(A previous series available on SoundCloud) Welcome to Health Pilots, where we interview people pursuing new solutions for health care in low-income communities. You’ll hear about new technologies and workflows, human-centered design, and how to collaboratively innovate. Many clinics face the challenge of delivering a pleasant and comfortable patient experience. Measuring that experience effectively can be one of the most vexing parts of that work. In 2014 CCI, with support from the Blue Shield of California Foundation, launched the Engaging Patients to Improve Care program to help safety net organizations take on patient experience work, as well as actively engage patients in their efforts. One part of that program involved rolling out to three clinics a unique patient experience survey, the Pulse One Minute Survey (POMS), a tool designed and managed by Quality Data Management (QDM), a health analytics company based out of Cleveland, OH. The POMS uses just two questions to solicit meaningful written feedback on a patient s visit. The completed POMS cards are analyzed by QDM who uses sophisticated techniques to turn the qualitative verbatim responses into meaningful insights that can inform change. To get some deeper insights into how effective this survey was, and the lessons learned implementing it, CCI s program manager Susannah Brouwer spoke with the project leads from the three POMS grantee clinics: Laila Gulzar of Ravenswood Family Health Center, Felipe Dest of Lifelong Medical Care, and Debra Rosen of Northeast Valley Health Corporation.
Susannah:
Hello, and welcome to the first ever CCI podcast. I’m Susannah Brouwer, a program manager at the Center for Care Innovations. Today we’ll be discussing a different way to collect and analyze information about the patient experience. The Pulse One Minute Survey or POMS. Palms was developed by Quality Data Management or QDM, a healthcare research and quality improvement firm based out of Cleveland, Ohio.
With support from Blue Shield of California Foundation, through our Engaging Patients to Improve Care program or EPIC, we’ve rolled out these surveys to 3 FUHC [inaudible 00:00:45] clinics, Northeast Valley Health Corporation in Los Angeles County, Ravenswood Family Health Center in Santa Clara County and Life Long Medical Care in Alameda County.
The POMS card created by QDM, has just 2 questions presented in both English and Spanish. One question ask patients to rate their experience from 0 to 10. The second solicits comments on the following simple prompt. Thinking about your overall experience during today’s visit at this health center, including your provider, care team, clerks and receptionist, what worked well and what can be improved?
We did 3 rounds of the survey process. In each round the clinic’s goal was to collect 264 cards that had written verbatim responses. They then sent the cards to QDM, who used sophisticated data technology to analyze the responses and suggest actionable changes. From there, the clinics developed improvement projects using the information from these reports. We’ve brought on our 3 program leads to hear why they pursue this program and what made it useful to them.
Laila:
My name is Laila Gulzar, and I am Quality Improvement Officer and RN trainer at Ravenswood Family Heath Center. Our internal survey is a 20 question survey, which was shortened from 33 questions that we used to have. It’s a quite long survey and so we’ve always wanted to try rapid response kind of surveys which our survey doesn’t allow us to do.
We saw a great opportunity with POMS to be able to learn that preference and test out short surveys with a narrow organization. POMS is also more patient centered in the sense that it takes significantly less amount of time to complete, which is just one minute, and gives patients and family the freedom to tell us what’s on their mind.
Susannah:
Life on medical care on Alameda County took on the project for similar reasons.
Felipe:
We felt the need for the interest in adding POMS, to add another dimension to really test out new ways of collecting patient’s experience data. One really appealing aspect of POMS is its brevity.
Susannah:
That was the project lead from Life Long Medical Care, Felipe.
Felipe:
My name is Felipe Dest, and I work at Life Long Medical Care and I’m the project manager for the Engaging Patients In Care POMS grant. At Life Long, we decided to implement the POMS project at our Brookside Community Health Center Clinic of St. Pablo. We chose this site because this was the health center organization that recently merged with Life Long. We were looking for a way to really engage with the staff and the patients of this newly merged health center.
In the past couple of years we’ve been collecting our own form of internal patients satisfaction surveys. One of our main challenges has been synthesizing the information and really being able to analyze what to do with the comments.
Deborah:
My name is Deborah Rosen. I work for Northeast Valley Health Corporation. I am the Director of Quality and Health Education, and I was the program lead for the POMS Project.
Susannah:
Northeast Valley chose the Sun Valley Health Center in Los Angeles County, one of the largest of their 14 sites. Sun Valley has all patients go through a single registration desk allowing the POMS team to more easily implement the survey for all departments at once.
Deborah:
At Northeast Valley, we have been using the CAHPS Survey.
Susannah:
That the Consumer Assessment of HealthCare Provider and Assistance Survey developed by the federal government.
Deborah:
The CAHPS Survey allows us to compare to a national benchmark. Of course, it’s a standardized validated tool, and we know from year to year whether we’re making improvements. One of the challenges of which the CAHPS Survey is that the data is actually fairly old by the time you see the data. Sometimes it takes about a year and a half, so it’s not easy to look at how interventions you make result in improvement. The POMS Survey really provides more rapid feedback, so when we make a change using the POMS Survey, we can really quickly evaluate whether the change has had improvements in the patient’s experience.
Susannah:
To review, the POMS is a simple card you can hand to patients. At the top, is a space for patients to write about their experience. At the bottom, a second question ask them to rank their experience from 0 to 10. It seems simple, but the question is what’s the best way to get these cards out to the patients? Laila brought down her team’s process for us.
Laila:
The tools that we created to facilitate the survey collection process were that we had that were created basically for patients to be informed that we’re implementing this new project and we would like you to participate. Those were place in all the exam rooms. They were also placed in corridors everywhere so that they were visible to our patients.
The staff also decided that they wanted to create separate collection box. They decorated it, they wanted to make sure that it was visible to the patients. The 3rd tool that we used was to monitor the process by counting the surveys at the end of the day, and matching them against what our goals was for that day, and then also doing a quick huddle with the staff and letting them know how many were collected, how many are due for the next day, establishing the goal with them for collection numbers for next day. We wanted to keep their energy high, we wanted to keep them engaged in the process.
Susannah:
Life Long tried a different approach. Here’s Phillipe.
Felipe:
We needed to come up with an idea of collecting the POMS during check outs because all patients at the time were flowing through the front desk counter to check out from their visit. We were really looking for a way to utilize this blank space in time for the patients where they would be able to provide their feedback on the visit. We also found it important to conduct the survey at the end of the encounter so they could reflect on their experience, whether it was wait time or provider interactions during that particular visit.
Susannah:
As Debbie explained to us, getting patients to actually fill out a survey, even a simple one, is still a challenge.
Deborah:
In terms of the roll-out at the site, I think that we discovered a challenge that many of our patients … During the 1st quarter, many of our patients were only completing the 2nd question. The first question is open-ended, second question is the 0 to 10 scale. Many of our patients were just putting a number in. Although that’s helpful, the real values to this, to the POMS survey, is getting the verbatim statements from our patients.
We discussed with our consultants, and actually came up with a plan that the front desk would not only explain, very quickly explain, what the POMS Survey was about, but ask the patient to write down at least 15 words. That simple change actually was quite effective.
Susannah:
This more targeted approach also helped Life Long increase their number of verbatim responses.
Felipe:
We worked on some language cues, some ways to prompt patients to actually write comments, and this worked well. We were able to increase our comments verbatim percentage over time. It really showed to how engaged the staff members were and their willingness to prompt patients to fill out their comments, because it showed how valuable the feedback was.
Susannah:
After the cards were collected, they were sent off to QDM. QDM analyzed the patients feedback and sent back a report to each clinic. The report described which parts of their experience the patients mentioned most, and the attitudes the patients expressed about these touch points.
Deborah:
The POMS Survey or the POMS Report, really provides the unique opportunity or understand of the patients experience that we don’t get from numbers and scores in the CAHPS Survey. The verbatim responses in particular really made a huge impact both on the health center and leadership and the organization as a whole. Along wait time is not a surprise to us, we’ve seen it in many reports. We see it in the CAHPS Reports.
However, seeing it as verbatim from our patients, seeing how frustrated they were with the wait time, it helped the entire organization really focus on the wait time. In fact, the feeling was that if we could fix the wait time problem, then most of our patients would be really quite happy at Northeast Valley.
Susannah:
The verbatim helped humanize and emphasize problems that the clinics might not have prioritized and tackled head on. That’s what’s unique about the POMS project. QDM takes verbatim data and makes it both visual and actionable.
Felipe:
The report did a really good job of grouping like comments. It was able to break down each comment and assign it to a specific touch point. Through this process, it worked to convert the patient’s comment into a quantitative data, data that can be shown on a graph, and turned it over time. For us, it was this was a new look.
Deborah:
Some of the things that light in the reports were touch point cumulative graph that were extremely helpful in visually representing what our strengths and areas of improvement were, probably the top concerns of our patients was waiting time, which we have also learned from our internal surveys, but the POMS Survey validated that concern for us.
Susannah:
Now that our 3 health centers have these insights, it’s time for action. What are these organizations actually doing with this information? Here’s Ravenswood.
Laila:
Our staff created a list of primary drivers of the long wait times, and determined that there are several reasons including space, shortage of space sometimes, not having sufficient staffing, the long check in process was also determined as one of the drivers, late patient arrival, a lot of people working pediatrics, et cetera, et cetera.
One set was done, then the team looked at interventions and organized those interventions into different PDSAC or Planned Due Study Act Cycles. These were some very concrete point of care interventions that the team decided to test and to do PDSAC on. Then there were some learning around which of these worked and which of these didn’t work, and whether we were able to significantly improve or change our overall completion of cycle time within the designated time which is in the benchmark is about 45 minutes per visit.
Susannah:
With data in hand, Northeast Valley focused on trying out interventions that seemed to have the biggest impact on major touch points.
Deborah:
We identified one opportunity in particular that patients were … A couple of patients mentioned, that when they went to register at the front desk, there were staff individuals not attending to them. These individuals were working on something else, but not attending to the person who was waiting on line. That’s something that was very specific, that was very important, and we talked about that as a team and really came up with a very relatively easy intervention that team members would not be doing other functions at the front desk.
If they needed to make phone calls, they would remove themselves from the front desk and take that somewhere else. If they were doing some work, they would remove it from the front desk and take it somewhere else, so that we would be responding to the patients who were on line. There were interventions that were accruing at the health center. We were doing things like improving medication reconciliation, where we did a better job to remind the patient to bring in their medications. We offered a receptacle for the patient to put their medications in so medication reconciliation was more efficient, and can improve that whole cycle time.
In addition to that, we started robust calling to make sure that the patient was bringing in all the information that they needed to register or to enroll, or all the forms they needed to complete. As well as scrubbing the charts, again that was in place but this reinforced it.
Susannah:
Meanwhile, Life Long join Ravenswood in Northeast Valley in tackling wait times.
Felipe:
We’ve always identified one of the main bottlenecks in terms of contributing to a longer wait time both for checking in and checking out. It’s through this process and in talking about what we’ve done in other health centers, that we were able to come up with a plan of implementing an [NA 00:14:43] checkout at the end of visits.
This really relieved the front desk from seeing every single patient that had to checkout, and it also allowed for the patients to not have to wait on that line once again. We did this time as a real win in terms of patients satisfaction regarding their wait time, but also allowing for the front desk to focus more on checking in the patients and potentially using up this free time for additional tasks or something like that.
Susannah:
We want to conclude by asking our project leads about the larger value they got from the POMS project.
Laila:
From the very beginning we looked at our alignment, it’s aligned under a larger umbrella of improving productivity and efficiency of patient’s visits in our [inaudible 00:15:31] department. As a result, we were not only able to get full attention from our organization, but also the resources and the monitoring and time needed to implement this project successfully, and to be able to share reports with our leadership team and get their attention in understanding how powerful the POMS process can be.
We’re hoping that we can sustain these thought surveys, frequent cycles to be able to provide valuable input to our managers and to our teams about what their patients are saying about the quality and experience of care.
Felipe:
This was a new healthcare Life Long and these were staff members that hadn’t necessary worked with quality improvement or PDSAC cycles before. Looking back, there was this [thick halo 00:16:22] that we had to cross at the beginning in terms of setup and physically getting the surveys to distribute at the center. It’s been really valuable in terms of helping us as we continue to transition into a more patient centered medical home, because that’s really what it comes down to.
We’ve been in this multi year long initiative to implement the standards of being a patient centered medical home. At the core of it, it’s involving the patient and involving their feedback, and also their perspective when re-working systems of care. Looking at that, we’ve realized that we don’t need to have a 10 question survey to get the heart of what the core issues or the things that are going really well at a health center.
That’s something that we’re going to be working on in the coming year. I think it’s really cool and it makes me excited about what other opportunities there are to engage patients with the health center and quality improvement projects. It’s really encouraged me to think on new ways like whether that actually includes bringing about patients into a quality improvement meeting for either the organization level or at the individual sites, and what value that could bring.
Deborah:
I don’t want to only talk about the negative in wait time, and maybe I should say this, but we … The clinic was put under a microscope. It was a little bit stressful for the clinic because we were going to be able to what our patients thought about them. We were really pleased to see that the results were overall really positive about customer service and their experience with the staff.
When you think about what the POMS data gave us was really what was most on the patients minds, which was the wait time and the total cycle time at the visit. How long it took them from the time they got there, and to the time that they left was a very long period of time. We heard that from a number of patients, how frustrating that was. The POMS Survey really helps us focus on what’s most important to the patients.
I presented the data to our executive of leaders and to all of or site administrators at Northeast Valley, and it was unanimous that we wanted to spread this to other health centers. We absolutely see the value in this POMS Survey as a great opportunity to really learn directly from our patients.
Susannah:
Thanks for listening, and thanks to our clinics pioneers for sharing their stories. For more information on this or any of our other programs, visit our website, careinnovations.org.
The post How to gather and use patient experience data with the Pulse One Minute Survey appeared first on CCI Innovation Hubs.