Meet Salem Health’s Patient Experience A3

16 Oct 2016

By: Sarah Horn, CNO, MBA, BSN, RN

 

We started a new series on Salem Health’s Daily Dose to explain strategy deployment, and wanted to share it here. Several pieces make up this huge annual planning effort, commonly referred to as Mother, Divisional, Baby and Unit A3s.

An A3 is simply the title of the form used for all planning documents. It comes from the size of the paper it’s printed on (11 by 17 inches). The nickname caught on when we started referencing this document when Strategy Deployment started a few years ago.

We have six Mother A3s for 2017: Employee Engagement, Financial Performance, Patient Experience, Physician Engagement, Population Management and Quality Safety.

Improving patient experience
Sarah Horn, chief nursing officer, and Nancy Boutin, MD, director of Palliative Medicine, are captains of this A3. It outlines the challenges and goals we have to improve patient care and satisfaction — a critical strategy for Salem Health with strong impacts on our financial health, along with patient care and our Magnet designation.

The full A3 is detailed with charts, graphs, schedules (with names assigned to tasks). If you’re bewildered by lots of detail, here’s a description:

Major problems we’re addressing
Inpatient admissions through the ED have tripled in the past 10 years; yet those who are admitted through the ED rate us lower in satisfaction than patients directly admitted — so we need to understand the specific needs of this group and create a better experience for them.

• Current pay for performance patient survey measures (H-CAHPS and soon ED CAHPS) have a financial impact. Communication about new medications is strongly correlated with our patient’s experience and is an area of focus for us this year.
• While our overall patient experience rating has improved in the ED, the bulk of our ED patients are of acuity level 3 and 4 (mid-lower acuity level). These patients rate us lower than all other ED acuities, so we’ll focus our leader rounding on this population.

 

Analysis and justification for this year’s goals
Our inpatient H-CAHPS ratings should increase to 76.7 by the end of 2017 if we:

• Improve communication to patients waiting in the ED for a hospital bed;
• Address throughput to reduce delays to transferring patients to beds and perform a transfer analysis (with OHSU) to ensure patients have optimized placement that is closest to home care; and
• Improve communication with patients about new medications.

Our ED ratings should improve to 85.9 by the end of 2017 if we:

• Balance ED leader rounding to focus on patients with acuity levels of 3 and 4.

This year’s action plan
Increase overall H-CAHPS rating from 75 to 76.7, through:

• A variety of activities to improve communication.
• Use Lean methods in various phases of patient care to reduce wait times.
• Reduce “admit order” time by 10 percent.
• Create a model to communicate and confirm understanding of new medications ordered for patients.

Increase overall ED Press Ganey scores from 65^th percentile to 70^th (first six months), then to the 76^th in final six months, through:

• Using a model of leader rounding proportioned to improve outcomes by distributing the intervention based on patient acuity level.

To involve OHSU Partners, the action plan also includes an analysis to improve transfers and optimize patient placement between the two organizations (Salem Health and OHSU).

Sustain and Operate

The goal is to maintain targets (i.e. hitting certain percentiles established under goals) in both inpatient, ED and outpatient settings. For example, we want nurse leader rounding at 90% and ED lobby rounding at 65%.