Patient engagement underlies population health

The Pop Health Forum, a conference put on by the Healthcare Information and Management Systems Society (HIMSS) in Chicago this week, was as much about patient engagement as it was about population health.

This makes sense, because it’s difficult to manage populations without reaching out — engaging — members of those populations.

Jeffrey Springer, a vice president at Princeton, New Jersey-based health IT vendor and consulting firm CitiusTech, said that getting to population health means checking all nine squares on a 3-by-3 matrix. The X axis covers acute, ambulatory and whole-patient care, while the Y axis is about execution on clinical, financial and operational metrics.

Patient engagement falls under all three care rows and at least two of the execution columns. Yes, financial performance has elements of patient engagement.

At University of Chicago Medicine, about nine miles south of the downtown conference site, the annual operating plan for fiscal year 2017 has patient experience as one of the five pillars of the plan, along with people, quality/safety, finance and long-term strategic positioning. Debra Albert, chief nursing officer and vice president of patient care services at U. of C. showed this slide during her presentation:

(Click here for a larger version.)

“We’re really trying to drive a consistent patient experience across all of our platforms [of care],” Albert said.

In fact, patient experience is part of what Albert called the “value-based core” of the academic health system’s goals for 2017. In her view, value equals quality — including the patient experience, proper resource utilization and clinical outcomes — divided by cost.

University of Chicago Medicine hasn’t reached true value-based care delivery yet. However, the goal is so important to the organization that the chief medical officer is in charge of implementing the core of enhancing collaboration, promoting telemedicine and selling faculty members on the concept of value-based healthcare, Albert explained.

Indeed, clinicians are empowered as much as the health system aspires to empower patients.

About three years ago, U. of C. instituted what Chief Experience and Innovation Officer Sue Murphy called “leader rounding.” At the time, rounding on inpatient wards and in the emergency department was paper-based. “We had no way of knowing what was going on,” Murphy said.

The organization standardized inpatient and ED nurse rounding on iPads, consulting unit leaders and rank-and-file staff on redesigning rounding processes. U. of C. created a system of alerts and accountability, analyzing rounding trends and rewarding nurses for good work.

Initially, Murphy and other executives didn’t realize that every nurse leader had a different comfort level with the iPads and with technology in general. Patients also had varying reactions to the presence of a tablet with each nurse who stopped in the room. “We came up with some keywords to say to patients,” Murphy said, to help reassure those who saw the iPad as an intrusion on the patient-clinician relationship.

Individual nursing leaders also have been given autonomy to make process improvements within their departments and wards. “We strongly believe that the leader of a unit is kind of the mayor of that unit,” Murphy said.

According to Press Ganey surveys of University of Chicago Medicine, 81.9 percent of inpatients in August 2015 reported that a nurse manager checked in on them daily. That number rose to 93.8 percent in July 2016.

Overall hospital ratings, as reported to the Centers for Medicare and Medicaid Services, jumped from about 60 percent in 2011 to nearly 75 percent in the reporting period that ended in the second quarter of 2016. There was a sharp increase in 2013, the year the health system started rethinking nurse rounding.

“Those many patients were touched,” Murphy said, gesturing to data on a PowerPoint slide. “They were touched by a kind word, by technology, by a caring nurse.”

Photo: Twitter user UChicago Medicine

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Patient engagement underlies population health