Effective Communication Through AIDET®

Key Words at Key Times Five Fundamentals for Hospitalists

Regina Shupe RN, MSN, CENApril 18, 2012

Overview - Value-Based Purchasing (VBP)

Another word for Pay-for-Performance, this is a program intended to transform healthcare by fostering a joint clinical and financial accountability system.

This new payment system will change CMS from a “passive payer” of services into an “active purchaser” of high quality, affordable, safe healthcare.

Hospitals will be reimbursed based on their performance, not just reporting of quality metrics, including the patient perception of quality.

What is VBP?

Why is it important?

How will it be used?

Source: “Report to Congress: Plan to Implement a Medicare Hospital Value-Based Purchasing Program” ,CMS, Nov. 27, 2007

HCAHPS – Hospital Consumer Assessment of Healthcare Providers and Systems

A standardized survey tool of 27 questions to measure the patient’s perception of quality care provided during their experience while a patient at an acute-care hospital.

The patient perception of care will be publicly reported with other quality metrics on the Hospital Compare website. www.hospitalcompare.hhs.gov

The information will be used to provide meaningful data for improvement efforts as well as provide comparisons between hospitals to help consumers choose a hospital.

What is HCAHPS

Why is it important?

How will it be used?

Value Based Purchasing FY 2013

12 Core Measures

(* 70% Weight)

8 HCAHPS Composites(* 30% Weight)

1% Base operating

DRG payments

Performance

attainment and

improvement will

determine total

hospital reimbursem

entImplementation FY 2013 (October 2012) Source: Value Based Purchasing Program final rule 4.29.11

Value Based Purchasing FY 2014

Core Measures(45% Weight)

HCAHPS Composites(30% Weight)

1.25% Base operating

DRG payments

Performance attainment and improvement

willdetermine total

hospital reimbursement

Outcomes(25% Weight)

New 2014

update

Note: Implementation FY 2014Source: OPPS VBP Final rule 11.1.11

2014 VBP Reimbursement Periods

Process of Care and Patient Experience of Care Domains:

Baseline Period: April 1, 2010 through December 31, 2010 (9-months)

Performance Period: April 1, 2012 through December 31, 2012 (9-months)

Outcomes Domain – Mortality Measures (previously adopted by CMS as final):

Baseline Period: July 1, 2009 through June 30, 2010 (12-months)

Performance Period: July 1, 2011 through June 30, 2012 (12-months)

Note: Implementation FY 2014Source: OPPS VBP Final rule 11.1.11

New 2014

update

12 Core Quality MeasuresValue Based Purchasing FY 2013

Core Quality Measures Selected2 Heart Attack (Fibrinolytic w/i 30 min’s; PCI w/i 90 min’s)

1 Heart Failure (Dx instruct)

2 Pneumonia (Culture in ED w/o anti; CAP immuno pt.)

7 Surgical Care: Infection and ImprovementProph anti w/i1 hr of incision

Proph anti selection-surg.

Proph anti Dx w/i 24 hrs of surg.

Cardiac pts-6AM post-op serum glucose

Beta blocker prior to arrival if received during period

Recommended Venous Thromboembolism proph ordered

Venous Thromboembolism proph w/i 24 hrs prior and post

Source: Value Based Purchasing Program final rule 4.29.11

HCAHPS QuestionsComposite Question Summary Response Scale Top Box

Nursing CommunicationNurse courtesy and respect ALWAYS1, Usually, Sometime, NeverNurses listen carefully ALWAYS, Usually, Sometime, NeverNurse explanations are clear ALWAYS, Usually, Sometime, Never

Doctor Communication

Doctor courtesy and respect ALWAYS, Usually, Sometime, NeverDoctors listen carefully ALWAYS, Usually, Sometime, NeverDoctor explanations are clear ALWAYS, Usually, Sometime, Never

Responsiveness of StaffDid you need help in getting to bathroom? 2 Yes No (screening question)Staff helped with bathroom needs ALWAYS, Usually, Sometime, NeverCall button answered ALWAYS, Usually, Sometime, Never

Pain ManagementDid you need medicine for pain? 2 Yes, No (screening question)Pain well controlled ALWAYS, Usually, Sometime, NeverStaff helped patient with pain ALWAYS, Usually, Sometime, Never

Communication of Medications

Were you given any new meds? 2 Yes, No (screening question)Staff explained medicine ALWAYS, Usually, Sometime, NeverStaff clearly described side effects ALWAYS, Usually, Sometime, Never

Discharge InformationDid you go home, someone else’s home, or to another facility? 2

Own home, Someone else’s home, Another facility (screening question)

Staff discussed help need after discharge YES, NoWritten symptom/health info provided YES, No

Cleanliness Area around room kept quiet at night ALWAYS, Usually, Sometime, NeverCleanliness Room and bathroom kept clean ALWAYS, Usually, Sometime, Never

Loyalty Willingness to Recommend DEFINITELY YES, Probably Yes, Probably No, Definitely NoLoyalty Hospital Rating Question 0 to 10 point scale (percent 9 and 10 reported)

1Response used to calculate the question score is designated by capital letters2For analysis purposes, it is important to know which areas have screening questions because the sample size will be lower than the other areas

“ALWAYS”

Execution FrameworkEvidence-Based LeadershipSM

Standardization AcceleratorsMust Haves®

Performance Gap

Objective Evaluation

System

Leader Development

Foundation Breakthrough

STUDER GROUP®:

Agreed upon tactics and behaviors to achieve goals (Must Haves®)

Re-recruit high and solid performers

Move low performers up or out

Processes that are consistent and standardizedProcess Improvement

PDCALeanSix Sigma Baldrige Framework

Software

Aligned Goals Aligned Behavior Aligned Process

Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results

Implement an organization-wide staff/leadership evaluation system to hardwire objective accountability

Rev 4.8.11

Evidence-Based LeadershipSM

Evidence-Based Care

LEADERSHIP(EBL)

PATIENT CARE(EBC)

PDCA, Lean, Six Sigma, Baldrige

Framework

Must Haves®

Goal Alignment and Cascading

ComplianceTreatment

Plan Prescribed

Diagnosis and Prognosis

Aligned Goals Aligned Behavior Aligned Process

Aligned Goals Aligned Behavior Aligned Process

OUTCOMESPatient and

organizational

e.g. Beta blocker for patient and core measures

for Value-based purchasing

Creating a Culture of “Always”Evidence-Based LeadershipSM

"The greatest danger in times of turbulence is not the turbulence; it is to act with

yesterday’s logic.“ -Peter Drucker

Studer Group Five FundamentalsAIDETSM

A Acknowledge

I Introduce

E Explanation

T Thank You

D Duration

The Definition

AIDET is a framework of communication used patients, their family members and one another. When used consistently, AIDET reduces anxiety, improving the patient care experience. Key Words at Key Times is part of AIDET.

Advantages of AIDETSM

=

Decrease anxiety with increased compliance

Decreased Anxiety

Increased Compliance+

Improved clinical outcomes and

increased patient and physician satisfaction

Communication and Malpractice Claims

Risk of most malpractice suits is predicted by practitioners’ inability to communicate well with their patients

Specific physician behaviors that significantly increased the likelihood of malpractice suits include:

Lack of respect

Not listening to the patient

Not providing adequate feedback

Hickson, GB, et al. NC Med.J 2007: 68:362-364

Levinson W, et al. JAMA 1997; 277: 553 – 559

Relationship between Patient Satisfaction, Complaints and Lawsuits

Physicians with lower patient satisfaction results are more likely to have  patient complaints

Each one point decrement in patient satisfaction scores is associated with a –

6% increase in complaints

5% increase in risk management episodes

Lower performing physicians were at greater risks for lawsuits

75% of complaints were related to communication issues

Stelfox HT, et al, The American Journal of Medicine 2005; 118: 1126 – 1133

 

Adherence to Care Plan

As shown in a meta analysis of 79 studies in the general literature of the impact of therapeutic relationship on medical outcomes, the impact is moderate but consistent

Key themes that impact adherence are trust, respect and communication

The Importance of the patient-clinician relationship in adherence to antiviral medication

International Journal of Nursing Practice 2007

Empathetic Responses in Clinical Practice

Of 200 empathetic opportunities, the oncologists in the study responded only 22% of the time. Instead they choose to discuss other aspects of medical care

In another study involving patients with lung cancer, oncologists acknowledged or explored only 11% of empathetic opportunities

Physician Empathy = Positive Clinical Outcomes

Through a landmark study, a research team from Jefferson Medical College (JMC) of Thomas Jefferson University has been able to quantify a relationship between physicians' empathy and their patients' positive clinical outcomes, suggesting that a physician's empathy is an important factor associated with clinical competence. The study is available in the March 2011 issue of Academic Medicine

*Source: Thomas Jefferson University, Physician's Empathy Directly Associated With Positive Clinical Outcomes In Diabetic Patients

Physician Empathy = Positive Clinical Outcomes

"Our results show that physicians with high empathy scores had better clinical outcomes than other physicians with lower empathy scores"

good control* (A1c<7.0 percent)

• Higher Empathy Good Control

• Lower EmpathyPoor Control

moderate control* (A1c≥ 7.0% and

A1c≤ 9.0%)

poor control* (A1c>9.0 percent)

good control* (LDL<100mg/dL)

moderate control* (LDL≥ 100 and ≤

130 mg/dL)

poor control* (LDL>130 mg/dL)

*Source: Thomas Jefferson University, Physician's Empathy Directly Associated With Positive Clinical Outcomes In Diabetic Patients

Em

pathy

A Acknowledge

In person, with your body:

(Wash In)

Smile!

Make eye contact

Acknowledge everyone in the room

Use open body language

“Good morning Mr. Warner…”

First Generation

NameDepartment

“Hello Mr. Warner. I am Dr. Edwards and I am the

hospitalist that is caring for you today….”

“Hello Mr. Warner. I am Dr. Edwards and I am the

hospitalist that is caring for you today. I am one of a team of

hospitalists that will be caring for you. Do you know what a

hospitalist is? We are a team of doctors that are specially

trained to take care of patients in the hospital. We

communicate regularly with your own doctor, and one of us is always here if you need us!”

Next Generation

Self, Skill Set, Experience and CertificationCo-workersOther DepartmentsPhysicians

I Introduce

Hospitalist Brochure

Advantages of Managing up Self, Coworkers and Other Departments

SELF HOSPITALIST TEAM NURSES ; OTHER DEPARTMENTS

Reduces patient anxiety

Builds trust Improves

compliance Improves clinical

outcomes Increases

patient perception of care

Reduces complaints

Patient feels better about their next care giver

The patient feels more at ease with the handoff, thus their coordination of care

Next provider has a head start in winning confidence

Reduces complaints

Reinforces coordination of care and teamwork

Positions other department well so they don’t have to win the patient over

Decreases patient anxiety and concern

Reduces complaints

How long will the test, procedure, appointment or admissions take?

How long will the patient need to wait before they can go home, return to work…?

When should they expect to see you or another hospitalist again?

D Duration

“The CT I ordered will take about 20 minutes to perform and then

about one hour for the results….”

“I am going to check on you this evening and

then Dr. Beeson will be here tomorrow morning and will stop by before

10 am. He and I will have reviewed your

case. He is an excellent physicians and I am leaving you in great

hands”

Review memo pad with patient

Why are we doing this?

What will happen and what should you expect?

What questions do you have?

USE UNDERSTANDABLE LANGUAGE

E Explanation

“Let me explain some more about the procedure.

First we are going to start an IV….”

(Explain why

performing the procedure, what will

happen and what they should expect,

understanding of side effects, and

answer any questions.)

Patient Memo Pad

Provided by physician to patient on first encounter

Patient is encouraged to capture questions they may have for the hospitalist team

Hospitalist will review memo pad when they visit with patient and family

The Reality of Explanation

Excellent communication between the patient and the provider improves adherence to medication regimens

Patients who do not comprehend all aspects of their disease or the importance of the treatment in controlling the disease and preventing adverse outcomes are less likely to be adherent with the treatment plan

Harmon G,et al, Curr Opin Cardiology 2006; 21: 310 – 315

T Thank you

Show appreciation

Provides a positive closing

Thank patients for trusting us with their care

Leave your business card

(Wash out)

“Thank you for choosing us

….Thank you for waiting … Thank you for coming in

today…What other questions do you

have?”

HCAHPS Doctor Composite Questions and AIDET:

Question Why is it important?

Doctor/Nurse treated you with courtesy and respectA I D E T

• Therapeutic relationship contributing to adherence to treatment regimes

• Improved clinical outcomes• Decreased complaints• Decreased litigation• Increased patient loyalty

Doctor/Nurse listened carefully to youA I D E T

• Improved information-gathering• Therapeutic relationship (increased trust and empathy)• Decreased anxiety• Increased patient loyalty

Doctor/Nurse explained in a way you could understand A I D E T

• Improved compliance with treatment plan and discharge instructions

• Decreased readmission related to poor treatment adherence

• Decreased patient and family complaints• Decreased pages/calls from staff requesting more

information

AIDET® HCAHPS – Explanation regarding Medications

A Acknowledge

“Mr. Perdue, I have the new medication your doctor ordered for your blood pressure.”

I Introduce

“Since it is new to you, I want to take some time to tell you about it – why you are taking it and some side effects to watch out for. Is now a good time? You are taking _____ and is to lower your blood pressure.”

D Duration“You will take it just once a day. You will need to remain on this through your follow-up appointment in 2 weeks.”

E Explanation

“Most people don’t have trouble with this medication but some of the more common side effects we have seen are dizziness and cough. I have printed out this information about your new medication and am going to highlight 2 things for your review when you go home. We will review it again before you are discharged. It is important you know what the medication is, why you are taking it, and what the common side effects are. Let’s go over it one more time…”

T Thank you

“Thank you for paying such close attention. It is important you understand your medications so you can heal faster and care for yourself when you go home. Let me know if you have any questions ….”

Tips for knowing when and how to use AIDET®

The elements of AIDET® are important in every interaction with a patient and their family

There are times when you will not need to verbalize all of the elements of AIDET®

Elements of AIDET® do not have to be delivered in any specific order

Managing up yourself and your team is often done with an initial introduction

It is useful to repeat introduction of yourself and your team when you sense increased anxiety in your patient

Duration is best communicated in specific time increments

When you cannot commit to a specific time, commit to a specific time interval in which you or another team member will update the patient on progress

Tips ~ Physician/Provider AIDET®

Sit down when entering the room (increases the perception of time)

Shake hands with patients and family members (78% of patients prefer a hand shake – sign of courtesy and respect)

Address patients by name (91% of patients want to be addressed by name)

Use a formal opening and closing statement with patient

Manage up – co-workers, hospital, support services (shows coordination of care, decreases complaints, and reduces anxiety of patients)

Website Resources at www.studergroup.comPartner Code EMCA - 551 

Improve Your HCAHPS Results With AIDET – New evidence demonstrates how AIDET can help organizations quickly improve their HCAHPS results

Studer Group Webinar Series:

HCAHPS - Part 2: Pay for Performance is Here – Join Quint Studer, Founder and CEO of Studer Group and David Callecod, FACHE, CEO of Lafayette General Medical Center, Lafayette, LA for a 45 minute web-based video learning session, "HCAHPS - Part II: Pay for Performance is Here"

“Vision without execution is h a l l u c i n a ti o n . ”

Thomas Edison

Thank You!

Regina Shupe MSN, RN, CEN www.studergroup.com