Bigger systems need easily shared solutions

Providence Health & Services was committed. System leaders knew monitoring and resolving patient problems in real time was the best way to raise its patient satisfaction scores.

They had also determined that daily patient rounding by senior executives or nurse leaders was the best way to accomplish that goal. But they needed a technology that facilitated analysis of patient complaints and enabled problem solving without adding another layer of burdensome data collection and input tasks.

They also needed a technology adaptable to a large, multi-state system with 32 hospitals, whose leaders desperately wanted to avoid the so-called popcorn effect, where the system's many institutions wind up trying to solve common problems in multiple ways.

After examining CipherHealth's patient monitoring technology during a “Shark Tank”-like competition, Providence chose the company's Orchid platform. System officials say it had the advantage of being customizable and device-agnostic, which allowed the application become the standard for the entire system.

Orchid “was accepted with open arms, and one of the nurse leaders summed it up best—it actually worked right out of the box, and that does not happen very often, especially with healthcare technology,” said Nancy Yates, chief nurse informatics officer at Providence Health & Services.

The first site went live with the digital rounding software in January of this year. It served as a proof-of-concept. Providence has since set up 15 sites, meaning almost half of all hospitals in the health system will soon be running Orchid.

The common platform allows Providence to easily compare performance across the whole enterprise. Yet it was customizable. CipherHealth worked with each Providence hospital to create site-specific survey questions and reports. The current version includes eight standard questions asked at every Providence hospital along with two site-specific questions.

Yates estimates Orchid saves nurse managers at least thirty minutes per day by simplifying the rounding process. It also generates reports so managers can identify staffers who don't keep up with their rounds. Their daily rounding goal is to reach 90% of patients in every hospital by using Orchid.

The results are already trending in a positive direction. Preliminary HCAHPS data on pre- versus post-Orchid patient experience looks promising with communication with doctors, communication about medicine, and responsiveness of hospital staff showing quarter-over-quarter increases.

And best of all, “it requires less than 10 minutes of training,” Yates said. “For those sites that are live, the patient experience trends are going upward and in the right direction.”

Virtually all healthcare systems are addressing the issue of patient satisfaction. Those that fail to address their patients' experience are rolling the dice with a sizable portion of their revenue. Direct and indirect costs that result from dissatisfied patients can quickly add up to millions of lost dollars.

The CMS uses patient experience data—taken from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey—to calculate a hospital's penalty or bonus in reimbursements each year. Up to 2% plus or minus in will be applied in 2017. According to Press Ganey, the average U.S. hospital will have anywhere from $500,000 to $850,000 at risk under the value-based purchasing program.

In addition, studies show happier patients can lead to reduced malpractice costs, lower patient turnover, and increased referrals to other facilities in their network. A study published in the American Journal of Medicine of 353 physicians found that those ranked in the lower third based on patient satisfaction survey scores had malpractice lawsuit rates 110% higher than doctors in the top third.

In an era of social media and review websites, a hospital's reputation can easily be dragged down by angry consumers who had an unpleasant experience.

Such costs—financial and reputational—have led many healthcare executives to rank patient satisfaction near the top of their priorities list. And a number of health systems have implemented digital rounding software like CipherHealth's Orchid to help them address patient concerns in real time.

“Patient experience and reaching our targets for HCAHPS scores is one of our strategic priorities,” said Brandy Fisher, vice president of clinical support services at OSF HealthCare in Peoria, Ill. “We wanted to make the rounding process much more efficient, as well as to understand what our patients were telling us about how we could overall improve the patient experience.”

In 2014, OSF HealthCare invited a number of vendors to its hospitals to showcase their competing rounding technologies. The health system selected Orchid as its solution and began roll-out in March 2015 at five of its 11 hospitals.

“I would say implementing Orchid was a very easy adoption,” Fisher said. “We had a few issues with our connectivity that did result in some continued use of the paper tools—but for the most part, it was full adoption right away.”

Because Orchid is device-agnostic, some leaders could use the Android tablets given to them, while others rounded with their own smartphones. CipherHealth gave the executives a detailed utilization report on a weekly basis, so they could see what percentage of patients were being rounded on.

OSF officials report they've seen an improvement in all HCAHPS domains, particularly in response to hospital staff and communication with doctors. Nurse morale has been boosted through the positive feedback received from patients. The system also allows senior leaders to give more frequent recognition to caregivers.

Perhaps most importantly, the rounding facilitated communication with patients that surfaced issues that otherwise might have gone unaddressed. One patient revealed a lack of working electricity in the home. The discharge plan called for in-home use of electronic equipment.

In part six, learn the lessons discovered in the rollout of the digital rounding tool Orchid.

Meeri Kim is a freelance healthcare writer based in Los Angeles.