I’m closing your hallway door, Mrs. Smith. We always want your room to be as quiet as possible.

We always strive to clean your bathroom twice a day.

It’s really second nature for us to always make sure you understand your medications.

It’s customary for our team to always answer call lights within five minutes.

It’s routine for us to always inquire about how well we’re managing your pain.

We make it a practice to always answer your questions without delay.

Service “all the time” is routine for us… We want your experience with us to always be excellent

On April 29, 2011 The Centers for Medicare & Medicaid Services today issued a final rule (42 CFR Parts 422 and 480) that sets forth its policies for the hospital value-based purchasing program. Under the Patient Protection and Affordable Care Act, the VBP program will pay hospitals based on their actual performance on quality measures, rather than just the reporting of those measures, beginning in fiscal year 2013. In the first year, the VBP program will include 12 clinical quality measures as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experiences with care survey.

The clinical measures will account for 70% of a hospital’s VBP score and the HCAHPS survey for 30%. For FY 2014, CMS will add the heart attack, heart failure and pneumonia mortality measures to the VBP program, as well as eight measures of hospital-acquired conditions and two composite patient safety and inpatient quality indicators developed by the Agency for Healthcare Research and Quality. The VBP program will apply to all acute-care prospective payment system hospitals with certain exceptions. For example, for the clinical process measures, CMS will exclude from hospitals’ scores any measures for which they report fewer than 10 cases and will exclude from the VBP program any hospitals for which fewer than four of the 12 proposed clinical process measures apply. CMS will also exclude from the VBP program any hospital that reports fewer than 100 HCAHPS surveys during the performance period.

For the FY 2013 incentive payments, CMS proposes that it will use data associated with hospital discharges from the third and fourth quarters of 2011 and the first quarter of FY 2012, as the “performance period” for the proposed clinical process of care and HCAHPS measures. So starting July 1, 2011 and running to March 31, 2012, our scores for “Room and restroom always clean” will be very, very important. All your hard work improving your scores will now be validated.

A hospital’s performance on each measure during the performance period will be compared with a “baseline period” from July 1, 2009 to March 31, 2010. Whether the hospital receives a value-based incentive payment, and the amount of such payment, will be based on either how well the hospital performs on the specified quality measures during the performance period or how much the hospital’s performance improves on the quality measures from its performance during the baseline period. The higher a hospital’s achievement or improvement during the performance period, the higher the hospital’s value-based incentive payment.

Do you know what your HCAHPS scores were July 1, 2009 to March 31, 2010? If you have been tracking and working on your performance good for you. If not, well, I’m sure you will be now. You should already have a spreadsheet setup for doing your own comparison and tracking.

In upcoming posts I will be writing about steps you can take to improve your scores and staff performance. Go HCAHPS!

Here I continue to list cleaning standards. We use these as a guide to understanding our responsibilities in general cleaning. This is not meant to be a complete list, rather a broad overview. Enjoy your reading:

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Chasing the numbers

I spent a good part of the day writing performance evaluations. I find it somewhat refreshing to think about a staff member and write wonderful words that reflect their performance during the last year. Of course not every word is, glowing, but for the most part all my staff are good, hard workers and each one has positive qualities that work together for the department, and the hospitals good.

A good portion of the rest of the day was spent chasing numbers. You know, the NRC Picker, or Press Ganey satisfaction survey results that go along with the HCAHPS survey results. I find I’m more and more often aligning strategies, scripting, and work teams to push these numbers up. It can become an obsession… the daily logging into Press Ganey, running the queries, reading the reports.

Hurray! +.5 % on the mean score for courtesy, oh sad, -.6 on cleanliness, but wait, the emergency room waiting area jumped up 7%. Lets go clean the furniture again, did we make enough patient room rounds today? It is not enough to manage by walking around (MBWA), we need to fill out some quality assurance checks and speak to a dozen patients as well, hold staff huddles, post the numbers, give more praise and recognition, re-train on high dusting, pass out more putty knives to scrape those corners, look into 55 gallon drums of floor finish, as we go through gallon jugs too fast and so on, so forth.

I find it rather exciting to push the numbers. Of course it is not smoke and mirrors. Behind those gains are many staff members and other hospital employees working hard, doing things right, taking care of the patients, guests and each other. That is why I am in this business, but we measure, measure and measure again to make sure we keep on doing those right things.

Chasing the numbers? Yes, it can seem that way. And those are moving targets, what with the hospitals we compete with doing everything they can to improve just as we are. I might achieve an increase in my cleanliness mean score but if other hospitals also increase, and higher than I do my percentile will go down. So we compete against ourselves, and against other hospitals. Makes it all just a little more complicated.

By now, everyone should know that patient satisfaction data is no longer public. The Centers for Medicare & Medicaid Services (CMS) developed the Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHPS for short, to increase accountability and transparency of healthcare delivery practices. It is the first public, and nationwide standardized survey that provides direct comparisons of hospital services.

Survey results are posted on the web at www.hospitalcompare.hhs.gov along with other clinical measures to give patients a fairly complete view of the quality any given hospital is providing. One idea behind this is that consumers will “shop around” for their healthcare, something like one would shop around for a restaurant or a new car.

At my, like most hospitals we use in addition to HCAHPS, another survey tool that measures many more aspects of patient care and performance. A drawback to HCAHPS is that it measures only the basic elements of patients care, excluding a lot of factors important to patients in their overall experience.

For my area of responsibility HCAHPS includes only one question: “During this stay, how often were your room and restroom kept clean?” -Never, Sometimes, Usually or Always. This can be misleading because it does not measure the level of cleanliness, only the frequency. If the housekeeper makes several visits to your room does that mean “Usually” or “Always”. If the housekeeper makes several visits to tidy or straighten up but does not clean would that influence the response”.

Regardless of the answer to that we take definite and clear steps to improve our scores and raise the patient awareness that we are cleaning, and we want their room and restroom to always be clean, really clean. Our staff are trained with scripting and hospitality programs that include greeting the patient and letting them know what we will be doing in their room. We use leave behind cards when the patient is asleep or away for a test letting them know their room was cleaned and a phone extension to call if they would like any further service.

I have no doubt that HCAHPS, in the present form or revised will remain. I work hard to help my staff be successful at delivering a quality service to our patients and guests worthy of the “Always” score. We will continue to do so regardless of this survey though. Our greatest satisfaction comes from the patient who really feels their room is very clean and safe for them.