the staff kept
  the family informed

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Improvement Tips Kept Family Informed

• Provide multiple learning formats videos,
  documentation, verbal instruction
• Communicate that you expect and welcome questions
• Dont use technical jargon

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Key Factors that Drive Satisfaction Conditions

• Presence of
• Pressure ulcer significantly lower ratings of
  aide friendliness
• Stasis ulcer significantly lower rating of
  therapist
• Surgical wound significantly higher rating
  overall
• Living Situation
• Alone significantly lower ratings of technical
  skills
• Spouse significantly more satisfied with
  therapists
• Paid live-in significantly more satisfied with
  nurses
• Risk Factors
• Smoking rated the amount of attention they got
  higher
• Obesity rated the concern for comfort higher
• No factors rated therapy items lower than any
  other group

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Improvement Tips Aide Friendliness

• Introduce yourself
• Explain your role thoroughly
• Use manners please thank you
• Gently inquire about things that interest the
  person (e.g. flowers, pictures, artwork)
• Appearance makes a difference

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Key Factors that Drive Satisfaction Events

• If emergent care is needed during the course of
  treatment is lowers satisfaction ratings for
  therapists
• Hospitalization due to falls or accidents at home
  during the course of treatment is related to
  lower overall satisfaction

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Key Factors that Drive Satisfaction

• Patients who improved on any aspect of clinical
  care rated higher than those who did not
• Patients who improved in upper body dressing were
  significantly more satisfied overall with
  scheduling, nurses, aides and therapists
• Patients who improved in toileting were more
  satisfied overall, and are more likely to
  recommend
• Improvement in maintenance of oral medications
  was associated with improved satisfaction, more
  than any other factor
• 70 of the items rated significantly higher by
  these patients

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Avera McKennan Home Health

• Sioux Falls, SD
• Scripting
• I care about your privacy/dignity/personal
  needs
• You are the most important member of our team
• We want to include you and your family as we
  plan your care
• CARE Campaign
• Communication
• Attitude
• Responsiveness
• Engagement

Additional information http//www.pressganey.com/
client_recognition/compass_awards/award.php?ca_id
101
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Kings Daughters Hospital

• Madison, WI
• Employees developed set of service standards
• Frequently reviewed Dashboard
• Obtained suggestions from each employee about
  improving departmental performance
• Posting returned surveys on Brag Board
• Co-workers nominated monthly Shining Star
• Managers recognized individual effort

Additional information http//www.pressganey.com/
client_recognition/compass_awards/award.php?ca_id
61
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Questions?

• Thanks for attending!