Increasing your Value-Based Purchasing Score through 5 Patient Rounding Best Practices

Increase Your Value-Based
Purchasing Score With 5 Patient
Rounding Best Practices
Jeff Echternach, Carilion Clinic
Carol Haney, Qualtrics

Senior Operations Consultant, Carilion Clinic
For Carilion Clinic, a non-profit health system based in Roanoke
Virginia, Jeff lead an organization-wide implementation of
rounding tools, starting with Patient facing satisfaction and
safety rounds and later including Staff Rounding and
Compliance and Audit (non-patient) rounding. Since inception,
almost 200,000 rounds have been completed and sustained
results including: improvement in HCAHPS, a reduction in HAI,
namely Catheter Associated Urinary Tract Infections (CAUTIs).
Rounding efforts have exposed improvement opportunity in a
variety of areas and the use of data and actionable follow-ups
have translated to improvement.
Jeff Echternach

Senior Research and Data Scientist
Carol Haney’s principal research area is online
quantitative research, specifically sampling,
methodological best practices, and advanced
analytics. Carol currently works with multiple clients in
the healthcare spaces. Carol has experience running
large survey programs that involve segmentation,
patient and customer experience, brand
communications, and performance measurement.
Carol Sue Haney

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oDetail the steps to designing a
patient rounding experience
oDescribe key steps that hospitals
should consider when implementing
a rounding tool
oUnderstand the impact that rounding
programs can have on your Value
Based Purchasing Score
Make a
Plan
PX
VALUE-BASED
PURCHASING
End User
Focus
Drive
Actions
Evaluate
Create
Account-
ability
Objectives

5
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Use data to
create
accountability
Make a
Plan
PX
VALUE-BASED
PURCHASING
End User
Focus
Drive
Actions
Evaluate
Create
Account-
ability
Design for your end users
Make a plan and
design your experience
Evaluate areas of opportunity
with change agents
Drive actions
and facilitate
connections
5 Key Steps 1
2
34
5

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VBP Program
The Hospital Value-
Based Purchasing
(VBP) Program is a
CMS initiative that
rewards hospitals with
incentive payments for
the quality of care they
provide to Medicare
beneficiaries.

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Understanding VBP
o Where can a rounding tool
have a meaningful impact
o Within patient experience
o Within Clinical Care
o Importance of scoring and
evaluation

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VBP
Measurement
across
Domains
Right now, we are
being evaluated
for how we will be
paid in the federal
fiscal year of 2019

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VBP-based
Withholding
FY2017 is the first
year where up to
2% of payment
may be withheld

EVALUATE AREAS OF OPPORTUNITY
WITH CHANGE AGENTS

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VBP Program
o Implementing a rounding tool
requires leadership buy-in at all
levels
o Mapping the journey will allow
you to maintain and measure
engagement
o Review your data with your
Quality and Operational
department
o Invite key leaders

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Reviewing your data
o HAI/HAC (CAUTI CLABSI, MRSA
CDIFF)
o PSI-90 composite
o Select SSI Compliance post-operative
care/
o HCAHPS
o Patient Complaint/advocacy data
o RCA findings (Serious and sentinel
events) and claim settlements

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Invite Key Leaders
o Nursing (Various staff and leader
levels)
o Consider CNO Sponsorship
o Emergency Room
o Surgical Areas
o Various Inpatient units
o Physician leadership (consider
someone from your larger medicine
service(s)
o Patient Risk/Advocacy
o Quality Department
o Ancillary department leaders
(key to inpatient)
o Therapy
o Pharmacy
o Bed Cleaning
o Environmental Services
o Maintenance
o Dietary

MAKE A PLAN AND
DESIGN YOUR EXPERIENCE

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Make a Plan
o Think FMEA:
o Outline the areas where you
want to improve
o Think about the level of impact
you could expect
o Organize your thoughts in to a
logical flow
o Think CONVERSATION:
o Use an envisioned rounding tool
or structured visit by a leader

VBP Impact
Issue
Identification
Safety -
CUSP
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Design your experience
Structure your questions and patient interactions in a way
that will facilitate an interactive experience

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Rounding Question HCAHPS Measure ID - HCAHPS Question
Are we responding to your call bells in a
timely manner?
H_COMP_3_A_P-Patients who reported that they
"Always" received help as soon as they wanted
Has your nurse explained what to expect
in your care today in a way you can
understand?
H_COMP_1_A_P-Patients who reported that their
nurses "Always" communicated well
How are we doing at managing your pain? H_COMP_4_A_P-Patients who reported that their
pain was "Always" well controlled
Have all of your medications been
explained to you?
H_COMP_5_A_P-Patients who reported that staff
"Always" explained about medicines before giving it
to them
Have possible side effects been explained
to you?
H_COMP_5_A_P-Patients who reported that staff
"Always" explained about medicines before giving it
to them

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Rounding Dialogue Prompt VBP Domain
I noticed your trash bin is full, I am going to ask
our housekeeper to come empty your trash bin
and mop in the bathroom
H_CLEAN_HSP_A_P-Patients who reported
that their room and bathroom were "Always"
clean
You told me that your bed is not raising up and
lowering appropriately. I am going to notify our bed
repair team to trade out your bed.
H_COMP_3_A_P-Patients who reported that
they "Always" received help as soon as they
wanted
You shared that you were not satisfied with part of
your meal yesterday. I have notified Dietary to talk
with you about today’s menu options
H_COMP_3_A_P-Patients who reported that
they "Always" received help as soon as they
wanted

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Rounding Question VBP Domain
Observe for central line dressing changed,
Dressing is clean and dry, dressing has date last
changed clearly marked
SAFETY-HAI-Central Line-Associated
Bloodstream Infections (CLABSI)
Observe Foley Catheter & Drain line: Line is clear,
bag below bladder, tamper evident seal in-tact,
area is clean, documentation that site was cleaned
each day / today.
SAFETY-HAI- Catheter-Associated Urinary
Tract Infections (CAUTI)
Engage patient in questions about infection
control: Are the nurses and doctors washing their
hands before and after working with you?
SAFETY-HAI- Methicillin-resistant
Staphylococcus aureus (MRSA) C. difficile
Infections (CDI)
Engage the patient in prevention of infection: Are
you encouraging your friends, family, and other
visitors to wash their hands before and after
visiting?
SAFETY-HAI- Methicillin-resistant
Staphylococcus aureus (MRSA) C. difficile
Infections (CDI)

21
Touch-screen ease,
part of the driver of
communication
between staff and
patient

In-Patient
Rounding
Survey
22
Medications driver
questions:
• if No is selected on
both or either, then
triggers are created
• if Yes is selected on
both, then triggers are
not created

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End User Focus
Who will be performing
the round?
What device will they use? Device compatibility?

25
In-Patient Rounding
Survey
Rounding Tool Link
Note: Each
unit has a
different
Nurse Admin
and Primary
Physician

DRIVE ACTIONS AND
FACILITATE CONNECTIONS

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Drive Action
o Address unfavorable
scores with escalation,
tickets, and service
recovery
o Engage your patient
advocacy department as a
collaborative partner in
responding to these
scenarios

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Examples
o Environmental Services Create a ticket to come clean the room, empty waste basket,
change linen, clean bathroom
o Maintenance Address problems in the room such as broken lights, equipment, or hvac issues
o Dietary Identify specific issues the patient is experiencing with food selection / delivery (or)
identify more complex systematic issues
o Therapy Escalate challenges in mobility and prompt for a therapist evaluation or escalate
complaints about painful ambulation or ADLs
o Pharmacy Escalate areas where patients remain confused about their medications and
leverage unit-based pharmacists to address questions

In-Patient Rounding
Survey
31
Patient
Rounding
identified
Medications
driver
question
asked
Triggers
based on
follow-up

32
Trigger one:
email and
task to
Pharmacist

33
Trigger two:
email and
trigger to
Nurse Admin
and Primary
Physician

34
Trigger
three:
email and
trigger to
Nurse Admin

35
Admin View of all
events
Pharmacist Nurse Admin
Primary
Physician
Facilitate connections
o Ticket based scenarios that you can automate or redirect

Overall Ticket Handling, Follow-Up View
36

38
Email Sent, with link to dashboard

40
Overall Ticket Handling, Reminder View Build

USE DATA TO CREATE ACCOUNTABILITY

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Data-driven decision making
o Use data to create
accountability
o Dashboards and accountability
reports are key
o Align process measurement
(your rounding tool) with
outcome measures (HCAHPS,
VBP Scoring on Safety (CAUTI,
CLABSI, Etc))
o Review data with your front line
staff

48
Dashboard View, all open tickets

49
Dashboard View, specific ticket handling

50
Dashboard View, setting root cause on specific ticket
(changes per ticket owner)

Increasing your Value-Based Purchasing Score through 5 Patient Rounding Best Practices

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