IUHA ED Patient Satisfaction Quality Improvement Presentation
1. IU Health Arnett Emergency Department
Patient Satisfaction Survey
By: Madalyn Tadrowski, Marissa Wuethrich, Jaclyn
Bourdon, Brianna Tharp, Margo Pok, Lyndsey Sangalis
2. HUMM Patient Satisfaction Survey
• IU Health Arnett Emergency Department
o HUMM surveys on patient satisfaction
5 questions
Administered on tablets
Started in December 2015
3. Key Stakeholders
• Practice Partners
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: In the 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 Patients choose 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)
7. Data Tools
• Nurse Survey
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
9. Nurse and Patient Data
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
12. Top 3 Categories of 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 Survey Questions
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.
16. • Release data results 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 Room visits
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:
o Director 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 on quality 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 satisfaction surveys 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
21.
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
Notas del editor
Madalyn begins: introduces self, project leader, states are project title. Introduces team members and they state their roles:
Lyndsey
Margo
Marrissa
Jackie
Bri
*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.
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.
Margo
Margo
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.
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.
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.
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.
Bri
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.
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.
lyndsey
Orange are the ones removed
lyndsey
Marissa Insert new map
madalyn
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%
lyndsey
bri
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