S2 Ep12: S2E12: KPIs to Improve Patient Experience (ft. Erin Shipley, Cooper University Health Care)

Erin Shipley, CEN, MSN, RN and Vice President of Consumer Experience at Cooper University Health Care, discusses setting KPIs to improve patient experience.

Episode Transcript

(00:03):
We're here today with AaronShipley from Cooper University
Health care.
Aaron is the VP of Consumerexperience.
However, those who don't knowCooper University Healthcare is
an academic health system basedin Camden, NJ, with 900
physicians and 663 beds.
So there's a number of differentinitiatives will be covering

(00:24):
today in our conversation, allpertaining to the consumer
experience at Cooper Universityand the first, I'd like to
discuss with with you Aarontoday and and for our listeners
benefit is to Cooper experienceexcellent program.
Now I know that it's focusedprimarily in your emergency
department and your high volumeinpatient units.

(00:45):
Tell me their listeners a littlebit about this program.
It's Genesis and what you'retrying to accomplish through it.
Absolutely, Jordan.
So, you know, I think just likea lot of organizations across
the country, we are we have veryhigh volume emergency
department.
You know we are struggling with.
We were struggling with some ofthat boarding and the throughput

(01:07):
issues that are plaguing many ofus and many of our
organizations.
And it's not just throughput andpatients.
You know in the AED to bedischarged, but it's also those
patients who are waiting for abed.
We wanted to do somethingdifferent.
We our tackling the throughputissues we are trying to you we
use hallway beds on the Ed onthe on the inpatient unit that

(01:30):
all those things that everybodyis doing.
But we wanted to create aprogram that looked at the
challenges of care in theemergency department and a much
more innovative way.
OK.
And we really started with ourpatient and family advisory
councils and our patientexperience data.
We have, of course, survey likepretty much everybody our

(01:52):
patients and we wanted to lookat those come we started with
comfort needs information abouttheir plan of care and then
rather than putting the burdenof those action plans on the
clinical staff, that experienceprogram is really designed as a
way to have team other nonclinical team members who can

(02:13):
who can jump in and meet thoseneeds of the patient more real
time.
So we've got LPN's and EMT's whocan serve as that first line of
defense for some of thatclinical information.
They can go right into the chartand they don't have to ask
someone they have access to thatinformation to people that
provide those patients and moreproactive update.

(02:34):
We have greeters and a lobby.
Ambassadors we we know patients,you know, don't wanna perk in
the garage.
And so we partner with thegreeter to be able to loop in
ballet.
So if there's a safer entranceto the emergency department and
already we're beginning to seeimprovement in their experience
results and that that we havethe sentiment of our team saying
Well.

(02:55):
that this is good news for them,it's making their jobs easier.
So was this excellence programcreated in reaction to some to a
poor performance on a HEDISreport?
What are the kind of thebusiness drivers behind this
excellence program?
And then how is it attached tothe financials at the

(03:16):
organization in terms of havingdedicated staff and just
coordinating resources toimplement this program?
Yeah, we'll start with the firstone.
I mean, I think anytime you areserving patients, you wanna, you
wanna look at that data andknock it out of the park and it
the the core experience resultswere not where we wanted it.
And the.

(03:36):
We want to be our goal at Cooperis to be what I would call top
desk file and the nation, and tocontinue to improve.
We wanna be a destination ofhealth care for our community.
We serve a very vulnerable groupof patients in, in our
Community, so that was reallythe Genesis less about the
scores and more about doing whatwe can to see patients in our Ed

(04:01):
and make sure we've got thatthroughput to be able to bed
OK.
patients on the floor from theinvestment perspective.
You know, there's there'sdefinitely a cost benefit to
this when we see more patientsthrough the emergency
department, we are improving ourscope and more new patients are
gonna want to enter our healthsystem and they have a positive

(04:23):
experience in the emergencydepartment.
It's the front door to yourhospital.
It's.
And so when you have a negativeexperience in the Ed, you may
opt out and choosing Cooper foryour your scheduled surgery
procedure that you need to have,or choosing a primary care
So.
physician or in your medicalpractice.

(04:44):
So absolutely, there's a peoplecost to this, but the return on
investment is also a huge Idon't wanna also underestimate
the the impact of doing theright thing by your team.
And when you're physicians areproviders and your staff have a
more positive workingenvironment, you're gonna see
that reduction in turnover.

(05:04):
And so you're turnover costs andyour employee costs are gonna go
way down.
You're gonna see a reduction inmortality.
Yes.
So when you have team memberswho are engaged and you have
team members who stay, you havebetter outcomes and you can't
put a price on that, right?
Like so, I love that we delveinto a bunch of the kind of
drivers of implementing thisprogram and some of the

(05:26):
operational mechanics of it.
I'd like to, since this ishealthy data podcast, dive into
the data component of how youfacilitate this.
So you're looking to free up.
Increased throughput put moreheads in beds.
How is Cooper healthaggregating, normalizing and
integrating data from acrossdifferent departmental data

(05:48):
silos to facilitate theirreporting of these KPIs?
You're dealing withenvironmental services and
registration, transport, the Ed.
How are you moving that datainto a single dashboard or
whatever you're doing to monitoryour progress and improve
patient experience?
So we have a very robust dataanalytics team.
You know, I believe these spoketo one of my colleagues.

(06:10):
Ladies and a previous podcast,you know that is the source of
Is it?
truth for all our dashboards.
So we we really take all of thatbig data digested into a series
of dashboards that are importantto not just our leaders to be
able to make the decisions fortheir departments, but the
frontline staff who needs to usethat information all the time.
Then.

(06:31):
So, specific to that, edx onceprogram Art team is both people
This.
times a day looking at thatthroughput dashboard to see OK
It's.
in the last four hours how manypatients have we seen through
OK.
the Ed yesterday as we lookahead to the next 4 hours, what
can we anticipate and what do weneed to do now to make sure that

(06:56):
that's a smoother piece.
We huddle with our environmentalservices, our transport team,
our excellence ambassadors andagain have that conversation.
I'm well.
What are we seeing in the in theback end?
Data around OK, we're atcapacity on the floor.
What changes do we need to donow to make sure we accommodate

(07:18):
that so we don't back up furtherthose ships?
So.
A couple of examples.
So you're producing thesedashboards with your analytics
team, but you also have adigital front door through epics
my chart correct?
Yes.
So to what?
And I believe that as part ofthis program, you publish wait
times and delays in the ER.
And I'm wondering to what extentthat information is being

(07:41):
integrated and how it's beingintegrated into epics my chart
so that patients can see thisdata and then how is how are you
seeing that affect patientdecisions?
Are they saying?
Oh, well, you know.
Are you are you seeing kind of aflattening of patient volumes?
So maybe people are avoidinghigh volume time, kind of like a

(08:01):
happy hour and synthesizingpeople to come at low volume
Right.
times.
What's how are you actuallytechnically integrating and then
what's the impact?
Well, I, you know, I think thewe look at the integration of
the data you know a lot of thosethose metrics are not, it's not
information that we're we aresharing publicly in that my my

(08:22):
Cooper way we my chart my Cooperway we really try to make sure
Umm.
that our patients are using thatas a more two way communication
channel where they're feelinglike they're talking to a live
caregiver not getting some kindof AI automated response not
that that's a bad thing you knowI I think gone are the days

(08:43):
where we you.
Drive past a billboard that saysER wait time is dot dot dot.
I don't think consumers reallytrust that.
I know I don't trust that as aconsumer, but there is
innovation and it's innovationthat we're looking at for on how
do you leverage a patient facingapp, whether it's integrated

(09:05):
with my chart or not.
That says something about what'snext for the patient because you
know it's not necessarily abouthow long am I waiting, but
what's the next step for me?
Do I know what my plan is hereis and that's where we can
leverage the technology and thepeople to help build that gap.
So there's something else thatyou're doing at Cooper Health,

(09:28):
which is kind of related towhat's the next step for a
patient.
So I know you are redefiningpatient rounding at Cooper
health, kind of experimentingwith different frequencies of
rounding.
Umm, anticipating patientrequests and documentation,

(09:48):
patients are in the inpatientward of the hospital, are
awaiting.
What's next?
Maybe there's another test.
Maybe there's a discharge, sohow?
Tell me about this redefiningpatient rounding is Cooper
Health shifting away fromphysicians towards Ppas and MPs
operating at the top of theirlicenses for inpatient care?

(10:11):
What's going on with patientrounding and how's that
affecting consumer experience?
Yeah, I mean, all the rounds,right?
And so it's really breaking itup the let's just start with our
frontline staff.
And so you you used a great termoperating at the top of the
license.
So when we think about ourfrontline nurses, our techs,

(10:31):
this is about helping them tobuild their skill, to take
advantage of their time thatthey do have the vet at the
bedside.
There is great research and datathat is continued that we
continue to update around whatwe call purposeful rounding,
which is like it's notnecessarily tied to the time no
clinical person is gonna want tonot have eyes on that patient

(10:54):
every hour or so, right.
But it is about building theirskill.
That when I'm there at thebedside, that I'm doing what I
need to do in clustering mypeer, I'm toileting patients
proactively for your physiciansand providers.
Perfect.
Absolutely.
We look at where leveragingnurse practitioners, Ppas, we've
got that team approach and we'realso an academic Medical Center.

(11:17):
So we also have learners who arepart of that rounding process
and helping to make sure thatthey all have the communication
skills to say something.
And when we don't have theinformation while waiting on a
test, we want them to saysomething about it.
Hey, we know we're waiting forthe test results of your MRI to

(11:37):
come back.
So because when you say nothing,patients are anxious, right?
They they make up a story oftheir head.
It's evolves beyond just thatfrontline patient care piece
that we're also thinkingdifferently about leadership
Yep.
rounding on patients.
So you know, there's two waysyou validate the behavior of
staff through direct observationand skill building and through

(11:59):
asking a patient, tell us aboutyour experience in the classic
That's.
old sense.
You know, we learned as a nurseleader, you should round on
every patient, every day and ona 72 bed unit with one nurse
leader.
That nurse leader would berunning all day long.
So we're really dividing andconquering.
We have an electronic poundingtool that we're able to see our

(12:22):
lives, census and and integrateswith EPIC.
And so we're able to see who'sbeen rounded on and who hasn't.
And that's 24 hour period and wehave physician leaders who will
It's.
round on casions.
We've got a members of ouressential services support
services team who will wrap onpatients, but we're all doing it
in our own bucket.
Like what's in it for me as thelab leader or the Environmental

(12:45):
Services leader to go in theroom and say, hey, you've seen
OK.
our housekeeper three or fourtimes today.
OK.
Talk.
Talk to me a little bit abouthow well work Manning your room
and then they're putting thatinformation in the tool not as a
compliance marker, but more as acommitment to improve our
services and care so that we cantrend the data.

(13:06):
I'm not sure how long thisredefining a patient rounding
has been implemented and hasbeen an active program at Cooper
Health, but do you have any kindof outcome measures on the
impact of this either frompatients satisfaction we I
mentioned HEDIS earlier fromNCQA or do you have measures on

(13:26):
clinical outcomes or if you haveany risk based sharing models
like an ACL or shared savings ifyou have, you know capitated
patients that you're able tosave on what has been the an,
yeah, so I'll leave it there.
The outcomes at so you know whatwe know is that when patients
have been rounded on and we seethis in our own data.

(13:49):
So when patients say yes, I sawa leader during my stay, they
will rate their experience ofcare on H caps, which you know
After that.
because we don't know thepatient experience required
survey from CMS, The Cooper datathey say yes they rate their
experience of care in the 90thpercentile or above in the

(14:09):
nation and that's all hospitalswho take the survey when they
Huh.
say no it's much slower belowthe 25th we also see and when we
think about innovation and datathose patients are less likely
to be readmitted because they wetie that data that.
Rounding data to readmissions,and if that patient was rounded

(14:29):
on during their stay and theirreadmitted, our experience team
goes back and reviewed therounding notes because that last
leadership round is really adischarge planning round, right.
So if we have not done that,well, of course that could
contribute to the readmission.
So we've seen the reduction ofreadmission through the rounding
piece.
Also, the posted that callprocess, which is like around

(14:51):
right, we called patients afterdischarge make sure that they're
Umm.
safe and well.
Of course we ask about theirexperience too, but that has
we've seen an almost a 4%reduction of readmissions just
over the last two or three yearsthrough the implementation and
the consistency of this.
Wow, that's an incrediblefigure.

(15:12):
4% reduction of readmissionsthrough this rounding reform,
which definitely has an impacton the hospital's bottom line.
And when the health systemsbottom line and when you're
operating on A1 or 2% margin,that's that's significant.
It's huge.
I I do want to pivot to thethird topic and final topic will
be covering today, which isactually somewhat unique and

(15:33):
it's quite interesting.
It pertains to the care ofpatients with a very complex set
of chronic conditions,particularly innovations
concerning the care of patientswith intellectual and
developmental disabilities.
I've done episodes before onhospital, at home.
I'd like to hear in particularwhat's going on with your care

(15:55):
of this particular patientpopulation.
How are you managing their care?
What are you doing to innovatehere?
Yeah.
There, what we call in theexperience.
Roll the silent populationbecause often there's not a they
can't speak for themselves.
There's not an advocate orguardian who's available to
speak for them, so we've createdthrough Epic what is called our

(16:19):
it's our disability supportprogram with a an ethnic
registry where we're able to aswe submit patients to the
program that have one of thosecomplex disability needs.
We will and they're basicallyflagged.
We get a daily email from epicArt our disabilities team that
not just shows the next sevendays of appointments for those

(16:42):
patients that the next 90 daysof procedures that are out and
above and our care coordinationteam calls those patients ahead
of time when they hit theregistry and our support
program, we begin to understandwhat are those special needs
that that are combinations thatthose patients would benefit
from, things like a privatewaiting room, sensory resources,

(17:05):
fidget tools do we can wecoordinate some of their visits
early in the program we had to.
Patient, who every day of theweek had a an office visit in
the same building.
Right.
And so those are all visits thatwe could consolidate together
and for a critical populationlike this, you know, this is a
chance for us.

(17:25):
If we're gonna sedate thatpatient for a procedure, we
should also do the dentalcleaning.
We should do their OBGYN visitif we should clip their
toenails.
And so all kinds of things thatwould cause stressor and then
the eventual arm for the patientin the Wellness and we're trying
to coordinate that altogether.
You mentioned the hospital athome.

(17:47):
We have a we're we're launchingour mobile program where we know
it's hard to get those patientsinto the office.
There's a potential forviolence, violence, but you
Yeah.
know, behavior that we don'twant to see from patients and
they don't.
They're well meaning right, butthat when we can go into the
patient's primary residence orgroup home to do that care

(18:08):
rather than having them comeinto the office, we not only
create capacity in our officesbecause those tickets tend to
OK.
take longer, but we're creatingWellness for the patients in our
team.
Aaron, you mentioned somethinginteresting.
You I think you mentioned thatyou're that the care teams are,
you've dedicated care teams forthis particular population.

(18:29):
They're looking to anticipatecertain sorts of visits by this
population.
Did you have any leadingindicators that Cooper is
leveraging in order toanticipate those care visits?
Well, you know, we start withour registry, right?
And so when when we look at,we've got over 1600 patients who
have diagnosis codes that arelinked to the support program.

(18:51):
So we we certainly track theintake of new patients into our
support program.
We're also tracking the contactrate as we are reaching out pre
office visit pre procedure andafterwards because we wanna make
sure that we're getting to theright or send to help support

(19:12):
1st.
that patient.
And.
Oftentimes one of the biggestreasons for cancellations for
It's.
OK.
procedures is that we don't havethe Guardian signature and
paperwork that we need.
OK.
And so we're really looking atreduction of no shows with the
office visits.
We're looking at office waitingand so as we on begin to improve

(19:35):
and anticipate thoseexperiences, we're saying wait
times go down and those officesand and we're also beginning to
look at decrease and emergencydepartment and urgent care usage
as we we launch our mobileprogram, we're our patients and
guardians are already telling usthat they are wanting to use

(19:55):
that for virtual urgent care.
How do we leverage telehealth inthe future that they avoid
coming in place?
I appreciate that explanation.
You mentioned virtual urgentcare and back to the topic of
data, we're approaching the endof the podcast episode.
I just want to wrap up thistopic.
How would you?
You've mentioned the EPICregistry a few times.

(20:17):
You have a dedicated registryfor this population.
How is that registry handlingidentity management and data
deduplication while managingthis?
These complex care plans thatinvolve things that aren't
typically the responsibility ofthe hospital, like doing OBGYN
and dental and nail clipping foran impatient for mental health.
Stay for this population.

(20:38):
So how are you?
Kind of ensuring that the rightinformation the right data is
technically available to the.
Care providers at the point ofcare.
Yeah.
You know, I think this is thebeauty of the care coordination.
Note you know we're not.
We don't require our cliniciansto go in and look at it.
They want to go in and at itbecause it helps them to better

(21:00):
deliver their care when wecomplete the care formation node
for first time that we all wehave to do is update it and so
it's not really our team didn'tsee it as duplication because
it's part of the record, it'ssecure and you know we when we
can we're trying to communicatewith the individual patient.
We try to do that for my chartif we can, or through obviously

(21:22):
Right.
secure ways to to communicatewith that, but it's it's an
exciting program or or teams arevery excited about it.
So I'd like to give you a finalopportunity to speak to the
listeners of this podcast rightnow.
Perhaps somebody's listening?
Who says?
You know, I think it may bereally interesting to do an

(21:43):
excellence program where we'retrying to improve patient
satisfaction and and reduce ERwait times.
Maybe we should change patientrounding.
I think that was an interestingpart of the conversation.
Looks like there's a reductionin I readmissions and that could
improve our our payment, ourdish payment or our payments
from Medicare for for risksharing agreements.

(22:05):
Or maybe I'm interested.
I also have a particularpopulation we work with
registries like to manage that.
What's something that you wouldsay to them?
Maybe there's some challengethat you were able to overcome
or some advice that you wishsomeone had given you when you
started any of these threejourneys.
What would you say to someonewhistling?
I I would say go back to yourgoals.

(22:26):
Go back to your goals.
I we in the past and experienceworld have been real big about
setting targets against thesurvey metric and that's not
necessarily a bad thing.
But you know, look at more ofthose process measures.
What are your key performanceindicators that speak to
something that is withinpeople's control that we know

(22:48):
what we have we can measure onand it's govern entire goal to
that it's going to have itdownstream impact on the place
in experience results, somethinglike did I have the opportunity
Well.
to participate in bedside shiftreport, yes or no that a goal
against that because when weknow when patients are informed
Yeah.
they're going to write theirexperience.

(23:08):
Here.
If you're better, they're it'sless likely to be readmitted.
They're going to know and trustwhat to do that so goal planning
is a big thing and it's it'scertainly innovation as well.
OK.
Well, thank you very much for alisteners.
This has been Aaron Shipley, ofCooper University Healthcare,
the vice president of consumerexperience.

(23:29):
Aaron, I'd like to thank you forjoining us today.