Achieving Medicine of theHighest Order – Cultural
Transformation Based on “Horton Hears a Who”
Bradford C. Berk, MD, PhD
May 22, 2013
Faculty Institute for Teaching and Learning
I’ve learned what’s important
• Treating patients and families with dignity and respect
• Showing compassion and attentiveness• Valuing the patient and family
as an integral part of the
health care team• Listening to our patients
and their families
2007-12 URMC Mission and Vision
• Mission: Using Education, Science and Technology to Improve Health.
• Vision: Develop a high quality, cost-effective patient-centered healthcare delivery; lead by our world class researchers, educators and clinicians.
2013-18 URMC Mission and Vision
• Mission: The University of Rochester Medical Center is a home of healing, learning, research and innovation committed to improving health and quality of life for our patients, families and community.
• Vision: To be nationally recognized by 2020 for improving community health through transformative approaches in compassionate care, education and research.
7
People and Culture- Key Component of Strategic Plan
11
Enhancing Standard HR duties — benefits, hiring, payroll
New-
Implement Business Partners: who understand the specific HR challenges that their clients face to learn time-tested tactics for fostering employee engagement to be able to help managers structure incentives that drive peak
performance
Talent management software to function with existing HRMS system
Boost Evaluation Process and Tools
The healing power of touch
Compassion – We need to show we care Attentiveness – We need to pay attention to
show we care
Patient and Family Centered Care (PFCC)
A set of principles and values that when implemented successfully improve quality, safety, and long-term outcome. In addition, data shows improvement in patient, family, care provider, and staff satisfaction.
Transforming a culture
Patients and families are repeatedly telling us we need to do better in these areas:
• Response to your concerns/complaints
• Staff addressed your emotional needs
• Staff included you in decisions regarding treatment • Nurses and Physicians kept you informed
• Staff worked together to care for you
• Time physician spent with you
Communication, Compassion and Attentiveness are Critical
Creating value enhances PFCC
Create Value (Quality/Cost) by implementing LEAN process improvement strategy
Eliminate waste in our system without diminishing the patient experience
• remove extra steps in patient flow• simplify operational processes• eradicate duplicate and unnecessary
paperwork results in better patient and staff
satisfaction Utilize LEAN approach to help create a patient and
family-centered care culture
Building a PFCC Culture
Areas of Focus:
• Facility• Medical Advances• Information Technology• Delivery of Care• People
Facility
PFCC requires a comfortable supportive environment
private rooms with family
sleeping spaces atmosphere that promotes healing
• Cancer Center Expansion• New Children’s Hospital • Upgrade of Current
Facilities
Information Technology
eRecord will promote PFCC
provides immediate and more thorough understanding
provides improved communication among providers
can identify high-risk patients to ensure comprehensive care plan and enhanced communication
can encourage attentiveness and compassion
o i.e. electronic sticky notes can enhance patient and provider’s bond by reminding care providers to engage in topics most important to patient
“I am very sorry to know that you recently lost a loved one” “I understand you are anxious to return home to care for your cat”
Transforming the way we Deliver Care
encourage patient/ family involvement
promote practices to improve patient/family and provider communication (i.e. rounding and shift change at the bedside)
breakdown silos – enhance communication among providers and multidisciplinary care teams
develop specialized Hospitalists to promote efficient, but compassionate care
shift from episodic approach to care to full continuum of care
advanced medical homes
People are the most important part of PFCC
Train all medical staff and employees to be respectful and offer compassion
• How we communicate determines how effectively we convey compassion and attentiveness
• We need to convey to our patients compassion and attentiveness by communicating about things that matter to them
• The healing power of touch
Our employees need to feel cared for to provide patient/family-centered care
Staff need to be: treated with respect supported empowered recognized
Caring for the caregivers
PFCC across URMC delivery system
GCHAS
URMC PFCC Steering Committee
SMH Highland Highlands at Brighton
Highlands at Pittsford
VNS
Patient and Family Members
26
Influences on Patient Experience
Personal – behaviors/culture
Operational – systems/processes
Physical – environment/facility
Coordination of 3 broad efforts - medical center-wide - department/unit level
focus of PFCC
initiative
•2010 - 2 of the 8 HCAHPS domains at national average
•2012 - 6 of the 8 HCAHPS domains exceeded national avg.
Hospital Environment Pain Management
•2013 - Hospital wide rollout – next stage of PFCC initiative
Clearly defining ‘desired patient experience’ Focus on ‘consistent delivery’ of the experience
PFCC efforts are making a difference
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Making progress butstill below national average
28
Patients’ Overall Score for Hospital is Improving
Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 201260
62
64
66
68
70
72
74
65.7
63.1
67.667
69.4
70.569.9
70.4
73
HCAHPS Overall Hospital RatingStrong Memorial Hospital
Achievement Threshold = CMS Value Based Purchasing minimum (National Median) / 50th PercentileDisplayed by Discharge Date / All Surveys
% 9
or
10 Achievement
Threshold
Nursing Communication continues to rise
29
Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 201270
72
74
76
78
80
82
84
71.7
73.6
76.5
75.3
77.9 7878.7
77.7
78.9
HCAHPS Nurse CommunicationStrong Memorial Hospital
Achievement Threshold = CMS Value Based Purchasing minimum (National Median) / 50th PercentileDisplayed by Discharge Date / All Surveys
% A
lwa
ys
Achievement Threshold
Staff Responsiveness exceeds national average
30
Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 201246
48
50
52
54
56
58
60
62
64
66
52.751.6
56.5
53.7
58.6
61.262.1
64 64
HCAHPS Staff ResponsivenessStrong Memorial Hospital
Achievement Threshold = CMS Value Based Purchasing minimum (National Median) / 50th PercentileDisplayed by Discharge Date / All Surveys
% A
lwa
ys
Achievement Threshold
Difference from:
Workforce Commitment Item
2012 URMC
ClinicalEntrprs
% Unfav
Natl UHC Avg
Natl HC Avg
2011 URMC
Clinical Entrprs
43. I am proud to tell people I work for this organization. 4.38 3% +.02 +.02 +.06
49. I would recommend this organization to family and friends who need care. 4.34 3% +.05 +.01 +.05
56. I would like to be working at this organization three years from now. 4.34 5% +.08 +.06 +.06
59. I would stay with this organization if offered a similar job elsewhere for slightly higher pay.
3.71 15% .00 -.01 +.07
64. I would recommend this organization as a good place to work. 4.29 3% +.14 +.11 +.10
65. Overall, I am a satisfied employee. 4.10 6% +.06 +.03 +.09
Measuring Workforce Commitment
“I’ve learned that people will forget what you said,
people will forget what you did, but people will never forget
how you made them feel.”
- Maya Angelou