Creating a Positive Patient Experience Driven Culture Melissa Taylor Director, Patient Access/Pre-Access Cleveland Clinic Cleveland Clinic – About us • Located in Cleveland, Ohio • Nonprofit multispecialty academic medical center, integrating clinical and hospital care with research and education • • • • • • • Main Campus 8 Community Hospitals 18 Family Health Centers Lou Ruvo Center for Brain Health Cleveland Clinic Florida Cleveland Clinic Canada Cleveland Clinic Abu Dhabi (2013) Cleveland Clinic - Statistics • • • • • • 1,300 beds on main campus More than 4,400 beds system-wide 4.2 million outpatient total visits 167,100 admissions 191,500 surgical cases 2,700 physicians and scientists State of Healthcare Reimbursement • CMS – Value Based Purchasing • • • • Pay for Performance – reimbursement contingencies Quality Efficiency Patient Satisfaction • Transparency • Published clinical measures • HCAHPS • Pricing • Informed Consumers Patient choice! HCAHPS - Goals Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Three goals 1. Meaningful comparison for consumers 2. Public reporting is incentive for hospitals to improve 3. Enhance accountability by increasing transparency of quality Source: www.hcahpsonline.org HCAHPS – The Survey • 18 questions about patient care, four screening questions and five demographic questions • Eight critical aspects of care, referred to as the HCAHPS Domains • • • • • • • • Communication with doctors Communication with nurses Communication about medicine Responsiveness of hospital staff Cleanliness and quietness of hospital environment Pain management Discharge information Overall hospital rating and recommendation Source: www.hcahpsonline.org What is Patient Experience? ALL OF IT! “One bad interaction can define the impression. This is well documented in retail and other service business.” - James Merlino, MD Chief Experience Office, Cleveland Clinic Quote Source: HealthLeaders Media, February 24, 2012 Office of Patient Experience • Video Placeholder Where is Patient Access in HCAHPs? • • Overall rating Would you recommend • Vendor Supplemental Questions 1. Speed of Admission Process 2. Courtesy of the person who admitted you Organizational Efforts • Cleveland Clinic Experience Exceptional Employee Experience + World Class Patient Experience = Cleveland Clinic Experience • • • • • • Caregivers Caregiver Awards Pre-hire survey – cultural fit START with HEART ® Patient Advisory Councils Employee Engagement Survey Patient Access Focus • • • • • • • Empower employees to be a part of the solution Minimize calls post-service due to registration issues Pre-Registration Patient wait times Registration times Affect and behaviors Non-patient interfacing registrants in registration area Pre-Registration • Waiting room as first impression • Impact on department through-put • Set standard as 95% pre-service registration for scheduled services • Opportunity – Busiest surgery center in enterprise • Delaying patients to OR • • • • Registered patients at point of decision for surgery Provided business cards with Express Regi phone # Leveraged online registration Supported call center with onsite registration downtime capacity • Used autodialer to contact patients • 35% pre-registration rate to 97% - Sustained! Customer Service Call Reduction We’re #1! Comprehensive Scorecard Scorecard Elements Quality Denials Insurance Ad Hoc = Coaching Score Future: Copay Contribution, Customer Service, Productivity Patient Tracking Software - Benefits • Elimination of paper sign-in sheets • Identification of bottleneck via dashboard and reporting • Real-time staff monitoring with opportunity to adjust • Real-time patient flow technology • Constant spotlight on patient experience in Patient Access Robust Reporting • Patient wait times • Summary • Detail to patient level • Patient flow • Productivity • On demand and scheduled reporting Registration Through-put Monitoring • Patient Check-In • • • • Patient to be greeted by person, not clipboard Patient checked into software tracking tool by greeter Clock begins to measure patient wait times Simple and easy to use Real-time Dashboard Dashboard Features • Ability to prioritize patients • Area and priority color-coding for easy detection • Patient Wait Times on dashboard turn colors as service urgency thresholds met • Manager access to all service locations • Alerts • • • • Via text or email Patient wait extends threshold Patient volume increase to adjust staffing Registrant in particular status for extended period Drill-down Reporting Reg Wt Time Patient Names Appear Here for Encounter Specific Detail Reg Time Creative Utilization of Tool - ED • ED Tracking Board • Extension of patient tracking beyond registration • Radiology – Baseline 65th percentile • Current 90th percentile SUCCESS!! • Call center return call monitoring Additional Software Features • Monitor patient flow and wait times • Registration • Ancillary Check Points • Anticipate patient arrival in ancillary areas • Identify scheduled or walk-in patients using "Visit Type" drop down menu • Prioritize by appointment time • Require delay code Additional Software Features (Cont’d.) • Customize patient surveys • Detailed view • Report by visit type with average processing time • Utilize high-level dashboard to see all locations at enterprise level - hospitals, desks, and current wait times Empowerment and Accountability • Scripting • Customer Service Standards Policy • Engagement in annual goals and monthly review of performance against metrics – as a team and individual • Accountability Statement Patient Survey trays • Real-time patient feedback • Focused on experience with registration and the registrant • Paging to manager if patient ranks low on “compassion and sincerity” for realtime service recovery • Download nightly • Reporting - online • • • • Individual Department Facility By question Results • Customer Service Tray Scores (registration specific) – above 95% Satisfaction • Cleveland Clinic HCAHPs – Top Box (Current – not yet published) • Rate Hospital • Recommend Hospital 82% 86% • Specific Domains • As high as 15% improvement in one year – 2010 to 2011 QUESTIONS?