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Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
2010 2011 2012 2013 2014 2015 2016 2017 2018
REPORTING HOSPITAL QUALITY DATA FOR ANNUAL PAYMENT UPDATE
VALUE-BASED PURCHASING
READMISSIONS
2% of APU
2%
3%
CMS quality-based payment initiatives will put more than 11% of payment at risk
HOSPITAL-ACQUIRED CONDITIONS 1%
MEANINGFUL USE 5%
1% 1.25% 1.5% 1.75% 2%
1% 2% 3% 3% 3%
1% 2% 3% 4% 5%
Value-Based Purchasing Roadmap
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Never Events: Financial ImpactCondition $ / Stay
Stage III & IV Pressure Ulcers $43,180
Falls & Trauma $33,894
Deep Vein Thrombosis/Pulmonary Embolism $50,937
Vascular Catheter-Associated Infection $103,027
Certain Manifestations of Poor Control of Blood Sugar Levels Range: $35k-45,989
Catheter-Associated Urinary Tract Infections $44,043
Foreign Object Retained After Surgery $63,631
Surgical Site Infections Following Certain Elective Procedures Range: $63k-180,142
Infection after Coronary Artery Bypass Graft $299,237
Air Embolism $71,636
Blood Incompatibility $50,455
Source: CMS Fact Sheet, “CMS PROPOSES ADDITIONS TO LIST OF HOSPITAL-ACQUIRED CONDITIONS FOR FISCAL YEAR 2009”
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Patients’ Perception of Care = QualityPressure Ulcer Stages III and IV
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Patients’ Perception of Care = QualityVascular Catheter-Association Infection
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Patients’ Perception of Care = QualityManifestations of Poor Glycemic Control
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
High Patient Perception of Care Equals Lower Preventable Readmissions
1/5 of Medicare Beneficiaries are readmitted within 30 days with an
annual cost of $17.4 Billion
Source: The American Journal of Managed Care; Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission Within 30 Days; 2011; Vol. 17(1)
2.3%Pneum-
onia
3.1%Heart
Failure
2.6%Acute
MI
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Figure 11Percent of AMI Patients Surviving To One Year Post Discharge
Stratified by Level of Patient-Centered Care (PCC)
0.992
0.978
0.957
0.944
0.930
0.906 0.9030.895
0.890
0.8790.871
0.989 0.9870.981
0.9700.962 0.960
0.954 0.951 0.949 0.9460.938
0.997
0.997
0.8
0.82
0.84
0.86
0.88
0.9
0.92
0.94
0.96
0.98
1
1 2 3 4 5 6 7 8 9 10 11 12
Months After Discharge
Per
cen
t o
f P
atie
nts
Su
rviv
ing
Low PCC (n=372) High PCC (n=371)
Level of PCC was defined using the composite average of Picker dimension scale scores (see Fig. 8.1). Low PCC = bottom fifth of the distribution (scores <=56.85);
high PCC = top fifth of the distribution (scores >=97.14).
Patient-Centered Care and Mortality
A different source: Glickman SW et al, Patient Satisfaction and Its Relationship with Clinical Quality and Inpatient Mortality in Acute Myocardial Infarction, Circa Cardiovasc Qual Outcomes 2010;3:188-195.
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Leader Rounding on Patients
Rounding for Outcomes
Performance Management
Aligned Behavior
Standardization Accelerators
Aligned ProcessAligned Goals
Objective Evaluation
System
Leader Development
Must Haves®
Aligning Leader Evaluations with Desired Outcomes
Rounding for Outcomes
Employee Thank You Notes
Employee Selection and the First 90 Days
Pre and Post Phone Calls
Key Words at Key Times
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Driving Performance
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Rounding on PatientsWhy?
Foundational tactic that drives results
Reconnects leaders to patient care
Provides best opportunity for “eyes on the field” “boots on the ground” leadership
Builds leadership assessment skills just like we built nursing assessment skills
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Leader Rounding on Patients“Did a Nurse Manager Visit You During Your Stay?”
Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010
n= 608
n= 106
n= 604n= 561
n= 601
n= 104
n= 96
n= 105
Tactic and Tool Implemented:• Leader Rounding on Patient
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Four Goals
Create Empathetic Connection with Patients
Service Recovery (if needed)
Harvest Compliments and Manage Up
Assess Quality of Care
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Rounding with Patients and Families
Align Questions to Fit Desired Outcomes of the Organization
Set expectations/Validate Behavior
Identify patient and family needs
Document needs
Give instructions on what to do if they do not get the care they expect
Explain any post stay/visit calls or surveys
Recognize and Coach Staff
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Two Key Questions
What have you learned about care being delivered?
What MUST you do with that information?
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Verification:
Patient Rounding Log
Priorities
Staff and Physicians to Recognize
Issues for follow-up
Notes and comments
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This is a test
The ability of nurse leaders to hardwire nurse leader rounding on patients directly correlates with their ability to lead the hardwiring of practices they
will be asking of their staff…
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Validation
A robust system of validation must be in place to ensure frequency, quality and outcomes are achieved
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If you are not getting value or results
Are you asking the right questions during rounds?
Are you using what you learned from rounding to make improvements?
Are you doing enough of it?
Round on one nurses assignments and then give him/her feedback, then repeat. The learning based on this ability to compare will be very beneficial
Every Patient, Every day…Always
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization. Reference: Studer Group Patient Care Model
Bedside Shift Report1. AIDET® introduction2. Communication of current state and plan of
care3. Teach back reinforcement of important
patient care information such as drug side effects
Individualized Patient Care
1. Ask what 2-3 things will ensure excellent care2. Write on board3. Used by all members of the care team4. Ask each shift to reinforce listening
Post visit calls1. Questions designed to assess patients progress at home2. Listening with more than your ears
Hourly Rounding® 1. Use opening Key words: Round2. Perform scheduled tasks3. Perform 3P’s4. Additional Comfort measures5. Environmental assessment of room6. Closing Key words7. Tell when you will return8. Log the round
Nursing and Patient Care Excellence
Hardwire the full scope of the Patient Care Model
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Hourly Rounding ℠
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The Why
Hourly Rounding on patients is one of ten (10) new ways hospitals can ‘see’ differently. “Hourly Rounding, developed by Studer Group, the largest study ever focused on the impact of rounding. Hourly Rounding ‘restores sanity and joy to our workforce.’”
» Maureen Bisognano, COO of IHI, 2007
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Behaviors of Hourly Rounds: The P’s Aren’t Enough
HOURLY ROUNDING BEHAVIOR EXPECTED RESULTS
1 Use Opening Key words Creates efficiency“checkin’ on ya” won’t suffice
2 Accomplish scheduled tasks Contributes to efficiency
3 Address 3 P’s (pain, potty, position) Quality indicators – falls, decubitis, pain management
4 Address additional comfort needs Improved patient satisfaction on pain, concern and caring, efficiency
5 Conduct environmental assessment and ensure bed technology is correctly utilized Contributes to efficiency, teamwork
6 Ask “Is there anything else I can do for you before I go? I have time.”
“Call me if you need me” decreases efficiency and improves patient satisfaction on teamwork and communication
7 Tell each patient when you will be back Contributes to efficiency
8 Document the round Quality and accountability
8
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Ancillary and Support Departments
Everyone can be trained to do the environmental assessment of the room
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THE LOGS…The Promise
Please place your initials in the corresponding time box after round has been complete. **Round is only complete if all 8 Key Behaviors have been done.**
6:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:0022:00-23:00
1:00-2:00
3:00-4:00
5:00-6:00
MM/DD/YY
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Eight Key Behaviors: Key:1) Use opening key words S= Patient Sleeping
2) Perform scheduled tasks R = Patient in Radiology
3) Address the 5 P's-Pain, Potty, Position, Possesion, Plan of Care E = Room Empty
4) Assess additional comfort needs OR = Patient in Surgery
5) Conduct environmental assessment P = Procedure in Process
6) Use closing key words and/or actions CT = Patient in C.T. Department
7) Explain when you or others will return PT = Phyisical Therapy
8) Document the round on the log
Initials: Signature: Initials: Signature: Initials: Signature: Initials: Signature:
Rounding Log
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Use of Communication Boards…the promise
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Cost Avoidances – Falls
99
70
0
50
100
1
Actual Falls Incidents
1st-3rd qtr average 4th qtr
Estimated Cost Avoidance =
$367,064
Source: Tennessee Organization, Admissions: 15,598, Bed size: 304, >1400 employees, Employees=1441
Tactic and Tool Implemented:
Hourly Rounding
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Cost Avoidances – Decubitus
120
10897
50
70
90
110
130
1
Actual Decubitus Incidents
2005 2006 2007
Tactic and Tool Implemented:
Hourly Rounding
Estimated Cost Avoidance =
$330,658
Source: Tennessee Organization, Admissions: 15,598, Bed size: 304, >1400 employees, Employees=1441
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Tips
Must have a buddy system formalizedCan’t be delegated outside of the staff within the matrix but needs to include all staff in the matrix.Let’s talk about pain, communication, medication, clean and quiet.Behaviors matter
Active ListeningEye contactTone of voiceAppropriate speed of speechAppropriate use of touchNot multi-taskingAppropriate use of humor/emotionPhysical positioning – sitting, kneeling, etc.Energy mirrors the needs of the patient
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Robots?!?
Being Robotic is a function of the messenger – Not the message!
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Jazzercise vs. Rockettes
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Phases of Competency and Change
Even with positive change, there is resistance . . .
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Rounding Queen
This is hard
Takes longer than you think
Try to make it fun
http://www.youtube.com/watch?v=ovNWV1D4X0c