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IUHA ED Patient Satisfaction Quality Improvement Presentation
The IU Health Arnett Emergency Department conducted a patient satisfaction survey aimed at improving response rates, which were only 0.3% in August 2016. Stakeholders identified key issues and proposed new survey questions designed to enhance patient feedback and engagement. The goal is to increase the response rate to 25% and gather meaningful data to enhance the quality of care in the emergency department.
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IUHA ED Patient Satisfaction Quality Improvement Presentation
- 1. IU Health ArnettEmergency Department Patient Satisfaction Survey By: Madalyn Tadrowski, Marissa Wuethrich, Jaclyn Bourdon, Brianna Tharp, Margo Pok, Lyndsey Sangalis
- 2. HUMM Patient SatisfactionSurvey • IU Health Arnett Emergency Department o HUMM surveys on patient satisfaction 5 questions Administered on tablets Started in December 2015
- 3. Key Stakeholders • PracticePartners o Nicole Adams, PhD, RN Director of Emergency Services of IU Health Arnett o IU Health Arnett Emergency Department Level 3 Trauma Center, 3 Trauma rooms 20 bed unit 1 ENT room, 3 Fast Track rooms • Stakeholders o Patients o Nurses o ED patient care technicians o C-suite www.iuhealth.org
- 4. Define • Problem: Inthe month of August 2016, only 13 out of 3859 (0.3%) patients completed a HUMM patient satisfaction survey. • Goal: Nurse leaders desire meaningful question content and a 25% response rate. 0.3% 25% 0 5 10 15 20 25 30 % Satisfaction %Satisfaction Performance Gap Now Goal
- 5. Define • Background: o Patientschoose where they go for healthcare o Patient satisfaction surveys can assist in identifying ways to improve practice resulting in better care and satisfied patients • Business case: o The top 25% of U.S. hospitals with the highest scores on the HCAHPS performance question were the most profitable and had the highest clinical scores. o CMS may develop a payment policy that penalizes facilities based on poor performance o Healthcare administrators should incorporate techniques based on the customer satisfiers (ED Patient Satisfaction, 2013; Hall 2010 ;Indovina et al., 2016; Mazurenko, Zemke & Lefforge, 2016;White, 1999; Mazurenko, Zemke & Lefforge, 2016)
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- 7. Data Tools • NurseSurvey o Total collected: 17 • Patient Interview o Total collected: 23 o Delegated to Junior clinical group • HUMM data provided by IU Health Arnett o Data collected from December 2015 to August 2016 www.austinchronicle.com
- 8. IUHA HUMM PatientResponses 14 24.9 24 7.75 0 0 0.3 0 10 20 30 40 50 60 70 80 90 100 DEC-15 JAN-16 FEB-16 MAR-16 JUN-16 JUL-16 AUG-16 ResponseRate(%) Month % HUMM Survey Responses
- 9. Nurse and PatientData 14 15 15 0 2 4 6 8 10 12 14 16 Worth Their Time Understand questions Voice Heard #Responses Questions Asked Patient interview Yes No Nurses: Patients DO NOT Find Value Patients DO Find Value 13 12 11 4 0 2 4 6 8 10 12 14 Process Not offered Pt. do not value Language #ofnurses Barriers Barriers As Indicated By Nurses
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- 12. Top 3 Categoriesof Questions 11 8 8 8 OVERALL EXPERIENCE D/C INFO DR COMMUNICATION NURSE COMMUNICATION #ofnurses? Category on Survey Top Suggestions For Questions: Nurses Nurses: 1.Overall Experience 2.Doctor and Nurse Communication 3.Discharge Information 5 4 3 3 3 QUICK THOROUGH WAITING TIME COMPETANTCOMMUNICATION #ofResponses Type of Care What Type of Care is Important To The Patient? Patients: 1.Quick Visit 2.Thorough care 3.Competent staff
- 13. Previous Survey Questions 1.Were the nurses and techs nice to you today? 2. Did the staff explain what they were going to do to you before they did it? 3. Did the nurses and techs wash their hands at the sink or use hand foam to clean their hands before and after taking care of you today? 4. Based on your experience, would you recommend Indiana University Health Arnett Hospital to someone you know? 5. Is there anything you’d like to share or a team member you’d like to recognize today? 6. Thank you for leaving your feedback! If you would like for a member of our leadership team to follow-up with you, please leave your email address.
- 14. Deliverable: New SurveyQuestions 1. Did the staff care for you in a respectful and polite way? 2. Did the staff explain your care in a way that you could understand? 3. Did the staff carefully listen to you during your stay? 4. Choose a number that you would use to rate the care you were given during this Emergency Room visit. 0 to 10 scale, 0 being the worst care, 10 being the best care. 5. Based on your experience, would you recommend Indiana University Health Arnett to someone you know? 6. Is there anything you would like to share or a team member you would like to recognize? 7. Thank you for leaving your feedback! If you would like for a member of our leadership team to follow-up with you, please leave your email address or phone number.
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- 16. • Release dataresults to staff • Add language options o Spanish o Burmese • Remove “skip” option • Add option to give phone number • Reward nurses who are recognized Recommendations
- 17. 14, 2% 850 Emergency Roomvisits 11/6-11/12 # surveys total # seen • Did the staff listen: 100% • Staff responsiveness: 100% • Respectful and polite care: 100% • Staff communication: 93% • Overall Experience: 89% • Explain care in a way you understand: 85.7% PDCA HUMM Survey Results New HUMM Survey Questions Implemented on November 1st, 2016
- 18. • Process Owner: oDirector of Emergency Services: Nicole Adams, PhD, RN • Review survey results weekly • Provide feedback to ED staff • Release positive results of increased survey rates to other IU Health hospitals Sustaining Improvement www.linkedin.com
- 19. • Focus onquality and not just quantity. • Drive out fear by encouraging employees to participate actively in the process. •Promote teamwork rather than individual accomplishments. • Delegation and collaboration with Junior clinical group Management Principles (Marquis & Houston, 2014)
- 20. Conclusion • Patient satisfactionsurveys are important • There was a discrepancy between what nurses believe and what patients truly think • Through implementation of our deliverable the expected outcome is to: o Motivate ED staff to administer surveys o Increase response rate from HUMM survey o Receive meaningful data from patients to improve care in ED www.careers.iuhealth.org
- 22. References ED Patient Satisfaction,The Future of Reimbursement. (2013). Retrieved from www.forerunsystems.com/news/bid Hall, E. (2010). Patient Satisfaction-Why Should We Care? Retrieved from http://www.medscape.com/viewarticle/736495 Indovina, K., Keniston, A., Reid, M., Sachs, K., Zheng, C., Tong, A., … Burden, M. (2016). Real- time patient experience surveys of hospitalized medical patients. Journal of Hospital Medicine, 11(4), 251-256. doi:10.1002/jhm.2533 Mazurenko, O., Zemke, D. M., & Lefforge, N. (2016). Who is a hospital's "customer"?. Journal Of Healthcare Management, 61(5), 319-333. Marquis, B. L., & Huston, C. J., (2015). Leadership Roles and Management Functions in Nursing: Theory and Application (8th ed.). Philadelphia, PA: Wolters Kluwer Health Lippincott Williams & Wilkins. White, B. (1999). Measuring patient satisfaction: how to do it and why to bother. Family Practice Management, 6 (1), p. 40-44. Retrieved from http://www.aafp.org/fpm/1999/0100/p40.html
Editor's Notes
- #2 Madalyn begins: introduces self, project leader, states are project title. Introduces team members and they state their roles: Lyndsey Margo Marrissa Jackie Bri
- #3 *Hospitals with higher scores on surveys achieve lower admission rates, lower mortality rates, and higher quality of care madalyn Start with 5 and end with 2 Patient satisfaction is important for many reasons at a hospital, and is why HCAHPS is required for most units, but does not apply for an ED. So currently at IUHA they have the HUMM satisfaction survey which consists of five questions administered by a tablet device physically in the ED. They started this in December and the timeline of events associated with the online survey are shown in this timeline. There was a big gap in the response rate due to changing from email surveys to ones being administered at the hospital, and then they ran into some current issues with response rates, specifically noted in August of this year.
- #4 madalyn We are working with multiple members of the hospital on our project, including the director of emergency services, Nicole Adams, all of the nursing staff including techs at IUHA and closely with Professor Hountz. Our main stakeholders and focus are the patients of the ED, while also taking into consideration opinions of the C-suite, staff, and techs.
- #5 Margo
- #6 Margo
- #7 Marissa ** insert new state map This is the current state of the HUMM patient satisfaction survey. It begins with the patient coming to the ED and receiving care. Then a nurse has to decide if she is going to offer the survey to the patient or not. If the nurse doesn’t, we have identified that as wasteful because there are no results. The patient also has to decide if they are going to complete the survey or not. If they don’t, then again there are no results. There are three ways the survey can be done. On a tablet, with their phone using a QR code, and by calling or texting a phone number. The patient begins the survey and answers the questions. For each question, if the patient answers no, then they are directed to input feedback or to skip the feedback section. Once they get to the 4th question about recommending the hospital, they are prompted to click a number rating. They also have the option to skip this question, which is another wasteful step. The last question they are asked is to provide their email address. They can choose to do that or skip the question. The patient can then exit the survey and be discharged from the ED.
- #8 Marissa We collected our data by doing nurse surveys and patient interviews. We were able to collect 17 surveys from ED nurses and some ED techs. Some of the juniors have helped in doing 15 patient interviews. We plan on having the juniors do another day of patient interviews soon. We also have been provided with HUMM data from the hospital, and that was collected starting in December of 2015 and goes to August of 2016.
- #9 Marissa this graph represents the data collected between December 2015 and august 2016 in regards to the Humm survey patient responses. As you can see, response rates were higher in december 2015 to january 2016 than they were in august 2016. This is due to the humm tablets being stolen from the emergency department, which then lead to complete removal of the tablets. after that, you can see that when the humm surveys were reintroduced in august 2016, with a poor response rate.
- #10 Jackie Don’t care to don’t find value We wanted to look into why there was such low response rates. so we conducted a nurse survey, as marissa mentioned earlier. This data is from the nurse survey we conducted in the ED. we asked the nurses in the emergency department what they thought was the reason why the patient satisfaction surveys have had such a low response rate. as you can see the top three barriers as indicated by nurses were the process related to taking the survey, patient's were not offered the survey, and also that the patients do not care. Some other barriers were volume, language, and more.
- #11 Bri
- #12 Jackie Another part of our nurse survey included a question to the nurses about what category of question would help provide constructive feedback and impact the way they provide care. As you can see the top suggestion for question categories included overall experience, discharge info, doctor communication, and nurse communication. Some other suggestions included were staff response, shared decision making, staff, and more.
- #13 jackie Mention quick visit – IUHA already monitors how fast each visit is In order to gain patient feedback about the HUMM survey, we conducted a questionnaire about it. We found that a majority of patients understood the questions on the survey, found that it was worth their time, and felt that their voice was heard. This demonstrates that most people who come into the ER are willing to complete the survey and that they believe that it is an important aspect of their visit.
- #14 lyndsey Orange are the ones removed
- #15 lyndsey
- #16 Marissa Insert new map
- #17 madalyn
- #18 lyndsey 850 patients register between 11/6 and 11/12 14 out of 850 patients during the week of 11/6 took the survey (0.02%) 93% staff communication 89% overall experience 100% staff responsiveness 7/10 rate the care you were given 100% staff care for you in a respectful and polite way 9/10 rated care during ER visit Did the staff explain your care in a way to understand 85.7% yes (12/14) Did the staff listen to you 100%
- #19 lyndsey
- #20 bri
- #21 Lyndsey: Next Steps: “Our next main step is to continue to obtain more data through patient interviewing. We want to have a good sample size to work with while analyzing the problem. We are also in the process of a PDCA to potentially make and administer new survey questions. We are hoping to create an educational tool based on our data to show the nurses what we are discovering through our interviews. This is a step that we are considering having our junior students help with. Another main step that we will be working on is finding ways to motivate the nurses of the ED to administer the survey. In order to do that, we need to get them to realize the value of these surveys. Down the road, we will be finalizing our deliverables and presenting them to the stakeholders at IUHA. We are looking forward to the next steps to come in the project, and seeing what will come from them.” Conclusion: margo