How are advances in social science being used to improve HCAHPS scores? Join Carol Packard, PhD, for key actions you can take to improve patient satisfaction scores, while improving clinical outcomes and reducing costs.

1. THE
Hope
Effect
Creating Diplomats For Hope
Webinar
Series

2. Creating Diplomats For Hope
Webinar
Series
HOUSEKEEPING
AUDIO is available through your computer speakers or
through dial-in. All lines are muted.
You can SUBMIT QUESTIONS/COMMENTS at any time.
We will address all questions during the Q&A session at
the end of today’s presentation.
Links to the slides and RECORDING will be made
available and sent to all attendees via e-mail.

3. Creating Diplomats For Hope
Webinar
Series
ABOUT US
WE WORK WITH NATIONALLY-RECOGNIZED INSTITUTIONS:
5 “Honor Roll” institutions
5 out of the top 10 cancer programs
3 out of the top 4 pediatric hospitals
3 out of the top 10 cardiovascular programs
NATIONAL BENCHMARKING STUDIES:
Patient experience management
Marketing practices
Physician relations programs
International programs
Ranked as one of top 50 Healthcare Consulting firms by Modern
Healthcare

4. REPRESENTATIVE CLIENTS:
Barnes-Jewish Hospital
Cleveland Clinic
Cincinnati Children’s Hospital
Duke Medicine
Froedtert Health
Mayo Clinic
MD Anderson Cancer Center
Memorial Sloan Kettering
Menninger Clinic
Texas Children’s Hospital
The Ohio State University Medical Center
University of Chicago Medicine
University of Colorado Health
University of Houston
University of Michigan Health System

5. Creating Diplomats For Hope
Webinar
Series
CAROL B. PACKARD
Senior Advisor & Strategist, Healthcare Performance
Improvement
Carol Packard has a Ph.D. in organizational
development, a master’s degree is in
organizational psychology, and 20 years
experience working in health care. Carol also
has designed and implemented enterprise-
wide Service Excellence programs, using
patient satisfaction data to drive process
improvements.

6. Creating Diplomats For Hope
Webinar
Series
JILL F. SECORD
Senior Advisor & Strategist, Healthcare
Performance Improvement
Jill has 38 years of experience as a Registered Nurse with a
Master's degree in business and expert skills in leadership,
operations, managed care, and nursing education. She has clinical
experience in critical care, orthopedics, home care, home infusion,
managed care, contracting, provider relations, data analysis, new
business development and strategic planning.
She is certified in Lean Quality Healthcare and has developed a system to integrate
Lean techniques with Patient Experience Mapping and Family Focused Care
initiatives. Jill has worked with a variety of healthcare organizations to create
departments, streamline current processes, and develop new
profitable programs.

8. Patient as Prisoner ?
Clothes taken AWAY
ASSIGNED a number
Turn OVER valuables
Allowed to see family on a LIMITED basis
Assigned a STRANGER as a roommate
DIFFERENT people in the room everyday
Institutional RULES and SCHEDULES
STERILE environment
Give up CONTROL

9. Does Any Of This Look Familiar?

10. Patient-Centered Health Care
Not only improves required
HCAHPS patient satisfaction
measures, but also
IMPROVES
CLINICAL
OUTCOMES
REDUCES
COSTS

11. The Psychology of Wait (January 20)
The Hope Effect (January 27)
Empathy & Lean (February 2)
Creating Diplomats For Hope
Webinar
Series

12. Today’s webinar
THE
HOPE
EFFECT
THE ANTICIPATION OF GETTING & BEING WELL

13. Before we Start -
I’d like you to think about a few questions - First, consider this situation:
The Benefits of the migraine drug Maxalt (rizatriptan) increased when
patients were told they received an effective drug for acute migraines.
What happened when they were told they were actually given a
placebo instead?
A. Patients reported less reductions in pain when they knew the
pill was a placebo.
B. When labels of Maxalt tablets & placebo pills were switched,
patients reported similar reductions in pain.
C. Patients reported more pain generally when they did not
know whether they received Maxalt or a placebo.
Keep this question in mind as we go along…….

14. Before we Start - A Second Question
What percent of patients have cognitive impairment at time of
discharge?
A - 10 - 25%
B - 30 - 45 %
C - 50 - 70%
D - 75 - 85%
Keep these questions in mind as we go along…

15. Evidence
When patients receive CARE and ATTENTION
from people- THEY believe can help ease their suffering and
distress
ENDORPHINS
ARE
RELEASED

16. Evidence
When patients receive CARE and ATTENTION
from people- THEY believe can help ease their suffering and
distress
ENDORPHINS
ARE
RELEASED
STRESS
IS
REDUCED

17. Evidence
When patients receive CARE and ATTENTION
from people- THEY believe can help ease their suffering and
distress
ENDORPHINS
ARE
RELEASED
STRESS
IS
REDUCED
SENSE OF PAIN
IS
REDUCED

18. Clinical Care + Positive Messaging
(Rami Burstein, and Ted Kaptchuk, ci Transl Med 8 January 2014: Vol. 6, Issue 218, p. 218ra5 Sci. Transl. Med.
Patients with severe migraines given either drug or placebo
Study drug labels 9 (Attack 1-6)
Two Attacks Two Attacks Two Attacks
Actual pill
Placebo
Actual pill
Placebo
Actual pill
Placebo
Actual pill
Maxalt
Actual pill
Maxalt
Actual pill
Maxalt
Negative Information
PLACEBO LABELLING
Neutral Information
UNSPECIFIED LABELING
Positive Information
MAXALT LABELING
PLACEBO
(nonactive)
MAXALT or PLACEBO
(active) (nonactive)
MAXALT
(active)
Envelope#1 – Study drug - Take pill 30 min after migraine onset - This envelope contains:

19. Clinical Care + Positive Messaging
(Rami Burstein, and Ted Kaptchuk, ci Transl Med 8 January 2014: Vol. 6, Issue 218, p. 218ra5 Sci. Transl. Med.
Patients with severe migraines given either drug or placebo

20. Important Take-Away!
HOPE
BOOSTED THE EFFICACY
OF BOTH
THE ACTIVE MIGRAINE
MEDICATION
AND
THE INERT PLACEBO

21. Hope Increases Adherence to Medical Advice
FAITH
IN
CARE
GIVERS
MAKAREM S, SMITH M, MUDAMBI S, HUNT J. Why People Do Not Always Follow the Doctor's Orders: The Role of Hope and
Perceived Control. Journal Of Consumer Affairs [serial online]. Fall2014 2014;48(3):457-485. Available from: Academic Search
Complete, Ipswich, MA. Accessed January 21, 2015
SELF-
EFFICACY
HOPE
ADHERENCE
TO
TREATMENT

22. Patient-Centered Care
THE INTERACTIONS
BETWEEN
HEALTHCARE PROVIDERS
&
A PATIENT
OFTEN HAS A
BIGGER IMPACT
THAN
THE “AGENT”
(I.E. MEDICATION, SURGERY)
WE TYPICALLY FOCUS ON!

23. Patients Feel more Hope
WHEN THEY SEE THEIR CAREGIVERS
COLLABORATING
WHEN THEY ARE PART OF THE SOLUTION

24. Involving Patients in Bedside Shift Reports:
In 29 studies on effects of BSRs:
• 13 (44.8%) indicated increased patient satisfaction
• 5 (17.2%) noted patient asked more questions
• 4 (13.8%) patient said they felt safer after seeing nurses
changing shift
• 10 (34.5%) noted increased patient safety
• 10 (34.5%) mentioned increased communication with nurses
• 5 (17.2%) noted patients demonstrated an increased
understanding of their care
What Does the EVIDENCE Say?

25. How many of you currently deliver
SHIFT REPORTS by the bedside?
Please answer using the textbox.

26. Concerns?
YES!
Delivering bedside reports
is a skill to be developed
TRAINING AND PRACTICE
Confidentiality issues
in semi-private rooms

27. What do Nurses Think?
After implementing BSRs,
• Average report time decreased from
45 to 29 min.
• Nurse satisfaction increased 37% to 78%
• White board adherence 25% to 98%.
Reasons for increased nurse satisfaction:
• Receiving accurate handoff without distractions,
reducing time
• Assessment of the patient & environment in real time

28. Implementation
Identify a model specific for your organization &
patient populations
to ensure CONSISTENCY
Set & track MEASURABLE indicators
Support the ADOPTION by clinical nurses
(training, incentives)
Adjust models as APPROPRIATE to attain and
sustain use

29. A HEALING
ENVIRONMENT
ALSO ADDS
TO THE
HOPE EFFECT

30. Bright Rooms
Walch (2005) retrospective study:
Patients in the bright rooms required
22% LESS analgesic medications
21% DECREASE in medication costs
Walch JM, Rabin BS, Day R, Williams JN, Choi K, Kang JD Psychosom Med. 2005 Jan-Feb; 67(1):156-63.

31. Prospective environmental studies suggest
blood pressure typically declines
within three minutes of viewing nature scenes
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2264925/
Nature Scenes

32. Hopeful Patient-Centered Care
Lowers Readmission Rates
In samples of
1798 hospitals for acute myocardial infarction
2562 hospitals for pneumonia
HIGHER hospital-level patient satisfaction
scores (overall and for discharge planning)
both associated with
LOWER 30-day readmission rates
(Am J Manag Care. 2011;17(1):41-48)

33. Meaningful Use Requirements
BUREAUCRATIC WASTE OF TIME
OR HELPFUL?
30 - 50 % of patients have
cognitive impairment
at time of discharge
impacting ability
to COMPREHEND or REMEMBER
discharge instructions
(Boustani et al., 2010; Coleman et al., 2013; Lindquist et al., 2011).

34. IMPROVED
CLINICAL
OUTCOMES
Clear
Discharge
Instruction
Personal
Efficacy
Hope

35. Lots of evidence that the
HOPE of improvement actually
leads to improved outcomes!
And that leads to
ENCHANTMENT!
The HOPE Effect

36. What Do you Do to Enhance HOPE ?

37. What Do you Do to Enhance HOPE ?

38. What Do you Do to Enhance HOPE ?

39. WHAT ARE THE HOPEFUL
MOMENTS OF TRUTH
FOR YOUR PATIENTS?

40. Care Coordination Communication
EXPECTED BEHAVIORS:
How interactions
occur and are managed
SYSTEMS:
Processes and technology
to increase efficiency
POSITIONING:
Communications,
conversations, and
messaging

41. What Stories will your Patients Tell?
PREVENT THE BAD ONES
CAPTURE THE GOOD ONES

42. What Can you to Today?
Add pictures of NATURE SCENES
and PLANTS in patient rooms
and in waiting rooms

43. Review & Redesign - Discharge Instructions
SOURCE: As presented by Paasche-Orlow, 2014

44. Begin discussions on implementing
a BEDSIDE REPORT PROTOCOL

45. Back To the Questions
Benefits of the migraine drug Maxalt (rizatriptan) increased
when patients were told they received an effective drug for
acute migraines. What happened when they were told they
were actually given a placebo instead?
A. Patients reported less reductions in pain when they
knew the pill was a placebo.
B. When labels of Maxalt tablets & placebo pills were
switched, patients reported similar reductions in pain.
C. Patients reported more pain generally when they
did not know whether they received Maxalt or a
placebo.

46. Back To the Questions
Benefits of the migraine drug Maxalt (rizatriptan) increased
when patients were told they received an effective drug for
acute migraines. What happened when they were told they
were actually given a placebo instead?
A. Patients reported less reductions in pain when they
knew the pill was a placebo.
B. When labels of Maxalt tablets & placebo pills
were switched, patients reported similar reductions
in pain.
C. Patients reported more pain generally when they
did not know whether they received Maxalt or a

47. Back To the Questions
What percent of patients have cognitive impairment at
time of discharge? (Among general population)
A - 10 - 25%
B - 30 - 45 %
C - 50 - 70%
D - 75 - 85%

48. Back To the Questions
What percent of patients have cognitive impairment at
time of discharge? (Among general population)
A - 10 - 25%
B - 30 - 45 % (general population)
C - 50 - 70% (elderly population)
D - 75 - 85%

49. QUESTIONS ?
COMMENTS ?

50. • Have a representative contact you?
• Have a representative come to speak at your
organization?
• Want more information?
Would You Like To:

51. 2700 Post Oak Blvd., Suite 1400
Houston, TX 77056
+1 713.877.8130
www.endeavormgmt.com/healthcare
Contact Us
Carol Packard
cpackard@endeavormgmt.com
Jill Secord
jsecord@endeavormgmt.com

52. Thank you for participating!
Please join us next week
on Tuesday, February 3 at 12:30 CT, 1:30 EST