http://jameslhollymd.com/Letters/SETMAs-approach-to-fulfilling-the-HCAHPS

The above link is to SETMA’s website and to SETMA’s plan of action to fulfill the HCAHPS measures for inpatient, patient satisfaction survey results. Posted to this link are the following:

1. SETMA’s plan of action
2. Healthstream’s* Physician Communication Standards
3. Healthstream’s Discharge Communication Standards
4. An example of SETMA’s Hospital Admission Plan of Care which is given to each patient by their attending physician upon admission to the hospital.
5. An example of SETMA’s Hospital Care Summary and Post Hospital Plan of Care and Treatment Plan

*Healthstreams is the private vendor Baptist Hospital has employed to complete patient satisfaction surveys.

Today is the first full day that SETMA’s new plan is in place.  This is a report of the results.  Dr. Le reported that yesterday, he sat next to the patient’s bed and held the patient’s hand while completing his rounds.  Other than the fact that three patients reported him for sexual harassment (smile, of course that is a joke) this seemed to work well.  The nurses reported to me that Dr. Deiparine has put this plan in place already. They were very complimentary of him.  Our hospital care team is placing the Hospital Plan of Care on the front of the chart for the attending physician to give to the patient and to review with them. 

New Dialogue

On rounds this morning, I sat in a chair by the bedside which was awkward and difficult particularly since the chairs are across the room and are heavy.  It seems odd but I’ll give it a try.  In addition to the history and physical with each patient, I did add some new dialogue including:

1. After explaining the diagnoses and the plan for the patient’s care, I asked, “Do you have any questions about your care?”
2. “Do you understand what is going to take place?
3. “Do you have adequate help and support when you go home?”  This is not a new question.
4. Concluding the visit with, “Is there anything else you need or that I can do for you?”
5. I then documented this conversation in the progress note in the chart.

The Boy Scout

I felt a little like the Boy Scout who returned to the Scout Hut eight hours after leaving.  The South Master said, “Where have you been?”  The Scout said, “I was doing my good deed for the day.”  The Scout Master said, “What did you do?”  To which the Scout responded, “I helped a little, old lady across the street.”  The Scout Master said, “Why did it take so long?”  The Scout said, “She didn’t want to go!”

Rounding took longer sitting in a chair by the bed because in too instances the “little, old Lady” in that chair didn’t want to get out of it and it took a while to wrestle the lady out of the chair.  Smile.

The New Plan

We will see how this goes but at present our plan is:

1. Give the patient their Plan of Care in writing on the day of admission and explain it to them.
2. Sit while talking to the patient.
3. Offer a conference at the office with any family member not present, who is on the patient’s HIPPA form, and who wants to know what the plan and expectations are for the patient.  In one case this morning the patient wants one thing (and she is competent) and the family wants another.  We have a conference schedule for this afternoon.
4. Give the patient a business card with identification and contact information for the SETMA team member seeing them and add, “Dr.  _____ (naming the attending) has asked me to see you....”  Ever SETMA team member will relate their contact with the patient back to the attending physician.  In some ways this violates my concept of a “team” but in that it is the attending who is being judged by the HCAHPS, we will focus attention on that person.
5. SETMA’s Care Coordination Department will add the following questions to their follow-up call:

• Did your physician and his/her team explain to you your care plan?
• Did your physician and his/her team answer all of your questions?
• Did your physician and his/her team listen to your questions or comments without interrupting you?
• Did anyone ask if you have adequate help at home once you leave the hospital?
• Did your physician give you in writing the symptoms which would make you need to return the hospital or to get immediate help? Did they explain this in a way you understood?  
• During this hospital stay, how often did doctors treat you with courtesy and respect?
• During this hospital stay, how often did doctors listen carefully to you?
• During this hospital stay, did doctors, nurses, or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?
• During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?

Test Sample

The HCAPS Survey done by the hospital’s vendor only questions a small percentage of the patients (5% or less) we care for.  Our Care Coordination team will question all patients.  We will compare our result with the result the hospital gets.

James (Larry) Holly, M.D.
C.E.O. SETMA
www.jameslhollymd.com

Adjunct Professor
Family & Community Medicine
University of Texas Health Science Center
San Antonio School of Medicine 

Clinical Associate Professor
Department of Internal Medicine
School of Medicine
Texas A&M Health Science Center