THE RELATIONSHIP BETWEEN HCAHPS
AND FACILITIES: HOW TO IMPROVE
SCORES IN NEW AND EXISTING
HEALTHCARE FACILITIES
NOVEMBER 7...
Learning Objectives
• Understand Patient Satisfaction (HCAHPS) questions and
scores and their relationship to the built en...
Presenters
Terry Thurston, RN, BSN, MBA
Director of Healthcare Operations Planning,
BSA LifeStructures
Joe Mynhier, AIA, A...
What are HCAHPS?

HCAHPS
Hospital Consumer Assessment of
Health Care Providers and Systems
Hospital’s reimbursement is par...
Comparative Analysis by State

The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing H...
Comparative Analysis by State

The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing H...
Interpreting the HCAHPS Scores

The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing ...
Interpreting the HCAHPS Scores

The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing ...
The Patient Experience Paradigm

The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing...
Operational & Facility Planning
Driven Design

The Relationship Between HCAHPS and Facilities: How To Improve Scores In Ne...
Value Based Purchasing – Aligned
Goals
(-)

SAFE

Hospital
Acquired
Condition
Measures

25% (+/-)
Outcome
Measure
(2014)

...
Relationship Between HCAHPS
& The Built Environment
HOSPITAL ENVIRONMENT
HOSPITAL ENVIRONMENT
QUESTIONS
QUESTIONS

Acceler...
Built Environment Response To Care
Composites
Questions 1-3, 5-7

Respect, Courtesy,
Listen, and Explain
(The Engaged
Empl...
Built Environment Response To Care
Composites
Adequate Caregiver Space At Bedside

•
•
•

•
BSA LifeStructures

•
BSA Life...
Built Environment Response To Care
Composites
Caregiver Support Spaces

•
•
•
•
•

Staff Lounges
Entrance
Respite Areas
Na...
Hospital Acquired Conditions: Patient
Falls
Condition

Built
Environment Impact

1

Travel path to and from the
patient ba...
Preventing Patient Falls
Environmental Recommendations

•
•
•
•
•
•
•

Unobstructed path from bed to
bathroom in few steps...
Hospital Acquired Conditions:
Infection Prevention
Condition

Hospital Acquired
Infections

Built
Environment Impact

1

L...
Hospital Acquired Conditions:
Infection Prevention
Environmental Recommendations

•

Sink located at entry to patient
room...
Private Rooms – Still Not There
PERCENTAGE OF MEDICARE PATIENT STAYS IN SINGLE
OCCUPANCY ROOMS 2002-2010
31.1%

30.2%

30....
The Hospital Environment: Patient
Room Cleanability And Finishes
Question #8

Built
Environment Impact

1

A clean room co...
Keeping The Patient Room Clean:
Cleanability
Design Considerations For Furniture, Casework, & Built-ins

•
•
•
•
•

Floor ...
Keeping The Patient Room Clean:
Furniture Location & Design

BSA LifeStructures

BSA LifeStructures

• Fixed vs. Moveable
...
Keeping The Patient Room
Clean: Floor Plan Design
Environmental Recommendations
• Floor plan configuration
– Avoid acute a...
Keeping The Patient Room
Clean: Finishes And Products

The Relationship Between HCAHPS and Facilities: How To Improve Scor...
Keeping The Patient Room Clean:
Finishes
Environmental Recommendations

Flooring, Walls, & Ceiling
•
•
•
The Mohawk Group
...
The Hospital Environment: Patient
Room Internal & External Noise
Question #9

Built
Environment Impact

1

Noise contribut...
Sound Levels In Decibels
• JACKHAMMER

130

• COMMERCIAL JET

120

• LEAF BLOWER

110

• BABY CRYING

110

• FLUSHING TOIL...
Preventing External Noise
Noise From Corridor To Patient Room
Noise From Other Sources To Patient Room

• From staff/physi...
Preventing External Noise
Decentralized Nurse Work Stations

BSA LifeStructures

•
•
•

Collaboration adds noise to corrid...
Preventing External Noise
Environmental Recommendations
• Implement sound attenuation techniques
– Sound masking at door
–...
Preventing Internal Noise
Noise Within The Patient Room
Noise From Patient Room To Patient Room

• From toilet in adjacent...
Preventing Internal Noise

The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healt...
Information Overload?
•

This year, 5 million times the
information included in all the books
ever written, will be create...
HCAHPS Improvement Grid

The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthc...
HCAHPS Improvement Grid

The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthc...
HCAHPS Improvement Grid

The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthc...
HCAHPS Improvement Grid

The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthc...
THE RELATIONSHIP BETWEEN HCAHPS
AND FACILITIES: HOW TO IMPROVE
SCORES IN NEW AND EXISTING
HEALTHCARE FACILITIES
NOVEMBER 7...
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The Relationship Between HCAHPS and Facilities: How to Improve Scores In New and Existing Healthcare Facilities

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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.

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The Relationship Between HCAHPS and Facilities: How to Improve Scores In New and Existing Healthcare Facilities

  1. 1. THE RELATIONSHIP BETWEEN HCAHPS AND FACILITIES: HOW TO IMPROVE SCORES IN NEW AND EXISTING HEALTHCARE FACILITIES NOVEMBER 7, 2013 The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 1
  2. 2. 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. The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 2
  3. 3. Presenters Terry Thurston, RN, BSN, MBA Director of Healthcare Operations Planning, BSA LifeStructures Joe Mynhier, AIA, ACHA, NCARB Principal, BSA LifeStructures The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 3
  4. 4. 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 CMS LINK: http://www.medicare.gov/hospitalcompare/compare.html#cmprTab=1&cmprID=150024%2C150056%2C150074&loc=INDIANAPOLIS%2C%20IN&lat=3 9.7685155&lng=-86.1580736 The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 4
  5. 5. Comparative Analysis by State The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 5
  6. 6. Comparative Analysis by State The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 6
  7. 7. Interpreting the HCAHPS Scores The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 7
  8. 8. Interpreting the HCAHPS Scores The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 8
  9. 9. The Patient Experience Paradigm The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 9
  10. 10. Operational & Facility Planning Driven Design The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 10
  11. 11. Value Based Purchasing – Aligned Goals (-) SAFE Hospital Acquired Condition Measures 25% (+/-) Outcome Measure (2014) EFFECTIVE PATIENT CENTERED EFFICIENT TIMELY 30% (+/-) EQUITABLE Patient Experience Measures (HCAHPS) AFFORDABLE (+/-) 45% Core Measures The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 11
  12. 12. Relationship Between HCAHPS & The Built Environment HOSPITAL ENVIRONMENT HOSPITAL ENVIRONMENT QUESTIONS QUESTIONS Accelerators CARE COMPOSITE QUESTIONS (QUESTIONS 8 & 9) (QUESTIONS 1-3, 5-7) During this hospital stay, how often were your room and bathroom kept clean? Courtesy During this hospital stay, how often was the area around your room quiet at night? Listen Respect Explain The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 12
  13. 13. Built Environment Response To Care Composites Questions 1-3, 5-7 Respect, Courtesy, Listen, and Explain (The Engaged Employee) Built Environment Impact 1 Adequate caregiver space at the bedside 2 Off-stage collaboration areas to facilitate manager rounding & team communication 3 Caregiver Support Spaces The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 13
  14. 14. Built Environment Response To Care Composites Adequate Caregiver Space At Bedside • • • • BSA LifeStructures • BSA LifeStructures 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 The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 14
  15. 15. Built Environment Response To Care Composites Caregiver Support Spaces • • • • • Staff Lounges Entrance Respite Areas Natural Light Ergonomics Photo © John Durant | www.johndurant.com The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 15
  16. 16. Hospital Acquired Conditions: Patient Falls Condition Built Environment Impact 1 Travel path to and from the patient bathroom are the most frequent contributors to falls 2 Unobstructed Pathways 3 Patient falls in room & bathroom contribute to increased patient morbidity, mortality, LOS, & cost of care Lighting and Finishes The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 16
  17. 17. Preventing Patient Falls Environmental Recommendations • • • • • • • 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) Clemson University Patient Room of the Future The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 17
  18. 18. Hospital Acquired Conditions: Infection Prevention Condition Hospital Acquired Infections Built Environment Impact 1 Location of sink and hand sanitizers 2 Personal protective equipment (PPE) location 3 Cleanability and surfaces The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 18
  19. 19. Hospital Acquired Conditions: Infection Prevention Environmental Recommendations • Sink located at entry to patient room – Features: height, depth, faucets, splash, visibility to patients Dublin Methodist Hospital © John Durant | www.johndurant.com © The Chester County Hospital http://www.cchosp.com/images/Tower/P_PatientRoom_lrg.jpg • • • Cubicle curtains: cleanable, hand guards Enclosed toilet in ICU Personal Protective Equipment Location The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 19
  20. 20. Private Rooms – Still Not There PERCENTAGE OF MEDICARE PATIENT STAYS IN SINGLE OCCUPANCY ROOMS 2002-2010 31.1% 30.2% 30.0% 29.7% 29.0% 28.5% 28.2% 27.5% 2002 27.7% 2003 2004 2005 2006 2007 2008 2009 2010 SOURCE: “HEALTH CARE CONSTRUCTION OUTLOOK FOR 2012 AND BEYOND” © 2012 THE ADVISORY BOARD COMPANY The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 20
  21. 21. The Hospital Environment: Patient Room Cleanability And Finishes Question #8 Built Environment Impact 1 A clean room contributes to higher patient satisfaction 2 Due to surfaces and products selected, a clean room may not look clean 3 During this hospital stay, how often was your room and bathroom kept clean? Contaminated environment contributes to hospital acquired infections The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 21
  22. 22. 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 The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 22
  23. 23. Keeping The Patient Room Clean: Furniture Location & Design BSA LifeStructures BSA LifeStructures • Fixed vs. Moveable • Snug Fit vs. Awkward Voids • Appropriate Cleaning Products BSA LifeStructures The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 23
  24. 24. Keeping The Patient Room Clean: Floor Plan Design Environmental Recommendations • 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 The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 24
  25. 25. Keeping The Patient Room Clean: Finishes And Products The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 25
  26. 26. Keeping The Patient Room Clean: Finishes Environmental Recommendations Flooring, Walls, & Ceiling • • • The Mohawk Group Armstrong easy to clean products products that look clean simple cleaning instructions MDO Wall The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 26
  27. 27. The Hospital Environment: Patient Room Internal & External Noise Question #9 Built Environment Impact 1 Noise contributes to lower patient satisfaction 2 Noise contributes to slower recovery of the patient 3 During this hospital stay, how often was the area around your room quiet at night? Noise contributes to longer lengths of stay The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 27
  28. 28. 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 The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 28
  29. 29. 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 The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 29
  30. 30. Preventing External Noise Decentralized Nurse Work Stations BSA LifeStructures • • • Collaboration adds noise to corridor Work station adds noise at patient room entry Corridors remain same width despite function change The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 30
  31. 31. Preventing External Noise Environmental Recommendations • 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 The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 31
  32. 32. 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 The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 32
  33. 33. Preventing Internal Noise The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 33
  34. 34. 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?....... The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 34
  35. 35. HCAHPS Improvement Grid The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 35
  36. 36. HCAHPS Improvement Grid The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 36
  37. 37. HCAHPS Improvement Grid The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 37
  38. 38. HCAHPS Improvement Grid The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 38
  39. 39. THE RELATIONSHIP BETWEEN HCAHPS AND FACILITIES: HOW TO IMPROVE SCORES IN NEW AND EXISTING HEALTHCARE FACILITIES NOVEMBER 7, 2013 The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities 39

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