CPXP Flashcards
Picker Institute Eight Characteristics of patient centered care?
Access to care, respect for patient values-preferences-needs, coordination/integration of care, information-communication-education, transition and continuity of care, involving family and friends, emotional support reducing fear/anxiety, physical comfort.
Reasons for not using minors to communicate with LEP
Limited emotional maturity
Vocabulary to communicate complex medical terminology
what is diversity?
dignity, respect and being a human being.
race, ethnicity, gender, age, religion, disabilities, sexual orientation.
Which year was the Health Maintenance Organization (HMO) act put into place?
1973
Most federal state and local programs specifically require, as a condition for receiving funds under such programs, and affirmation statement on the part of the organization that it will not _______
Discriminate
Which year was the American Society for Hospital Risk Management formed?
1980
Patient responsibilities
Inform staff about past and present illnesses and current medications
communicate care preferences
practice a healthy lifestyle
inform staff about changes in condition
accurately describe symptoms
understand illness and treatment plan
staying informed
assure appropriate behavior of both patients and visitors
avoid self administration of medication
adhere to agreed upon treatment plan
provide accurate insurance information and responsible payment of medical bills
keep appointments
comply with hospital policy
show respect for other patients and health workers as they expect for themselves
understand medical science has limitations
ask questions
Complaints are defined as:
Issues that are handled on the spot
Billing Issues
all lost and found issues
What is value based purchasing
payment method that rewards quality of care through payment incentives and transparency
Patient Right: Admission
Admission - although persons who are not within the statutory classes have no right of admission, hospitals and their employees owe a duty to extend reasonable care for those who present himself for assistance and need immediate attention. With respect to such person’s governmental hospitals are subject to the same rules that apply to private hospitals.
The FY 2014 Hospital Value Based Purchasing (Hospital VBP) links a portion of IPPS (Inpatient Prospective Pricing System) hospital payment from CMS to performance on a set of quality measures. The HCAHPS survey is the basis of the Patient Experience of Care Domain and accounts for this percent of the hospital’s Total Performance Score.
25%
Culturally Competent Model of Care
Cultural Awareness
Cultural knowledge
cultural skill - conducting an assessment of cultural data of the patient
Cultural encounters - personal experience with patient of different backgrounds
Cultural desire - process of anting to be culturally competent
What are the main functions of the Office of Patient Relations?
Provide a centralized mechanism for addressing patient concerns, liaison between patients and medical providers
three R words that guide healthcare workers when approaching unknown religious situations
Religion - determine religion and practices/traditions associated with them
Respect - Consciously respect the persons religious tradition
Resources - known who to call, handbook, webpages, etc.
What is BART?
Behavior action response team
Dangers of ALL CAPS on location signs
All CAPS changes the shape of the word. By creating a rectangle, those with learning disabilities can no longer recognize words. Those with learning disabilities may requires the hook of a lower-case “g” to understand the word.
Who is Family?
Family is defined by the patient and can be a spouse, parents, significant other, or simply anyone whom the patient is emotionally attached, like a best friend.
Grievances are defined as:
Issues not handled on the spot
Any letter email fax or other written correspondence
any attachment or letter with a patient survey
Teach Back: do and Don’ts
Don’t: “do you understand?”
Do: “what are you going to tell your wife about the food she buys?”
What was the original name for the CMS
Health Care Financing Administration
When faced with a difficult or violent patient, the most important things remember are:
safety
judge a level of what is happening before jumping in with both feet
stay in control and demonstrate this control with a strong voice and body language
debriefing is important for both the involved staff in the patient and family members
What is a grievance?
more formal complaint that is filed with the hospital and can address bigger issues such as abuse
In which year did the American hospital association develop patients bill of rights
1973
Patient Right: Participate in Care Decisions
patients have the right to choose the medical care they wish to receive. They have the rights and other treatment options and to accept or refuse care. Although the patients have a right to make their own care and treatment decisions, they often face conflicting religious and moral values in their decision-making process
Who assures the patient’s rights and responsibilities
American Hospital Association The Joint Commission DNV Healthcare The Center for Medicare and Medicaid Services CMS State and Federal Regulatory agencies
Describe health literacy
capacity to obtain, process and understand basic health information needed to make appropriate health decisions
What does RUSH stand for?
systematic approach to process improvement (Ready, understand, solve, hold)
Patient Bill of Rights
known as the consumer bill of rights and responsibilities that was adopted by the US advisory commission on consumer protection and quality in the healthcare industry in 1998
What are core concepts of patient centered care
respect & dignity
information sharing
participation
collaboration
Goals of the Patient Bill of Rights
To help patients feel more confident in the US healthcare system
To stress the importance of a strong relationship between patients and their healthcare providers
to stress the key role patients play and staying healthy by laying out rights and responsibilities for all patients and healthcare providers
Health Literacy and PX
Average 6% more hospital admission More frequent ED visits
2 days long for hospitalization
Earlier mortality
Cost $106 billion to $238 billion annually
The act which address that federal funds must provide effective communication services to their limited English proficient, deaf and hard of hearing patient.
Civil Rights Act of 1964, revised in 2000 commonly known as “Title VI”
What percentage of CMS reimbursement is dependent on patient satisfaction scores
1%
Proactive model for disruptive behavior
- develop a common definition for what is disruptive. pair of appropriate limiting responses with the identify behavior
- educate clinical staff on effective limit setting and the importance of upholding those limits. identify results of not staying within the limits
- establish expectations for communication by various disciplines and in various situations
a. shift to shift, unit leaders, unit manager, ancillary services as needed
b. medical social worker, patient advocate, social worker, risk manager
c. nursing supervisor, administrator on call, etc. - Roll all of these components into an education program for staff. Create a quick reference or refresher it available to staff
Describe pay for performance?
provide financial incentives to hospitals, physicians, and other providers to carry out improvement and achieve optimal outcomes for patients
Steps in building cultural competence
Starts with Awareness - this includes addressing simple concept of difference and understanding the importance
Grows with Knowledge - identifying key knowledge staff must focus on
Enhanced by Skill - develop core skills such as effective cross cultural communication and conflict resolution
Polished through interactions - Application of these ideas in a day to day interactions that one is both tested and behaviors are refined
What is HCAHPS?
Hospital Consumer Assessment of Healthcare Providers and System
Time frame that AHA establishes membership group: National society for patient representation and consumer affairs
early 1970s
What other surveys are in use or under development?
Clinical and group consumer assessment of healthcare providers (CGCAHPS) and systems and EDCAHPS (ED Department)
What is a “Likert” scale?
Ex: Very poor, poor, fair, good, very good
In which year did the IOM publish the report “To Err is Human” regarding the significance of medical errors?
1999
What is the definition of Culture (Irwin Press)
Culture exists when its members share values and behaviors that they take for granted
Describe three reasons used by CMS/ARHQ to justify the development of the HCAHPS survey
incentive to improve quality of care
create a standardization survey for hospital comparison
creates accountability
Viewing culture through diversity
It is important not to see one type of diversity and presume the other (primary vs secondary diversity)
What is the RATER scale and when was it developed
Reliability, Assurance, Tangibles, Empathy, Responsiveness (early 1980)
Patient Right: Paint Management
patients have the right whereby caregivers work with the patient to develop a pain control plan
The writing of patient rights and responsibilities must ___
be written in common, understandable language
Using family and friends to communicate with LEP
Friends and family members regardless of age, are not appropriate to use as interpreters for medical conversations. They often present as support to the patient and adding the role of interpreting changes this dynamic
Family and friends often inadvertently and sometimes intentionally leave out information that might affect the completeness or effectiveness of the communication
Institute for Patient-and Family Centered Care
- 31% of those caring for persons sixty-five and older describe their own physical health as fair to poor
- caregivers experienced mental or emotional strain and elderly spousal caregivers have a 63% higher risk of dying than non-caregivers
- about 40 to 70% of caregivers show signs of clinical depression as a result of caregiving and take more prescription medications including those for anxiety and depression, than others in their age group
- stress associated with the family caregiving has resulted in increased risk of infectious disease such as cold and flu and chronic diseases such as heart disease diabetes and cancer
Describe service recovery
apology to patient if service wasn’t satisfactory
Which year was the Institute of Patient Family Centered Care (IPFCC) created?
1992
What are some key differences between HCAHPS and Rush Press Ganey surveys?
PG offers a neutral answer, while HCAHPS does not. PG does not effect reimbursement. HCAHPS publicly
reported on Medicare website
Patient Rights for minors
Rights and responsibilities may apply to the patients parents or guardians
What are some of the limitations to the Press Ganey Surveys?
low return rate, minorities underrepresented
Patient Right: Informed Consent
patients have the right to receive all the information necessary to make an informed decision prior to consenting to a proposed procedure or treatment. This information should include the possible risks and benefits of the procedure or treatment the right to receive information from the physician includes information about the illness , the suggested course of treatment, the prospects of recovery in terms that can be understood, the risk of treatment, the benefits of treatment, alternative care options, and proof of consent.
competence
capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs of the community
What is the relationship to HCAHPS and Value based purchasing?
Hospital that fail to publicly report the required quality measure, may receive an annual payment update that is reduced by 2%
Which year did the Cleveland Clinic hire the first MD as a CEO?
Bridget Duffy 2006
What is a complaint?
expresses displeasure that is addressed when it occurs
What is the goal of Partnership for Patients?
decrease preventable hospital-acquired conditions, decrease preventable complications during care center transition
Factors that can impact the relationship between patients and health providers
Communication and interpersonal relationship styles including word choice, voice tone and volume, eye contact, and proper titles
Gender issues and consideration of appropriate male/female interaction
age, respect and seniority
individualism and equality
clothing, hairstyles, and body adornment
informal and social interactions
language spoken/use of interpreters or family members
What is the Emergency Medical Treatment and Labor Act (EMTALA) and when was it established?
requires hospitals to stabilize any patient who shows up in the ER regardless of ability to pay (1986)
How can one enhance patient participation?
Honor and respect the patients culture. This illustrates respect for the patient as an individual rather than as just another patient.
What is empathy?
the ability to understand and share the feelings of another
Patient Right: Examination and Treatment
patients have the right to expect their physician will conduct an appropriate history and physical examination based on the patients presenting complaints
Name one significant person in the evolution of the field of patient experience and his/her contribution
Angelica Theriot who developed the Planetree model
What are the main goals of the Office of Patient Relations at Rush
Understand service gaps through increased complaint capture
Improve complaint resolution time
What are the 4 basic needs that should be met to create an ideal patient experience (CIPP)
confidence, integrity, pride, passion
What is the quadruple aim?
Better Outcomes
Lower Costs
Improved clinician experience
Improved patient experience
What is the main difference between a complaint and a grievance?
a grievance requires a written response
What is the name of the federal government website where consumers can go to find information about clinical quality and patient experience?
Medicare.gov
When was the Health Insurance Portability and Patient Protection Act (HIPPA) created?
1996
Other skills for a medical interpreter
Completeness accuracy transparency positioning ethical decision-making medical terminology and vocabulary anatomy
Impact of cultural competency and diversity in health care
more successful resident/patient education
increases in health care-seeking behavior
more appropriate testing and screening
few diagnosis errors
avoidance of drug complications
greater adherence to medical advice
expanded choices and access to high quality clinicians
What is the AHRQ and in which year did they begin to develop the HCAHSP survey?
Agency for healthcare research and quality
2002
Which year was the Institute for Healthcare Improvement (IHI) established
1991
Classifications of Patient Rights
Legal - those emanating from law
Human Statements of Desirable Ethical Principles - the right to be treated with dignity and respect
Secondary diversity
factors such as income and social status, life and work experience, education background, geographic location, marital status, and religious beliefs
Language Proficiency
the ability to convey the appropriate tense, syntax and other components of language structure as well as comprehension of the non-native speaker, such as localized accents
Ask Me 3: the questions
- What is my main problem?
- What do I need to do?
- Why is it important for me to do this?
Experience and Perception
Other people’s experience of the interaction is built on their receptions rather than intentions
Level Two Service Recovery
Staffers elevate the concerns to a manager or charge nurse
This person may be able to recover the situation and ensure the confidence of the patient and family. Although it may not change the outcome, sometimes involvement of the manager makes the patient feel that his or her concerns were taken more seriously.
What percentage of adults are estimated to have a proficient health literacy
12%
What is a level 2 Complaint?
addressed at employee or escalated to management with additional tools (coupons, parking, flowers)
Name one difference between how the Press Ganey survey results and the HCAHPS survey results are calculated and reported?
Press Ganey uses a Likert scale and is not publicly reported, while HCAHPS uses a “Top Box” calculation and is reported on a CMS website
What is a Grievance?
All written letters, emails, faxes and social media from patients or the representative including any written attachment to a patient satisfaction survey
All complaints alleging abuse, neglect, patient harm, or noncompliance with any CMS requirement
Any instance where the patient or the representative requests a complaint to be handled as a grievance
All complaints not resolved by “staff present”
What is the primary reason for patient lawsuits against physicians
Lack of communication
What are some metrics for outcome of care?
mortality, readmission, complications, hospital associated infections
In what year were Diagnostic Related Group (DRG) introduced?
1983
According to the Beryl Institute article, which method of patient survey is the most effective?
phone surveys tend to give more positive responses than paper survey
What are the characteristics of hospitals that did NOT do well with value based purchasing?
bigger, teaching hospital, poor patients, govt owned
Follow-Up on grievances:
Grievances must be acknowledged and in writing within seven days
Follow up is required in writing, in accordance with CMS standard and guidelines
letters should be approved by (name/role) with a copy of the grievance and follow up forwarded to patient relations
Which year were Medicaid and Medicare established?
1965
CLAS, Office of Minority Health
CLAS is a tool that promotes cultural and linguistic competence. CLAS standards are primarily directed at health care organizations
Health Literacy: who is at risk?
Older adults, racial and ethnic minorities, people with less than a HS diploma or GED, low income, non-native speakers of English and people with compromised health status
Paraverbal Communication
How we say the words we say, for example do we seem happy, sad, angry, determined, or forceful
What is the JCAHO
Joint commission on accreditation of health care (set patient centered communication standards)
Patient Rights: Other Examples
have special needs addressed, execute advanced directives, compassionate care, confidentiality, privacy and HIPAA, patient advocacy, Ethics consultation, chaplaincy services, discharge, transfer, access medical records, patient education, transparency and hospital charges.
In which year did hospitals establish patient advocates and representatives?
1965
When did Medicare Physician Pay for Performance begin?
started in 2015 for some physicians and physician groups - projected to be for all physicians by 2017
What does the communication model include?
4 Es engaging empathizing educating enlisting
Which RUSH locations have the largest amount of grievances filed?
RUMG (Rush university medical group) & IP
Culture subcategories affecting health care provision
shared values (family customs), shared beliefs (world view), religion, shared practices (who makes decisions), dietary traditions, birth and death rituals, use of herbal or home remedies
Follow Up on complaints:
Complaint follow up may be via phone, in person, or by letter
Note, a letter is not required
What is the IHI triple aim? Beaver
improve patient experience, improve health of populations, reduce per capita cost
What is the Rush patient promise
safe care
high quality care
patient satisfaction
Definition of patient centered care
When healthcare works together across the continuum of care to meet the needs of the patient
JCAHO now The Joint Commission (nonprofit formed in 1951)
Mission: to improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations
Policy: views the delivery of services in a culturally and linguistically appropriate manner as an important health care safety and quality issue
National Council for Interpreting in Healthcare
resource in the interpreting field and has work to professionalize the field of interpreting through activities such as developing standards of practice in the medical interpreter code of ethics
Level One Service Recovery
Level one service recovery reverse a situation that occurs when frontline staff member becomes aware of a patients concerns and is able to resolve it satisfactorily
Communicating with the deaf or heard of hearing
Hearing aids Lip reading sign language TTY devices communication signs whiteboards assisted listening devices
negative impacts of cultural competency and diversity in healthcare
disrupting the relationship between patients and providers creating mistrusting miscommunication diminished care experience legal consequences financial impact
What was the Karen Quinlan case?
Young woman slipped into coma after drug interaction with alcohol (ethics of euthanasia)
What is AIDET?
Acknowledge Introduce Duration Explanation Thank you
What are 3 goals of complaint management?
correct what went wrong
learn from patients/customers/others
create a positive relationship and increase satisfaction
In which decade did malpractice lead to the development of risk management departments?
1970s
What is the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
first national standardized publicly reported survey of patients perceptions of hospital experience
How did the report of quality measure to CMS begin?
Hospitals could voluntarily report quality measures starting in 2001-adapting to current state from there
Helpful resource in the area of diversity
www.diversityrx.org
Grievance Exceptions:
No requirement is made to provide information that can be used against the hospital
These are designated as risk management “Watch Files”
Anonymous surveys - investigations are still required internally to address issues
Anonymous calls - same as anonymous surveys
Key rights provided to patients
Admission examination and treatment participation and care decision informed consent refuse treatment pain management quality care
Value Based Purchasing started as ________ and then went up to __________?
Pay for reporting
Pay for performance
Plain Language
a strategy for making written and oral information easier to understand
What are the IOM six aims of for quality (established in 2001)? STEEP
Safe, time, effective, efficient, equitable, patient-centered (STEEP)
Primary Diversity
The individual’s skin color, body size, sexual orientation, gender, ethnicity, age, physical/mental abilities, primary language.
LEP
Limited Language Proficient
Understanding the value of knowing the community demographics being served
- understand the community strengths and the challenges it faces
- understanding influential rules and norms
- understanding attitudes and opinions of the community
- ensuring the security of your organization staff and participants, knowing the character of various areas in the invisible borders that exist among various groups and neighborhoods
- converse intelligently with the residents about community issues, personalities and geography
- speak convincingly with media about the community
- share information with other organizations or coalitions that work in the community
- providing background and justification for proposals
- knowing the context of the community so that you can tailor interventions and programs to its norms and culture and increase chances of success
What do the initials in the HEART model for handling complaints stand for?
H - hear the patient E - empathize A-apologize R - respond T - thank
It is estimated that nearly ___ out of 10 adults may lack the skills needed to manage their health and prevent disease
9
Received Communication Breakdown
7% verbal
55% non-verbal
38% Paraverbal
What is EMTALA?
law that prohibits ED’s from turning away patients, no matter their ability to pay
What is a level 3 complaint?
employee escalates to manager refers patient/family or concern to patient relations
Examples of cultural and religious situations that affect patient care
Spanish word for bladder and gallbladder may only be known by a Spanish speaking healthcare and not a non-healthcare worker.
Body language and tone say more to patients than what is verbally expressed.
Are schedules reviewed to make accommodations for patients prayer traditions? Is there private space for patients and family members to use for prayer? Is the healthcare worker responding appropriately and doing what is necessary to answer these questions?
Patient Visitation Rights
To have written policies and procedures about patient’s visitation rights
Inform patients or an attending friend or family member of the patient’s rights to visitors of his or her choosing
to have a policy which prohibits discrimination against a visitor based on race, ethnicity, religion, sex, gender identity, sexual orientation or disability
to designate a supportive visitor and to be present through the procedure of his or her hospital stay
What is IPFCC
Institute for patient family-centered care
What is the name of the rules that give rise to a patient’s right to file a grievance against a hospital
Patient rights and responsibilities
Patient Right: Refuse Treatment
patients have the right to refuse treatment and be told what effect such a decision might have under health
Ask Me 3
An educational program that encourages patient and families to ask three specific questions of their providers to better understand their health conditions and what they need to do to stay healthy
What is cultural competence
being sensitive to others cultures and beliefs
Staff Present
“Staff present” is further defined to all and any involved staff to resolve the issue that moment for that day
What is a level I complaint?
concern addressed immediately by employee
Which year did AHA develop and adopt patient bill of rights?
1973
what is culture
it is how we see the world. it is behind what we do, see and perceive
According to the Beryl Institute article, what are the three areas that integrate to create patient experience
quality, safety and service
Statistics of those who may lack the skills needed to manage their health and prevent disease
9 out of 10 adults lack the skills
14% of adults have Below Basic health literacy (42% are poor and 28% lack health insurance)
What are some of the key concepts of the Planetree model
Importance of social support, patient/resident education, healing environment (design-iron curtain)
Which year was the Institute of Healthcare Improvement (IHI) tripe aim created?
2007
BEST way to show respect for an individual?
Honor cultural and personal choices
Patient Right: Quality of Care
the patient has the right to expect of the quality of care rendered will be based on best practices recognized in healthcare industry.
Common reasons regarding lack of awareness in cultural competence
Lack of knowledge resulting in an inability to recognize differences
Self protection and denial leading to an attitude that these differences are not significant or that are common humanity transcends our differences
fear of the unknown or the new because it is challenging and perhaps intimidating to understand something new that does not fit into one’s worldview
feeling of pressure and due to time constraints, which can lead to feeling rushed and unable to look in depth at an individual patient’s needs
What are the characteristics of hospitals that did well with value based purchasing?
smaller, didn’t train resident, more affluent patient mix, for profit
